Let's get something straight: thanks to Obamacare, people with pre-existing conditions now have medical insurance.
The only thing Republicans have done since Obamacare care passed, is try to take this away. Shame on them.
14
When the insurance industry lets out waves of propaganda against Medicare for all, ask yourself why folks sign up for Medicare the first chance they get.
Do you think any of them would give it up to go back to the "Your Money or Your life" insurance scam?
10
Here’s some stuff the M4A folks don’t seem to want to discuss.
1. Currently, you pay in for maybe fifty years before you start Medicare. However your payins, and your ongoing premiums, don’t cover your real costs. Those are chipped in for by people who are paying, but not using yet. So where’s the loot gonna come from?
2. Estimates are that maybe half a million people’d lose their jobs if we dumped private providers and insurers. I assure you, they ain’t fat cats. So do they just go take a jump? And when they’re unemployed...who makes up their taxes, and pays their med costs?
3. Small rural hospitals really would go bye-bye. Then what?
4. Countries like Canada pay docs and nurses much less. Okay, who’s gonna break the news?
5. About half of Americans’ costs are because we’re fat, lazy, stressed, and eat bad. The plan to fix that is...?
6. Another big cost: we demand fancy drugs and treatment because they’re new! Not because they work better. Show of hands...who wants to tellpeople no?
7. You think unions are ginna tell members to give up their current health care? Did you follow the “Cadillac tax,” arg at all?
8. What exactly, and I mean exactly, will M4A plan designs look like?
9. You can bet that anybody currently uninsured is gonna use a ton of care at first. Plans for oaying that?
10. So the plan is, abolish private insurance, chop salaries and benefits for health workers and docs...and we will then magically get thiusands more regular docs?
10
Are outlets like this demanding nothing less than "sure' on this particular issue for some reasosn other than to scare people out of the possibility of change? And if so--why?
1
Here's the honest headline.
"Epi Pens cost $5.00 each to manufacture"
USA cost: $300
"Aids drugs cost $3.00 per month to manufacture" -
USA cost $3000 per month.
Now lets talk Private Health Insurance
10
To answer your question, yes.
2
Insurance companies are in the business of making money by being a sometimes useful, sometimes abusive, middleman. When EVERYONE needs something, like roads, it is pure idiocy to inject such entities into the middle of providing the service. Tax and provide. It is so simple that even less great and advanced countries than ours [heavy sarcasm] are able to do this.
3
Yes
2
For-profit healthcare is ghoulish. Why can't anyone just come out and say it?
5
The availability of a public healthcare option enhances the choices that Americans have. It doesn't mean that private health insurance has to go away entirely. One can pay for whatever one wishes, but there are an awful lot of people that can't pay for private insurance. What harm does it do to have a situation where one can buy into either, or both plans? Maybe, insurance companies can turn their giant buildings into housing instead of being facades for money & life sucking businesses? They could make those buildings into mixed use complexes that could be greened up to stop the light pollution and save energy from the excessive air conditioning needed to make men who wear suits & ties to be comfortable. Lastly, wouldn't it also be of great benefit to have a national entity that could negotiate the price one pays for care & medications?
2
I don't know who "we" are, but eliminating private insurance is a terrible idea. Why? First, because private industry is always more efficient than governmental bureaucracy, and, second, because the people who work for private insurance companies have a horde of institutional knowledge that it would be outrageous to throw away. So use the private industry to effectuate universal coverage. Treat it as a utility, with a public service commission over it to make sure the charges are reasonable, and then, with everyone covered, outlaw subrogation, which sucks money out of us and out of the system and in the end has absolutely no value. We have two goals: cover everyone and stop the gouging. This way you do both in the most efficient manner.
1
Ok, unlike most Americans I have lived in a country (Australia) that has a single payer system and private insurance. The single payer system is good basic health insurance that no one goes broke because of a healthcare crisis or can’t afford. Most people then buy additional coverage on the private market so they can have a private room in hospitals and additional perks above their basic coverage. It’s a pretty good system and I never met a single Aussie that wanted to trade their system for ours. In fact two subjects that Aussie’s always seemed to want to talk to me about were Americans gun culture and our screwed up healthcare situation.
8
"... America’s hospitals would stand to lose billions of dollars ..." And?!
1
Are Americans really too stupid to understand that even though hospitals would "lose billions of dollars" they would also lose billions of dollars in overhead?
Are Americans also too stupid to understand that even though they would "pay more in taxes" they would pay "zero in premiums" and they could demand more in wages because their employer is no longer forking over the raise they should have been getting for the last 20 years to pay inflated healthcare costs?
I don't believe Americans are too stupid to understand these things. However, they will never understand when they are constantly being misinformed by media and politicians obfuscating the truth for lobbying and advertising dollars.
5
"Medicare for all" is a terrible slogan. People take it to imply all sorts of things. Current Medicare premiums are low but that's because it's largely funded by taxes paid by later generations. They're also low because it only pays 80%, so people who can afford it have supplementary insurance. They're also low because Medicare pays providers very little, with the result that many providers limit the number of Medicare patients in order to stay afloat.
So if you take the slogan literally it isn't likely to happen and enough stake holders (including the insured) would be turned off that it would probably lose the next election.
We need an easily explained plan that makes sense to enough people to win the next presidential election. Of course, the vital step is to win control of the Senate. Nothing will happen at all if McConnell is in charge.
2
Well somethings got to give or it will all melt down along with our Federal budget.
Giving out corporate tax breaks for health insurance costs the government $280 Billion a year. In a lot of cases businesses try to put their nose in especially with women's issues. Is it the employer's health insurance or the employee's?
That tax break came about from price and wage controls during WW2. There is really no need for them now. It is but one more boondoggle to (big) businesses. Small businesses, not really at all helpful.
People are going to complain but what is it going to take, another Depression like event to get everyone on board? Are we such a reactionary society that we should try to do what is best, now? Are we just going to waste time and money just watching the whole thing explode?
As I write (listening to an ambulance outside), I am starting to have issues that anything other than a catastrophe will not solve healthcare!
1
I am for getting rid of the whole rotting private health insurance system with hospital and insurance industry CEOs making millions and charging you $6.00 for a single baby aspirin. Fire the executives and reemploy the insurance company workers in Medicare for All. Hospitals can remain private but they must be non-profit or owned by the communities they serve.
3
@Peter Suderman, I am assuming since you work at Reason magazine you must lean conservative? instead of criticizing what the Democrats are proposing and debating, why not propose a conservative plan to give ALL Americans heath coverage at a reasonable price. Not "access," which is useless because I have access to all the best care but I can't pay for it all.
Do it before the next round of debates and then write it up here on the opinion pages and maybe we'll pay respect to conservatives again. You do know that the ACA was loosely based upon a Heritage Foundation plan (https://krugman.blogs.nytimes.com/2017/07/30/heritage-on-health-1989/?)
4
Why are people afraid of losing private health insurance? Do they love co-pays? Deductibles? Service denials? Time consuming referrals? Billing errors? If you are well cared for, it is your doctors you love, not profit driven middle men who add no medical value to your care.
39
@David Johnson...What medical value is the Government as middle man going to add to peoples' well being? The Government currently runs three health care systems in this country - Medicare, Medical and the Veterans Health Administration. Co-Pays? Deductibles? Service Denials? Time Consuming Delays? Networks? You bet. And, more - actually, in terms of value added, LESS. Free health care a la the socialists will come with a free lunch, also.
6
Liberals can't stand Trump -- But liberal selfishness over healthcare and insurance will be the very issue which re-elects him...
Anyone see the irony?
Yes, we're sure.
1
Let people happy with their employer supplied health insurance keep that insurance.
Let others who are under 65 buy into Medicare by paying a small premium.
Start for eligibility to buy in at age 50 and gradually lower the age.
A Dem presidential candidate who advocates abruptly abolishing employer supplied health insurance will lose.
6
The health insurance financial model cannot possibly provide comprehensive insurance for all. That is not how insurance works! Insuring everyone including those with pre-existing conditions breaks the model.
The government should provide basic coverage, and provide protection against catastrophic loss. Let the insurance market fill in the gaps or shortfalls, something along the lines of Medicare or TRICARE supplements.
1
Getting rid of private insurance means there will be no supplemental insurance to go along with Medicare? I don't see how that will work since private insurance is used. Otherwise, the Medicare alone will not be enough coverage. We'll be right back to too expensive out of our pockets.
5
Are you kidding me? Those rapacious vultures the insurance companies who squeeze as much money as they can from people and pay out the least amount they can and not be sued? They should be tired and convicted of crimes against humanity. What are they good for? Absolutely nothing, We need to spend billions more dollars for their robbery and not having doctors decide which treatment is best for us? Medicare for all would cost us, you know the people, half of what insurance costs now and yes our taxes would go up a bit, but isn't better to pay a bit more in taxes upfront and never have to worry about getting medical help with no co payments or deductibles ever again and if we need help with serious illnesses there is no cut off of insurance benefits. In short no one has to go bankrupt or lose their savings or home because of cancer or some other awful disease. No one has to worry about a 5,000 dollar deductible to take their child to the ER emergency room. And doctors and nurses are for this, especially nurses. Let the dead beat and grossly over paid CEOs of the insurance companies and their lobbyists find another occupation. Are you paid by lobbyists to write this opinion ?
6
Canada’s health care system is essentially “Medicare for All” with the option of carrying private health insurance for conditions, drugs, and procedures not covered by the government plan, as well as for dental and vision care. Large corporations and industries and services with strong union contracts generally provide this supplemental insurance as in the USA.
Insurance companies here still make healthy profits in a competitive market.
It’s a good, hybrid public/private model that works well.
It’s not an either/or choice - you can have the best of both.
6
Our healthcare system can DEFINITELY do better without UNITED helathcare its ilk. Insurance never provides the care. Insurance companies DENY care. Insurance is supposed to be a system of spreading risk. Currently the insurance companies take the money and DENY the care.
4
The flaw in Obamacare is that it preserved private coverage. The attempt to provide adequate, affordable coverage while preserving private insurance resulted in excessive complexity. Single payer has the huge benefit of simplicity: one plan for everyone.
2
just back from the UK visiting and one family member is an MD. i asked him about their health care system and he told me point blank, if you want treatment for most anything, you still need PRIVATE insurance. this current debate is full of problems no matter what over the hill Bernie has to say.. fix the ACA and have something great, simple but tough to do.
3
Clearly the constant undercutting by States, congress, and then by president Trump have had something to do with ACAs effectiveness over time.
Practically none of the initial horror stories have come to pass, and the cost of healthcare stabilized, at least until Trump took office. The law has been unexpectedly resilient to sabotage.
7
This is just another fear-mongering exercise to denigrate Obamacare and stave off the dreaded onset of a decent single payer system, the modern global standard that our corruption problem has delayed for decades. Suderman doesn't seem to know how single payer really works in practice around the world. Some form of private insurance option usually exists alongside the basic universal systems for those who prefer different coverage at a higher cost. Change is obviously hardest for a parasitic, overblown private insurance culture that will no longer profit by providing overpriced, inadequate coverage.
3
In the long term, eliminating or greatly reducing the role of private insurance is probably one of the steps to attaining full coverage and greatly reduced costs. In the shorter term, the transition of the health care system to single payer should be more gradual, to avoid disrupting delivery and payment for care.
Introducing more government-sponsored choices such as the "federal option" for ACA exchanges and early Medicare enrollment for people 55+ who lose employer coverage could be the beginning of evolving how we pay for health care. We also should fully federalize the Medicaid system. Ability to afford health care should not depend on where a person lives.
3
This is why I hate reading conservative "big thinkers". This article is soaked in innuendo and false interpretation. It uses the tired old conservative playbook of making an incorrect statement and then proceeding to discuss it as if it were true.
President Obama created the largest health care revolution for Americans since Social Security, yet Mr. Suderman says Obama failed. Failed? Why? Because Obama was not the last President to have to deal with the issue. If that's failure let's have a lot more of it, please.
Mr. Suderman also makes the false claim that liberals promised that the ACA would be the end product never meant to progress to single payer, but conservatives managed to devine the truth and are now proven right. Where did that little fairy tales come from Mr. Suderman, because I do not remember *any* liberal legislator claiming that the ACA wasn't a path to single payer. Everyone knows it was a base to build on, from the beginning.
There are other examples, but you get the point. It is necessary to analyze every sentence in this type of word-smithed article -- because the Big Lies are in the little throw-away assumptions that contaminate the entire premise.
4
Eliminating private insurance is a kamikaze mission.
Elizabeth Warren and Kamala Harris just made themselves not electable.
3
Let’s try to avoided the “if you like your health insurance” thing again. “Options”...choices...people like to have options. Makes them feel they’re in control. A public option. A choice for the public to make. Should have included the first time around, but, it’s not too late...
1
YES, I'm quite sure eliminating private insurance is a good idea. There's been misery enough, thank-you... the only people I know who are "happy" with their private, for-profit insurers are pensioners and union members who are having it paid for by someone else (often uninsured or under-insured taxpayers). And anyway, as in the UK, the wealthy will always have their private options. But the rest of us desperately want out of this crushing, for-profit nightmare. And to the NYT: if you are going to publish op-ed pieces by reporters from libertarian screed-sites, at least check their facts: The Medicare for All Act (H.R. 1384) calls for special subsidies for rural hospitals who need it, so let's not add to the already copious Republican fear-mongering by allowing statements such as, "Policy experts reportedly believe 'some hospitals, especially struggling rural centers, would close virtually overnight.' " What policy experts? What hospitals? Where? Enough of that nonsense already! It doesn't belong in the Times.
5
As someone who has lived half of my life in the US and half of my life in Canada, I am always taken by how little Americans know about the actual workings of "single payer" health care. We moved to Canada in 1985 and have been served by the Ontario Health Insurance Plan (OHIP) ever since. Here are some points. First, do not believe the ads currently playing by some astroturf organization. What figures they use come from the Frasier Institute, Canada's largest right-wing propaganda source, euphemistically called a "think tank." Neither I nor anyone I know has waited that long for surgery, and emergency surgery happens immediately. Second, Medicare in Canada has not eliminated private insurance. I wish it had, but currently OHIP does not cover everything and so there is a place for private insurance. Canada is currently contemplating pharmacare, which would be welcome. Third, we all get to choose our own family physician. My family physician and I decide what care I need, not any insurer, not the government. If I need a specialist my family physician makes a referral.
Something Americans might want to think about: What you are calling "Medicare for all" started in Canada in one province, Saskatchewan, instituted by the social democratic government of Premier Tommy Douglas. The existence of tax-supported single payer in one province more or less forced the federal government to adopt it for the whole country.
4
Reality check:
1. It is recognized that it is most unlikely that the Democrats will take the Senate in 2020. Too many really good candidates are running for President and not for the Senate. That means the idea of Medicare for all is a non-starter in 2021.
2. The cost of health insurance and out of pocket expenses is over $20k per year for a young family with kids or a pair of older adults. Providing them Medicare will cost about the same unless there are substantial cuts in drug prices and in the liability doctors face. While Medicare has much lower administration cost than insurance companies, it has a much higher fraudulent claims cost. Reducing it will require more administrative effort. As stated in the first debate, hospitals can't survive on Medicare payment rates, so they will have to go up. Many people with Medicare get a supplemental policy to cover what Medicare doesn't. Don't know how that will be solved. Bottom line -- we won't cut the cost of care in half. We won't cut it at all without a great effort against stiff opposition.
3. The cost will be very high. The increase in taxes for average income citizens will be well over $10k/family/year, even making the big assumption that higher taxes on the well compensated are enough to take care of insurance for the poor. Maybe they will get big wage and salary increases if employers no longer have to chip in for health insurance, but that will be a huge huge adjustment.
1
I am so tired of opinion columnists who refer to "surveys" which show people do not want to lose their private medical insurance. That is because they have no real life experience with universal healthcare or any alternative.
Ask them instead if they want to do away with co-pays, waiting for approval for treatment, deductibles and high priced prescriptions.
The health insurance industry and big pharma are killing us.
3
I don't understand this debate. The private insurers are betting that you won't get sick. If you do get sick, then they are going to go all out not to pay claims. As a matter of fact, it is much better for the private insurers if you die quickly. They are not beholden to patients (or, as they like to call us, "consumers"); they are beholden to their stockholders. There is no incentive to help somebody with a chronic condition, and God help you if you lose your job. As for taxes, when people add up their premiums and their deductibles and their co-pays -- all the money they have to spend before they get any help at all with their soaring medical bills, surely a tax increase to pay for universal health care is not going to be as much as that! So what is the problem here? Are we not a wealthy and civilized country? Do our lives have no value beyond our "productivity"?
2
First of all, Medicare as it is now depends on supplemental coverage (20% plus part D) from insurers- so why does everyone say Medicare-for-all would absolutely eliminate private insurance? Second, employers are paying an arm and a leg to provide health insurance to employees and are increasingly unable to afford these great plans that people like and are shifting some or all costs to employees (see your deductibles and copays going up?) or sending employees to the Obamacare marketplace. Which brings me to individual plans, which are such a ripoff for anyone over age 50 ($7000 per year plus $7400 deductible for a crummy HMO with $50 copay to see my GP-really? Yes, really!). How many older people with individual Obamacare Bronze plans want to keep them? Likely not many. And we can't afford anything else. Insurance companies can jump off a cliff for all I care. Medicare-for-all looks very, very good to me!
3
What I would like to know is in Medicare for All programs does the elimination of insurance companies in the health care are mean the elimination of Medicare Advantage programs, which I believe are run by private insurance companies. As I understand it approximately 1/3 of Medicare eligible individuals on enrolled in a Medicare Advantage program. Since this is optional they must believe that these plans are better than the straight Medicare program. If Medicare for All means the elimination of these programs doesn’t this mean that the individuals currently enrolled in these plans when they find this out are likely in the general election to vote against anyone who supports the Medicare for All approach. I would think that the loss of 1/3 of the Medicare eligible individuals would doom anyone’s changes of winning the general election.
Life expectancy in this country is 53rd in the world!!!
If for profit is the way to go why is this the case?
In addition to that if I hear one more politician tell us we are a country of 327 million so medicare for all or single payer will never work, I want to know where the cutoff point is and why it will work for one number but not another.
That's just another talking point with NO evidence to back it up.
1
The CEO of Blue Cross Blue Shield Florida made 6.8 million in 2012 so god knows how much he is making now. This is wrong. I think the US is will slowly move from insurance companies to public options in the next 10-20 years. Here's hoping the US congress forms a committee to study plans from other countries to figure out what is best for the US. I'm one of the lucky US citizens, I have a great health plan, thanks to working in a great school system and in a few years I will benefit from Medicare. However, I see too many students and their families without health care. We are the wealthiest country in the world, we need to figure this out.
2
I worked half of my free-lance career in the US and half in Canada, during which time I became a dual US/Canadian citizen. For my family of four, we paid about $200/mo for our Canadian provincial medical plan, under which every Canadian is covered for all health services. While these plans don’t cover glasses, prescriptions, or dentistry, most Canadian workers have such supplemental coverage through their employers.
Canada has a population smaller than California’s, yet everyone has health coverage. Sure, Canadians are taxed more than Americans, but they get something important for the taxes they pay. If people cannot afford the monthly fee, the coverage is free.
I understand that many people fear giving up their private medical insurance plans. OK, fine. You keep your multi-thousand-dollar private plans, with all the co-pays and huge deductibles, constantly changing rates, claims-denial, and exorbitant drug prices. And think about the billions of your hard-earned dollars that go into those horrible and ridiculous drug ads on TV.
And remember: to the health industry profiteers, that’s chump change. But at least let’s have a single payer option. I am confident that if Americans are offered such a plan, within a year there would be a stampede to Medicare for All.
3
You must do it. Taiwan spends 6% GDP on universal healthcare for all and has an 85% satisfaction rate. 99.9% coverage. Low cost to all patients, budget runs at a surplus. Very high quality care. US spends 18% GDP for low coverage, high cost, inferior patient outcomes, higher infant mortality and life expectancy.
In sum, healthcare in the US is really bad and very expensive. No brainer. Do it.
2
Was eliminating private firefighters a good idea? In the early 1900's there were no public firefighters. People had to buy a fire badge, a form of private insurance, and put it on their house. If there was a fire and you didn't have the appropriate badge, they would let your house burn to the ground.
To put it another way, what if the police department was privatized? Only those who could afford it would have protection from criminals. How about getting rid of public defenders? Or privatizing the military?
The idea of leaving a public necessity in the hands of private - for profit - entities in antithetical to the very idea of "civilized society". Then again, since the GOP took over, no one in their right mind would accused this country of being civilized.
A better question might be, if we had public healthcare as good as most industrialized nations already do, who would want, or need, private insurance?
Or, better yet, ask the citizens of the Nordic countries if they would want to go to a privatized healthcare system. I'd be surprised if you could find a dozen people that would support it. And those who did would undoubtedly be profiteers. People for whom their concern for money outweighs any concern for their fellow man.
3
The reason people get frightened is that they are convinced that they pay nothing for their employer provided health insurance. They are also convinced that it will stay the same, even though the terms change every year like clockwork!
If you have employer provided insurance, you will lose it. It is just a question of when. Someday you will leave. Then its gone. Someday your employer may decide you are not worth insuring. Or they will simply place so much of the burden on you it is unaffordable.
But more to the point, what do private insurers actually do for us. As far as I can tell, they specialize in trying to narrow their pool to the most profitable segment of society. Not all employees get insurance benefits. Only the ones that the oligarchs have decided are worth providing it to.
And if the oligarch believe that you are worth insuring, it is because you are likely younger, healthy, and better educated. And as you get older, they find ways to replace you with the younger, healthy, and better educated yet.
The result is that private insurers take the prime part of the market, the profitable part of the market, and leave the rest for somebody else. And if that means you go without, well too bad.
I see them as teats on a bull.
2
The Republican/conservative/Trump policy on health care has consistently been to eliminate Obamacare either entirely or in pieces. Rural hospitals are going under primarily in non-Medicaid-expansion states because they get nothing for treating a lot of uninsured patients, and Medicaid pays less than Medicare. The days when most private insurance plans paid a lot more than Medicare are long gone. And to be fair, all the uninsured are in the PRIVATE INSURANCE MARKET, not the public/government insurance market. You have to average in all those zero's from patients that private insurers have refused or discouraged from coverage when you calculate the reimbursement from private plans. Some version of Medicare for All would simplify billing, saving a lot of overhead for all concerned, not to mention reduce the headaches for patients and eventually improve health outcomes as every other industrialized country has proven.
2
Why should our employers be responsible for our healthcare?
That doesn't seem to follow the Republican pro-business approach.
It should be like public schools used to be and should be again: you have to pay for the public stuff, and if you have money left over and don't like the public stuff you're free to get private stuff.
2
@Southern Boy
Welcome back!
Yes.
The experiment to see if for-profit insurance companies could be, or would be, constructive partners in achieving a rational, functional and moral healthcare system for this country has been run. It is called the ACA and the answer to that question is NO! Those who believed that the insurance industry would accept protection for preexisting conditions as a trade-off for subsidies and increased business were naïve. In response to being required to insure the actually sick, they went ballistic with new measures (exorbitant deductibles - narrow and frequently inaccurate provider networks - etc.) designed to render the insurance itself frequently useless for either sick or healthy subscribers. Many other countries do have private insurers around the edges of their robust public healthcare systems, but those are not the same as OUR current private, for-profit health insurance extortion racket. To the extent that we preserve any part of this system, the people who run it can only be trusted to do everything in their considerable power to warp, bend, manipulate, distort, and otherwise rip off whatever public arrangements we make. They are in the business of using "healthcare" to produce money - not the business of providing healthcare itself.
2
What you are saying is that hospitals in concert with big pharma and the useless middleman insurance companies are charging outrageously too much for their services and would go broke if they were not allowed to do so. Does that really make sense? Allowing the coexistence of private insurance with a free government plan will create an onerous two-tier system replicating the huge income gap existing in the economy as a whole. (Just compare the quality of services offered to poor Medical patients to the deluxe services and facilities provided by Medicare.) Coexistence of private and public systems is inherently flawed.
1
Sometimes I feel an evil genie is lurking on the side of Congress where the democrats roam and as soon as they seem on a winning path, this evil genie whispers into the democrats' ears how they can quickly demolish their hopes by coming out with the most asinine idea that will antagonize the most people.
No, it's not a good idea to eliminate private insurance. I don't know where these people get their ideas. Is it Norway? Are WE Norway? Why not look across the pond to countries that are closer to us, from a psycho0social background, like for example Germany. Their system seems to be working, and they insure everybody, employed or not, PLUS they offer private insurance for those who want it and can afford it. Why is this wrong?
What compels otherwise appealing candidates like Elizabeth Warren to pick up a fork and stick themselves in the eye by pledging to get rid of private health insurance? Please, senator, take that back. You mis-spoke. You are not "with Bernie" on that one. It can't be you are for such foolishness when on everything else you are so rational.
In this country, the national mindset isn't ready to do away with private insurance. The elite, and those who long to belong to them (i.e. right-wing conservatives who keep voting against their own economic interests) will feel deprived if they can't differentiate themselves from the unwashed masses. Let them pay for private insurance if it shuts them up and "allows" us a public option that won't ruin us.
1
"Yet surveys have found that support for single-payer drops when respondents are told that it would eliminate private coverage."
Mr. Suderman apparently doesn't understand that Medicare as it exists now, has supplemental private plans.
No one is talking about eliminating such things.
Other news for Mr. Suderman: Rural hospitals have been closing for 20+ years. This is a massive omission in his essay. These closures track with the rise of for profit medical insurance over the last 30 years. Rural hospitals can be preserved by yes direct government grants, of course the heads of such hospitals can't be making half a million dollars, in 2020 dollars.
Racist dixiecrats stopped nation wide single payer in the 1940s, no reason to have the same happen again in 2021 Mr. Suderman.
Also you may want to survey big employers that provide real insurance for their workers, so not Amazon and Walmart, most are in favor of single payer.
Submitted June 28th 4:08 PM
2
I'm not so sure that it's that people are happy with their private coverage as it's that they are unhapy with the uncertainty of the current system.
If you're on Obama care, you're ok if your state supports it. What happens if you move to a GOP state?
Can you depend on the subsidies?
Can you even depend on coverage for your pre-existing conditions?
These concerns are all due to the GOP which is determined to make sure we all die quickly and broke. If they were not actively undermining and attempting to destroy the improvement in healthcare coverage, I think people would be more open to further change in the system.
I guess I'm saying that the pollsters are not asking the right questions about healthcare.
1
Not everyone has the good fortune to work in a job that had union benefits. Most of Americans work with no benefits and poor medical care. If you love your insurance then please keep it, however remember when you get cancer, dementia the private insurance premiums will skyrocket and you will find out that you arent truly covered.
The reason why people like Bernie are fighting so hard for universal health care because anyone with a high school degree realizes that insurance only takes care of there shareholders and CEO's the rest of us will die because we wont get the care we deserve. Remember President Obama talking about his mom worrying about what bills she could afford to pay and what she couldn't. He remembered her being worried about bills and cancer.
Remember the 9/11 first responders begging the politicians just like week with Jon Stewart to help pay their ,medical bills Washington has ignored them. Not one CEO even talked about the scenario because they just don't care.
Bernie keeps telling us the truth we better start to listen before our loved ones are going to an early grave.
Would this go on in any other country,? No only here where living is not important but greed is.
1
It's easy to attack other people's policy proposals. It's much, much harder to come up with your own. What's your solution to health care and health insurance, Peter Suderman? I know what you're against, but you've yet to tell me what you're for.
33
I suspect that if you check out Singapore’s system, you’ll be in the ballpark.
@Shea
Does the name 'Bismarck' mean anything to you?
Works for almost 150 years and counting.
A universal health care plan for all citizens would take away the necessity of private insurance for the segment of the population that is suffering the most. Regulations on pharma would drop the price of prescription drugs for everyone. Regulations on hospitals and emergency services would keep more than half the population from bankruptcy. I think this is a false narrative and a question meant to be divisive and scare people into thinking private medical facilities and private doctors would disappear. If there are people who still insist on, or have the money to throw it away on private insurance, of course they can. The question of the elimination of private insurance is disingenuous and is meant to scare and confuse the people who need universal health care the most. Quit creating false narratives the purpose of which is either misinformed or something darker.
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To understand the Medical Industrial Complex this physician's book is an excellent read.
https://www.goodreads.com/book/show/31253737-an-american-sickness
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Are we sure eliminating private health insurance is a good idea ??? .............. YES
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"...when President Barack Obama pitched his health care reform to the nation, he did so by repeatedly promising that those who like their plans could keep them."
Since nobody at the NYT hesitates to use the L-word about Trump, why doesn't this read "Obama pitched his health care reform by repeatedly lying that those who like their plans could keep them."
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Yes, private insurance needs to be eliminated. But, knowing the political realities in Congress and lobbying muscle, it needs to be a stepwise approach. Biden is right- fix Obamacare first. Due to the same powerful lobbying, Obamacare was enacted with many flaws which resulted in escalating cost. It was not perfect- but we needed to get it approved. Unfortunately, the needed changes did not occur because of the obstinate Republicans who are driven by the insurance industry paymasters.
Readers should know the destructive abilities of the Insurance Companies. Due to advances in research, we have the ability to use biosimilars (similar biologic origin product as the brand one) which can reduce billions of health care cost. United Health decided to block the market entry of those products because they got kick back from brand name makers to force providers to use biosimilars. This is just an example of their egregious act.
How about this instead: Are We Sure Eliminating Private Insurance is a bad Idea? Can you write an article with this question without listing profit/margin that health care provider/insurance companies charge against our health - say, 50 cancer patience will bring XX million dollar profit (or XX dollar EPS, yeah, good for the shareholders and stock option holding executives), or say, overcharging the same medication that cost $10 in Canada by 10 times will bring XX million dollar profit (or XX dollar EPS). I look forward to the counter-arguing article.
The moderator's question, "Who wants to eliminate private insurance?" was a loaded question, kind of like asking about reproductive rights by asking, "Who wants to kill babes, raise your hand?" It shows in stark relief the bias the news media have against Medicare for All and other single-payer plans and one of the candidates should have called them out on the spot. It's a bias they need to correct and one all voters need to keep in mind as the debate over healthcare continues. That said, Sanders, Warren and Harris need to ramp up their positive talk about Med4All because the benefits far outweigh the negatives. It should be easy to sell. They need to start selling it.
Quite shameful that a county that calls itself an example for the rest of the world still hasn't figured out how to provide all of it citizens with the fundamental right of good healthcare.
There are so many examples of countries with a good working universal healthcare system. It's about time to start learning from them.
As long as we deny people basic healthcare, just because they cannot afford it, we should not call this country civilized.
Some polls show that people do not want Medicare for All if it means being deprived of their choice of private insurance. If Mr Suderman's article had ask: "Would you give up the private health insurance you now have if the new public plan was guaranteed for life, always providing you with your choice of physicians and hospitals, providing all essential benefits, including drugs, dental, eye, mental health, and long term care, had no out-of-pocket costs whenever accessing health care, and was paid for in advance by taxes that you could afford because they are based on your ability to pay instead of being based on insurance company profiteering ,making for the high costs of care?" Most would agree that eliminating private health insurance is a very good idea.
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Nah. I’d want a bunny, some candy, a plastic rockert ship, a guarantee I could eat all the cheeseburgers I want and stay healthy, every drug I see onna TV, eternal life....
It is not possible to provide all that at no real cost. It just isn’t.
See also what a HMO or MCO is. There’re reasons they provide oretty much the best and cheapest care in the country—like sharp limits on choices, which people aren’t competent to make anyway.
This is just wrong. Single payer with no private option does not mean closure of hospitals, not even the struggling rural ones. Why?
The single payer system would have the flexibility to change the rates it pays for services. Single payer does not mean it would have to pay madicare or madiaid rates. The system would be significantly more efficient and significantly less expensive than the current one. Part of the difference in the overall cost could be used to increase the payouts made by the government plan to make it sustainable and prevent any hospital closures. We could still save a lot of money and and have everybody ensured and no hospitals closed. Simple calculation is that hospitals, doctors, and pharmaceutical industry could be payed exactly the same as they are payed now, and by switching to a single payer system we would save all the profits of the health insurance industry. That is the lower limit. we could probably save samo portion of the administrative cost of the current system as well.
So, NO. Single payer does not mean closing hospitals. Do not believe when they say that.
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Your theory is that it’d cut costs, and pay small hospitals way more.
Good grief.
I realize that the fantasy is ot all goes to waster, fraud and abuse, but that’s just silly.
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I'm struck by how many people don't seem to know how Medicare currently works. It has NOT eliminated private insurance for people over 65. Many people on Medicare also sign up for PRIVATE Medicare supplement plans, because Medicare pays 80 percent, and the remaining 20 percent could be a very large amount with a severe illness. Medicare itself also offers entirely private sector options called Medicare Advantage plans.
It is a scare tactic and deliberately misleading to say that either Medicare for All or the ACA would eliminate private insurance. Some candidates like Bernie may WANT to do that, but that has not been the actual result of either Medicare or the ACA. Even if Bernie were elected, he wouldn't be able to do it.
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The point is that the proposals are put forward by people that want to eliminate private insurance. Your argument just supports the idea that Medicare is insufficient. If private insurance is eliminated the people running it would now be running Medicare. It is so simplistic to describe a $3T industry in 3 words. Medicare has virtually no experience with children, adolescents, young adults, obstetrical, substance abuse, family mental health, and cancer in middle age, multiple sclerosis. How does that go with young people and families needs, minority families. Universal health insurance is important. It is not a right. It is not a privilege. It IS a necessity.
W
Obamacare has shown us that insuring people won’t ruin the economy but too much power and it’s exerted on the patients. ee need to have the government provide catastrophic insurance to every individual at an income related cost and sell it to insurance companies based on the quality of the policies. Charge the insurance companies a premium for POST existing conditions. That may save the doctor patient relationships.
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@Wayne Hi, Wayne I don't care whether we build on Medicare or build on the ACA. I'm saying that Medicare does not eliminate private insurance and that those who claim that it would are trying to scare us away from even discussing the issues you raise. Lack of real access to health insurance is causing unnecessary deaths, disability, bankruptcy, and more. Yes, we have to find solutions, and not be scared away from even trying.
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Insurance underwriting is based on the law of large numbers. In order to cover people who have very serious chronic or acute medical conditions, there has to be a healthy population who are in effect supporting those who have greater needs. The lack of large numbers (dividing small populations among competing insurers) is one reason why the Affordable Care Act, AKA Obamacare, has not been as effective in lowering costs as a single payer plan would be, although it was a good start to provide coverage for those who had no insurance or who had pre-existing conditions.
It’s true that Medicare/or the Single Payer option would probably have to adjust their hospital negotiated rates higher as well as include some more cost containment features of private plans. But the current models of $5,000 - $10,000 individual deductibles renders most of these still expensive health plans practically useless for middle to low income families. Private insurance could be an option for those employers or individuals who can afford a Cadillac plan. There also would need to be a transition period as the insurance industry employs a lot of people, and the impact of a loss of jobs needs to be analyzed. But the cost savings from employer subsidies, lower overhead, and better negotiated and regulated pharmaceutical costs should go a long ways in reducing health care costs.
So many people ask how would we pay for Medicare for all.
We already are paying for it. We just aren't getting it.
We pay about twice as much per capita for health care as most of the other first world countries.
And we have parts of the country with infant mortality rates of a second world country.
The money we give to insurance companies, either via our employers or ourselves, would be paid to Medicare for all.
And we would save money.
The other is Republicans say it would be government take over of health care.
But Medicare pays all the current hospitals and doctors, etc.
Yes, you are sure and you are right. The private insurance companies are money sponges robbing the populous. However, you are opening the door needlessly to Trumpian fear mongering. I've already seen TV commercials saying Medicare for All will take your insurance away and leave you waiting for months for surgery. In short, its a political loser because it is so easy to attack.
Instead, the proposal has to allow choice... Medicare for All Who Want It. With time, the insurance companies will have to be more competitive (unlikely), die or find a new business model. Most likely it will be a combination of the latter two. Some insurance companies will die. Others will offer supplemental insurance for those who want and can to pay for it. Meanwhile, the MC4AWWI raises the quality of life for the majority of us.
Yes healthcare is a major issue and concern for voters as are jobs and other bread & butter issues. However, the overarching issue is voting Trump out of office. This is what will unite Democrats and many independents regardless of who is the Democratic presidential nominee. Trump is the geopolitical threat we and the world face as he has undermined institutions,promoted division and hate and embraced autocratic regimes. We know Trump and many around him are corrupt but spineless Republicans will not vote to impeach him. Removing Trump and all the Republicans who have been his enablers from office is essential first step to begin to fix all that Trump and his minions have broken.
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Yes. Next question. That was easy.
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It's not fair to throw entire blame on Obama for the failures of Obamacare. The lobbyist and the Republicans made it as impossible as they could, and successfully killing the most progressive aspects that were proposed.
People who call themselves conservatives and advocate Reason should stop lying. They are neither conservative or reasonable.
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Private health insurance is the "buggy whip" of the American health-care system.
Sorry ,but having seen the ridiculous drug markups and the absolutely obscene salaries being paid in the health care industry, I'm ready to try anything else.
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Campaigning is one thing, governing is another. Except for Trump, most office holders recognize this.
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Currently, if you are on medicare, you can have a private insurance too and it can be subsedized by former employers. I agree, that is not good enough, there needs to be more equality in the availability of good healthcare for
all. Health insurance raises the cost of health care overall and exacerbates inequality.
No OECD country has private health insurance companies to adjudicate claims and none is as costly as the U.S. We have a whole other industry which nobody else in the entire world finds necessary or useful. Its the chief reason for substandard care in the U.S. at high prices.
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I'm on board with those who think healthcare should be a right, and I favor a government run system like that in Canada. But there are over 2.5 million Americans working in the health insurance industry, which accounts for about 3% of the US GDP. Do people really believe that we can eliminate the health insurance industry in four years without causing incredible turmoil? This is an admirable long term goal, but it seems pretty likely to me that any Democrat that actually accomplishes this goal will be handing the white house right back to Republicans at the end of their term.
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Absolutely this country needs to go to a Medicare for All system. The health insurance industry and therefore medicine has stopped being about the patient, the patient's needs and improving health/recovery from and curing illness/accidents.
The health insurance industry and medicine is all about money and the bottom line. It is scandalous and bankrupting too many families. The doctors and the insurance industry and big pharma have figured out how to each make millions and billions to the detriment of the American people and patients. Medicare and Medicaid work. Private health insurance is hurting Americans, not helping them. Americans are getting ripped off by these industries. The problem is no one cares until they are sick, hurt or suffering from a chronic disease - but then it is too late to fight for change - they are vulnerable. People stop going to the doctor because of the hassle it takes to get their visit covered or they have a high copay or deductable. People stop getting their medicine because the drug either isn't covered under their plan or the deductable is too high. Get rid of the private health insurance industry and let doctors and hospitals start caring about patients again and patient outcome. Make hospitals not for profit. Make the drug industry reform so they stop ripping off people with outrageous charges for simple medicines. I vote for structural change such as that Sanders and Warren are proposing.
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What makes sense is a mix of private insurance for innovation and a government backstop to ensure everyone gets a minimal level of care.
Wait, we already have that. Maybe just make that work better.
But politicians need to invent crises or else why would you vote for them?
We need a simple, a very simple legislation - grounded in reality. Basic human needs such as healthcare can't be profited from. That's it. Abolish the insurance industry, whose only goal is to make as much money as possible. Allow the government to negotiate drug prices and that doesn't mean cabinet officers. Establish a jury consisting of lay people in each state to oversee how government negotiates the rates and to make sure that they don't give unfair advantage to drug companies. We must not allow profiteering from basic human needs.
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Sanders is a politician who sells the sizzle not the steak. He has an inspiring set of ideas, but his explanations of implementing them are basically too vague to offer his ideas as real proposals. Medicare is better overall than is private insurance for the elderly and disabled but it has some very clear disadvantages in comparison to some private plans which are offered both by big private and big public institutions to their employees. He basically just ignores this fact. In addition, people cannot afford paying the kind of taxes that are needed to implement this system. It will take time and patience to accomplish a transition to a single omnibus health care coverage system, but Sanders just ignores that.
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I believe that private health insurance should be available for those who want it i.e., the very wealthy and perhaps those who are getting a good deal from their employer. Shutting down private insurance creates fear on the part of those who are leery about government sponsored healthcare. Private insurance companies would probably be driven out of business eventually. If the insurance premiums of every American were added up, the number would probably pay for a serious gov't program many times over.
Please wake up America. Our citizens are being harmed by our healthcare system. Everywhere. It's producing a gradually progressive drain on our lives, our families and our security.
Rural hospitals will close is shear poppycock.
As a specialist I practice in cities and have clinics and work in small town hospitals.
Medicare fraud is in 95% of the hospitals I've worked in. False claims, i.e.. billing for services not rendered and up coding, charging everyone for a first class airline seat while most should be charged for tourist section way in the back, the Group 5 folks to board.
Rural hospitals have been given a huge break in the past such that smart administrators and so called non profit hospitals have made so much money from their rural hospital they open up clinics and outpatient surgery centers in the city.
The money has been rolling in for about 2 decades and administrators and non for profit hospitals are reaping a bounty. The hospitals, of course don't raise salaries to providers, but expand and develop and build.
There is so much money behind the status quo, so much power in Washington most medicare fraud complaints aren't even investigated. Recently a US attorney stated it wasn't worth investigating as the fraud only involved a $million dollars for one small event.
So expect to hear every scare tactic you can imagine as the healthcare industry gears up their huge amount of ill gotten gains to defeat any changes.
Sorry folks, I wish it wasn't so.
Health care is the wrong term. The correct term is medical insurance.
Medical insurance is a part of health care. An important part, but only a part.
As a family doc, I can tell you that another huge part of the American health care crises is a physician shortage. Giving everyone health insurance one way or another will not get this country to medical nirvana. It will exacerbate the doctor/nurse shortage. It is worth doing, but is only one step in a long process.
Insurance is a poor model for paying for routine and chronic care. It is reasonable for covering car accidents: relatively rare, random, and expensive events. But how affordable would car insurance be if it had to cover checking and changing the oil, the tires, the windshield wipers, etc.? In the US, healthcare insurance is used as a third party payer, so it only works well for people who have someone else--employers, usually--pay the premiums for comprehensive, low deductible policies. Medicare is like that.
It's not about abolishing private insurance but people must not be forced to rely solely on private insurance companies to get even basic health care needs. The private insurance companies can be here and compete with Govt or universal health care in case someone need more coverage. Private companies also can compete with universal or Govt health care to provide more efficient and cheaper care. That would improve both efficiency and cost for health care as a whole.
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My mother is on Medicare but it doesn't work for her without a supplemental policy that costs her about the same as what I pay for my employer-sponsored healthcare and it only covers the 20% that Medicare doesn't pay.
Before I would vote for a "Medicare for all" policy or candidate, I would want to see some improvements in Medicare.
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Everyone should understand that in the current climate, private insurance WILL NOT go away. If well over half the electorate, and -- more importantly -- both houses of congress and the president were for it, yes, there would be a chance of private insurance going away. But given the current climate among the people and in government, whatever Dems create will end up being something of a hybrid.
Consider that there are some millions of us, me included, who -- through good union negotiated benefits -- already pay nothing for healthcare. So why would I want to go from $0 in annual premiums to some as-yet-determined thousands that I'll have to pay for Medicare for All in the form of greatly increased taxes?
So no, insurance companies need not worry. This is one deep blue dem who will bet his paycheck that it ain't gonna happen.
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Why eliminate private health care insurance? Just offer Medicare as an option on the Obamacare exchanges. Most individuals and employers will choose it over other plans.
Medicare is the future of American health care. It's the only base we have to build on. The notion of formulating and implementing a new health care system for 300+ million people is preposterous.
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How is it there appear to be zero candidates in either party endorsing a European style, universal healthcare scheme? Honestly, ACA is a broken down band-aid and Medicare for all, as Sanders proposes, will *increase* the percentage GDP we as a nation spend on healthcare by orders of magnitude. Meanwhile, Germany, Switzerland, Sweden, where government insurance provides access to private providers abiding by strict mandated cost controls, produce better outcomes for a fraction of what we spend. Even 2016 candidate Trump said we’d be better off with this type of system, indeed, during the Court fight over ADA, Justice Roberts said he saw no constitutional impediment to the government simply creating its own insurance plan.
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If everyone had Medicare, it will bankrupt the country. There won't be much left for roads, schools, etc. Period. Unlike European countries, we have millions more people and most of them want EVERYTHING done under the sky. Americans have a tremendous fear of death. Quality of life is merely a hypothetical discussion. When the chips are down, people prefer to be kept alive like vegetables in a nursing home, with feeding tube, pacemaker, thrice weekly dialysis, and diapers. One point no one talks about... if healthcare is a right, then what does that make the doctors? Federal employees? Does that mean the government will pay their malpractice insurance? Does that mean they will be compensated at Medicare rate when they take care of people who failed to sign up for Medicare or have Medicaid?
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Insurance companies have been acting in bad faith to maximize profits forever. We are at the point of considering this option because of that fact. If private insurance ever goes away, the insurance companies have only themselves to blame.
This is what happens when healthcare - a basic right - is run by for-profit companies. The patient comes last. The shareholder ALWAYS comes first.
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Why does the arguement for private health insurance vs a national system have to be stated as a black or white choice? "Are we sure eliminating . . ." asks for an unreasonable choice that's not implicit in the quest for a fair and effective publicly-funded health program.
The system we have with a for-profit medical services industry paid for by a for-profit insurance system is innately economically unstable. We have run away prices and an insurance system that cheats the public on every opportunity. Health care for too many is being eliminated now, and not by choice.
If medicare for all is implemented, prices will stabilize, and will be more affordable.
I acknowledge that far too many people treat medical care as a status symbol subject to the display of conspicuous consumption. The medical services industry's advertising endorses that relentlessly.
If we need to make a grey choice for political expediency for universal public health care, then it should be to guarantee every American a broad range of medical services for a medicare like payment structure. The exceptional therapy or untested treatment could be paid for with an insurance policy.
We don't need to have a perfect alternative to the present system before we choose to replace it with one that provides care more broadly and affordably.
Why would you deny people the chance of keeping the insurance that you like, which may be a private one ! I am a liberal and work in healthcare and want good and optimal insurance for everyone. Why would you break the system for people that works for them ? Why would you not introduce the govt healthcare option for people who want it. Going extreme left in this policy decision, just because you have louder voice than the president is a disaster waiting to happen. I am talking about Mr. Sanders. It should not be allowed.
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Like most Canadian's with access to Universal Healthcare, I also have private health insurance to cover areas UH doesn't handle, like dental, eye exams, drugs, etc.
As a rural resident, I've learned the advantages of attending the emergency room of a rural hospital in our area vs the more crowded one's in the city. Universal Healthcare doesn't have to mean the death of rural hospitals.
The agonized USA debate about Medicare-for-all is almost hypnotizing for those already living with universal healthcare.
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Why does Medicare for All eliminate private insurance? This is the point I am most confused about since there is an alive and well private insurance market for Medicare beneficiaries to fill in for the 20% that Medicare doesn't cover.
Is part of the plan for Medicare for All to eliminate Medigap and Medicare Advantage plans?
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American are so funny. Almost all pvt. insurance provided by corportation at work health care benefit is already subsidised by the federal gov. in the forms of tax credits given to the employer ie the corp. in addition corp. like health care that get non profit designation are also given tax credits. We already pay as tax payers are insurance people just don;t know or realize that the holy corporations are given hudge dollar credits from the government. Name it any thing you want . We still pay for it. and the corp. profit.
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Countries with single payer have VERY long wait lists, often deny specialized and lifesaving treatments for things like cancer, and have a far more bare bones experience of going to a hospital stay than in the US.
In the US, if you have private health insurance, you will be seen, including for elective things, within a few weeks usually, at the most. You will likely get a private room in a hospital (unless you are in NYC). You will have access to top notch, state of the art cancer care. If you are a woman giving birth, you will not get turned away from a hospital for overcrowding, you will get a private room for 48 hours, an epidural, access to an OB, and a well baby nursery so you can rest.
This is not how it is in Canada and the UK.
The kind of birth and delivery care that British women have to pay 10k out of pocket for at "posh" private hospitals is what is normal with insurance in the US. In Canada you might wait 2 years for an autism evaluation - long enough to make many treatments no long effective. In the UK, many specialized cancer drugs are denied for cost.
We live in a world where people can talk across borders. These kind of stories WILL get told as soon as we start talking about single payer health care.
Middle and Professional class, hardworking Americans WILL see a loss of quality of care.s.
Let's try to improve the system we already have first.
Many countries have hybrid systems with universal coverage that work well. Let's look into those.
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The Labor Union vote for democrats is critical. Unions [at least the strong ones] have "Cadillac" insurance plans and pay next to nothing in premiums, co-pays and deductibles. The Long Beach, CA Longshoreman Union went on strike a few years back when it was suggested they have a $10 co-pay for prescription drugs.
Harris has already flip-flopped and backtracked TWICE on this issue!
There will be no medicare for all .. Pie in the sky wishful thinking.
In fact there will be no great insurance reform package either --
It's all a bunch of empty promises.
One of weaknesses of any health insurance plan is the affordability, high deductibles and premiums. Annual premiums of $5,000 with $8,000 are terrible and will rightfully be rejected by voters. Payments to hospitals and MD's have to be capped to lower patients costs will have to be part of any plan. Medicare For All is a non-starter as most Americans want the freedom to decide and do not want the Gov't deciding for them. A payer public option with individual free to choose private or public insurance is by far the more acceptable way to go. But, can a public option plan be devised that will not have high expenses but still allow Hospitals and MD's to stay in practice?
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The US needs to decide on which form of universal health care plan to follow. All three models -- single payer, insurance mandate, or two-tier -- can work. It may be that given the existing entanglements in a 330 million person country that two-tier is the easier to implement, but the point is to adopt one of these models.
Enough with demands for single payer health care, such as Medicare for All. Most counties we compare to don’t utilize single payer. What they have is universal coverage.
Only three of the 25 top rated nations use single payer.
1. Luxembourg
2. Singapore
3. Switzerland
4. Japan
5. Austria
6. Sweden
7. Norway
8. Netherlands
9. Hong Kong
10. Australia
11. Belgium
12. Germany
13. Qatar
14. Finland
15. South Korea (single payer)
16. Spain
17. New Zealand
18. France
19. UK (single payer)
20. Iceland
21. Denmark
22. Israel
23. Malta
24. Canada (single payer)
25. United Arab Emirates
What we need is universal coverage. Many health care systems have better outcomes and lower cost than single payer.
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The UK isn’t single-payer.
Single payer means that one entity collects all the premiums, and pays all the providers. Private providers.
You are generally correct, but Britain’s NHS is true socialized medicine: the gov collects by way of taxes, builds the hospitals and clinics, hires the docs and nurses, and so on.
You are basically quite correct, however.
It is difficult for anyone to understand how the very reasonable economic proposition -- of sharing the risk among a large pool of insureds would provide improved health care for all -- so totally wrong.
It created a cartel that fixed prices by eliminating competition, and has now succeeded at denying health care to an ever-expanding pool of under-insureds. At the same time, it has contributed massively to the death of a free market economy and the recreation of an economic class structure not seen since the mercantile period.
Reform efforts failed. The system must be replaced.
I am in favor of having the government pay for medical care using the taxes which we pay. The government, however, doesn't know how to run an insurance program. It's not what they do.
When it comes to FEMA flood insurance the government retained private insurance companies to run it for them. The private insurance companies sell the insurance, adjust the claims, and, when it comes to paying, the government writes the check. Let's do the same with single-payer health insurance.
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cpmpared to 12% and up for private insurance@MIKEinNYC..."The government, however, doesn't know how to run an insurance program. It's not what they do.".....15% of the U.S. population is on Medicare. Medicare has a 3% administrative cost as compared to 12%+ for private insurance. Medicare generally gets high marks from the people it serves. You need to provide supporting evidence for your claim.
Lose your job. lose your health insurance. Get sick. Go Bankrupt. Die.
What there should be: universal coverage. The largest possible pool of people (namely everyone) so that paying the costs for universal coverage comes at a reasonable price for individuals.
Other advanced countries have managed to do this in a large number of ways. Non-profit insurance, as in Germany. Supplemental private insurance, beyond good (not bare-bones) coverage for everyone, as in the UK. We could learn from seeing what works in different places.
But hats off to the Democrats, who – starting with President Obama – changed the subject from "should we change this dysfunctional and unfair system where illness bankrupts people and unemployment means no health coverage?" to "how can we best ensure that everyone is covered and that nobody becomes a billionaire from denying healthcare to people when they get sick or hurt?"
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If medical insurance is a necessity for life, liberty, and the pursuit of happiness the way voting rights, and the Bill of Rights is, then it doesn't matter if doing away with private insurance is a good idea or not. What matters is whether disallowing some people who aren't employed and who can't afford private medical insurance can be excluded a government policy that allows private insurance not to take them, pro bono. Being able to have money is a right. Not having it doesn't mean you don't have the right to have it. Not having medical insurance does compromise a person's right to self-determination, for they are required to pay for it and therefore to earn money. People have the right to refuse care and to refuse money, but the government does not have the right to disallow a person from seeking money or care and a government policy that allows private insurance companies from providing the support that ends in care, is not acceptable. It never was and it's less so now.
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Look at the credentials and what then mean: Peter Suderman, features editor as Reason.
Those familiar with Reason already know the story: an allegiance to the individual versus the state, born of Ayn Rand and the suppression of the individual under the totalitarian state. The doctrine, belief, mantra and presumably rational (i.e Reason) is the force of the unrestricted market place (laissez-faire capitalism) to self-correct and provide the most efficient way of distributing economic benefit to both "creators" and everyone else. The matra is "hands-off" to every level of societal control beyond individual choice and I mean EVERY LEVEL. This is the core belief and driving intent of the Libertarian idea. It is, to state it bluntly "dog eat dog". If this is the society you want do whatever Peter advises. The arguments are diversions.
I think we need to create a new hybrid system - basic healthcare for all in a public "free of cost" system paid for by taxes on corporate revenues and personal income. Access to public hospitals, urgent care, telemedicine and generic drugs should be part of this offering. All private hospitals or doctor groups are welcome to participate at Medicare rates.
In parallel, private silver. gold and platinum plans for private hospital rooms, branded drugs (vs generics) etc. The wealthy can pay for these plans if they want "special" treatment. But it would be an either / or option. No Medicare reimbursement for those on private plans.
I'm guessing that most companies would shut down private plans and seek the public option. One addendum would be that if companies want private plans for executives they have to offer it to all employees if they want to deduct it as an expense on their income tax filings. If not the company and the executives both pay taxes on this part of compensation.
We are arguing about which democratic plan, the republicans will oppose? There can be no substantive debate on these issues, until we hear a republican plan? Didn't Trump promise a beautiful, inexpensive, comprehensive health plan that would be superior to Obama's ACO he is trying to destroy. Still waiting on the republican options and without it this is a useless exercise.
The truth is health care in this country has been failing for the last fifty years. The fact that we have largely an employer based system is preposterous. I fail to understand why Americans wring their hands over this issue when nearly every country in the western industrialized world has some form of universal heath care. What makes us so special or especially stupid that we cannot figure this out. As to all of the scaremongering this comes to us through the media fostered by the private insurance companies, big pharma and for profit medical practice.
I do not buy the argument that universal coverage will result in rural hospitals closing, quite the contrary. Rural areas typically do not have enough larger employers that offer their employees an insurance plan so more rural people go without private insurance. If they were all covered by a universal plan it would be logical that they will tend to use more medical facilities, not less.
After 3 years in the excellent Swiss system, the US must do something. And fast.
1
Republicans playing down the issue is a political move but it shows they really have no solution.
As far as closing hospitals due to lower medicare payments, that is simple medicare would be able to pay more, with more money coming in. Rural centers are already closing at a high rate. Here is a link from some news organization.
https://www.nytimes.com/2018/10/29/upshot/a-sense-of-alarm-as-rural-hospitals-keep-closing.html
If you support your private insurance, remember their goal is profits and that is dependent upon denying, denying, and denying.
1) do you like your insurance plan now? If yes, how well do you know it, do you know what they cover and what they don't, do you know if there is a cap? You don't know, why not? Can you take it with you? How much is insurance for you in the "market"? Are you prepared to lose the ACA protections, that's what republicans have done?
This is how the current system fails.
1. wait times or lack of access (when no one has insurance)
2. closing of rural hospitals (see above)
3. wait times again (this is due now to lacking insurance, in single payer it is due to medical neccessity)
4. You can lose your employer insurance at anytime and how well do you know your employer's insurance
5. Insurance motive is profit, so they find ways to deny
6. lack of freedom from insurance being dependent upon your employer and your pre-existing conditions.
7. It leaves people behind and it could be you at any moment.
8. medical bills
9. end of space
This is a mushy, "on the one hand/on the other hand" piece. It does not make a few crucial points. This list is not exhaistive. It just is examples of some pf the improvements that "single;e payer" (use of publc finds to cover health care costs) would make.:
:1.Public funds to cover health care expenses would raise taxes but cost the same or less for health care services and pouducts.
2. No co-pays or deductibles.
3. Everybody covered no age/ orincome rstrictions as in Medicre/Medicaid.
4. Negotiated prices for healthcare services and products.
5.. " Global"coverage of operating costs of health care organizations, e.g. hospitals, clinics. For example there would b annual estimates of and negotiation fo rof all costs for operations of hospitals, clinice and similar organiations, including both salaries of operating personel and the operating expenses. .
6. negotaited pricing of health care services and procedures. The bsic strategyfor health careoperating: "public funding, privatet practice.
Most of the opposition to :"single payer" (publicly funding costs) of health services and oriductsy omitsfseatures of a publcly finance system, avoiding foact s on the success of public financing of costs, and wild "scare"claims of what public financing would do: e.g. rural or small hospitals would close, too few professiobal health care personnel could be recruited, drastic reductions of jobsin private insurance companies.
The Democrats need to stop taking extreme positions on healthcare when all available evidence points to a combination of private and tax-funded healthcare models like in Europe. Germany has had such a combined model since the late 19th century, and it's doing just fine.
I read with interest the debate going on in the US concerning the possible adoption of a "Canadian style single payer" health plan. From the tone of the debate, it appears to me that both proponents and opponents do not understand what we have in this country, especially relating to private health insurance.
Our public plan covers 100% of doctor and hospital costs in public wards. There are no co-pays and pre existing conditions are not an issue. But, the government plans do not cover everything. For example, in Ontario the Ontario Health Insurance Plan (OHIP) does not pay for a vast array of services such as prescription drugs for those under 65, physiotherapy in private clinics, chiropractors, dentistry, optometry for those over 18 and under 65, dietitians, etc. These services are covered by private health insurance plans. It is my view that Americans would not have to abandon private health insurance if a Canadian single payer program is adopted. Rather, the focus of private insurance would change.
3
Other countries spend three-fifths or so of what we do on health care and get better results. This means that our health care system is wasteful and inefficient. Period.
Part of this waste is health insurance companies, which are much smaller and less politically powerful in other countries. It is upside-down logic to point to voter acceptance of health insurance companies without pointing to the untold millions that health insurance companies spend to promote their existence and power (also part of the waste).
Medical effectiveness should be determined by research done by experts (as we do with aircraft crashes), but our system forces it to be judged by the effectiveness of advertising and marketing campaigns. The quality (measured in effectiveness) of the work of a hospital's ad agency is what we are given to measure the quality of care at the hospital.
If the world runs and should run on spin, then this is as it should be. Otherwise, it is carefully and creatively maintained group insanity.
Some of Obamacare's critics think it does too much, and others think that it does not go far enough. By design, this article does not make clear where its author stands.
Among other things, health insurance is a jobs program in a country that loves jobs programs -- as long as they are called something else. So the article defends health insurance as providing jobs while deftly sidestepping the implications of this defense.
Its world runs on spin.
Econ 101 tell us that ANY private insurance company, whether for-profit or nonprofit, must take in more money than it spends. It can't survive otherwise.
Which means decisions are sometimes made that are NOT in the best interests of the patient.
The goal should not be to ban private insurance, but to take the profit out of healthcare and make private insurance redundant and obsolete.
Whether you call it Medicaid Expansion, Medicare for All, Obamacare Public Option or my monkey's uncle, whatever healthcare plan finally emerges should:
a) cover everyone,
b) cover everything (including dental, eye care, hearing, etc., but not optional stuff, like cosmetic surgery), and
c) cost nothing out-of-pocket.
When you go to the doctor or a hospital in the U.K., the only bill you receive when you leave is for parking.
That should be the gold standard for American healthcare in the future.
1
I was around when HMOs came into being as the end-all do-all of cost management health care. They were awful.
Medicare-for-all with no option for private coverage will be more of the same. In order to control costs, reimbursements will be tightly controlled and what is covered will be limited. Control will be absolute with no place to go.
I can't support Medicare for all until very specific coverage details are provided and a private option guaranteed. My fear is that with total government control - and the fact that Big Pharma will have their fingers in the pie as usual - my access to Complimentary Medicine could be revoked.
I pay for my insurance yet I use almost no reimbursable services because I am totally healthy - no prescriptions and no chronic dis-eases. I am the person who subsidizes those who need healthcare. That's how the system works and I'm lucky I can pay for insurance. Medicare-for-all needs people like me to pay for everyone else or it will need constant infusions of capital. This is why private insurance isn't attractive to those who want single payer.
The worst thing voters can do is believe in another medical care wonder bill without understanding the details. Demand that Bernie, Warren, Harris and everyone who raised their hand spell out how much the premiums run, how easy is to sign up, what the costs will be and how will it be funded. No more 'pass it now, read it later' attitudes such as we got from Pelosi.
1
Of course eliminating private health insurance is a bad idea. Very bad in fact. Medicare now offers only partial coverage to seniors, which is why many seniors like me buy private supplemental Medicare insurance to plug the gap. The US is already running a trillion dollar annual deficit. Medicare for All together with a ban on private insurance would only aggravate this very serious problem.
3
Eliminating private insurance is a fake issue and Medicare for All should become Medicare for All step by step. Medicare for All should remain what Medicare is today: a matter of choice, and it should be allowerd to negotiate drug prices, oh and the government should do what it used to do: keep a share of patents earned with government funded research. Today there is private insurance offered for what Medicare doesn't cover. As the age for access to Medicare is lowered a majority will choose Medicare because it's job-independent and a much better deal than private insurance which is a very expensive middleman: an insurance company with a CEO paid millions and an army of workers trying to find ways of excluding customers from treatment. There's no reason for any law or regulation to eliminate private insurance - let the market decide.
3
This is just a ploy to get votes; it will never happen. Insurance companies will not let it happen, nor will the healthcare industry. I support the private insurance market. Thank you.
2
It would be extremely more productive to our national debate if the misleading and, in some cases, deliberate misinformation about the Medicare For All plan proposed by Sen. Sanders was countered by the text of the legislation instead of abstracted by comments and innuendo.
Section 107 subsection b (Construction) of the Medicare For All bill it states;
(b) CONSTRUCTION .—Nothing in this Act shall be
construed as prohibiting the sale of health insurance cov-
erage 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.
This section unequivocally permits private or employer insurance coverage for medical or dental benefits NOT ALREADY PROVIDED by the Act. This type of exclusion clause is standard in other national healthcare plans.
Statements that the Medicare For All bill "outlaws" or otherwise make private/employer health insurance illegal is wrong.
1
Another extreme policy (Luke abolishing ICE) that will (1) make a field day for Rs, and (2) drive away Dems, moderates and independents whose votes are absolutely necessary to win and who also are employed and have good health insurance. Not everyone is out in the cold on this. Dems will cause people to stay home and not vote if the promise is to eliminate the medical insurance they’ve worked hard to earn. As others point out, there are ways to provide medical care to those who struggle to pay w/out punishing people who’ve been successful.
2
@jkk The problem is, success has nothing to do with it. It's getting sick with the private insurance industry that will clean you out.
For someone who has had the very best private insurance for 52 years I am a strong supporter of Medicare for all. Private insurance works great until you really need it.
A serious illness and the need for monthly infusions might sound like a big issue but the far bigger issue is dealing with Blue Cross Blue Shield. While I work full time, my other (sometimes full-time) job is dealing with insurance. They are capricious, will postpone and delay, will claim the billing department put the wrong code in, hide behind privacy regulations, and blame social security and medicare for their problems.
While my wife and I have the education and background to deal with them, I feel the pain of those who are so overwhelmed that they might give up.
When you are sick the last thing you want to do is deal with a collection agency because your medical insurance did not (mistakenly!) pay your bill.
3
Let’s attack billing fraud. Open public pricing, the same for everyone getting that procedure at that facility. At the moment, this or that procedure is coded as something insane price-wise and free market capitalism is used to justify the deep deep gouging. Oh, and those billing codes? They need to be free and publicly accessible.
The level of public discourse on this topic is going to remain frustrating as long as we insist on talking in absolutes and slogans (complete with bogeymen) and refuse to talk realistically and constructively about the various shades of universal health care/insurance that represent potential paths for the US. It doesn't have to all or nothing. It doesn't have to be all single-payer and no private insurance. We don't have to duplicate Canada, Great Britain, Germany, or Switzerland (and others). But (please!) note these each of these countries has a *different* system. And if we're smart, we can at least try to compare them and apply lessons learned from these and other countries and have a real debate about what fits best for this country -- both in the short-term (as in a transitional phase) and the long-term.
" Yet surveys have found that support for single-payer drops when respondents are told that it would eliminate private coverage. "
This is the right thing to do but the American public are going to need to be convinced/sold on the idea. We spend more and get worse care than any other industrialized nation. Until Americans can be convinced that the point of healthcare is to make and keep you healthy (and will not include fancy art on walls, grand pianos in the lobby, Starbucks coffee delivered to your room, etc., etc)
This is going to require an FDR-sized presentation. Not sure we have anybody who can do this.
@Larry I'm thinking Americans are not able to process the idea anyway. The Repubs say "boo", and that's all it takes. No analysis will be done.
It may be a good idea but it's one fraught with anxiety. Calculating that into the equation is the challenge and it's probably an insurmountable one at that. A pragmatic rather than a radical approach would more likely win the day.
There are 180 million private health insurance policies that Americans have paid for. According to a poll in WaPO 80% of Americans want to keep their policies. There are 3 million people working for these companies who are part of 65% of all American investment portfolios. What possible reason is there for destroying a major segment of our society and depriving people of a product they purchased?
The argument health care is a human right is pablum. Food and shelter are also human rights, we all don't eat the same food or live in the same house. People are hungry, we don't eliminate private restaurants, others are homeless but Bernie Sanders has 3 homes. Why would putting everyone on Medicare improve the situation? Have you dealt with Medicare? Less paperwork, are you joking?
I practiced medicine in Canada. Every major Dem candidate wants single-payer eventually. Canadian medicine isn't terrible, it has its good points, but it is the antithesis of every major healthcare initiative since Obamacare. The 20th Century Cure Act expands patients' access to experimental therapies, every month Health Canada turns down therapies the FDA approves because of cost. Every day a million Canadians wait for procedures they can have here as soon as they get in. Doctors go on strike and my patient died waiting for a procedure. It's just reality.
I despise Trump but I can't vote for this. It takes away people's freedom and solves no problems. It just creates inferior health care.
5
I was working in the health care field in Asia, and my home country has a universal health coverage for all citizens. Since coming to the US, I am shocked to learn that everything costs so much for health care and someone makes a good business (a lot of money) beyond reasonable levels.
- Why can health care be a lucrative business?
- Why do you want to make so much money out of other people's unfortunate illness - can you be so evil?
Believe me - You will find it wonderful to transition to the single payer system with a reasonable speed slow enough to make everyone adjust to it. So, this is not even an issue to me.
2
I'm bewildered. I read that surveys indicate that the majority of those covered by private insurance express satisfaction with their coverage. But then I read surveys that indicate that many of those covered by private insurance are becoming overwhelmed by the ever-increasing cost of that coverage -- what with escalating premiums, deductibles and co-pays -- with the result that they try desperately to avoid using it. Sometimes we seem to be discussing completely different systems -- even when speaking only about private insurance.
Last week the Washington Post published a devastating report on a visit by a traveling non-profit clinic to a rural Tennessee town. Those who obsess about the effect ending private coverage would have on rural hospitals have nothing to worry about; the free market is already doing a fabulous job of decimating rural health care.
1
It isn't. Ask anyone who lives with socialized medicine. It works but it does not work very well.
However, what we have now is a debacle. The money being made on the backs of the ill and dying should be an embarrassment to us all. The problem is the lobbying and the spineless politicians who will not act to rein in the greed in Pharma and Insurance companies.
If the last can't be changed perhaps we have no choice anymore than to scrap the entire structure and build a new one.
2
the ceo of united health care in 2015 made $31,000--AN HOUR!!!!--- base on a 40 hour work week and 52 weeks- $63 million that year total....the people of this country need to open their eyes. I've been a pediatrician in rural appalachia for 30 years and our practice is 50% medicaid.We WISH we were reimbursed at Medicare rates,but children are not valued like seniors, since they and their tired, over worked parents dont vote as much...
Anyway- lower the medicare age to 55 --thats when millions of folks have been working for 30+ years, are getting cancer, heart disease, arthrits, and getting laid off, new poor quality insurance plans- would they not LOVE to get onto medicare!!! When the 45-55, then 35-45, ... see what is happening they will clamor for further medicare access.
Raise the ceiling for medicare tax from 132,000 to $500,000 and above that work out a formula that is fair to those suffering making over a 1/2 million. Funding problem GONE. Might even decrease the tax for under $132k earners...
Expand medicare into a public option that people can BUY into for reasonable/sliding scale premiums. This would put pressure on private corporate and 'non profit' to lower their premiums.
just a few thoughts- and DONT mandate that people must give up what their unions have fought for, or what they are comfortable with-- let the situation unfold and give people choice. Kamala- are you listening??
150
@SW The CEO of United Health Care only made that money because he delivered exceptional value to investors in United Health CAre.
You were championing them 10 years ago when they agree to go along with ObamaCare. What happened.
For people like me, I looked at the 'rigged system' and took advantage of it by investing $100,000 into UNH.
The company had a valuation of $20 billion at the time and today has a valuation of nearly $240 billion.
For those of you with public school math skills, that means my $100k grew to $1.2 million in less than 9 years.
If you had invested in UNH just 10 years earlier on New Years Day 2000, the stock was trading at $6.25 a share. Today it's trading at $241 a share.
The compensation of executives that you cite as a reason for us not having good health care is intellectually dishonest.
The stock options he was given have ZERO impact on the operations and profitability of United Health, or the cost of your insurance.
If those stock options were worth less than when they were issued, he'd be making about the same as you.
If you don't understand how Congress made this kind of compensation possible when Democrats ran Congress, you might want to do some homework.
Used to be companies paid salary and bonuses...but then you Democrats decided no company should be able to take a salary expense of more than $1 mil for an individual...and now we have stock option mania.
Sad to be you.
For some of us..when the fix is in..we're all in.
2
@Erica Smythe
First, I must say that I'm very impressed that you can remember what SW was championing 10 years ago. I wish my memory was that good.
Second, while I'm sure it's very nice to be rich, you changed the subject to one that is completely irrelevant to the discussion.
SMH
14
@Erica Smythe
All true. Except one thing. You making 1.2 mil over the last 9 years IS part of the healthcare cost in the US. That is clearly good for you, and I am happy for you. But the question is, do we as a country want that or not. Do we wont our co-pay and our premiums paying for your profit and , yes, for CEOs compensation. I think that most Americans would say no we don't.
14
Always amazed me how hard AHIP fought against Obamacare when it was working its way through the legislative process. Considering how Obamacare further entrenched private insurers into our healthcare system, they should have been going all out to sell it to the American people, instead of fighting against it. The alternative (tens of millions without healthacre) was unsustainable. Short a functioning Obamacare, the other option is to kneecap private insurance entirely, basically put them out of business except as small, boutique operations paying for facelifts and boob jobs. They were so incredibly short-sighted, but I guess when your CEO is raking in $40 million a year in salary, what can you expect.
Am I the only person who is disappointed at how easily a vote can be purchased?
Have student debt? Want that debt to go away? Vote for the side that is blue!
Don't like what our party did to your ancestors? Then vote Blue and we will make it up to you!
Want free health care? Then vote for the Blue Candidates!
Want higher wages? Vote for the Blue team!
Want lower prescription costs? Vote Blue!
If it is costing you money and you don't like it... then you should only vote blue!
If you vote for any party or candidate that is not 'Blue' then life, the Universe and everything... will end - So think of the children and vote Blue!
Come on, vote Blue for a free ride!
4
@The Critic
Buying votes? How ironic.
Am I the only person who is disappointed at how easily a vote can be purchased?
Have student debt? Want that debt to go away? Vote for the side that is blue!
Don't like what our party did to your ancestors? Then vote Blue and we will make it up to you!
Want free health care? Then vote for the Blue Candidates!
Want higher wages? Vote for the Blue team!
Want lower prescription costs? Vote Blue!
If it is costing you money and you don't like it... then you should only vote blue!
If you vote for any party or candidate that is not 'Blue' then life, the Universe and everything... will end!
Come on, vote Blue for a free ride!
1
I'm interested as to why single-payer health insurance has the most popularity amongst Democrats at the moment. There are other kinds of universal health care that work just as well, if not better, than single-payer. There could be universal multi-payer insurance, for instance, like in Germany where there is a health insurance mandate. Public and Private health insurance can definitely thrive side-by-side.
3
Yes we are sure.
2
Am I the only person who is disappointed at how easily a vote can be purchased?
Have student debt? Want that debt to go away? Vote for the side that is blue!
Don't like what our party did to your ancestors? Then vote Blue and we will make it up to you!
Want free health care? Then vote for the Blue Candidates!
Want higher wages? Vote for the Blue team!
Want lower prescription costs? Vote Blue!
If it is costing you money and you don't like it... then you should only vote blue!
If you vote for any party or candidate that is not 'Blue' then life, the Universe and everything... will end - So for the sake of our children and humanity, whatever you do vote blue
Come on, vote Blue for a free ride!
Folks, it doesn't matter if you agree with me or not, nor does it matter how it is spun... it is still buying your vote!
Removing an entire useless layer of profit is always a good idea. It's called disintermediation.
3
Is the question that is the title of this article meant to be serious?
1
Yes.
2
In it's current form, yes it needs to go. The costs of healthcare are high. The money to pay for it is scarce. The private insurance model is, of course, charge as much as possible for coverage, pay out as little as possible for care, and keep the rest. The rest is billions. We can't afford it.
Given this piece alongside David Brooks piece today, it seems like the New York Times doesn’t like the idea of Medicare for all.
Do people with insurance through their employer know how expensive high deductible premiums actually are? It’s $200/300 a month for a healthy young adult! I work in the gig economy. I can’t afford insurance and I don’t qualify for Medicaid. I support Medicare for all because it makes sense to me.
Maybe those struggling hospitals in rural areas wouldn’t be struggling under Universal Healthcare because they’d actually have patients who could afford to go there.
3
"...Eliminating Private Insurance is a Good Idea?"
Yes! I'm sick spending hours arguing with the insurance company and being put on hold for half that time.
Tired of asking what is covered and what isn't and ALWAYS without fail getting an incorrect answer if I even get an answer at all.
Disgusted with large co-pays and items not covered for no apparent reason.
Angry about seeing such a large percentage of my pay going to an insurance company that doesn't care whether I'm getting what I really need. Also angry at having to deal with their insolent ill-informed "service" staff.
Etc., etc. Public option? Sign me up!
Supplemental insurance? Well, maybe if it's reasonably priced and they promise to do better..
Insurance companies SHOULD be negotiating better prices for us but NONE of them do. They rather keep our money without bothering to do the necessary work.
6
We don't need to eliminate totally. Insurance companies merely refocus on non healthcare insurances. They'll still have profits only not as much.
Remember, Medicare at first caused an adjustment back then too and they survived with more than enough profit.
And Medicare still requires supplemental insurance for total coverage.
This is just another scare tactic.... Wake Up America and stop being manipulated!
1
"Are We Sure Eliminating Private Insurance is a Good Idea?"....You won't have to eliminate private insurance. All you will need to do is offer Medicare as a healthcare insurance option, and private healthcare insurance will disappear all by itself.
2
Worth pointing out that private health insurance is common in the UK and thrives in parallel with the NHS.
64
@John Stroughair
But not very.
The real issue, anywhere we go from here, isn't the destination (though it would be neat to have one), rather the road map.
The thing to consider is how our hospitals were, and are, paid for. Private hospitals (almost all of ours are) carry debt that counts on a certain amount of excess CMS collection. A lower tier medical school costs at least $16k a year. For tuition. No room and board. That's in-state. Doctors make a little more than half as much in the UK, where their education is cheap to free. The first question then, how do we manage our cost of living and debt load to get it all down to NHS levels?
Moreover, while the UK thinks that its commute times from village to village are just insane and that it's not really that small of a place, IT IS. It takes a little more than 8 hours to drive from the south to the north, not all of it on highway. That's the time it takes to get from Denver to Kansas City of I-70, going 80MPH. They have London and Edinburgh to support the left to right in that distance. We have the aforementioned towns to support the majority of Nebraska, all of Kansas and Colorado.
Worth pointing out as well that the UK has grown around 15% in population since the NHS was created. The US has nearly doubled its population in that time.
We should be looking to other countries for inspiration and learning from their histories, there won't be a single solution. Certainly not when you consider the cost of the journey.
2
@Kate I would disagree with your characterization of what doctors earn in the UK. As a primary care doc, I learned that my equivalent in the UK earned the same or even higher amounts than I did. The disparity you refer to is more related to some medicine specialists in the US who earn many times more than your average pediatrician, general internist, family practice doc. We also have lower paying specialties (infectious disease) and higher paying ones (dermatology). Yet, what we need a whole lot more of here in the US are primary care docs. And let's not get into what surgeons get paid: more than the average medical specialist even. But -- looking over everyone -- as already noted in the comments is the tens of millions healthcare CEOs make by delaying or denying care to people.
1
@John Stroughair...Why would anyone need to purchase private health insurance if they have wonderful cradle-to-grave national health care? That seems bloody silly.
1
Best idea ever is to eliminate private insurance companies that are MAKING MONEY from people's health woes. The only other money-making operation that is this lame is the PRIVATE PRISON industry.
3
"Seventy percent of Americans describe the current U.S. healthcare system as being "in a state of crisis" or having "major problems."
https://news.gallup.com/poll/245873/seven-maintain-negative-view-healthcare-system.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication
Are We Sure Eliminating Private Insurance is a Good Idea?
Yes, we are sure.
2
Article's title is a question, "Are we sure eliminating private insurance is a good idea?"
Answer, Yes.
1
Oh please! Eliminating private insurance was served up by the moderators to trick the candidates. No country bans private insurance and we won’t either.
3
People are one job loss away from not having any insurance----a critical issue in this economic climate.
A national plan would allow people to start a business, or move somewhere else for a better job that may/may not offer insurance.
And the insurance many people have thru their employer is very expensive (employers rarely pay for the whole cost), and it is horrible, and you have no choice of the insurance company.
Retired folks don't complain too much --
1
Understanding that the numbers show many Americans say they're happy with their health care - and putting aside the question of how many of us would still be if we all of a sudden had to deal with a massive health scare - why exactly do we have this understanding that health insurance companies are so wildly popular that talking about getting rid of them is a political loser?
I have had private health insurance my whole adult life, around 40 years.
Please take it away and replace with whatever you want to call a public option or medicare for all.
Private health insurance companies are in the BUSINESS of denying you care.
151
@jb Total agreement here. I would give up my employer-provided health insurance in a heartbeat! What freedom! I have to stay at my job because I could not afford private health insurance on my own. I am 56 years old. I would like to slow down but can't.
13
Private health insurance can exist alongside any national plan, but all must pay into the national plan through modest increases in Medicare (or similar) taxes just as we all pay into FICA, etc. Those who prefer private insurance can stay where they are. Those who switch to a national plan should, overall, pay less since employers & employees would no longer pay their respective share of premiums. If you earn 100k/yr & pay 1k/month for health insurance, that’s 12k/yr for you alone, then add the employer share. If you switch, a tax increase of 2-3% is still going to save you a lot of money; employers should also love this & could be allowed to pay part of this for employees. People will shift to a national plan with less costs & equivalent, or better, care. However, MFA is less than satisfactory if private plans are needed as supplements & you can still go bankrupt due to medical bills.
U.S. healthcare annual spending PER CAPITA (2016) was $9,892 compared to UK 4,192 & Canada 4,753. We now spend nearly twice as much PER CAPITA as these major developed nations with successful national healthcare programs & our healthcare outcomes are worse than theirs. The “PER CAPITA” means we, as a nation, are already spending enough to provide national healthcare FOR EVERYONE equivalent to the nations listed. If our healthcare was as efficient as theirs, could actually provide their level of healthcare for about 600 million citizens! So the number of citizens in each nation is irrelevant.
"... It is the sense, shared by Republicans and Democrats alike, that Obamacare has failed or, at minimum, that it still needs considerable work." It has not failed: Far fewer uninsured, except in states that did not support ACA and did not expand Medicaid coverage. Medical underwriting for preexisting conditions no longer permitted. No public option to compete with private insurers? Right, because at the time, that was too heavy a lift politically. Republicans have blocked corrective fixes, and have done what they can to weaken it. So, no, ACA has not failed, and yes, it needs considerable work. Rather than starting over, the practical and politically feasible best path forward seems to be: build on what is working. Is it a perfect solution? No it isn't.
As a senior on a Medicare plus plan, I see a place for private insurance. Medicare provides a base, and I pay the private plan a little more to cover things that Medicare does not, such as vision and dental. Many Western European countries do more or less the same. These plans are highly regulated by the government, but still administered by companies that are out to make a profit. And, they make a profit paying out 90% of revenues to medical bills, as opposed to the 80% mandated by the ACA.
I personally prefer the Medicare for All, but as it is administered now, with the government providing a base and added private insurance available. I also think it is an easier sell because people know what they can expect.
2
Effective health insurance (access and affordability) cannot be provided by corporations whose responsibility is profit maximization for its shareholders. Shareholders’ interests are at odds with policy holders’ needs for services. The only way to maximize profits is to minimize payments/coverage. You can have private insurers, but they have to be non-profit organizations.
2
How do European countries make their health systems work? There is no insurance middleman for them. Citizens pay more taxes but they don't have to worry they will lose everything if they get sick, like in the US.
The issue of rural hospitals and services is already a problem which could be solved by making working in these areas for a certain number of years part of free medical school for physicians. Medical school needs to be more affordable, also.
2
As a retiree with Medicare as the primary payer, I can tell you there's a good reason I also have private insurance as a "secondary payer." The reason, of course, is Medicare doesn't cover everything. Those who want to eliminate private insurance might want to consider that.
68
@Carl
Even in Canada, people are allowed to have private insurance to cover things like prescription drugs, or private rooms while in the hospital.
Though some friends I spoke with a few days ago, said over 65 y.o. they now just pay a "dispensing fee" of $1.00 for their prescription meds. That's in Ontario, which I am visiting now.
5
@Carl Yes, but the supplementary doesn't cost all that much.
6
@Carl
Medicare "doesn't cover everything" because they are still competing with an abusive Medical Insurance Complex that drives all costs up--so the insurance companies are at the root of the problem. Medicare cannot keep up with such artificially-set prices...and that is where the "supplemental" insurance kicks in.
How clever for the pirate (no spelling mistake here) to set up a system of win-win at the expense of the American citizen, o "heads-I-win-tails-you-lose": the two-prong attack of private insurance & supplemental. Profiteering, anyone?
14
As a Canadian, I love our single payer system and having had a bout with cancer in the past, a US system would have bankrupted me. In spite of Republican rhetoric, ours is not a socialist system. Cuba has a socialist system in that the doctors are government employees. In the establishment of the NHS in the UK patients were assigned doctors so that was in effect a quasi socialist system. In Canada, doctors are private practitioners and the provincial gov't is the insurance company. Fees are negotiated periodically with the medical association. The upshot is that doctors don't need a large clerical staff to fight with an insurance bureaucracy, hence lower administration costs.
However, trying establish a similar system in the US would be a long term undertaking. When Canada established its single payer system we had a population of about 25 million. Our hospitals, with one or two exceptions were owned and run by provincial govt's. I wish you well, but it is not going to be easy.
3
Medicare for all is simplistic and wrong. A strong ACA coupled with medicare for the seniors is the solution.
Single payer is a BAD idea, and Democrats running for president would be wise to get off of it. Besides the very sound and statistically-backed arguments made by David Brooks in his column today, single payer, by its very nature, is a SINGLE POINT OF FAILURE opportunity. Sure, single payer works well in many places around the world. But it also works poorly in many places. Stroll across the border to Quebec, Canada and you will find a single-payer system where half of the population does not have a primary-care doctor, and waits for standard diagnostic tests can stretch to months or years. When single payer goes off the rails, lots of people suffer and it can take years to get back on track. Obamacare, properly adjusted, was and is the best answer. A public option is worthy of discussion; but single payer is not!
@Steve
Why do so few Canadians seem to agree with you?
4
@gratis Because those Canadians are not talking about the Quebec system. I suppose that most of them are from Ontario, where the system works better. Which simply reinforces my point that when single-payer works then it works, and when it doesn't a bunch of people end up with a bad system and almost no recourse for near-term recovery. That is the single-point-of-failure problem. Let's take another example, the VA effectively is a single-payer system, and yet it was just a few short years ago that we heard of people being bedded in hallways and waiting moths for appointments and tests. One cannot count on any single system to reliably work effectively and efficiently for long periods of time without failure.
1
The entire industrialized world, except for us, has universal medical care. Perhaps not by coincidence, they pay on average HALF of what we do for health care, and get better results.
Insurance is still around in some of these places, but it is highly regulated and not allowed the shameful tricks insurance companies do here. Just one example: you go to a hospital which is in network for your treatment ,only to be hit by a high bill from some rogue (but essential) doctor who is not in network.
I think we should sign on for universal, affordable care (the Dutch for example have this...when did the Dutch get to be smarter than we are?) and work out the details later. Also, we need to be willing to learn from other countries and their experience. Too many people weighing in here don't even have a passport. They have zero idea what is going on past our borders.
The Netherlands system relies on managed private insurance that is well-regulated, and tax-subsidized, actually.
https://en.m.wikipedia.org/wiki/Healthcare_in_the_Netherlands
1
I am personally for Medicare for All, but it's not true that all developed nations have it. Germany for one (biggest country in Europe) has a system of private insurers who are capped in how much they can charge. There, a national non-profit group of experts determines fair prices for all drugs and services, then insurers are bound by that price.
While I would definitely prefer a simpler, cleaner, 100 % universal system (and I am a strong supporter of Elizabeth Warren) I also understand why some Americans are fearful. I don't think it's a terrible idea to explore other options, like a buy-in, or something like Germany's plan. Creativity and attention to details could be our friend here if we don't destroy each other first.
1
Getting into a discussion about whether private insurance should be eliminated with health care reform just plays into Republican hands. There are lots of options between the two extremes...even the UK has private insurance options that are often employer-provided. Please don’t blow this election by arguing unnecessarily about policy minutia.
188
@Mike "Plays into Republican hands" is exactly right. That is Suderman's goal. He works for a "free-market"-promoting think tank, so of course he wants to throw shade on non-market solutions even if it kills us.
16
@Mike
The debate moderators actually did the Republicans a favor by asking for a show of hands on the most divisive question regarding health care - elimination of private health insurance.
Candidates need to respond by stating clearly that the goal is not "socialist" de-privatization, but universal, affordable coverage. Dems, even the most progressive ones, should not be demanding allegiance to the dream of single payer. It's highly doubtful that will pass even a Democratic House and Senate, precisely because any American has good reason to doubt that the government can actually handle such a massive program. I'm not saying the government is incapable, it's just that there are reasonable doubts.
Candidates need to chart out a likely path or paths to universal coverage. This is not wonky discussion of minutiae - it's called realistic leadership. Private insurance may be eliminated or wither away or continue for the few that can afford it, but elimination is not the goal. Universal coverage through a mixed set of alternatives works for most of the industrialized world, it can work here.
Don't let the Right frame the debate.
16
@Mike
Sadly, we can expect more meaningless "gotcha" health policy questions from the corporate media. From their point of view, any Democratic candidates who disagree that American families should be mandated to pay a regressive monthly nut to subsidize private profits (rather than a progressive tax spent solely on the delivery of health care) must be disparaged and undermined. (See for example David Brooks' column today.)
8
The large corporation I work for just told people in my position that as we get laid off, new hires will be recent college grads in Mexico. My company has been laying off as many people as possible who are over 45. The only ones they hire are recent grads. If you want to work here you have to really know someone or there is no way in. Want to know why? Healthcare. They don’t want expensive older people with health issues. They have to pay that dividend and there is no where else to cut.
4
It is not necessary to eliminate private insurance to dramatically improve our healthcare system. It is necessary that we must remove some of the profiteering in our system. It is also true that eliminating private insurance would save enormous cost.
The Bismark system is used by most advanced 'Western' nations. In that system government mandates universal coverage and sets the standards and prices for care. The private healthcare system including insurance companies then compete to provide care within that farmework. Those entities all make money providing better care than ours and at lower costs.
What we have is the Wild Wild West. Republicans love it because the profits are eye popping and huge profits are aphrodisiacs to Republicans. However something as complex as healthcare absolutely requires serious, thoughtful and comprehensive structure to be effective and efficient.
Expecting to provide good care at appropriate costs with our system is like expecting to reach the moon riding a bottle rocket.
The problem with Medicare for All, when coupled with the Functional Open Borders Democratic platform is the resulting Medicare for Every Person in a Developing Country.
This is the old “I’d rather do without than have people I disapprove of get this benefit.”
Anyway, illegal immigrants are not eligible for ANY government benefits, no matter how many times your favorite AM radio ranger says that they are.
One of the real problems with Medicare is its "one size fits all" idea. Why do people advocate for such a system for their health care but oppose the idea in all other areas of their lives. No one walks into an apparel store and goes to the "one size fits all" rack nor do they go to an auto dealer and look for the OSFA lot. Nor should we have too. The federal government has a health program that offers dozens of national plans and many more local or regional HMO plans. This allows people to select a program that fits their needs without unduly burdening them. Some plans offer special programs offsetting a great deal of the cost for special needs such as diabetes or mental illness. Others do not offer these incentives and are therefore less expensive for themselves and the nation.
This program fosters competition in the health services while promoting high end service and best of all each fall all participants are allowed to easily change plans which punishes programs that provide substandard services, long waits, minimal doctors selection and etc.
This plan has existed for 50 years and is proven to meet the needs of the federal workforce. Premiums are subsidised for all but not free to all.
The system is not perfect but there are none that will meet that standard. All citizens can be insured without adopting a "one size fits all" system.
@sandman338
Maybe some peopld would rather put on a shirt that doesn't fit than have no shirt at all?
2
@sandman338
There is no perfect anything that fits everyone. There is no perfection for all, in any aspect of life. So there is that.
The big idea of insurance is to spread the risk. The larger the pool, the lower the cost. That is just the way it is.
The smaller the pools, as you suggest, lowers the cost for a few, but increases the cost for others. Generally, the older one is, the more one pays. Get a "pre existing condition" and the costs skyrocket. Add administrative costs to each choice and the overall costs are higher. It is what we had before Obamacare, and one big reason we got Obamacare.
2
Does eliminating private health insurance mean outlawing it? I don't think so. I think it means that everyone will automatically be enrolled in a public system paid for by taxes. But I don't think there would be anything stopping you (like a law) for someone to offer private insurance and for you to buy it, even while you are also enrolled automatically in the public system. So what do we mean by eliminate? Even though, first offering a public option might be a good way to start this out. It was one of Obama's huge attempt-to-compromise mistakes to not have done this in the ACA at the outset. Giant missed opportunity.
1
@James Smith
This is exactly the case in the UK. Wealthy people get their insurance for swanky hospitals and plastic surgery and whatever else. The rest of the people scratch their head when they hear Americans say, "medical bills".
Actually, it does. read the text of the bill. Senate bill 1804 section 107 clearly states that insurance coverage would be prohibited for anything provided by Medicare. only procedures not covered by Medicare such as cosmetic surgery would be allowed to be covered by private insurance.
Why can't we all have the same baseline healthcare and opt for additional healtchare, like most nations in the world? What is wrong with America?
3
Several candidates made the argument that the fastest way to Medicare for All is through a public option or some other intermediate step that preserves the health insurance business. The logic of this argument escapes me. The fastest way to get Medicare for All is to enact Medicare for All. The time for the public option was when Obamacare was first enacted. That time is well past, and we have waited long enough. Much too long. Obamacare WAS the compromise, and it has shown that compromise with the insurance industry and its army of lobbyists doesn’t work. Really, what we need is Medicaid for All, with reimbursement rates to doctors and hospitals set at reasonable levels so hospitals do not in fact close down. It can be done here, like it is done in every other advanced nation. Those who say it can’t, or that it has to be done gradually, are really just saying they are not willing to fight for it, like Elizabeth Warren said.
1
Let me echo David from Brisbane- yes, I am quite sure. And I work in the health insurance industry. Have been for years. Absurd to even ask if we need to eliminate an insurance system that will bankrupt you and cause you to lose your house if you become seriously ill.
1
Kirsten Gillibrand had the right idea.
Introduce Medicare as a parallel alternative. Once the private insurance companies realize they can't compete with a pool this large, they will gradually change their offering into a complementary one as is common in Europe: repatriation, private hospital room coverage, etc.
3
Any plan based on the current Medicare system would, by definition, include private health insurance as Medicare does with Medicare supplement, Advantage, and prescription plans. Even the UK with a single payer NHS allows people the option of "going private" with private insurance to cover the cost. It is both unrealistic ad short-sighted to call for the total elimination of private health insurance.
2
Health insurance companies are making money from uninsured patients, because they collect a profit on the part of your hospital bill that pays for uninsured patients. So they have a captive market, they will always make money, they have no reason to cut or manage costs that they can just pass along.
Eliminating private health insurance for the majority of needed coverage is a fantastic idea. No current plan bans it for everything. Private insurance serves no one except to it's upper management and its shareholders. It's reason for being is to extract profit. Even the so-called non-profit insurance companies do this with super high executive pay and vast cash reserves. These are medical bankruptcy factories, pure and simple. We can provide our own public insurance simply and easily, with super low overhead and and with much more complete coverage than people have today. Patient choice goes way up under public insurance, not down. The network is nationwide, so no worrying about lack of coverage or high charges with traveling to another state. It makes financial sense, moral sense, and medical sense.
3
I've just been exposed to a lot of wasted time, and some risk to my heath, resulting from the complexity of our system, with so many separate insurance policies for everyone to deal with.
It tends to push me towards single payer.
I just had my health insurance plan switched on me, owing to passing between one half of the ACA, on-exchange plans that people over 138% of Fed. Pov. Level (FPL) get, to expanded Medicaid, that those up to 138% FPL get.
(The problem was worse than it needed to be, owing to a bungling by the MA agencies handling the ACA, so that I had only 6 days notice of a switch in plans, which switch I otherwise could not predict. I also happened to be sick at the time, with a bacterial infection that ultimately needed to be diagnosed and treated.)
I had to put in about 50 hours of time picking an expanded Medicaid subplan from the 9 available in my area, and finding a primary care provider in that subplan.
The issue was that the insurer databases of providers had all kinds of omissions and inaccuracies.
The insurers ultimately told me that the only reliable way to find out if a provider was covered by the insurer was to phone the provider's billing office, get all possible 10 digit National Provider Identifiers (NPIs) that could be presented with a bill, and phone the insurer with that NPI.
This even failed once, and the provider had to resolve the disagreement about whether they were covered by the insurer over a few days time.
Crazy. Let's simplify.
If gov’t single-payer were enacted, private, for-profit heath insurance would wither away. As such, laws to ban the latter are largely irrelevant.
2
As anyone who has Medicare knows, without private insurance supplement, basic Medicare does not offer the coverage most used by consumers. Medicare for all would require not only replacing private insurance for workers, but replace the parts of coverage for those over 65. So calling this idea Medicare for all is not what they are proposing. Medicare for all who don't have other coverage is one thing. Morphing Obamacare to a Medicare model should be the goal.
1
Let's assume that having health insurance is a right. So is getting an education. But even under our system of free public education, every parent has the right to send his/her child to a private school and pay for it. Why should health insurance be any different?
3
Step 1: Create a meaningful public option and require employers to offer it alongside whatever private insurance plans they wish to offer.
Step 2: See what happens to enrollment.
In other words, don’t mandate a massive change to private insurance from the top. Let the market decide which works better. Most likely, what will happen is what happens in most other countries. Private insurance continues to be an option, alongside a government run (e.g., Medicare) insurance system. People use their private plans (if they can afford them) to SUPPLEMENT the public plan they are a part of, not to replace it.
3
It doesn’t have to be all or none, you know. Plenty of countries have a mix of public and private insurances. The difference is that the private companies have controls on them for profit, denial of coverage, etc. If one has a large powerful animal along with the assistance dog, make sure the leash is strong.
4
As a Canadian whose provinces have has single payer, universal health care for the entire population since the 1960's I am always shocked when visiting the US to see people on the streets with obvious medical conditions that would have been treated and cured in Canada.
Greed and profit are the overwhelming impulses in the US health care system. In Canada some 12% of GDP is spent on health care. In the US it is some 18%.
At every step in the US process, insurers, doctors, hospitals, big pharma and other care givers are squeezing out as many dollars as they can. And now American mothers are crossing the border to buy insulin which in Canada is 10% of the cost in the US.
Obama care was a good step in reforming a process that ignores those who are ill but cannot pay. But more reform is needed.
3
There is great fear that eliminating private insurance will mean the government is your doctor (think death panels). Republicans successfully sold that fear to the public years ago. And yet our system is a mess! We pay nearly twice and have worse outcomes and lower life expectancy than counties with universal coverage. Changing that needs to be the starting point. Then consider that universal coverage comes in flavors, with and without a private option. Several like Germany and Australia offer private options. Canada (yes only 35M people) does not and for a good reason: when it comes to health, we ALL deserve excellent care. It also simplifies the system and dives down costs. Sounds right to me. Elizabeth is on the mark - time for big, structural change. Let’s get someone in there ready to fight for that. A country that provides care to all is clearly better than one that assumes the market will be your doctor.
I believe in universal healthcare, but Sanders, Warren and a few others who advocate Medicare for all and the elimination of private insurance companies are dead wrong. The public should be offered a federal government health insurance option but private insurance options with all of the protections and required coverage of Obamacare should be an available alternative. Current Medicare only pays 80% of usual and customary charges, has only limited prescription coverage and does not cover vision and dental. Most current Medicare participants have to purchase private insurance supplements to cover the balance of their medical expenses. None of the Democratic candidates have articulated how Medicare for all would be funded and whether it would cover 100% with perhaps reasonable deductibles or co-pays. We should adopt a health care plan similar to those in Germany and Switzerland that cover everyone with either a choice of a government or private insurance plan.
None of this matters. Unless President Warren has a filibuster-proof majority in the senate, precisely zero progressive legislation will get past McConnell.
1
Yes, we are sure that eliminating private health insurers is a great idea.
The question is not whether we are sure eliminating private health insurance is a good idea, but what has taken us so long to talk about doing so.
Private health insurance is a form of tax imposed by insurers. People actually need medical treatment, just as they need food. Yet, people now pay over $2,000 per month premiums for bad individual health care that has more copay, exemption, deduction, and coverage exception loopholes than a ball of swiss cheese has holes. Why not jack up the price of milk similarly--$2,000 a gallon sounds fair.
It is not possible to regulate the insurance market, as the insurers have Congress' ear, and write the laws themselves, or pay legislators who will keep government hands off this cushy market. Consumers have nowhere else to go, unless they can seek asylum in a country that has a rational health care system.
Even the "non-profit" insurers are in on the game. Kaiser is supposed to be a nonprofit. Bernard Tyson, Kaiser's CEO, got paid $10 million in 2016. Meanwhile, thousands of Kaiser insureds do without durable medical goods or other adequate coverage, while paying $2,000 per month for the privilege of fighting with Kaiser to obtain treatment.
Yep, let's eliminate this malicious corporate tyranny.
1
On the single-payer vs. Obamacare system, let me just toss in some less-publicized aspects, which tend to favor single payer, unless a major Federal revision can happen to Medicaid, and be permitted by the courts.
There are problems, even when states expand Medicaid, that result from the division of the ACA into two halves: Medicaid and expanded Medicaid for people up to 138% of the Fed. Pov. Level (FPL), and an on-exchange plan, subsidized or not, for people above 138% FPL.
Being:
1)
If states don't do a really great job with Medicaid eligibility, synchronizing income sources and timing to the same annual current year MAGI as on-exchange plans, then it can mathematically happen that people can be INELIGIBLE for BOTH halves of Obamacare certain months.
Further, they can be thrashed back and forth between an on-exchange plan and expanded Medicaid as often as every month.
2)
As I understand the law, people over 55 receiving Obamacare as Medicaid expansion are subject to having full medical bills paid by the ACA clawed back from their estates at death. This could be millions of dollars.
That is, expanded Medicaid, if a state chooses, is not insurance, but just a loan until death.
This estate clawback of Medicaid is done now for nursing home expenses routinely. I don't see any guarantees by any state that I know of that it will not clawback expanded Medicaid. It's a real risk, and a real flaw of the ACA, unless the law is corrected.
Medicare for All could well be an Achilles Heel for Democrats. It sounds like another case of the elite telling the rest of us what’s good for us.
I don’t think private insurers can compete with an expanded Medicare, but let them try.
Instead of Medicare for All, Healthcare for All.
I have news for the Democrats, that should not even be news, eliminating private insurance is a losing issue.
First, even if they were somehow able to control the Executive and Legislative branches of government, eliminating private insurers will never become law.
I can see the attack ads now; remember when Obama said you can keep your doctor, well how did that work out for you.
Another problem with their proposal is the fact that a majority of the western European nations they cite as examples of universal healthcare have private health insurers, except the government, through personal taxes, pays the insurance premiums.
Additionally, whereas many of the private insurers in Western Europe are non-profit organizations, they also have for-profit health insurers.
Moreover, eliminating private health insurers will also eliminate a significant number of jobs; what's the Democrats plan to mitigate this loss.
This is not how private insurance works in most European countries. For example in Germany, you choose an insurance company and the premium is deducted from your paycheck directly but it does not come from your taxes. In the UK with a state run provider most people have no private insurance, most of those who do receive it as an employer provided benefit.
John, none of that is correct.
German coverage is indeed partly subsidized through taxes; the British NHS is tax-paid, and many do indeed have supplementary private insurance.
Both are excellent systems.
1
@John Stroughair
I will give you the fact that the premium payments are not taxes, but in Germany and a number of other EU nations, health insurance is mandatory and the premiums are deducted from your paycheck, unless you reach or exceed an income threshold where you are allowed to opt out of the public system.
Given the 1500 word threshold here, it would be impossible to write a comprehensive description of the US v the European healthcare systems, but, I believe for the most part my above comment makes my initial point, and that is the so-called socialist western democracies also have private non-profit, and for profit health insurance industries.
Could it have better, of course, but
In the interest of broadening the discussion of Medicare-for-all as a next step to the ACA’s mission—making US health care accessible and affordable—I suggest the slogan: If you’re not part of the solution, you’re part of the problem. Ask this of every player in our un-integrated, un-coordinated, protectionist so-called health care and insurance system.
Private insurers were, at one time, the canary in the coal mine, first seeing and trying to address unchecked inflation in health care costs. Then they bailed; it’s easier just raise prices, “share” costs with customers, and lobby against everything (including their customers). But we have to stop thinking there’s one villain, one silver bullet to the reform problem.
We have to stop letting the major corporate forces play off one another, a battle of lobbyists and scare tactics. Everyone gets scrutinized and either you’re part of the solution...
One more comment: yes, eliminating private insurance as the primary method for Americans to receive health care is a good idea. Our for profit wealth care industry is behaving too much like the airline industry in that they are adding fees for everything and a good number of them are outrageously high and shouldn't be there. It's called unbundling in order to charge a fortune at out expense.
2
Allow me to emphasize Bernie Sanders point. Once those with private health care are given complete coverage as in every major country in the world, which has proven to be completely satisfactory, there no longe is a need for private insurance of any kind. Why hospitals would close is a mystery, and in face of health-care for all taking place in orderly fashion in so many other countries, hardly likely.
1
@JFP
Well we cannot expect the levels of fancy that we Americans are used to if we switch to a universal system. I have been in hospitals in Europe and have received great healthcare. In Italy, there were no private rooms and common bathrooms on each floor. No television, but the view and the food were great and so was the doctor's care. We are all about the icing on the cake but not about the substance in this country. So no, we can't have it all. There would have to be some price capping, some reduction in testing, and maybe/probably lower salaries for medical workers. We are a spoiled people. Still, medicare for all with option to buy private insurance would work.
While I support a single payer health insurance system with the need to eliminate the current private insurance system, I remain frustrated with the Democratic candidates (even Elizabeth Warren) for the failure to explain the necessity for doing so. Granted, the argument is technical and involves relative risk assessments and dividing risk pools. A not-for-profit single payer can provide relatively cheap coverage for all since the premiums from healthy, low risk individuals cover the expenses of those requiring more extensive medical services. However, allowing private insurance competition opens the possibility for private companies to offer low cost plans to healthy, young, low risk individuals. While these policies are temporarily advantageous (because of their low premiums) to the low risk population, they undercut the universal plans by reducing revenue to cover people requiring more extensive medical services. As for the low risk group, eventually they age and join the high risk pool, so their long term interest is to support a large universal pool. Thus there are technical reasons to support a single payer system such as proposed in Medicare for All.
Private insurance is part of current Medicare and I can see any Dr I want, never had a problem finding one. No one I know has to wait for a surgical appt either. There are also retirees who receive money to pay for part of their Medicare not based on income as well as Union members. That will all change with Medicare for all provided solely by Uncle Sam. Sorry but count me out.
3
I'm amazed at how few commenters don't distinguish between single payer with no private insurance or single payer WITHOUT private insurance. This shows how muddled this argument is and I wonder whether the candidates have truly investigated this since there is basically no country without a role for private insurance.
My husband is from Britain, which indeed has a National British Health Service. When I asked him if he would want private insurance eliminated in the UK, he answered, "Oh. Is that what these candidates are saying? No way!"
In effect, without private insurance, if the national service says you can't have the care, there'd be no way to pay for the gap in care. Ask the candidates how that would work?
1
Excellent point. The candidates no doubt will be asked to explain further on their positions and why. My concern is that some voters may not vote accordingly but stick with a perhaps uninformed assumption.
1
For those with means, there will always be a private option.
1
Having health insurance does not translate into being able to afford health care when and where we need it. Having health insurance doesn't mean that the medications we might need are affordable or allowed by the insurance company. It doesn't mean that we won't be slammed with out of network charges for things we couldn't control like that out of network doctor in the in-network hospital or the facility fee that is piled on top of the doctor's fee.
Receiving health care in America has become a financial gamble for too many Americans. We pay monthly premiums that come out of our salaries, have high deductibles, co-pays, and out of network fees in addition. Then there are the denials or lost claims or incorrectly filed claims. Next come the bills which are confusing and frustrating. Even nicer is when the bills are turned over to collection agencies and our credit is ruined. But don't explain those things in an essay. No, make sure to say that Medicare for all would bankrupt and close rural hospitals instead of explaining that reimbursements would change. In other words, scare people.
You know what scares me? Not being able to find a job because of my age (60) despite being in IT. Being unable to save because I'm unemployed. Being told that I'm a waste and feeling quite depressed and frustrated because the country I've paid taxes in refuses to do anything to help anyone but the richest. Even with Medicaid I can't afford medical care.
6/28/2019 12:21pm
5
In Canada, which has a reasonably good public health system, there is a single-payer for each province, as well as multiple private insurers that provide supplementary coverage, such as newer and more convenient medications, a private room as opposed to semi-private, and so on. There are also many services that have to be paid for privately, such as physical and mental therapy beyond the limits set by the public plan (or your private plan, if you have one).
The United States could best achieve this level of coverage by expanding Obamacare and offering a robust public option, which over time could reduce the role of private insurance to what it is in other advanced economies.
Having lived for many years in the United States, and having coped with many private insurance companies, there is no question in my mind that the scope of their activity has to be reduced.
However, Medicare for All makes me think of a health care system run by the same people that run the DMV. In effect, a national single payer system would replace a predatory oligopoly with an indifferent monopoly. This is not the way that medicine is organized in countries with effective public health care systems, and it dismays me to see it creeping into the Democratic platform.
2
My family has private insurance through one of the largest corporations in the world. (It ain't what it used to be, which was free.)
Now we have a high premium and co-pay, and unless we experience a major illness, nothing is covered because of the high co-pay (except routine checkups).
The insurance companies have gamed the system for maximum profit. It's time to join the rest of the civilized world and cut out the greedy middleman.
6
Your insurance was never free. It was free to you...
Correction: I wrote "co-pay" when I meant "deductible".
randomxyz,
When I say "free" I mean there was no premium. It was considered to be an employee benefit.
2
An antibiotic was 1000 $ in the USA. A friend doctor in France provided the same for 50 $ . Same product from same German pharmaceutical company .
Who pockets the 950 $ difference in the USA ?
4
The answer to that question is likely quite complicated, between drug companies, insurance companies, doctors, hospitals, pharmacies, pharmacy benefit managers, and likely others I have missed. This is one of the real problems with the US system that needs to be addressed.
3
@JPH the CEO pockets the difference. It doesn't go to the science side of the pharmaceutical company, not in America anyway. Furthermore, there are other reasons it's $1000 dollars. You have to pay the insurance company its cut, the pharmacy, the manager for the insurance company's formulary, the insurance company's CEO, etc. It's a wonder we can afford any medical care at all in America.
1
@randomxyz You don't say that the highest revenue of Wall Street is health care stocks.
1
The answer to delivering universal coverage and cost-containment may not lie in completely eliminating private health insurance but the experience of every other developed nation on earth, all of hich have dramatically lower costs with health outcomes that are as good as ours or better, suggests that it will involve an overarching, nationally directed public system. We need as a nation to recognize humbly that there are a lot of countries which have addressed this matter far better than we have. Sadly, as the current occupant of 1600 Pennsylvania Ave so amply demonstrates, humility is not our outstanding national characteristic.
3
How odd that America thinks it needs to invent the wheel, instead of simply choosing from among the perfectly fine, reliably field-tested wheels used by its allies for nearly 50 years now!
11
Buttigieg was right -- do the public option, and if you're right that Medicare for All is better and cheaper than private plans then you will win the market. Don't force it down peoples' throats--they won't like it and it won't ever pass into law.
9
If America's health care system is so infinitely superior, it begs the question why isn't the rest of the world clamoring and shouting from the hustings "We want the same healthcare America has."?
Maybe it's because lining the pockets of the insurance company middle man is only super popular here in America because they use a lot of that money to fund politicians reelection campaigns and the con men politicians don't tell the truth.
5
Dear Mr. Suderman: Please review the salaries of the major executives of each for-profit health insurance company in the US, and then explain exactly how those dollars are beneficial to anybody other than the recipients. Please note that we are talking about hundreds of millions of dollars that provide zero health care to anybody. Thank you in advance for your thoughtful comments.
3
Even the so-called “non-profit” companies pay their executives lavishly, employ armies of people whose job it is to find excuses to deny claims, and have palatial headquarters.
Just remember that if Medicare for All is put in effect, taxes will have to rise annually as we pay for unneeded care.l Or else we will need rationing. is america ready for tyhat?
no dialysis past a certain age. no hip or knee surgery over a certain age, etc.
2
@Rhsmd1 that's already happening. If we can't pay for the care we need we don't get it. Rationing is here and now and necessary whether you or I or anyone else like it or not. At some point all of us die. I'd rather die in comfort. But even more than that, I'd like to be able to work again instead of being turned down because I'm too expensive to insure.
1
@Rhsmd1
Your comment is exactly what the GOP has been claiming for years, increase coverage and our taxes will skyrocket. The problem is that our insurance premiums are not taxes, and with recent changes to the tax law, they have become a meaningless itemized deduction. If the premiums we pay were added into our "real tax rate" I am willing to bet our "real tax rate" would match or exceed the tax rates of those so-called "socialist" countries.
@Rhsmd1 And how is that working now?
Private insurers run part C (Advantage) of Medicare. They will not disappear. Those advocating a public option and gradual change--not a wholesale switch--make far more sense.
As far as other issues--insurance administrative overhead, overpricing and over-sale of everything deemed medical--we have a long ways to go.
Private insurers are OK. They must be non-profit, regulated by the government, and compete in a structured market.
That is the model used in Israel, the Netherlands, Germany, Belgium and Austria.
It works.
3
Based on what I have read in these comments its laughable where information is coming from in articles regarding healthcare. The majority will agree healthcare in the US has run amok. Zero transparency on cost for services and drugs. A Byzantine billing process. AMA protecting itself and continuing their negativity...something they've been hanging onto for at least 70 years. ENOUGH. Throw out the greedy CEO s. Make insurance non-profit. MAKE INSURANCE WHAT IT SHOULD BE. EVERYONE wants and needs health insurance. POLITICIANS GET IT DONE!!!
4
How many Americans have private insurance through their employers?
What is the gender and racial make-up of those insured in this manner?
Is it possible to compare this insurance coverage to that offered privately to individuals and the insurance options via the Affordable Care Act as it now stands?
Comparing the American approach to health care to that of the Europeans is pointless, as the RW has characterized European countries as "socialist" or somehow misguided, despite all the statistics showing them at the top of just about all "top-ten lists."
Also, the RW will use their trademark scare-mongering to claim that the leftist liberals want to take their health care away. And they'll also obfuscate the real reasons why Medicaid - run by the to-be-feared government - is not available in their red states.
In short, it's an uphill battle for the Democrats. This is not to say the battle can't be won, but we are continue to be in uncharted territory when the other side is anti-education, anti-intelligent, anti-government. To say nothing of their abject fear and horror that they will be subject to the same health care system that includes black and brown people.
All I know is that the private health insurance market has given me a health care plan that gives me 3 doctor's visits a year, birth control pills (I'm male) and literally nothing else, even Generic prescriptions. And my alternative to that is to spend literally 15% of my takehome on health insurance that provides coverage.
The private health insurance model has killed my grandfather too- It decided that his liver failure wasn't recovering fast enough and shoved him into an assisted living facility where, after physical abuse and emotional torture, he died. We had to sue to shut them down but it doesn't bring my grandfather back.
The private health insurance model subjected my mother to 13 years of Endometriosis that left her basically crippled and asleep to avoid the pain. Unable to work, unable to basically wake up and do *anything*, a simple hysterectomy that would have (and eventually) did cure her was denied because it was considered a *luxury*.
I'm not special, my family isn't unlucky, the truth is, this is how reality works for most people. If you're lucky enough to avoid dealing with the health insurance industry you really have no right to make judgement calls on how the industry works, because really, you don't know how it works.
As for me? Yeah. I'm fine with burning it down and starting over again.
7
@Sean I agree with your sentiment. Most people don't realize until they're sick with a serious illness how bad for-profit health insurance is. They don't realize insurance companies earn money by denying or delaying care. On the professional side, doctors, other healthcare professionals, and staff have to spend hours of time and energy which could be used to take care of patients arguing for coverage of tests and treatments. Even if what you ask for is standard of care or reasonable, insurance companies know that by delaying or denying, they wear out both staff and patient and if they delay long enough...who knows, maybe the patient will just die and then they don't have to pay at all.
“reason,” magazine, huh? Reason, my...foot.
The primary problem with the PPACA right now is that Republicans and the Right have spent years, and billions, attacking it in every way they could. Frivolous lawsuits, wacko-bird lying, attacks on fundings, refusal to expand Medicaid—you name it, they’ve done it.
And try to fix any of the real limitations? Nah, why do that? Much better to do what they do in England—defund the NHS, then run a lunatic Brexit campaign on lies about how the NHS doesn’t work.
Address medicaid expansion, which works? Nah. Allow HHS to bargain over drug costs? Naw. Figure out how to handle the premium issues (mostly for those in the 55-64 age bracket) or deductible problems? Nope. Just scream, wreck stuff, and tell the suckers it was always broke.
That’s pretty obvious. Also obvious: claiming you’ll eliminate private insurance is just dippy. No system on the planet does that, not one. For openers, kick 160 million off their plans? Good luck there, and good luck with the ignorance and dishonesty about costs and rationings.
And no, St. Bernie didn’t explain jack about costs and paying for it. Nor has he ever explained what the plan designs would look like. Nor has he...nor has he...nor has he.
Biden, Buttigieg and a couple others are dead right about this.
This is a false choice - having a mandatory national health plan is not the end of private insurance and your assertions to the contrary are both disingenuous and wrong.
Nearly every developed country (and many that are considered developing) have nationwide insurance plans that cover everyone for affordable fees or are paid for with taxes. In Japan, where I used to live, I was covered by the national insurance for a fraction of what I pay in the US even with employer help. It was a straight 70% cover with no faffing about with overly complicated co-pays and deductibles. I was able to have surgery and recovery there that would have bankrupted me in the US because they recognize health as a human right and force healthcare providers to cap costs (no one is charging me $350 for a box of tissues) and provide transparent information on fees.
That said, there was still a role for private insurance. There was insurance to cover private rooms, insurance to cover medical transport, insurance to cover stays in higher-end hospitals. Even places with nationalized healthcare systems in the UK have private insurance that can bump people up the queue.
If you think for a second that American insurance companies would curl up and die when there's still money to be made you are severely underestimating their desire to wring profit from human misery.
4
My guess is that what most mean, when they say they "like" the health insurance provided by their employers, is that they like the health "care" they are getting when they are able to get it, they like to be able to chose their doctors and they like that someone is paying part of their premiums.
They likely think that ending private insurance means ending the choice of doctors. Medicare (but not Medicare Advantage) is based on a patient's free choice of doctor.
The Medicare for All plan would continue free choice of one's doctor. It would continue to prevent denial of services based on preexisting conditions. And employers would still share in the cost of premiums, but in a less direct way -- they would either pass on their savings from no longer providing health care directly to employees or they would be taxed in such a way to continue to provide the funding for the MFA.
And hospitals in rural areas would have to be provided alternative funding (perhaps even increased payments for services as compared with urban hospitals).
With overhead being reduced and the agony of dealing with for-profit insurance companies ending, the result would be great. But this all requires a lot of complex details being written into the legislation.
A transitional time-period is required to prepare the way. During that transition each person would be able to see how their health care wold be paid for and what their benefits would be.
If this cannot be worked out, then we are hopeless.
2
Insurance is something that every American should be able to have not based on color, ethnicity, or by money. I think that the eliminating private insurance is a good idea because it allows for universal health care in which every American can be able to afford health care at a cheaper cost. Based a video I watched, Hong Kong has a universal health care system where public hospitals have lower pay rates which allows for the public to afford for cheaper medicine, co-pay, and of course the availability, affordability, and quality is above standards. Hong Kong has Universal health care that can lead to higher life expectancies because of how cheap health care is. This allows for the population to grow and help maintain a steady growth in the economy. The healthier the people, the healthier the economy. Although it has a ethical argument to it like, a public hospital vs. a private hospital, and the wait time to see a doctor is depended on the consuming time of each patient, Universal Health care allows for each aspect of the country to grow and to become a better place for the public to live in. I think having Universal Health care in the long run will help not just those who work 9-5 hrs but for those who need health care just because.
1
Harris gave a good explanation of eliminating private insurers. Yes, no private insurers for main coverage. But, as with current Medicare, Supplemental policies will be available. I also liked that she explained that 91% of American doctors accept Medicare today. So, keeping your doctor has better odds than you currently have with "private" insurers.
4
@baltcate 91% of doctors accept Medicare because of the existence of third party payers to offset losses. Some providers would see their payments slashed 70% or more.
with 100% Medicare rates. Such draconian changes (especially in a short time) would have devastating unintended consequences. Perhaps it would be schadenfreuede for you; but that won't be enough to fix your leaky heart valve.
As the UK offers affordable public healthcare to all residents via the NHS and HSC, there is often no pressing reason for people to buy private health insurance for themselves and their families. In fact, only 10.5% of the population, just under four million people, opted for private medical insurance.
Canadians can purchase supplemental private coverage for services that are not covered by the public plan, but cannot purchase private insurance for basic services. As CBC News points out, private health insurance is “a crucial part of the system,” and Canadians spent about $43.2 billion on private coverage in 2005.
So, the solution is to make people use the government plan for basic services, but leave the option open to supplement it with private insurance.
2
Private insurers are a unnecessary expense. They are a middle man we do not need. Medicare has a 4% overhead insurers 17%. Insurers charge way too much and overcharge billions in fraud (proven many times).
Medicare deals directly with the doctors, you choose your doc medicare pays. Insurers choose your docs, not you. You have a non registered doc and you pay big time.
As an ex MD I know medicare never told me what tests I could order or restricted me but almost all insurers did trying to save $$.
Get aware folks, Private Insurers are another con.
2
First, the author's question seeks to confuse. Why is it not reasonable to seek a better, more efficient healthcare system for all Americans? God knows that all other industrial nations have reformed their healthcare system and provide high quality care for much lower costs than the US even though the US likes to brag about the market being free. It is not! I spent many years getting healthcare from a socialized military healthcare system and currently receive service from medicare/tricare for life and I choose my own doctor and hospital that accepts these plans (most do!).
Second, any healthcare reform will threaten the big players--insurance companies, doctors, and hospitals and yes, some people will lose their jobs. We are beginning to see ads designed to scare the average person that doing away with insurance will result in longer wait times and less service for those who have insurance. What is unstated is that 27 million people in the US have no healthcare!
Lastly, it is amazing that so little has been said in the comments section about the Republicans not having any plan even though their "Great Leader" has promised wonderful healthcare for all at a lower price. There can be a "wonderful" healthcare plan that provides basic services, requires a co-pay, and allows supplemental health insurance for those who want extras. Sadly, most political leaders don't have the will to oppose the big players!
3
I tend to agree, but there are at least 400, 000 of those, “some people,” who’d lose their jobs under a strict Medicare for All imposition.
Not to mention kicking 160 million or so off their private plans, not to mention the dishonesty about paying for it, not to mention nobody ever discusses exactly what the plans would look like, not to mention what this’d do to people currently on Medicare.
Not to mention about fifty other things.
We could do way better, but demanding an immeidate flip to M4A is just bonkers.
@Robert, thanks for your response but at no time did I say we should adopt anything specific--don't think you will find M4A in my comments. The purpose of my comments was to say that healthcare could be improved and made less expensive, but there were plenty of players against any changes because it would cut into their profit margins. I would respond that the current medical system is dishonest in charging patients and the non-profit insurance companies paying their executives exorbitant salaries!
The US has the highest medical costs in the world and do not deliver the best results. Do you by chance have suggestions for improving the system?
The problem with Obamacare is it focused on expanding coverage without doing hardly anything about cost. It should have focused first on cost. Expanding converage would then have been much easier.
I'm in favor of single payer but I don't see why it would have to be mandatory, at least at first. Let's have a public option where people of any age can sign up for Medicare. Let Medicare negotiate prices for drugs and any other medical services and refuse to cover things that are over priced or not effective enough. If private insurance can compete on both price and performance with Medicare then that company deserves it's share of the market.
Cap Medicare's spending at the same amount per person as the average country in Europe spends while at the same time expanding coverage to anyone who wants it. And yes that means less money for insurance companies, doctors, drug companies, etc. Most importantly, change the way billing for health care works so the insurance premium is the only bill the patient ever sees and that amount is capped at levels comparable with Canada, Europe, etc. No more balance billing, no more out of network charges, etc.
Tell drug companies to lower prices to levels comparable to Canada and Europe or their patents will be invalidated and just given to the generics makers for free. Obviously this would require changing patent law. That's fine.
1
Simply not true, Paul.
Obamacare has about a dozen major cost-controllers in it, starting with the caps on insurer profits and the move away from fee-for-service towards outcomes-based reimbursement.
And then there’s the cap on yearly OOP costs, and about ten other things.
Please read up, okay?
Healthcare insurance and prescription drugs should be administered by non-profit entities only. Advertising should not figure into the cost of insurance and drugs. Look at the beginning of BlueCross for success before profiteers corrupted the sector by lowering premiums and only taking the healthiest of subscribers, leaving BlueCross with low premiums and mostly ill people. What we have today is the result of greed.
And to think we are concerned with the closure of hospitals and bankruptcy of hospitals and hospital systems if private health insurance is eliminated. Do you realize that some CEOs of healthcare systems make over $50 million a year? Why should we worry about the “health” of the “health” industry rather than our own health? Physicians are being driven toward burnout by greedy healthcare executives and their private insurance company enablers. Surely a better system must exist.
2
Social Security is not a for-profit system. Education for the most part is not for-profit. Health care should not be a for-profit system. I have a doctor who has two doctors in his office, and NINE administrative people. That is to handle all the extra work of addressing the differing claims processes and documentation required by all the for-profit insurance companies.
Certainly a public option, as described in today's article about Washington state's efforts, would bring to the fore the difficult issues of setting appropriate rates for care. But that is a useful and important debate to take on. Paying large administrative costs for care is not useful.
Were we to simplify and standardize one claims process for all providers, even if we used that for multiple carriers, we would be ahead. Were we to establish regional levels of costs (even at 140% of Medicare rates), we would be ahead.
2
When I hear the words "Most people love their current health insurance coverage", I cringe. Unbelievable premiums and high deductibles are the norm even with employer based plans. What is wrong with making what we currently receive better?
2
@Maryellen. There is nothing wrong about making what we currently have better, but you offer no PROOF that Medicare for all will achieve that.
I am quite certain that eliminating private health insurance is a good idea.
Private health insurance provides precisely zero added value to the provision of health care. Insurance has never cured anyone's disease, healed anyone's wound, or delivered anyone's baby. All they do is take their cut -- an ENORMOUS cut -- out of the health care dollar, and they provide for enormous insurance executive salaries, travel in private jets, and armies of clerks trained to deny your claims.
Health insurance is PURE overhead.
Those on the right say that people like their insurance. But people seldom even get to choose their insurance policies and coverage -- that is done for them by the HR departments where they work -- take it or leave it.
The right-wingers also disingenuously ask, "Do you want your health care decisions to be made by government employees?" I ask in return, "Do you want those decisions made by private insurance company clerks whose career advancement depends on their denial of your claims?"
5
A lot of the reason Obamacare hasn't worked as well as hoped is because the GOP spent the better part of a decade tearing it down and trying to keep it from working as intended. If it's failing the GOP deserves a large share of the blame.
But Obamacare *is* the conservative alternative to single payer. So if the Right is fretting the possibility of single payer, it should take a hard look at how we got here.
I'm an insurance industry professional and I don't disagree with most of what the author says. There's a reason why Obama built onto the existing health care landscape--because it's a moderate approach that causes the least disruption. But unfortunately there doesn't seem to be a place for moderate, level headed discussion in American political life anymore.
5
I, too, worked in the health care industry, and I can tell you that the ACA left insurers untouched, and their response has been pure, protectionist pricing and cost-shifting to its customers, not risk-sharing, group insurance.
1
I insist on my right to pay a $5,000 deductible. And my insurer can refuse to pay for a procedure or drop me any time it sees fit. That is the American way.
4
If Medicare pays too little, then why did my husband get inundated for offers for Medi-gap insurance to help cover the remaining 20% of insurance costs?
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Why do we pay 50% to 100% more for medical care with no improvement in health outcomes as compared to other countries?
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How is it that we are only only major industrial nation not to provide universal health care?
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Where do people get their information that other modern industrial nations accept less quality care than here in the U.S? Are the Germans, Japanese, French, Italians and many other countries populated with clueless people?
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I think I know why. The medical industry is happy with how things are going. What does it matter that 40 million people get left behind? What does it matter that the second leading cause of bankruptcy is due to medical costs. Money is a good thing if you can get it with minimal effort.
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Campaign and lobbying reforms are needed. The power to vote in or out a politician needs to be solely in the hands of the many.
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Politicians must prove their cases by the weight of their words and not the weight of their pocketbooks.
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Or, we can all sit and complain, vote in demagogues who lie, know nothing but convince the unwary that the swamp is being "cleaned" by ex-lobbyists and the wealthiest cabinet in U.S. history only to wonder why "all that winning" hasn't changed anything.
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Until we re-shape politics, only rich and the well-connected will prevail. This takes work.
4
In Germany the basic hospital infrastructure is run by the counties or major universities (which are run by the states). That keeps cost on a reasonable level while still have at least one hospital in every county. Hospitals are infrastructure and therefore need to be supported by tax payer money. Germany spends 11% of GDP on health care while the US spends 18%. Outcomes on average and general population health is better in Germany.
3
Suderman oversimplifies the issue. People liking their current healthcare and liking health insurance companies aren't the same. Also, besides Bernie and the ultra-left, most Democrats favor offering a public option in addition to allowing people to keep their employer-sponsored plans as well as improving Obamacare and healthcare cost. Even the revolutionaries know that we can't just wave a magic wand and insurance companies will go away. However, reducing or eliminating the greed and profiteering that goes on with private health insurance is something almost everyone, except insurance CEO's, favors. Reducing the 30% we currently spend on health administration because of private insurance is certainly realistic and will benefit our country tremendously.
2
I have the impression that Reason magazine is an Objectivist/Libertarian/Ayn Randian publication so I question his "reasoning" in this Op-ed. I think he would prefer a "free market solution.
1
Unequivocally. Remove the leach. Cure the victims.
1
The national Republicans dealt with the issue of Obamacare in utter bad faith so far as I’m concerned. Nothing demonstrates their greed and lust for power and their lack of concern for the people they govern more than the way they approached this issue. Obamacare represented from the beginning a compromise with R ways of approaching the problem. But the national Rs did nothing but obstruct for political gain.
There are issues where I think the Ds and their base are idiots or pernicious, but the Rs own the dysfunction here. The only major thing about Obamacare I’m willing to blame on the Ds is the fact that when the Rs repeatedly hit them on this issue the Ds responded by cowering or sticking out their collective chin. The answer always was and still is to defend their law and take their case to the voters (and for the Rs to act like the loyal opposition when the Ds hold power). Instead, at best, D politicians cowered while their base sat around and whined about single payer.
I’d prefer a fiscally sound and tweaked as necessary Obamacare with an added public option.
But if things work out so that we get a single payer system financed with high taxes on the wealthy, the Rs will surely deserve it given the way they’ve behaved on this.
2
OK, this is disturbing.
Citing, quasi-anonymously, a stream of conservative-leaning pundits you make, and reinforce for the public, a classic conservative/propagandist case against single payer healthcare. This is a very one sided piece.
First, you make huge assumptions without acknowledging even one.
"Hospitals will be forced to close by radical Democrats!!!"
What do you mean "hospitals"? certainly not that majority which belong to huge medical "foundations", rich beyond counting and efficient in pursuit of cash like no other industry.
Oh, small, isolated, independent rural hospitals? Except your argument, your sources, clearly say "if they eliminate private health insurance AND reduce payment rates to current Medicare levels.
Which is the plan for only a heedless few. Eliminating private health insurance (yay!) in no way obliges a reduction of payment to current Medicare levels. Most plans I know of either do not comment on the issue or explicitly say they will not do so.
Simply eliminating private health insurance would pay much of the cost of single payer health care.
One comment you, and your colleagues, never deign to make is that private health insurance has demonstrated a level of dishonesty and corruption that makes clear leaving it any beachhead invites further failure and a return to very high costs and ineffective care.
Its not that we hate private insurance, its that industry which, very clearly, hates us.
2
The current Medicare system DEPENDS on private insurance to fill in where it leaves off. Why isn't anyone pointing this out? Retirees have Medicare (A and B if they pay for it) AND Gap insurance for C and D. We have to continue to have private insurance, unless they truly make a bona fide single payer system.
3
@J
"We have to continue to have private insurance, unless they truly make a bona fide single payer system."
OMG, J, thanks for that! Yes!
Somehow single payer health care has morphed in the journalistic mind to Medicare for All.
While Medicare is, in fact, the best health-provision system in the country it is riven with punitive, bizarre, needless administrative and practical obstacles to care.
This is because, like everything else in America, it is a system designed with deep mistrust and suspicion that our own citizens are perfidious crooks, liars, and cheats.
If everyone has every bill paid by the same payer, no questions asked, those concerns vanish overnight and a more efficient, far less costly and, as if it matters, a more humane system takes their place.
Its funny, though, because the biggest thieves, the biggest cheats, the biggest beneficiaries of Medicare fraud are the wealthy, conservative doctors and corporations that make the system go.
Which is one reason they're fighting so hard to keep it going, why they lie and induce panic.
What the ACA accomplished was to give the corporate health insurance industry control of health care delivery in America. Resulting in health care subject to the rules and restrictions of insurers and less about the patient/doctor relationship. This has impacted quality of care allowing those that can buy into premium plans to be subject to fewer restrictions and have access to the widest range of medical professionals and ancillary services. Resulting in yet another demonstration of operational government in America working to serve corporate interests. Messaging that America is an elitist society where those that have the financial means get the best medical care. America better get to work to do better than that for its people.
1
I'm curious, Peter - every other developed nation has medical care for all.
Why don't we?
There are millions in this country who have no coverage at all.
Why?
Coverage is tied to your employer.
Why?
Why does Medicare cover only 80%?
Why are there no inclusions of dental and glasses?
Why is everything 'extra'?
Why is a 'deductable' even a factor?
"For profit" medications?
Why?
And why is my tv FILLED to over flowing with medical ads, most of which say, "Has been found to cause non-Hodgkins Lymphoma"?
Oh, yup.
Someone is making a PILE of $$$$$.
That's all there is to this.
239
@rosa I'm curious Rosa, when you slash payments to hospitals and physicians overnight by 50% what do YOU think will happen? Besides massive layoffs all the costliest (aka sickest) patients will get kicked out and kept out of the hospital. Or you close the doors.
2
@rosa
It is not saying no universal health care. The question is should we eliminate private insurance. Canada and Europe ALL have private insurance markets.
6
@rosa You forgot to mention the scam Medicare Part D. This was set up with a specific rule that the government was NOT to negotiate price with the Pharma companies (thanks to George W Bush).
So folks who sign up pay premiums (it is 'insurance' after all) and then Pharma companies get to bill the government whatever, with impunity. The only reason it took awhile for Pharma prices to rise is that the companies didn't realize they could charge so much and get away with it.
"Free" markets need to be regulated so they are free for everyone, not just the Pharma owners.
19
Is it really surprising that Peter Suderman, whose publication and foundation is financed (and in large degree, run) by the Koch Brothers,
https://www.sourcewatch.org/index.php/Reason_Foundation
would oppose a health care system free of insurance-company profit skimming?
Declining to make money off the sick is downright unAmerican.
3
Oh, so the arch-libertarians over at Reason have a problem with single-payer? Wow, OK: I guess we'll continue to have 30-50,000 people die needlessly (depending on how you count it) so that some rich people can have another yacht to waterski behind.
This near-lie about how your average person is somehow emotionally connected to their insurance company--their *insurance company*!--to the point at which they'd like to continue the torture shows just how desperate these people are. People are emotionally connected to their *doctors*, not to their freaking insurance companies.
Only very well educated people can hear this and not instantly fall over laughing.
And I actually click links. I clicked it. The poll shows that the general public supports, strongly or somewhat, single-payer: "The most recent KFF Health Tracking Poll finds 56 percent of the public favor “a national health plan, sometimes called Medicare-for-all, where all Americans would get their insurance from a single government plan” with four in ten (42 percent) opposing such a plan."
And that's against a solid Phil-Spector-like wall of propaganda noise since forever that hasn't and won't ever stop. Imagine how much bigger that number could be.
You do understand that these op-eds, and all the columnists here, there, and everywhere, are trying to sell you something. They are trying to manufacture consent: how they go about it tells you all you need to know about them.
5
The United States has, by far, the most expensive health care system among the OECD nations. It also has the worst performing, by outcomes, heath care system in the OECD.
That this has lasted as long as it has is remarkable. It is more expensive not because of evil insurance companies, it is more expensive because doctors and hospitals in the US charge more than do doctors and hospitals in the other OECD countries. And they do a worse job providing health care than doctors and hospitals in the rest of the OECD.
We could fix that, overnight, by doing one of two things:
1. Cover a wall with the names of the OECD countries. Throw a dart at the wall. Whatever country the dart hits, copy their health care system here.
--or--
2. Go through the Medicare legislation and find every mention of age and white it out.,
Either one of those would not only dramatically improve the quality of health care in the US, but would dramatically LOWER its cost.
How do I know this? Because that's exactly what happened in all of the other OECD countries. Much better care at a much lower cost. It's as close to a "no brainer" as I can think.
3
An admission that Obamacare has failed?
20 million people or so gained coverage. Millions more would have it the supreme court didn't make the medicaid expansion optional by the states. And, this failed, or inadequate program keeps expanding in states, when the issue is before voters in referendums. So, really?
And let's also acknowledge the implicit, but silly criticism of this piece: Obamacare wasn't perfect right out-of-the-box. Because one would expect a huge overhaul to be perfect? Especially when one party has done everything in its power and beyond to sabotage it? Straw man, I hear thee sing.
I completely understand that the people at Reason cannot fathom that a government (always utter the word through clenched teeth and with contempt) is workable and can help millions of people.
So, look past the evidence. Mischaracterize the evidence. Do ANYTHING that can make stubborn reality comport with your rigid ideology.
Oh, and to top it off, fail to answer the initial question posed by the article, i.e., why eliminating private insurance would be a bad thing.
God forbid you actually cite how doing so in other countries has lead us down the path to hell.
Maybe because the actual evidence says otherwise?
3
If you want to know how a single-payer healthcare system works, you need go no further than our neighbor Canada. I spoke with six Canadian friends from both the Quebec and Ontario provinces who unanimously agreed their socialist type system sucks. Long waits in doctors’ offices — often three or four hours — and for major surgeries, you have to get on a waiting list! Of course, none of this applies to those more affluent Canadians who can afford private health insurance. And none of this comes cheap. My friends said their incomes are taxed at over 50 percent and, in addition, they are burdened by a nationwide 15 percent sales tax! Politicians like Sanders, Warren and Harris don’t have a clue what they’re proposing, and it will be their undoing.
1
Hospital closure resulting from universal healthcare is only the latest lie from the right. Let’s consider evidence and the source of the “information”.
Evidence: every other wealthy country provides universal healthcare at, on average, half the cost of our so-called system. So does the VA. So why can’t we?
Evidence: rural hospitals are closing now, at alarming rates. There are women who drive 100 miles to the maternity ward, hardly exotic care. Expanded Medicaid has staved off more than one closure.
Source: of course hospitals would “lose money” if paid less. Of course the overpaid executive — who shouldn’t be here to start with — cries crocodile tears over the diminishment of his plum income. Of course the wealthy who oppose every social program will fund “studies” purporting to predict disaster.
In reality, hospitals will become less lucrative to run.
Naturally those profiting from the system want to keep it, and speak darkly of losing profits. But running hospitals for profit is part of the problem. If you’re not part of the solution, well, you’re part of the problem.
4
For the zillionth time: the Affordable Care Act *was* the Republican plan (Heritage, Romney). That’s why they have never come up with an alternative all these years later.
145
"Republicans . . . have given Democrats license to run with their wildest health policy dreams."
Sorry, but what's so "wild" about wanting Americans to have some version of a sane, competent health care system? Most other first-world countries have managed to achieve this--is our version of capitalism so twisted and corrupt that healthcare for all is a pipe dream just for our nation?
127
@Alicia - Excellent response. If they have universal care in many, many countries, there is simply no reason other than $$$ why we can't have it here. Good ol Reason, er, Libertarian Magazine sticking up for making tons more $$$.
5
@Alicia
The problem with Obamacare was that it was:
(1) written by and designed for health insurers, (see Bill Moyers series on Obamacare),
(2) designed to allow premium price increases in an unregulated market that insurers could control by threatening to withdraw from the market, and
(3) included a tax provision masquerading as a penalty provision.
That was all done because lobbyists have government's ear and Republicans have controlled the tax narrative for years, touting no new taxes while deficit spending for corporate giveaways and useless wars to enrich military pride.
Democrats, willingly answering to lobbyists instead of the public good, went along. Hence, tens of millions of Americans pay indirect taxes by paying exorbitant insurance premiums.
3
@Alicia
"is our version of capitalism so twisted and corrupt that healthcare for all is a pipe dream just for our nation?"
Yup. We worship and obsess over profit. Our "finest" citizens are all OCD hoarders of money, psychopaths, and narcissists. We've bought into the myth of the Meritocracy, and justify the end results by the myth that if things are screwed we just didn't work hard enough. It's the capitalist version of prosperity gospel and our country is totally in the cult.
3
This topic is bogus. Clearly I can buy insurance for almost anything, if there is someone selling it, regardless of whether the government provides similar insurance. Since employer provided insurance is mostly a side-effect of WWII, a different system might be better...as other countries are doing. And apparently pretty successfully. So lets not be suckered into debating a meaningless issue but work on installing a better system for all.
2
Health care today subverts the people who need it most, it is managed by the one percent that subvert Americans. There is power in numbers and why Americans need to flex their muscle. 21 century is here time for this Ponzi pyramid to end.
53
Getting rid of private insurance would deprive the rich of one of their best means to distinguish themselves from “others”. Something like changing the capitalist soul of America.
1
Totally disagree with your conclusion that just because Obamacare needs tweaking means it is a failure.
First of all, all the tweaking that stripped away the parts that would have made it stronger bill were insisted on by Republicans before they would vote for the bill and then they didn't vote for it, at all!
If the public "option," the operative word meaning one choice made available, were part of the ACA Act, it most likely would have been even more successful to alleviate the numbers of uninsured.
The GOP demonizes the idea when Democratic administrations have the potential to enact it.
That's what happened when the Clinton's tried to get it done and it's why there was such vigorous opposition to the ACA.
The GOP has been in charge for a lot of the intervening time. Where is your better solution, your brilliant plan?
2
For profit private healthcare is bankrupting and killing many Americans due to unaffordability. Private healthcare works for the wealthy, especially the wealthy profiting from it. It does not work for the majority. So yes, eliminating private health insurance is a good idea.
4
Healthcare is a mess right now. People are on the hook for insanely high deductibles, while no one can tell them what anything costs before they are treated. No other exchange of services operates like that. We desperately need to fix the system. This is my worry with eliminating private insurance, and it's a personal one. Many of my loved ones work in the healthcare industry as nurses, techs, and P.A.s. These job are some of the few well-paying middle class jobs left in America, which is why they trained for them. What happens to these jobs when deep cuts need to be made to reimbursements? Will the many low and mid-level workers in the industry have to take pay cuts? I'd like to here more about the economic fallout before I support any plan.
2
I’m sorry but this ain’t rocket science — and the last rocket scientist I need is a libertarian who believes in unrestrained, unregulated capitalism. Eliminating private insurance — the kind we have as opposed, say, to the kind Switzerland has — would do at least one thing: stop draining the system of $.20-.25 out of every healthcare dollar being used to process claims and pay insurance company executives small fortunes. (Yes, it’s supposed to be 15% for all administrative costs, and anybody who thinks it is, please invite me to your fantasy planet.) There’s one way to find out whether private insurance should be eliminated: the public option. Have an insurance company without shareholders looking for a profit. If that company has customers, and if they’re good at what they do, we might be able to approach a system like Switzerland’s where the profit margins of insurance companies are strictly regulated. It’s insanity to have commercial insurance companies spending a documented nearly 20% for administrative costs when Medicare does it for 2%. (However little they like the size of the payment, doctors will tell you they don’t fight Medicare to get paid but they do fight Prudential and Aetna.) Let’s save a couple of hundred billion in insurance company costs and pay it to doctors instead. No, I’m not a doctor and I’m not grinding there axe. I just don’t like seeing a hospital call me “a revenue unit“ and a doctor a “provider.” Doctor and patient worked fine.
119
@ADN The Swiss system is not necessarily the best (although the University Hospital Zurich is an excellent hospital).
Check with T.R. Reid's Frontline show - "Sick Around the World". He went around the world with a bum shoulder, collecting hospital proposals (and prices) on what they could do for him. As I remember, Taiwan's system came out on top. A very informative show. The scene with the two ladies who were asked about their National Health System (Brits) - "Bills? What bills." was priceless.
10
@ADN Prudential got out of the health insurance business years ago.
@Robert Gustafson
Will do, thank you. Reid is terrific.
Two points come to mind in relation to this piece:
First, the best way to lower healthcare costs for the individual is to spread out the overall costs among the largest possible group: the entirety of the American public.
Second, to help with the sharp reduction of excessive bureaucracy, the entire system should use the same electronic forms and processes. Under the present, piecemeal system, every office I visit has its own set of unique forms, most paper(!) and a few electronic. Paired with the best available encryption and on-location authentication, a uniform electronic medical record will go a long way toward eliminating duplicity and needless labor.
As I see healthcare as a “right,” it should be accessible, effective and affordable. A healthy public is one that is more likely to be happy and productive.
2
Evidence based analysis shows that private insurance drives up costs, diverts health care providers' time and resources away from providing health care to comply with bureaucracy, does not provide better health overall, and leaves millions without any coverage.
As a corporation, their first loyalty is to be profitable, as with any capitalistic enterprise. That is the wrong motivation when trying to serve the best interests of the American people in this case.
3
Medicare Advantage uses private insurers for more efficient administration and to offer more benefits for the premium dollar. Private insurance can be more effective cost wise and health wise within constraints. They can also contain spiraling total health costs through utilization management. The ACA constrains the plans to spend at least 85 cents of the premium for patient care. Private insurance can still be useful with M4A if they are similarly required. A Sanders approach with zero premium and infinite utilization will explode total health care costs. Warren's statement that Medicare currently has only 2% total overhead has no basis.
1
Private insurance is available in the UK, if you want a nicer room, shorter waiting time for an elective etc. It's just that it is a luxury rather than a necessity.
For the zillionth time: the Affordable Care Act *was* the Republican plan (Heritage, Romney). That’s why they have yet to come up with an alternative all these years later.
3
I don't understand this piece. Mr. Suderman cites experts claims that hospitals will lose billions and thousands of hospitals will close with the elimination of private insurance. But he then derides the present arrangement under the ACA. It sounds a bit like the arguments before ACA, the positive impacts unacknowledged in this piece. Also missing in his argument is the answer to the rising costs of health care. The ACA along with the increased enrollment in Medicare (baby boomers getting access) have dramatically slowed the rise of health care costs.
The free market as represented by insurance companies have failed to provide affordable care and access, and they are the most to blame for the high cost/low benefit ratio relative to the rest of the developed world.
Moving to single payer will enable addressing the deficiencies of the current system while curbing rising costs.
3
Even with the NHS in the UK people can take out private medical insurance or have it provided by an employer, this would guarantee a private room for inpatient treatment at an NHS hospital or avoid NHS waiting lists by being treated at a private hospital, but I would be surprised if more than 10% of Brits have this insurance
1
My personal belief is not only that universal health care is a universal human right it is also essential for maintaining a nation's health and well being. Under no circumsances should the word "profit" have any connection whatsoever with health care. To my mind private health care organizations are an abomination. They "profit" from people's misery. If, on the road to a truly national health service, private health "businesses" must be temporarily tolerated, so be it. Hopefully, they will eventually go the way of the dinosours. As for the argument that "we can't afford universal health care" I don't want to hear it! If more money is needed - find it! The government seems to find money to support Trump's extravagances don't tell me it can't find the funds to keep hospitals open and support scientists in their search for better medicines, etc. This is not socialism, it is plain common sense.Why should 21 year olds receive disability payments if they could have had proper medical care while growing up that would have prevented them from becoming disabled in the first place?
3
Let's be honest here, public healthcare can not work in America: Obama tried to implement it, couldn't do it ; worse Trump scraped the small improvements that were made.
I can only imagine running such a platform is bound to be met with huge pushback from both the top and part of the electorate. N9t a good look for Democrats, especially if they can't deliver on it.
@Jules The Medicare enrollment impacts are the key reason the share of health care spending sponsored by federal, state, and local governments is expected to increase by 2 percentage points over the projection period, reaching 47 percent by 2027.
With no changes, half of the US health care will be 'public'.
1
@Mark
You shouldn't confuse public spending towards private entities and institutionalized healthcare
What may be emerging—and only because all this health care talk is finally going beyond slogans and, barely, getting more detailed—is the original wish for Obamacare: inclusion of a federal, Medicare-like option that would nudge insurers into true market competition. Currently insurers are, really, absent from any real reform or challenge to improve, insulated by the ACA’s focus on access over cost, living in a protectionist, self-regulating bubble. All the fretting over “Medicare for all” goes away with the simple addition of one word—“option.”
And I believe the real idea, the real value embedded in the Medicare for all slogan, is what no one can bear go talk about with any specificity: the unregulated, unchecked cost of US health care, notably driven by corporations—hospital systems, medical device manufacturers and drug companies. Medicare is poorly understood—including by its beneficiaries. But it is gratefully embraced by these same lucky beneficiaries because, alone among “insurance” options, it does the job of insurance—protecting individuals financially. And it is the only “insurer” with any element of cost regulation.
Give us a choice of Medicare over private insurance with ever-higher deductibles, premiums and hidden “cost-sharing” that undercuts the notion of risk-sharing, and private insurance will be more clearly seen for profit-over-protection modus operandi. But know that the real need is for the power to push back on the cost of corporate-run health care.
4
People should read more about the public health systems in other countries. In most, many or the majority of people still buy private insurance. The basic public option is far too "bare bones" for the American culture. Will folks really be ok with waiting months for elective surgery?
In Australia, there are 2 completely different systems, public and private. Those with only public insurance go to public hospitals and those with private insurance go to private hospitals. Would Americans accept this kind of 2-tiered system?
The main barrier to reform is that Medicare is great, patients can go to any hospital and will have private rooms, 24 hour room service meals, meditation gardens, access to as many specialists as they need, no waiting times, etc. Everything is covered. People who have Medicare now know it won't be as good if everyone has it, and those folks vote much more than the young.
@Phil
Phil what you describe as evidence of severe problems are intentional features of some national insurance schemes.
Some countries have genuine single payer insurance.
Some have what you pejoratively describe as two-tier systems: they are intentionally designed to guarantee everyone access to some base level of care and then to make decisions ( free market, capitalist decisions!) about the rest of their care.
Its not because things aren't working, its because they are. Because that's the way they made it.
I hope we never reach your "everybody has Medicare" medical Armageddon, because we can do much better than even that excellent system.
But there is no reason, and I sincerely doubt that everyone who has Medicare knows it will fall apart if everybody else gets it, too. What makes you say such thing? Wishful thinking?
Yes, we're sure. The health and well being of our citizens should not be up for profitable grabs. Healthcare and education should NEVER be for profit. These life and death aspects of American life should be run by the government, with NO middlemen, as they are in every other successful "western" country. If people want to choose private insurance let them do that, if they can afford it. It hasn't worked yet, and it's not likely to do so, any time soon. As for Union insurance, let Unions be free to concern themselves with wages, benefits, and working conditions, rather than having to worry and charge for health insurance. This is good for working people. It's good for all of us. EVERYBODY gets health insurance, at a lower cost. EVERYBODY. I would think that dissenters are in the minority of citizens, the wealthy, who own stock in these hospital, drug, and insurance companies, and are making lots of money from the misfortune of the majority of us. Vote for your own best interests!
4
With Obamacare the tale of two states says a lot. New Mexico and Oklahoma, both Republican states, New Mexico accepted Obamacare, Oklahoma fought Obamacare. I'm on Medicare, and AARP PPO, that's my choice. Other's can accept joining a HMO for little to nothing in costs. So, as far as insurance goes private insurance is a viable option, and won't be going away.
1
I am disappointed that this opinion piece did not explore the possibilities of Medicare and private insurance co-existing. You can have Medicare for all without eliminating private insurance. Medicare could be offered as an option to all and the Medigap plans would still exist in a Medicare for all world. Private insurance would play a lesser role but still not be eliminated.
1
"Mr. Delaney may have overstated the case by saying that all hospitals would close, but America’s hospitals would stand to lose billions of dollars."
That is the idea! They say we have to go from 15% to 2% overhead. Let's make a simple 10%. on about 2.5 TRILLION that we consume a year, that 10% is a cool 200 billion.
Their problem is not that they will not be profitable, it's that they will not be INSANELY profitable.
3
First, ff the model for universal coverage is to be Medicare, then please note that private insurance currently sells plans supplemental to Medicare and could presumably continue to do so if everyone were included.
Second, if Senator Warren believes the private insurance sector is an obstacle to reform, then stand back in awe as they fight not just for the business but for their very existence.
Third, if the entire private insurance industry were to go away tomorrow, it is highly likely that a Recession or Depression would ensue, since a huge number of people would become unemployed--even if it is inefficient, it does provide work.
I believe the Public Option option is both the smartest and the most politically palatable.
3
The “let’s keep what isn’t broken” contingent is overlooking a key dynamic. Once a public option becomes available corporations will reduce their employee health plan contributions in order to lower their operating expense. This will drive employees to choose the public option over the private option. So the public option argument in a red herring. There are only a few ways forward: maintain the status quo, fix the ACA or single payer.
3
If there is a public option, there will be rules. Someone will determine who can buy in to medicare (everyone, 40year olds, 50?) and someone will determine how much it will cost.
Someone will also need to decide whether companies can switch their plans to medicare, and how much it will cost. These decisions are probably the most crucial for any such plan.
@BarbaraAnn
Respectfully disagree. If a mountain of rules are attached to the public option then it’ll never get out of committee. It’s DOA.
The argument is fallacious on its surface. We will provide a basic universal care, similar to many countries. We will also offer private supplemental insurance to those who want and can afford access to upgraded services. We will not "eliminate" private insurance; it will remain as an option.
4
@Tom
This person is correct; this is how England operates (I am pretty sure) and I think Canada has a similar system. This will reduce the role of the insurance companies though, so they will fight it tooth, nail and band-aid.
2
@Tom--The fewer for-profit entities standing between you and your health care, the better the result.
3
The biggest problem with obamacare is republicans who have fought it relentlessly. No country has a hodgepodge such as would result from a public option. There is a reason for that. Medicare for all is he best answer.
5
Private insurance would not be eliminated. Seniors pay private insurance companies for Medicare Supplements since Medicare only pays 80% of the cost of health insurance.
Medicare Advantage, run by private insurance companies, has been denying medical claims so the insurance companies can make more money. It's time to take the insurance companies to task.
5
The nice thing about private health care is that the costs are so out of control that eventually it will consume 100% of GDP. At that point even Mitch McConnell's voters will be ready to replace the system with single-payer. It's just a matter of time.
6
As a Swede, it appears to me that when Sanders, other candidates, and news outlets discuss the “Nordic” healthcare model, they get so many things wrong that I do not recognize my own country. So this is how it works. First, it is a single payer system with multiple (unlimited number) providers of your free choice. Dentals work the same way: single payer system, but multiple providers of your unlimited choice. Healthcare is not “socialized": only payments are “socialized” in that the government acts as the sole insurance company. Second, prices are regulated. Third, there is a small co-pay: around USD25 per visit (ER visits cost USD45) regardless of treatment or surgery provided; if you are admitted to a hospital, then the daily extra cost is USD12 (yes,12); annual cost for prescription medicines is capped at around USD250, beyond that no charges; costs for visiting doctors are capped at USD150 per year, beyond that no charge. Dental care is without charge until the age of 23. Maternity care: no charges. Fourth, all these benefit examples are tied to a single condition: you have to be part of the national population registry. And what about the tax burden? First, fortune/wealth tax is … 0%. Second, inheritance tax and gift tax is … 0%. Property tax is…0%. Property sales gain tax is 20%. VAT ranges from 6 to 25%. Maximum income tax rate (for the lucky few) is 55%, most middle class income earners pay less than 30%. All bank loan, credit card, etc. interests are deductible.
11
@Rebus so the biggest difference might well be the % of tax spent on military?
2
@Tamza Hi, I would actually say "no". US spends 3.2% of GDP on defence, while Sweden is inching up towards 1.7%. The defence spending difference is a marginal expense issue. It is more, I think, about having a simple tax code without obvious loopholes, having companies to pay their taxes (Swedish company tase rate is just 22%), avoid private healthcare insurers that spend 30% of their expenses on admin, and on top of that aim for profit. Private healthcare insurers and providers try to maximise costs and minimise expenses. Public healthcare tries to minimise costs and maximise deliverables (and in addition regulate prices of price healthcare providers).
1
@Tamza Hi, Also forgot to mention that there exist private health insurance providers in Sweden, for those who want preferential treatment (like extra fast surgery on a day and time of their choice). But when used, it is virtually always only by large companies for selected key staff. It is rare.
If you had good private employer insurance like I did, good chance, like me, you were a union member. Unions can get good private insurance for their members. If you are non-union, can you get your employer to get you better coverage?
2
@lksuss get rid of ‘employer-provided’ insurance - EVERYONE should have portable coverage.
Countries like Japan and the UK already have co-existing public and private systems.
Japan's private system covers company employees, and the public system covers those who do not work for a major employee, but the premiums and benefits are the same.
Every legal resident of the UK is eligible for treatment in the NHS, but wealthier people buy private policies so that they can jump the queues or receive other special treatment.
Germany achieves great outcomes at a lower cost than the U.S. through an entirely private system, although their insurance companies are all on choke chains and operate under regulations that American companies would never accept in closed-door sessions with any president.
(Side note: Obama's closed-door sessions with the insurance companies infuriated me, as did Cheney's closed-door sessions with the oil companies. Federal officials should not be allowed to hold closed-door sessions with any industry group. Why should corporations have input into which laws they are willing to obey?)
Even Canada's private insurance companies operate somewhat like Medicare supplements in this country, covering things that the government program does not. An acquaintance who lived in Israel for a while told me that the Israeli system is similar, with private coverage for extras.
There are many models for universal health care, and as Taiwan did, we should look at systems around the world and take the best features of each one.
4
Your article speaks about health care in absolutes. If Medicare for all adversely affects community hospitals it will require reimbursement tweaks. As in France, Canada and England, the universal healthcare system will adapt to our needs. I was a recipient of employer based health care for over forty years and my out of pocket costs steadily increased because of escalating drug costs and deductibles and co-pays. I have received Medicare for the past seven years and I have found it to be superior in every way to employer based health insurance.
3
Yes.
I’m tired of worrying about being broke every time me or my family has a medical need. All private insurance gives me is the freedom to go broke if I have bad medical luck.
3
While Obamacare ACA did much to cover those who would not otherwise have been covered, it also did much to increase wealth of both insurance companies (whose premiums rose greatly) and health care providers. I know Mr. Suderman is an independent writer from Reason magazine who views government intervention as a negative, most people agree that the cost of healthcare in our country is obscene and opportunistic. Capitalism isn't the answer to everything. Healthcare is a right, like education and clean air and water. The almighty dollar is not everything, Mr. Sunderman.
1
First of all create a medicare for all type system and then let the market decide.
Under the current system, healthcare is largely paid for by employers and consumed by employees. This disconnect means that the consumers take very little interest in the cost of their healthcare and companies pick up the bill. HIPAA ensure bills are difficult to challenge and collusion between monopoly providers and monopoly insurers ensure that costs stay high.
The focus of healthcare policy is always towards the employees. Change the focus towards the employers.
As a small company employer I would gladly switch all my employees from private fully insured situation to a medicare for all health plan if offered the choice. Less involvement, less risk, less cost, less administration, less distraction. Whats not to like? As the CEO of a small business I would love to get rid of the burden of managing health insurance and healthcare and spend that time growing sales, helping customers and building my business. Focus on the benefits for employers and the Chamber of Commerce will do the rest.
4
@MrC
The "market" should have nothing whatsoever to do with any health care system. There should be no connection between health care and profits. If the state can pay for an army, navy and airforce to protect the country from foreign invasions it can pay for a universal heath care system. Nations other than the US do this and some of these nations aren't even as wealthy as the US. The very idea of treating someone's illness for a profit is barf-provoking to my mind.
1
Pete - in a word - yes.
Profits and healthcare do not mix. Inevitably, shareholder return will increase if healthcare performed decreases. This creates in ineradicable tension between the purpose of health insurance and the needs of the shareholders, and therefore the operators of the company. Health insurance companies must be very heavily, tightly regulated, and they really should be run as non-profit entities, constrained by law to a minimal operating surplus, or as a very tightly constrained utility, with shareholder returns prescribed by law, and excess profit surplus returned to the customers.
If the private enterprise system will not cover everyone within these constraints, then the private, for-profit health insurance industry should be replaced, in a controlled and phased manner, with a non-profit, regulated, or public health insurance industry. These could exist together; perhaps a "Medicare for All" model with supplemental insurance coverages offered by non-profit or very tightly regulated private insurers.
Health care is a fundamental human right, as necessary to life as clean water, adequate food, and secure shelter. A society that allows denial of health care because of inability to pay, or pushes indigent care costs onto others without control or recognizing that for what it is, is an inhumane and unjust society. We can do better.
4
Aside from the support from the lobbyists, an open question is why the Republicans and their wealthy donors are so firmly opposed to any plan that extends health care to everybody, especially those people who cannot afford it now.
i suspect the reason is that the Republicans and their wealthy donors, don't want THOSE PEOPLE in their doctors' offices, waiting rooms and hospitals.
3
Private insurance is only for the 1 percent who can afford to pay the 5times higher premiums the out of touch GOP charge. They had 70 years to get it right and affordable and failed. Now is the time to make insurance affordable for the 99 percent. They got it right in Europe and millions are happy to have it there.
7
No, eliminating private health insurance is NOT a good idea. Additional private insurance remains an option in most countries with universal health coverage. Many Medicare recipients have such supplemental private insurance.
Since millions of people are employed in the US private health insurance sector, promising to eliminate that sector - and those jobs - may be political suicide. Instead of eliminating private insurance, A public option for Medicare would force private health insurance to compete for basic insurance policyholders, while still allowing the choice to purchase premium coverage for those who want it.
1
Medicare reimbursement rates are lower than almost all negotiated insurance rates. Many doctors won't take medicare because of this. Delaney is right that many hospitals would close if medicare for all were in effect. Therefore, the rates would have to be increased which renders the savings negligible.
2
@John
And this is why besides Medicare for all, we need price controls on medicines and medical practices. We need basic health care for all minus the posh, private room with tv hotels we're building. There is no need for all this luxury. Just basic care for all. If you want luxury... alright keep the private insurance for those who want it.
I don't know why abolishing private insurance is part of this debate. The two systems coexist very happily in the UK and most other European countries.
4
I don’t see why the private cannot coexist with the public. It is the best option available and what most voters want. Nobody should have to go with no medical coverage. Having an accident or catching a virus shouldn’t bankrupt anyone.
If your job does not offer insurance, a public option should be made available. Sanders will not get the nomination. Warren and Harris will be hurt if the continue with single payer.
Have a group come to your campaign, explain it and tell the American people after further review, your position is public option in addition to private insurers. And if the lying, cheating GOP brings up your switch, ask them to see that infamous replacement they’ve been working on since the tea party and freedom caucus got in in 2010.they should have 9 years of data.
2
First off it is unlikely you could “outlaw” the private practice of Medicine. SCOTUS would need to weigh in on that for sure.
Second off, why would you want to? If people with the means to buy very expensive treatment and special attention, are willing to pay big, who cares? Treat it like any other business.
Compared to the rest of the world that’s what is going on in America right now. But the statistics on population health show that they are actually getting inferior care at a much higher price.
1
@Nick Benton There is a big, big difference between the private practice of medicine and the private (employer based) insurance that pays for it. What the candidates favoring the "outlaw" of the latter is seen by them to address and solve the gross and greedy hold the insurance companies have on how much is paid for care and which care they will pay for at all, including tests and more importantly drugs. They construct ever higher and sometimes insurmountable hurdles that must be dealt with to get our patients the care they need. Even in the countries that have the most socialist policies i.e. where the government owns all the means of the production of care, there are supplementary private insurance plans avalable and private practices in which the patients pays for the care out of their own pocket. What is increasingly happening here is that hospitals, both nonprofit and for profit, are acquiring medical practices and making doctors into salaried personnel i.e. hospitals own the means of production.
As to "treat it like any other business" it is unlike "any other business". No other business literally has the life and health of all of its clients (patients) in its hands.
1
These debates, held by Telemundo and MSNBC, baited the candidates into taking extreme positions, not only on healthcare, but on immigration and other issues. The moderators loved it. The crowd loved it.The candidates could feel self-righteous. But we at home squirmed.
I think the candidates will spend the next year walking back their positions.
3
@Murray Kamala Harris already did and it took her all of a few hours to claim she didn't say what she said live on television.
Shocking I know.
Health Insurance Companies, like AK 47 & AR 15's, must be removed from our society. They are both very bad for the health of our nation. I would posit that the problem is, they should never have been permitted in the first place. Insurance Companies are like a broken ATM; they are glad to take your deposits, but somehow cannot find a way to deliver the services you need
In spite of Insurance Companies claims in their advertising, they are, primarily, a simple opportunity to drain resources out of the health care system and into the pockets of overpaid people who do nothing to alleviate the problems of the sick. Insurance Comp
It will be difficult to take them away, and they will spend a lot of money to keep their source of income, BUT, if not now, when?I am ready to fight for Health justice for all.
4
Private insurers still exist in Canada despite the universal healthcare we have. They are offered mostly through jobs and they usually cover things that Medicare doesn't cover like vision and dental. It can include other things like chiropractors, massages, and other wellness practices. They are usually a bit more affordable than regular medical insurance. My last employer had us pay $40/month for a private plan that had some dental and vision coverage.
11
@Dahlia
This is a system that works. What the US cannot seem to get to is that healthcare should not be a for profit industry with hospitals run as a profit center. When that changes, along with universal coverage, the US will finally join the developed nations of the world in providing care for all of its people.
1
@Judy
If the US does convert to universal coverage, expect hospital facilities to not upgrade their equipment or see any renovations for a long while. Due to our Medicare system being around for so long, a lot of the clinics and hospitals look kind of shabby. It is very basic in terms of aesthetics and in the long term, at least from what I've seen here, doctors will become more aloof to your needs but i don't see that happening in the US in the immediate 5 or 10 years once the system is in place. It is the flip side of it being government run. There are private clinics for sure, but they are mostly specialized areas. But hey, at least we are not in the red and you can leave your employer if you're not happy at any time!
1
@Dahlia As a US physician who studies quality of medical care, most people are razzled-dazzled by new furniture, views, and paintings. However, my team learned that those extras come at a higher cost of care and don't contribute to quality much. And upgrades to equipment are good only if there is a reason for the upgrade besides simply padding someone's pocket. When friends or family ask me about quality of care, I give them some pointers, including don't get distracted by appearances. A key factor is also staffing turnover (although this is not publicly available): it is not only a marker that employees may not be treated well, it also means that employees have less experience with the setting, patients, their co-workers, etc.
Seventeen months until the election and seven before the first primary. The media prefers to cover every policy proposal as though the election were to be held tomorrow. When Trump promised a cheaper better health plan that covered every American, all the Republicans actually did with their majority was try to take health care away from twenty five million people (thank you John McCain and every Democratic Senator). A public option (which should have been part of the original ACA but was vigorously opposed by Republicans and abandoned too soon by Democrats) that allows Americans to choose, if they wish, over their employer provided plans (which by the way tether Americans to their current employer and since costs come directly from the paycheck many Americans don't know what they pay for it) will eventually require private insurance companies to compete effectively on premium price and coverage or abandon the market (which they already do in any small market which does not provide them sufficient profits). Give policy the opportunity to develop without all the handwringing.
3
Keep private insurance, but...
- mandate a minimum of five insurance companies to compete in each state (break them up if needed, and allow cross state line operations);
- decouple health insurance from employer or employment status. This will increase labor mobility and entrepreneurship, and reduce the financial burden of people who are in-between jobs;
- require that each insurance company offer three standardized plans (since we consumers/patients do not have the knowledge to interpret the fine-print of the insurance policies) approved by an independent council: (a) a Basic plan covering emergencies and preventive, regular GP checkups and treatments; (b) a Basic Plus plan adding vision, dental, and additional non-emergency care; and (c) a Premium plan with a very comprehensive coverage. Each of the three plans should work nation-wide, and not restrict pre-existing conditions. All hospitals and healthcare organizations should be mandated to accept the three standardized plans. Insurance companies should be allowed to offer any number of additional policies - in addition to the three standardized national plans - as market demands.
2
Yes, eliminating private health insurance is a good idea. It redirects vast amounts of money from patient care to administration and adds virtually nothing of real value. Health care is not like other insurance that you buy hoping you'll never use it. You buy health coverage knowing that you will. Granted, the U.S. hybrid public-private system is extremely complex and can't be unwound overnight, or even in four years. Many people are satisfied with their present coverage, if only because they understandably fear the unknown in regard to such a personal issue. The candidates should recognize that. But the gradual elimination of the private insurance industry is certainly a worthwhile goal to work toward over the next several decades.
2
Two points here:
1) There's an assumption built into the thought of eliminating private healthcare, which is that the benefits provided by government run healthcare would be the same as private insurance. Also, this would be at a lower cost to provide, through a combination of the various current healthcare systems into one so that efficiencies in administrative costs can be realized. Then, with unified cost controls for providers and prescription drugs, the savings are even more significant. Once companies see this, it will be them who will stop offering private insurance. And individuals will accede to that over time because they also see the benefits of centralized healthcare, since it would have the same benefits as private insurance and is not threaten by corporate layoffs or coverage reductions for budgetary reasons.
2) Obama was correct when he said that people could keep their healthcare plans if they wanted to. He was referring to the grandfather clause in the ACA, which let people do that. But, the insurance companies were the ones to stop offering certain plans because they didn't offer the full essential benefits that the ACA required. Providing the full range of these benefits wouldn't meet the insurers financial goals. So, we need to stop criticizing Obama for this. It was the insurance companies who took these plans away.
10
Insanity is doing the same thing repeatedly and expecting a different outcome: continuing a for-profit healthcare system and expecting it to be successful.
4
True Medicare doesn't cover all health care costs for retirees which is why private insurers offer supplemental plans with varying premiums that even cover vision and dentistry if you can afford them. But those arguing for private insurance with a public option don't seem to realize that the public option will always win out if it turns out to be cheaper than private insurance. If corporate CFOs are given the choice of providing employees with company-paid private insurance or a public option called Medicare, you can bet the shirt off your back they'll opt for Medicare. And while Medicare For All would have to be funded by a slight tax increase, it could cover 100% of everyone's health care costs if everyone was enrolled and the government set prices. And a Medicare tax hike would still be a lot cheaper than the private insurance premiums, copays and deductibles which have made health care a business in our country, one that now costs a family of four an average of $1,168 a month.
9
@Christy
In my experience, what you are stating is very accurate. I have been through private insurance, ACA, and now Medicare. Medicare is not free, you pay a tax all your life until age 65, then you pay premiums for Part A and B to the government. If you want additional coverage or lower deductibles, you can pay premiums to a insurance company for supplemental coverage. I have found that Medicare with supplemental coverage, gives me the same doctors and better medical coverage at a lower rate than I have ever had. What is not to like?
3
Private insurance must be regulated, ACA did just that. The industry made sure the taxpayers made up for lost profit. To ensure pre-existing conditions, ensure young adult college student and use 80% of revenue to pay for health care was too much to ask and Republicans went in high gear to destroy it completely with 50 some repeal votes and all the way to the SC and guess what, ACA is almost dead.
Republicans have expertise in tearing down social services of any kind.
1
To those who treat single-payer government run healthcare as inevitable because of this or that economic or health statistic, remember that most of those statistics have applied for the last 50 years, and little has changed.
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Every other rich country has universal care, but each has a different system. Single-payer healthcare is not a thing, it is a hundred different things. Which do you want? Also, while most people with universal health care want to keep it, it is also the number one thing people complain about to their politicians. Everyone complains about health care, everywhere.
.
Any dramatic change to our system will be very disruptive, in particular to people who work in the industry, some of whom would lose their jobs, and the chronically ill, who are mostly old people who vote. Medicare for All means Medicare will have to change; old people don't like change.
.
How will this pass the Senate? I can see a public option making it through a 50/50 Senate, which is the best we can hope for. Eliminating private insurance? No hope.
.
If we want dramatic change and some form of one-payer healthcare, it will only happen by offering to let states take their Medicare and Medicaid money as block grants and run their own system. I see no signs of the courage that it would take to loosen control from Washington.
.
The only thing I see coming from this is a limited public option (allowing early buy-in to Medicare) and some changes to the regulation of private insurance.
3
Private insurance companies wouldn't go away. If Medicare for all is like Medicare is now you'd still have insurance companies processing claims and offering supplemental coverage. There may even be something like Medicare Advantage that is private coverage through Medicare. It might make them more profitable.since the much of the risk is shifted to the government.
We would be wise to consider what has worked well with the ACA. Medicaid expansion has been enormously successful, so successful that Red states have voted for it in referendums. Some of the cost control provisions have also been effective. Trying to dramatically change 20% of the US economy (health care) over 4 years is impractical and will create enormous politcal resistance among the losers. A 20 year transition that gradually lowered the eligibility age for Medicare, while expanding Medicaid eligibility to higher income levels, could work if it were coupled with effective policies to reduce excessive prices of hospital care, drugs, procedures and specialty care, along with eliminating inefficient payment systems. Medicare for All in 4 years would be popular AFTER it was implemented for 4-5 years, if costs were controlled. In the short-term MfA could cost the Dems the 2020 election, as the ACA (now popular) cost the Dems control of the Congress under Obama. Those who don't learn from history are destined to repeat it.
1
As an older adult on Medicate, I am know that Medicare only covers 80% of charges. One has to buy a separate Medigap or Medicare Advantage plan from a private insurance company. Some Medicare Advantage Plans have no premium, but those with better networks do. Also have to buy separate private insurance drug coverage. I haven't heard this addressed by any candidates. "The devil is in the details".
3
@Susan Friedman Medicare covers 80% of hospital charges and pays (imposed) fees for outpatient services with a small copay. In addition there is an annual cap on out-of-pocket expenses, this year it is $2900. The biggest problem for all too many people is the 'donut hole' gap in coverage for medications, which was the way the Bush 43 got it passed in the establishment of Medicare part D since otherwise the plan would have costed many billions of taxpayer dollars. In addition, the part D law forbids the government from negotiating with drug companies on price. Thes 2 part D provisions result in many people, particularly diabetics, having to choose between getting their meds and eating.
You should look at the Spanish system where both public and private co-exist without problem, we need to be able to look and see how it works in other countries and try to emulate what works...
4
@Rober González
Here is the "C" word that has baffled us in Canada watching Americans fight over who deserves to be healthy; CANADA.
Don't let your politicians fool you - 35 million vs 350 million population is a chimera. Qua Bono?
Do the folks that are advocating this absurd position know what they are talking about? Do they know the limits of Medicare? Do they understand that many companies offer insurance that covers dental, optical, and prescription drugs while Medicare does not?
For those who are not on Medicare you do not receive your Medicare card when you are sixty-five and have great coverage. You have to pay for these services by purchasing a supplemental Medicare package from a private insurance company that can cost thousands of dollars per year.
Why would anyone want to give up superior coverage for lesser coverage and be forced to pay thousands of dollars to equal what they had?
The progressives like to claim that all this is fixable and that by taxing the wealthy we can offer everyone health insurance that will cover 100% of our needs and will not cost the lower and middle class anything. That's not possible unless Democrats take back the Senate.
The best way to expand health insurance is to strengthen ObamaCare and shore up its weaknesses. Any plan that since its inception is insuring thirty million Americans who had no health insurance should be the model.
Scaring people that they will lose benefits they currently have is not the way to win back the White House. If the Democrats really want to have Medicare for all with 100% coverage and minimal out of pocket expenditures they should put all their efforts into recapturing the Senate because that is the only way this will happen.
11
@Mark Jeffery Koch
Medicare would be much better if it were not limited to high risk elderly and disabled people. The industry let us have Medicare because it was unprofitable to ensure all the people with pre-conditions. Yes, old age is a precondition, a very expensive one too.
3
@Mark Jeffery Koch: Yes, I'm just old enough to remember when Medicare was introduced. It came about because insurance companies were unwilling to insure seniors at any price that the average senior could afford.
The Republicans fought it and proposed a system under which seniors with high medical bills could individually petition the government for reimbursement.
Now that I am on Medicare (even on a Medicare Advantage program) myself, I have to say that, while not perfect, it is so much better than what I had as a 64-year-old that I wish all people over 50, whom even the ACA allows insurance companies to price-gouge, could be on it.
@Mark Jeffery Koch
Mr. Koch, I care for my elderly father who has medicare advantage plan. He pays no premiums and very minimally for drugs. He has received excellent benefits. Please educate yourself on how much working people are paying for private insurance today. It is way more than anyone pays on Medicare. The answer is Medicare for all because more people paying into it would lower prices AND price controls on drugs and on medical practices and structures. We have the poshest hospitals of anywhere in the world and the highest paid doctors and nurses and of course worst of all highest paid administrators not to even mention private health insurance companies that are fleecing the American public.
1
Obamacare failed to lower health care costs because the for profit insurance companies still exist. Eliminate them. Stop pandering to the health care Luddites.
8
@Steve
You put your finger on the real reason why they must be eliminated. It is a question of survival for the people. We must get rid of the predatory industry and the Republicans too.
@ARL
Hundreds of thousands of Americans work for those "predatory" companies doing their best to earn an income while serving their customers. Entire communities are dependent on those employers. It is too easy to be dismissive of someone else's livilihood.
I can’t wait to see the Democrat campaign to end Obamacare. My wife and I each pay over $4000 a year for Medicare Advantage insurance and a supplemental insurance. Medicare doesn’t cover everything. We cannot see all doctors in all hospitals. We have copays and deductibles. Our plans do not cover long term care. We pay an added $2,500 each, every year for long term care insurance. Oh, did you think Medicare was free? Surprise! As I see it, a family of four can expect to pay about $15,000 a year for “Medicare for all”. And then there is the inadequacies in the drug coverage to deal with. Democrats I’m sure will say, “You can keep your doctor, we promise, this time”.
2
@Richard Bourne
Medicare Advantage is the privatized part of Medicare, or not? Why must we pay for Part B in order to be able to even buy Medicare Advantage and stingy part D? It all is because the insurance industry's market and profits are protected and they make sure it stays that way.
In Germany, seniors are in the system they always belonged to. They pay their 100 some Euro and are covered, dental and drugs included. they do have some minor co-payments, but they can be sure their government will not take their insurance away. We don't have that peace of mind. Trump's budget includes more cuts to Medicare.
1
Eliminate private insurance? Of course not. But you don't reveal your hand when you are playing poker. Single payer is an opening negotiating position.
There is however a trend that cannot be denied. Medical care is becoming ridiculously expensive, and wages are declining, or flat. Care is unaffordable for the poor, bankrupting for the middle class, and a drag on the upper middle class who are also paying for very expensive college educations. It is trending towards a One-percenters luxury. Medical bankruptcies are common among the insured!
It was just announced that a large corporation is building a one BILLION dollar boutique cancer treatment facility a few miles from here. A billion dollars for a building with equipment in it. Where did that billion come from? From middle class premiums and middle class bankruptcies and taxpayer dollars to pay for care. Cancer is big business with inelastic demand.
The medical-industrial complex is sucking the life out of our economy at the moment when many other countries are better competing with us. Something has to change.
Obamacare hasn't failed. It was sabotaged. Our for-profit healthcare system has failed. Only a small percentage of people can afford it anymore.
39
Only true leftist radicals want Medicare for All and the average person is covered through Medicare or work or Medicaid. A fraction of the population is not covered and out of that 12% many are independent contractors and can afford it. No we do not want to get into another socialist democrat Ponzi scheme for the rest of our lives.
1
@Jan I disagree entirely. I am no leftist radical, just a family man who has seen health problems affecting all four of us push our lives closer to the breaking point than I had ever hoped. In this 'gig economy' people are talking about, eliminating the dependency on employment for health insurance is becoming a critical need.
4
"…America’s hospitals would stand to lose billions of dollars."
The nearest hospital to me, in a southern UT "city" of 30,000 peeps, has soaring 30 foot atria and hallways, with marble floors, expensive artwork on the walls and bathrooms that are better suited to an upscale hotel. Maybe Big Hospital Inc. could divert this money to curing the sick?
10
The Democrat appeal is easy to understand. Elect us and we promise to give away the store.
1
@Ronald B. Duke: As opposed to the Republican plan to "give away the store" to the world's most profitable corporations in the form of tax cuts that give them massive refunds?
We certainly want to be careful about eliminating private insurance. Who or what will replace those insurance company profit margins and multi million dollar health care provider executive salaries, whether for profit or not for profit? This would bring about a government monopoly like the one we have with social security, a massive insurance program that pays out benefits with no opportunity for private interests to wet their beaks.
1
Can you just imagine the horror? The idea of my money being more efficiently used for its nominal purpose is the one thing that keeps me up at night.
3
@Edwin Not to mention the hundreds of thousands of ordinary Americans working in the health insurance industry also.
We can strip them of their jobs and then have another huge number of folks dependent on the government to look after.
The Author works at Reason magazine which is basically an Ayn Randian Libertarian broadsheet. This column is basically a tired and tedious screed and jeremiad against the national cry for Medicare for All or Single Payer. It is beyond me to understand why the Times keeps giving column inches to neoliberal and libertarian dogma which we have tried in the last 3 decades. We have tried giving free rein to 'market forces' and all we have seen is skyrocketing income inequality, rise in White collar crime, evisceration of the middle class with disappearing jobs ine very sector due to outsourcing and yet we are constantly exhorted to keep trying the same failed panaceas of the 1%.
29
@Paul Art
A newspaper is supposed to give me a diversity of ideas, not just the ones I agree with, or the ones they have decided are "right." I want to hear the tedious screeds of Reason magazine because when we try to get a single payer system, those are the tedious screeds we will have to answer, and I want to be prepared to answer them.
I admit that the NYT has not given us a diversity of ideas in the past, and it was obvious that until the last few years they were ignoring single payer. Nonetheless, I'd rather have too great a diversity of ideas than too narrow.
I recommend John Stuart Mill's On Liberty for a more complete discussion.
http://www.gutenberg.org/files/34901/34901-h/34901-h.htm#Page_28
First, if any opinion is compelled to silence, that opinion may, for aught we can certainly know, be true. To deny this is to assume our own infallibility.
Secondly, though the silenced opinion be an error, it may, and very commonly does, contain a portion of truth; and since the general or prevailing opinion on any subject is rarely or never the whole truth, it is only by the collision of adverse opinions, that the remainder of the truth has any chance of being supplied.
Thirdly, even if the received opinion be not only true, but the whole truth; unless it is suffered to be, and actually is, vigorously and earnestly contested, it will, by most of those who receive it, be held in the manner of a prejudice, with little comprehension or feeling of its rational grounds.
2
@Paul Art
"It is beyond me to understand why the Times keeps giving column inches to neoliberal and libertarian dogma which we have tried in the last 3 decades."
So should the Times only include liberal commentators and liberal points of view? I have no problem with America's "Newspaper of Record" allowing different viewpoints on this or any other issue.
1
Obama said “if you like your plan, you can keep your plan” but you couldn’t. So I take it that when Warren says “we don’t like your plan, you can’t keep it” she really means we can. So no need to worry.
1
Yes, we are sure. Next question.
106
@David Best. Comment. Ever!!!
@David And you are sure because you get your health care in the US?
California Brisbane? Illinois Brisbane? North Dakota Brisbane?
Or the down under Brisbane? Just curious.
@David...Who are "we"? The US Chamber of Commerce? Veterans Hospital Administration shirts? Unionized corporations? Democrats pandering at the polls? Lots of folks would love to capture the excess rents that flow into the insurance complex. Since no one is talking about reducing health care costs - they all just want to re-shuffle the deck and deal off the bottom - who stands to claim the pot?
Would it be possible to force private insurers to become not for profit entities which would moderate their greed to an extent?
2
@MikeJJNYC Blue Cross Blue Shield is non-profit. That status is a complete joke. Like every other insurer, they have raised rates and deductibles and narrowed networks. And their executive are paid as much as any for-profit entity's CEO.
Look at the salary of the BSBS CEO for ONE state:
Total compensation for Daniel Loepp, CEO of Blue Cross MI since 2006, reached $13.4 million in 2017, a new record for him. That was up from his $10.9 million payday in 2016 and $9 million in 2015.
And there are 36 members of the BCBS association.
1
Government run single payer healthcare is inevitable. Simply put, it is more efficient; and in every example where it has been employed it has easily out performed our present system both in cost and in healthcare outcomes. The question isn't if it will happen, but rather how do we get there. The most logical way to proceed is to offer Medicare as a health insurance option. It will not be necessary to eliminate private healthcare insurance, because private for profit healthcare insurance will be largely eliminated by the public when you offer them Medicare as a choice.
15
@W.A. Spitzer Government run single payer healthcare is more efficient at doing what? If we look at the successful healthcare plans around the world, almost none are single payer. Nevertheless, these systems work and everyone is covered. They have many variations, and the government is heavily involved in all of them, but most involve some private insurance (usually non-profit insurers). Even employers in the UK with single payer health provide supplemental insurance to some employees to enable their workers to go outside the single payer system on occasion. It's easy to contain costs if a bureaucrat can just say we're going not to cover a treatment, but to contain costs and be responsive is a huge challenge.
Look at the requirement for electronic record keeping imposed by the federal government for Medicare and other federally reimbursed programs. Doctors complain rightly that they are burdened with more administrative work and spend too much time inputing into computers instead of maintaining contact with patients. And Medicare "improved" billing by introducing about 10 times more billing codes than were in use in the past. This has spawned an army of consultants who guide doctors and hospitals on how to bill at the highest possible codes so as to maximize revenue.
Single payer could turn into a nightmare. Electronic record keeping and billing codes are examples of well-intended, out of touch bureaucrats. Let's take time and try to build a better system.
1
@john640..."Single payer could turn into a nightmare."...A nightmare, sort of like Canada where they pay 40% less per person and get better healthcare outcomes? But hey, who would want better healthcare and save $800 billion dollars a year?
@W.A.
It wont happen as long as we have Republicans in office. Time to sweep them out of the White House as well as the Senate.
Rural hospitals are already closing. It won't be just because of public healthcare.
If a candidate does not address healthcare in America, then he/she is failing in the support of Americans. As the article indicated it is a major concern for all Americans.
Bottom line, this issue has been an issue for many decades, long before Obama. Ignoring its resolution, is of course not an option. As long as it is a profitable system, it will not get better. We are getting outpriced year by year while pharmaceuticals, insurance companies, lobbyists, etc. gain.
We can send a man to the moon --50 years ago, but we can't fix healthcare.
4
Other countries including the UK take the same approach - private insurance as supplemental. This works with Medicare and could work as part of a universal insurance system. If we limit the universe in which they operate, including pre existing conditions and arbitrary control over drugs, they could play a useful role. Democrats cannot go into the election facing a drum beat of accusations that they’re going to take away people’s insurance and providers. Can’t happen.
3
I don't understand why this is so hard:
1. Medicare-for-all-who want-to-enroll-now, plus higher taxes for all to pay for it.
2. Let people stay in their current plans and give them a tax credit equivalent to the cost/value of the Medicare plan. Pretty soon, but gradually,those people will see the benefit of switching over.
3. No new enrollments in private plans.
13
I know one of the most recognized healthcare policy experts in the country, and this person recently told me that none of the candidates of either party have taken the steps necessary to move the single-payer concept from sound bites to reality.
The candidate who said hospitals will go bankrupt if we suddenly switch to Medicare-for-all over a four year period is spot-on. The candidates lie when they say "you can go to any doctor" if you have Medicare. Many do not accept Medicare because of the low rates.
As a Democrat who works in the healthcare sector, I want a realistic plan: gradual introduction of single-payer system that allows people to keep their private insurance. That allows fine-tuning and fixes along the way so that in 10 or 15 years people will find it more attractive to move away from private insurance.
5
@NR
I ask this out of curiousity....yes, currently many doctors/facilities turn away Medicare/Medicaid because of the "low rates," but if that is the only payor out there, wouldn't the provider have to accept it - or nothing? Or are you saying you think they would only accept payments in cash payable immediately upon service?
I'm not really in favor of Medicare for all immediately, but like you, introduction over time, I think a publicly funded option is inevitable.
1
@NR: For now, rural hospitals have benefitted from the Medicaid expansion, so I expect they'd benefit even more from the more generous Medicare expansion. If almost all people have Medicare, doctors and hospitals cannot but accept Medicare, or move to another developed country that has the same system as the USA has now... (hmmm, what would that country be?...) But I do like your plan, and things probably will turn out to go that way. People will like the independence of their employer that requires them to stay put in a job they have come to dislike for the health benefits and they will like the certaintly they will remain covered if they lose their job. They will also like the fact they don't have to pay 20-30% in overhead, ever increasing premiums, co-pays and out-of-pocket costs anymore. Plus vision, dental and hearing will hopefully be included in single-payer as well. They will like to not have to go through the hassle of choosing a health plan every year. I think it will take less than 10-15 years for people to abandon private for-profit insurance if that is offered under the same conditions as it is now.
Suderman skillfully analyzes the weaknesses of the Medicare for all plan and accurately, I think, places it on the debit side of the Democratic platform balance sheet. The fact that two of the strongest candidates fielded by the party support it should trouble progressives.
That said, I think he exaggerates the popularity of the plan among the party's faithful. The eventual nominee will almost certainly drop it in favor of an alternative that will offer the public option as a choice. Suderman's criticism of Obamacare, moreover, while valid, omits the the fact that some of the shortcomings stem from the president's effort to gain the support of Republicans and conservative Democrats. The reforms broadly suggested by most of the candidates would substantially improve the current law.
As for the Republicans, Suderman only hints at the party's betrayal of its promise to create a better healthcare law. Neither the GOP nor Trump ever offered a replacement for the ACA; they merely sought to repeal a law which, for all its shortcomings, did improve access for millions of Americans.
The difference between the two parties on this issue, and what that contrast reveals about their core principles, could not be plainer. Trump could lie about his intentions in 2016, but in 2020 his failure to deliver on this key issue will expose the deceit at the heart of his so-called populism.
4
We need both options. Just expand Medicare to include all for basic coverage and still have private insurance to pick up the remaining like the supplemental policies do now. Everyone can keep their own doctor and still opt for the coverage they want at the price they are willing to pay. Obamacare is on the right track, it just needs to be fixed, not taken away. The republicans just want to sabotage Obamacare to make a point that it doesn't work and never will. Healthcare is a number one priority for most people, and one should never have to worry about losing everything they ever worked for in the event they get sick. Healthcare is a right, not a privilege, and should be treated as such.
24
This is not an either/or question. Germany's mandated health care system relies on over 200 private insurers including a public option. The big difference to US health care is that those private insurers are NOT FOR PROFIT. They are allowed to have operating gains as long as those assets are banked in company hands for use in loss years. They are not publicly traded. They have no stockholders.
It makes an enormous difference.
The ACA (Obamacard) was set up similarly - a mandate to purchase(enroll in) insurance and allowing multiple private providers to offer plans with minimum coverage standards. If taken to its logical conclusion, with insurers becoming not for profit rather than stockholder oriented, it would be a major improvement.
Because there are multiple ways to guarantee every Amerifcan decent care for medical problems, perhaps the wisest thing Democrats can do is to focus on health care as a right and develop that concept when in office.
89
Perhaps the Americans could take a lesson from the Germans. Setting up the privater insurers as not-for-profit utilities under regulation rather than private for-profit corporations could be the key to fixing the American healthcare system.
Of course focusing on health care as a right is also key, especially when one considers the public health and the national security aspects. Even if one wants to claim that some individual does not deserve to have health care ('cause he's a lazy bum?), one also needs to recognize that he and everyone else deserves that his community0 is healthy and able to work, and robust against epidemics. It's just common sense.
1
@Sara, Your statement, "The ACA (Obamacard) was set up similarly [to Germany's nonprofit system]" is simply untrue. The premiums rose and the insurance companies never agreed to nonprofit status. As another reader commented, "the Affordable Care Act *was* the Republican plan."
1
Approximately 1/3 of current Medicare recipients get their care from private companies, most of which are insurance companies. I am one of them and it is terrific. I pay an occasional co-pay about the equivalent of a latte, but zero premiums. The current cost to the government for the Medicare Advantage plans (a capitation-type plan) is quite high (averaging around $800/month per person), but this could be significantly reduced if it covered everyone who selected the private option. Republicans refuse to even acknowledge the success of the Advantage plans, which they created, because it would cut into their campaign contributions, or worse, because they simply hate government.
3
@Mister Ed
You could look at this another way. The Medicare Advantage plans (advantage to the insurance industry?)
are bleeding funds from CMS , as you point out $800 a month.
That is $9600 a year subsidy going to Private Insurance providers, who can require you to stay "in network" for care. Your Medicare Advantage plan may not cover you in other States, or if you are sick abroad.
My Traditional Medicare plus a Medigap plan F covers me abroad , and only costs an additional $172 a month.
I believe these Medicare Advantage plans are just a giveaway to Private Insurance companies that CMS is forced to subsidize.
2
Insurance companies would jump for joy If we set up Medicare-like and still allow private insurance companies. A public option will relieve the private insurance companies of covering everyone and will enable "cream skimming" in the name of "choice".
U.S. businesses, including those in insurance, continue to be masters of "cream skimming". Since private insurance companies always filter their clients to eliminate expensive risks, the pool of clients for the government to cover will be sicker and more expensive. Conservatives will then say "See, government is always more expensive and has worse outcomes."
41
Neither Sanders or Harris seem able to explain this downside of the “public option” when asked to defend their support of Medicare for All with no private insurance. A public option would appeal to the sicker, older and less well off, who are hardest hit by coats and their medical costs would be paid by us, the taxpayers. The private insurers would continue to collect premiums from individuals and employers that are lower risk.
Getting private, particularly for profit, insurance out of the system is essential and I’m surprised that Sanders, in particular, after all these decades, can’t explain why that is in ALL of our interests.
3
@rbitset
To a large degree, private insurers are already "cream skimming". At the very least, they are heavily subsidized by the taxpayer by taking out the oldest (and most costly as a group) Americans from the risk pool. I don't understand why Republicans aren't angry about that? I thought they believed in the beauty of the market free of public interference?
3
@rbitset
I am actually replying to the replies. In a number of countries, the insurance carriers offer plans, and their profit margins are governed by law. Private insurance is part of universal healthcare in many countries.
There was a recent Atlantic article about how patients in the USA demand access to treatments with little proven effectiveness. Many countries have much lower rates of medical testing, expensive procedures, and the like, because a sense of resignation is built in to attitudes. End of life care in the USA, for example, is an enormous cost burden, done at the expense of family closeness and patient comfort. Treatments are given that are not likely to extend a meaningful life, and may actually cause more distress that palliative care. We have more to do here than simply bash insurance companies. I will say, however, that medical and pharmaceutical advertising creates some of this demand. It is not done in almost all other countries.
2
I’m a strong proponent of Single Payer or if you prefer, Medicare for all. It makes the most sense economically. We have a successful and popular program in Medicare that we can build on.
As far as the politics goes, it doesn’t make sense to me if your ultimate goal is single payer to start negotiating with a public option. That’s what Obama did and we ended up with the pricey compromise that is Obamacare—a compromise which did little to rein in the insurance companies.
That being said it’s important that the politicians pushing single payer do what they can to get in front of the attacks that are already starting. The health insurance industry is well funded and will not go away easily. They are already running ads against it with an ominous sounding female voice asking “How Long will you wait?”
Sanders admission that yes, people will pay more in taxes was a good start. I think that they also have to answer the concerns of people who get their insurance through their employers at little or no cost. Will there be a provision that they will see more take home pay now that their employers are not paying for health care?
I’m looking forward to this debate. Like him or not Senator Sanders did this country a great favor by putting this idea into the public arena. I’m looking forward to the debate.
39
@Brooklyncowgirl
Amen! Proponents of Medicare-for-All also need to de-fang the "tax" bogeyman by explaining exactly what the increased taxes would entail. A private "Bronze" plan (with an insanely high deductible) in my state runs around $13,000 a year for a couple in their 50s. That's a whopping 13 percent for a household earning $100K, but only 5.2% for a household earning $250K. The whole point of funding health care through taxation is that everyone pays the same percentage per dollar earned.
As things stand now, those on the lower end of the income spectrum (and many in the middle as well) are getting whacked by regressive private insurance premiums and high deductibles -- not to mention the cruelty of surprise "out-of-network" costs.
4
@Frank F
Spot on, Frank! This is the exact "machinery" the private/pirate Medical Insurance Complex (another MIC) does not want the American citizen to know.
Thanks also for bringing up this whole system of categories: bronze, silver, gold, platinum, etc. They exacerbate inequality by reinforcing a class system based on $$$, something Obamacare should not have allowed. These insidious systems of loopholes (deductible, co-pay, out-of-network) belong in the playbook of common hustlers, bait-and-switchers, gotcha capitalism, & scammers. Criminal, anyone?
The focus on healthcare is essential since our healthcare "system" is failing our citizens. The focus on single payer vs. private insurance however is a distraction and misses the point entirely.
The reason our system fails our people is the outsized influence big corporations have and the amount of money they are able to drain from the available pool. Other countries have private insurers, but they are highly regulated and are not allowed to steal too much in the form of profit taking and "administrative costs." Other countries use the same private pharmaceutical companies, but the prices are negotiated and regulated. Other countries have private hospitals and physicians, but again the charges are negotiated and regulated.
The US differs mainly in lacking an effective counterbalance to the private interests seeking to maximize their share of the pie. Government is supposed to be that counterbalance. Government is supposed to represent the interests of the people and put a brake on price gouging or on mergers which threaten the market and don't serve the public interest. We have failed completely on that score.
There are many roads to a healthcare system which serves the people well. Private vs. public is actually not so important. But having a government which actually represents the interests of the public and constrains excessive private greed is the missing piece. I want to hear a candidate say that and mean it.
30
There are several reason that the public option will not work
The 1st one is obvious. It is much, much cheaper to administer a program where everyone is treated the same than one that has Medicare, Medicaid, VA, Indian health, TriCare, etc, AND 1,500 different private insurance policies (not counting Part D Medicare). Not only is there vastly higher overhead for the private insurers, but the compliance costs for physicians, hospitals, and patients is enormous, at least $600 Billion every year. A public option will not save this sum
The 2nd one is that if the public option has to treat everybody the same while private plans can develop plans that cater to the young, the healthy, and the wealthy. They can give bribes to companies to get them to buy their coverage, This would leave the old, the sick, and the poor to the public option or Medicare itself. All this would raise the cost of the public option & negate any administrative savings. Conservatives would point this as a failure of government supported health insurance.
The 3rd reason is that the universal gov run plan of other countries ALL have one entity that can gather data, analyze it, & make recommendations based on medicine, not profit. If a lot of people are covered by private companies which keep their data secret, we could not do this.
We can look next door to see how efficient MfA would be. In 2017, Canada spent $4,753 in PPP dollars per person for health care. We spent $9,892.
7
Stop the hand-wringing, already.
Every sentient human knows that the Great American Healthcare Rip-Off is an ongoing right-wing, Republican crime against humanity and demands structural reform.
And most Americans know that the President is not an all-powerful dictator - despite the current wannabe dictator's efforts to make it so - and that Congress must craft the law for Presidential signature.
So the candidates' ideas are important, but Congressional compromise will be part of the process.
And most Americans know that the Republican idea of 'healthcare' is wealthcare, as in 'take two tax cuts and call me from the morgue'.
Republicans came within a vote of ripping healthcare away from 15 million Americans and replacing it with a Christmas gift for rich people.
American healthcare costs $1 trillion more annually than it would if we had the universal or single-payer healthcare other countries have...and their healthcare is better.
Country and % of GDP spent on healthcare
USA 17.2 %
Switzerland 12.3 %
France 11.5
Germany 11.3
Sweden 10.9
Japan 10.7
Canada 10.4
Norway 10.4
Austria 10.3
Denmark 10.2
Netherlands 10.1
Belgium 10.0
UK 9.6
Finland 9.2
Australia 9.1
New Zealand 9.0
Portugal 9.0
Italy 8.9
Spain 8.8
Iceland 8.5
Greece 8.4
Chile 8.1
Slovenia 8.0
Korea 7.6
Israel 7.4
Hungary 7.2
Ireland 7.1
Czech 7.1
Slovak 7.1
Estonia 6.7
Poland 6.7
Lithuania 6.3
Latvia 6.3
Luxembourg 6.1
Mexico 5.4
Turkey 4.2
D to go forward; R for reverse.
175
@Socrates
Yes, and it’s why people from many of these countries come in droves to the U.S. to have special surgeries and other treatments offered by our far superior medical system!
3
@Joe Gagen
Until they find out how much it costs. On the other hand, thousands of Americans buy drugs in Mexico or Canada and travel to India and Japan for medical treatments at far less cost than they can get then here. The US has special treatments at costs far beyond what ordinary people can pay.
24
@Joe Gagen
There are many more Americans going overseas to have expensive surgeries than people coming here for it.
As the wealthiest country in the world it would be shocking if the U.S. didn't have available the most highly sophisticated specialty science, including some surgical methods, in the world. Sad is that so many Americans are heading to places like Mexico and India for surgeries that they should be able to easily and affordably have at home.
34
Medicare for all is not going to lead to hospital closures in rural areas or anywhere else. That is an assumption designed to cause fear.
Medicare for all is going to provide more money especially to rural and poor areas.
Things can and will get ironed out in the process. Other countries do it.
We can do it and provide reasonable healthcare for all.
As usual it is the for PROFIT sector, the corporate shills, sowing seeds of fear because they won’t be making truckloads of money off the backs of Americans.
It is time that America does the right thing and stop letting corporate greed hurt us and kill us with healthcare limitations.
3
@Thinking What's the basis for your claim? You do realize that single payer is relatively unique in other countries, right? Yes, virtually every country has "universal healthcare" but in countries like Germany, Japan, and Israel the government provided care is a very basic, barebones healthcare that most people supplement with private insurance. Second, in countries that do have single payer (UK and Canada) there are very long waits to see a doctor or get treatment. Third, Medicare pays hospitals on average $0.87 for ever $1 of care they deliver to patients. In other words, they lose money on Medicare on balance across the nation. That's not sustainable.
1
@JP
The "long waits" is a line designed to scare people, as is the "bare bones". Those can be managed.
In countries where people carry supplemental insurance, the cost of that supplemental insurance is a fraction of what it costs here. Either way, the total cost per capita for health insurance is much less than under the current U.S. system, and produces better outcomes.
1
I think most people would agree we would net benefit from a Medicare for all plan, but when we think about how to get there people become more apprehensive. I think Democrats need to be discussing these details to the public. A public option is a great first step to help ease us into single payer. A buy-in(tax) from large employers would also preserve the value of medical benefits that many unions and employees have fought instead of pay raises. These details matter because they can be the difference between a blunt messy transition that would hurt many average Americans and a clean transition that succeeds and alleviates us of our currently broken healthcare system.
4
It is good that people are pointing out that medicare is not free and relies upon decades of payroll deductions before you can activate it. People are quite uninformed if they think it will drop like manna from heaven upon the whole family from birth to death. But the whole business is such a mess that it does need to be dismantled and given a redesign. The ACA does not work for many people. I need to keep pointing out that only about 20% of the populace has to navigate it. Others have private employer based which is sometimes excellent, Medicare, Medicaid or military provided. I have family members who have had horrible experiences with the options in their area for ACA plans-simply horrible-doctors disappear, clinics pop up and pop down, deductibles in the stratosphere, no real access to specialists or higher level labs and tests, long waits when sick with a serious illness. Please don't pretend it is a good option. I have employer based, union negotiated excellent coverage. But it covers only me, not any dependents at an affordable level. Add those and it is very costly but still excellent coverage. Medicare does work and does not bankrupt providers but providers had better code well and be stable enough to wait for reimbursement for months. Hospitals will not close but figure out how to be more on top of the rules. But it comes out of your taxes and requires actual co pays. Please inform people of the mechanics and costs when these discussions about policy take place.
7
The Republicans have been the best at political messaging for decades. For some reasons Democrats seem to be unable to do it as well. While it appears that all Democratic presidential candidates support health care for all they are all over the place when trying to explain how they would do it. Whatever plan they support they should stop using the term "elimination of private insurance." Private insurance will always be available to those who wish to pay for it. In the UK where health insurance has been nationalized you can buy private insurance. Perhaps we should think of it as we think of public schools in America: it's free from (pre)K through 12th grade. Private schools haven't been "eliminated." You just have to pay for them privately.
36
@Vic Losick Actually, private schools are rather consistently turning into charters so that they may pull in funding from the state and the federal governments.
2
Whatever position the nominee takes, the insurance companies & the GOP media will bombard us with scare tactics about bureaucracy & wait times and whatever they can dream up to prevent an honest discussion. Whatever policy eventually emerges from whatever president will be a matter of politics in that future moment. What matters now is how to most effectively speak to & over the propaganda.
We’re constantly told that most Americans love their private insurance, but all I hear are complaints about lack of choice and outrageous charges (& wait times & bureaucracy). I think “moderates” & Republicans are more attached to their fear of Democrats than they are to their insurance.
In many ways, adding a public option seems wisest. Unless the GOP is able to sabotage it, there will be a growing landslide by individuals & employers, and private insurance will be a relatively small part of the equation very soon. But the insurance companies easily vetoed the public option last time, so I wonder if it’s more practical to call them out from the start for what they are (people who get rich by rationing health care) & try to marginalize their voice. Also, in a political-media system that’s designed to encourage fighting & suppress debate, I wonder whether the radical position isn’t an easier case to make? I don’t know.
19
Given that most Americans purchase a supplementary policy to go along with Medicare, inasmuch as the current program only covers 80% of expenses, any effort to abolish the for-profit industry would necessarily involve completely re-visioning Medicare itself from both the patient and supplier perspective.
Such legislation is the business of the House and Senate, not the Presidency. Hence, unless Democrats regain a commanding majority in the Senate (with or without the non-talking filibuster), I fail to see how any of this is accomplished.
Anyone who remembers the Senate Finance Committee "gang of six" negotiations will recall how torturous those negotiations were. It wasn't just Republicans who were objecting to suggestions that rural hospitals be content to be compensated at current Medicare rates.
It can, in fact, be argued that from the perspective of the hospitals, Medicare has been riding on the back of the largess of the for-profit insurance industry.
The Medicare system that would emerge from the elimination of private insurance would surely be significantly more expensive than advocates imagine.
Which is not to suggest that we should not attempt to completely transform the American health care system - but only to emphasize how challenging it will be, and much time and cooperation it will likely require.
If Democrats over-promise on this issue, they are merely setting themselves up for failure in the next mid-term election.
Realism is our friend.
5
@Matthew Carnicelli - "It can, in fact, be argued that from the perspective of the hospitals, Medicare has been riding on the back of the largess of the for-profit insurance industry."
Read my comment just below yours. This is not true.
@Len Charlap
From the article you yourself cite:
"Experts we spoke with offered a different take — mainly, that his evidence is not strong enough to support his claim. In addition, they told us that the potential impact of Medicare for All on hospitals would be much more nuanced — it is not at all clear that “every single hospital” would close, and while some would do worse, some might do better."
***
"Analysts noted that Delaney is getting at something real, and important. Medicare for All would represent a seismic change for hospitals. Figuring out how to pay them would be complicated and must be done carefully."
“It is not an easy — it’s not a wave of the hand to fix this,” Blumberg said."
***
I support a slow, careful, politically-sensitive transition to a full federal system - but one that leaves a safety valve for those unwilling to put up with the compromises that will doubtless be entailed, and have the cash to pay for it.
As it is today, we have Canadians who come here for quick elective surgeries. We are their safety valve. Which national system will be our safety valve?
Gosh Matthew, you seem to know every myth there is about health care. Now we have the myth of the Marching Canadians. Here is the definitive study:
http://content.healthaffairs.org/cgi/content/full/21/3/19?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=snow&andorexactfulltext=and&searchid=1
Here is what they say:
"the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the
amount of care provided by their own system."
Here are some figures:
"These findings from U.S. data are supported by responses to a large population-based health survey, the NPHS, in Canada undertaken during our study period
(1996). As noted above, 0.5 percent of respondents indicated that they had received health care in the United States in the prior year, but only 0.11
percent (20 of 18,000 respondents) said that they had gone there for the purpose of obtaining any type of health care, whether or not covered by the
public plans."
And if you read the study, you will see that most of the Canadians who come to the US for Health care are sent here and paid for by their health care system because they have a rare problem that we see more frequently than they do because we are 13 time larger.
In case you think this data is out of date (although I don't know why that should matter) more recent data is at https://www.quora.com/How-many-Canadians-seek-healthcare-in-America-and-hate-their-own-system
Here is a careful examination of former Maryland Representative John Delaney statement that a Sanders-style Medicare for All that paid current Medicare rates would result in the closure of hospitals.
https://khn.org/news/delaneys-debate-claim-that-medicare-for-all-will-shutter-hospitals-goes-overboard/
They point out that the reason most hospitals that are in financial difficulties is not due to what Medicare pays them, but the the number of uninsured patients they MUST treat under law. MfA would pay for these patients greatly increasing the income of these hospitals.
The next point to consider is that is is generally believed that because Medicare does not pay enough, hospitals must overcharge private insurers to make that up. This is called "cost shifting." If this were the case, then hospitals with a higher percentage of Medicare patients would have to charge private insurers more than those with a lower percentage. There would be a correlation. There is MedPac data that shows that no such correlation exists.
The hospitals that charge private insurers the most are large hospital chains that have an essential monopoly in a an area. These “have high staffing ratios, generous salaries, engage in capital expansion and have billions in reserves from ‘retained earnings’. The reserves alone would forestall bankruptcy for some time.”
Finally there is no reason to believe that MfA would pay all hospitals at the same rate. For example, rural ones might have higher rates.
23
@Len Charlap
Thank you for adding some meat to this vacuous opinion piece. I highly recommend that people read the link in your comment.
1
Perhaps the best solution to the issue of health care would be to include the public option -- that would in principle be Medicare-- to the ACA, while at the same time allowing those who want to retain a private health care plan provided by their employers the opportunity to do so. In time, market forces will prevail and most -- if not all-- will transfer over to the Medicare for all option, because private health insurance will no longer be competitive.
Not having to maintain an employer-based health insurance program would offer economic benefits for a large segment of the population as well. Since Japan has a national health insurance program, their auto makers do not have to provide health insurance for all their employees, thereby reducing the price tag on imported Japanese cars by as much as $4,000. That is an important consideration, and one that is often ignored in all of this discussion. However, none of this will happen unless Trump is defeated. He did fulfill one promise that he made about offering an alternative to the ACA. It's quite simple and straightforward. It's called "You're on Your Own".
4
The trick, of course, is to make people separate health insurance from employment status gradually and seemingly voluntarily. (Linking health insurance with employment status is a historical anomaly from the World War II era that no one thinks is a very efficient way to provide care, and no other nation still does so.)
I believe the compromise position is a public option/Medicare "for anyone who wants it" plan that will allow a gradual transition. Many employers would be glad to offer it--it would simply be much simpler administratively-- and over time many employees would opt into it--and, of course, many who were not traditionally employed could be covered by it. And, with sufficient membership, premiums would be a lot lower than they are now, and likely lower than they are for current seniors, given the potential huge younger pool of patients. Not that there wouldn't be costs, but eliminating most of those insurance middlepeople and the more than half of all health care staff devoted just to reimbursement would help keep that lower than now--possibly much lower. (Not that we shouldn't strive for more progressive taxation to help with this anyway.)
And, of course, "if you like your current insurance, you can keep it". But I suspect over time, most wouldn't.
This is the way you get to a version of single-payer or a mixed system over time--there can still be room for niche private insurance such as exists in other nations.
11
Right now, the democratic party, or one or more of the candidates needs to put out a short, maybe two page, outline of what their plan would look like---frame that issue right now, on paper. What that plan should look like is a list of improvements to Obamacare--the ones that have been floating around Congress for the last two years. Whoever ends up running against Trump cannot be boxed into any plan that could be branded socialistic---now is the time to throttle back on this issue to the comfort level of most of the public.
Requiring and allowing all Americans to participate in a Medicare for All system is flawed. I am really disappointed that Warren jumped on this Bernie bandwagon. Maybe she's trying too hard to be viewed as a progressive. I support Medicare for Some, e.g. the uninsured or those who can't afford their private payer premiums and co-pays insurance. I also support making the public option available, which Obama and Red State Democrats) chose not to do in 2008, to appeal to Republicans. The bottom line is all Americans don't need or want subsidized health insurance.
1
@EGreen
"The bottom line is all Americans don't need or want subsidized health insurance."
All Americans already have subsidized health insurance. Private insurers' business model is based on shutting out some people and some conditions, and the government subsidizes that model by picking up the tab, whether through Medicaid, or the safety net needed by people bankrupted by uninsured treatment.
1
At present, medical providers of all types have difficulty with Medicare reimbursement rates in part because they have no way to reduce a costly item of overhead that would disappear with a single payer plan.
What is not mentioned in the health care debate is that the cost of service goes down for medical and mental health care because any form of single payer drastically reduces the need for an army of clerks specialized in billing. Hospitals and medical offices spend a huge amount of effort chasing reimbursement with insurance providers using every trick they can find to deny payment.
My husband and I are both mental health professionals. Our billing service (all offices need to purchase special and expensive software available only from the insurance provider to do billing, hence the hiring of a billing service) dropped all of its mental health providers because they could not make a profit. The hoops to reimbursement are byzantine. Example, services that had prior approval - as all mental health care must have - are denied payment for months because of changes in codes issued after bills were submitted. A provider can wait up to six months for reimbursement through strategies created to stall and discourage re-submission of a claim. Call it what you will, having one payer to submit a claim to will create a huge reduction in overhead, which in turn reduces the need for higher reimbursement.
71
@nora m Right, if only we had a highly efficient government bureaucracy of full of motivated, genius IQ level government workers reimbursement would be prompt and easy! Because the government does such a good! HUD housing is a dream! The TSA respects your privacy and gets you through airport security in record time! All vets love the the healthcare they get through the VA and are never denied treatment or help!
Get a clue, pal. The people who will be hired to do the billing for whatever new government monstrosity is created to handle reimbursement of care costs will almost certainly just hire the same people from private insurance that are already causing you problems. Only this time around those people will be making even less money and will not have profit to motivate them. They'll do as little work as possible while waiting to run out the clock on early government retirement with a fat pension plan financed by taxpayers like us.
1
@JP
FACT CHECK
As Paul Krugman and others have reported, the Koch brothers have been spending hundreds of millions of dollars to discredit the Veterans Health Administration and promote privatization. First they tried to get the traditional veterans' organizations behind it. The veterans knew that VA care was, overall, the best you can get in the country, and sent them off. Then the Koch brothers created an astroturf veterans' organization, but that fell apart in a comical disaster.
Veterans can always find things to complain about, like waiting times or parking. But VA hospitals are better than private hospitals in the outcome that really counts -- saving your life.
In a pair of articles in the Journal of the American Medical Association, the VA compared outcomes of the major life-threatening diseases in VA and non-VA hospitals. Patients were more likely to survive in VA hospitals.
For example, patients with acute myocardial infarction had a death rate of 9% in VA hospitals. The death rate for matched patients in non-VA hospitals was 14%.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2618816
June 2017
Initial Public Reporting of Quality at Veterans Affairs vs Non–Veterans Affairs Hospitals
Eddie Blay Jr, et al.
JAMA Intern Med. 2017;177(6):882-885. doi:10.1001/jamainternmed.2017.0605
Free Access
I don't suppose you've ever heard government employees talk about "giving something back to your country."
9
@JP
Taking care of the sick and injured is not profitable. It is by definition a money-losing proposition. Which is why insurance companies are happy to palm off the citizens who are most likely to get sick -- the elderly (Medicare) and the poor (Medicaid) -- onto the taxpayers, while they keep the healthy ones. If and when any of those healthy patients fall truly sick and starts to slow down the gravy train, hey, no problem! Just inform them that the expensive anti-cancer drug their doctor has proscribed is not included in your formulary. Better still: assign them to an "out-of-network" doctor.
This is why the United States leads the world in medical bankruptcies -- among people who HAVE insurance! Profit uber alles.
7
Since the passage of Social Security, conservatives have been trying to dismantle it. Likewise with Obamacare Mitch McConnell and the GOP Congress tried about 50 time (?) to eliminate it. Yet, the public understand the value of the program. Has Mr. Obama’s Obamacare failed? No! ... at least not yet.
3
Has a "Medicare for All" proponent ever publicly admitted that Medicare is not free? It costs about $130 per month per person, but few people notice because that money is usually deducted from a Social Security check.
That is still a great deal, especially considering the age adjusted risks for those it covers, but do these candidates really expect a family of four to be coming up with $500 per month out of pocket?
9
@Jim S.
Although Medicare as it exists today does have premiums and additional out-of-pocket expenses, my understanding is that the healthcare proposals being propounded by Mr. Sanders and Ms. Warren would have no premiums or any out-of-pocket expenses whatsoever.
1
@William Wroblicka Which ought to highlight for you just how expensive the program would be. Currently hospitals get $0.87 for every $1 they spend on average treating Medicare patients. So the cost estimate $30 trillion that was based on current reimbursement rates is woefully low.
Then you have to factor in the illegal immigration decriminalization police of Warren and so-called "progressives" and the reality is it would likely cost us $50 trillion as we're soon subsidizing free healthcare for millions of Central American families with minimal education or earning power.
1
@Jim S.
Do you know what a family of 4 is paying for an ACA ( Obamacare policy ) ? Often it is a $6,000 deductible per person and way over $ 1,000 a month in premiums. A lot of middle class working families would jump for joy at $500 a month. If you are too poor to afford that and many are you are probably in Medicaid territory.
Democrats need to stop focusing on the minutiae of proposed solutions to the medical crisis in America. No Plan can ever be implemented if Trump is not defeated. Don't argue about whether there should be no private insurance, some private insurance, Medicare for all, an improved Affordable Care Act or something else. All must agree that there is a crisis and that the only thing that matters is recognizing the existence of the crisis and defeating Trump. There can be no solution without a victory. Focus on unity and harmony and stop destroying all candidates.
57
@Disillusioned
While a nice sentiment, the reality is that only one of those 20 candidates will be running for president as the head of a Democratic ticket. Choosing which one requires knowing what their plans will be for key issues before the electorate. A generic response of “something needs to be done” could be used by both sides (Republican and Democrat) in the general election with vastly different meanings. As the old saying goes, “the devil is in the details”.
1
@AS Pruyn - "…requires knowing what their plans will be…". Why? The only plan the (R)egressives have put forward is, "let 'em die in the streets if they're not a major donor" and the ill-informed continue to vote for them.
3
@Disillusioned - You cant defeat Trump just by chanting "Trump is bad." You have to offer policies that are better.
3
One of the many discussions absent in the rush to embrace Medicare for All is how this becomes law. A problem linked to proponents' failure to note that Medicare only pays part of hospital bills and reimburses hospitals and doctors at rates that neither group's powerful lobby is going to accept. Love or hate Obamacare, at least its proponents had a winning strategy for making it law. They acknowledged and dealt with the enormous power of those who could block it -- not only the easily demonized insurance lobby, but the AMA, hospitals -- people who can and will stop anything they strongly object to from becoming law. Too many have forgotten how effective the 1990s "Harry and Louise" ads were.
18
@Dave Scott
The elephant under that rug of reimbursement for services rendered is the high cost of billing personnel. An army of clerks in every hospital, outpatient facility and private office is needed to get prior approval, submit a bill for services coded differently by every insurance plan - and even for plans within the same company, and follow the claims for months waiting for reimbursement.
We complain when we have to jump through hoops for insurance reimbursement. What individuals go through to get an ostensibly covered service paid is repeated daily in medical facilities across the country.
This can stop. We can get better care for less money. All we need is push for it as relentlessly as the insurance lobby does to prevent it from happening.
15
@Dave Scott - Actually several surveys of physicians have found them in favor of MfA. One of the reasons is that the compliance costs of dealing with 1,500 different insurance plans plus an equal number of Medicare part D plans is enormous. Doctors and hospitals are will to give up a significant part of their income if these costs are minimized by having everyone on one plan.
Another reason is that Medicare payments are not as low as many conservative claim. Here is a computation from 2012. The figures, of course, would be substantially higher today.
http://healthaffairs.org/blog/2012/10/02/do-medicare-and-medicaid-payment-
rates-really-threaten-physicians-with-bankruptcy/
The author, a private practice orthopedic surgeon, looks at orthopedists and family doctors. He finds that an orthopedist who had only Medicare patients
would have a take home income of $411,000. I could live on that.
A family doctor who had only Medicare patients would end up with $137,000, a lot less, but you know I could live on that, too (which is more than I ever earned) if I didn't serve Chateau Petrus on weekdays.
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@Len Charlap We will see, or we might. I am skeptical that the AMA supports MfA without lots more money for doctors. I am certain the hospital lobby won't, and even insurance companies will hire smart and effective media strategists, as they did with the Harry and Louise ads. Proponents underestimate how possible it is to block a majority for legislation. Or to make an issue a liability for candidates in November.
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