It's all about the republican-Reptilians; They are NOT interested in having the government (Except THEIR gold plated system as "our" representatives) provide any benefits for the public.
Republican's engineer the systems to create bureaucratic barriers to access. I had recent problems with both the VA and my efforts to enroll under the ACA; The VA, where there just are not enough resources ("Money") in the system for out of network specialty care (Cardiac rehab after bypass surgery is exotic?), with the added joy of negotiating with people in a contract center in Mississippi (WHY should red states get that contractor money?); The individuals and caregivers from the VA were helpful and willing, it was "Proving" my need to the third party administrators. (I have this scar on my chest; How much proof did they need?).
Trying to get my ACA subsidy"? Another complex story. They really have built a system around denying payment.
6
Let me know how you feel about the NHS a year from now.
Lost in the conversation is that, while American health care costs are the highest in the world, US life expectancy is dropping. https://www.cdc.gov/media/releases/2018/s1129-US-life-expectancy.html
8
A lot easier to manage in the U.K., with a 60 million population versus the 330+ million U.S. Probably wasn't such a swift idea to double the American population since the 1960s with a lot of 3rd world legal and illegal immigrants that divert resources and divide voters into factions.
2
This is probably a dumb question, but why was Medicare Part D given to the private insurance industry?
7
The healthcare mess, the border disaster, the budget deficit.
We have a crisis in this country, about 50% of the population doesn't want to or care to understand what is going on and vote intelligently. They just know abortion is bad hence that is how they vote. Sad!
11
Get the politicians actually working and have them go on study trips to some of the many countries that long ago solved what to them seems an intractable problem they have so far been unable to adress, let alone solve.
Perhaps seeing up close and for real all the many ways and means so many other nations have managed to cover all their citizens with effective, affordable and safe health care...they will be shamed into actually acting in the people's best interests and providing the greater welfare that others have achieved for their people decades ago.
If they refuse or continue to do nothing , fire the bums and get someone who can do what hasn't been done...NOW.
If Rwanda and Burkina Faso can do it...surely the greatest Nation on Earth can.
Can't it?
4
I've been on Medicare for more than a decade...I have never had a problem navigating the system, nor have I had Medicare reject one of my submissions.
And anyone that buys into one of the Medicare advantage programs is just throwing good money awy.
6
I am delighted to read that someone has been asking the same questions as I have, listening to both the Medicare for All and the Public Option "solutions" to our insanely clumsy and ineffective health care system. I fear that either will be years in the making, if ever achieved. Get ready for "death panels" threats and "let's throw the baby out with the bathwater" struggles. Surely we Americans are just as smart as the rest of the civilized world?
2
Folks
You've been had (you being US citizens).
You are the wealthiest large country in the world, and yet somehow your vested interests have persuaded you that as a nation you cannot afford universal healthcare.
Even more startling , your vested interests have managed to get you to pay vast amounts of money to end up with overall outcomes that are much, much worse than you should have.
Of course the care for the top end is the best in the world.
But, from the outside, this looks like yet another fraud perpetrated by the wealthy in the US on the not-so-wealthy, a system designed to give plutocrats the best care that money can buy and yet deprive others of any care at all and setting many others to a perpetual state of fear about whether they will have cover.
The designers and defenders of your system were identified a lomg time ago.
He lieth in wait secretly as a lion in his den:
he lieth in wait to catch the poor:
he doth catch the poor, when he draweth him into his net.
9
Administrative obfuscation, deception, inefficiencies, and absurdities aside, there is one extremely important reality that neither the authors, the Democrats, nor the Republicans address: what good is insurance, private, public, single payer, Medicare, whatever, if there is no effective access?
Back during the winter, the Albuquerque Journal reported that the state's larges medical plan did not have a single primary care physician accepting new patients. Along with discussions of medical insurance, there needs to be discussions of how to encourage more people into the medical field, especially in primary care. Anyone who lays claims to lead our country needs to address that issue, if they are to be taken seriously when speaking about health care.
Around six to nine times every month I receive various statements concerning costs from my insurer. While I may not be particularly smart, I am not particularly stupid either. Not only are these statements truly incomprehensible but when I call Customer Service, the people at the other end can't explain what it means either. However, with each one or two pages of statement, I receive another four pages guaranteeing that I have a right to not understand the smokescreen in my choice of seven languages.
Though the authors are clearly right about the counterproductive, often absurd, barrier-creating administrative burdens for patients, the actual financial cost to the entire health care system of such is also substantial.
4
Wealthy people, in America are good people. People who have been making money off of misery and sickness, are good people. So it is really hard for us to take away these good people's source of income.
Now, in any healthy society, the fate of the profiteers who make money off of the death and misery of others, the health insurance companies and salesmen, the benefits managers, the corporate human resources departments, would not keep us up at night. These folks should not be making money, and the blood money they have made should be irrelevant in our decisions.
But this is America, and we can't make these "good people" suffer! We must keep their pockets full, and praise them. After all, the only measurement of a person in America is the size of his or her (well, let's be honest, his) bank account.
5
i have medicare with blue cross blue shield medigap. i love it. i have leukemia and would be bankrupt with medicare alone. do not kill private insurance.
2
The friction in our current system is excessive, expensive, and totally unnecessary.
6
I wanted to add something about my Medicare Advantage plan. I have a serious chronic illness & did careful research to find a primary care doctor in my plan. I wanted someone knowledgable about my disease.
I found someone who specializes in my illness, affiliated with a good hospital & excellent patient ratings as an attentive, kind & knowledgable doctor. When I called to make a first appointment, it took 11 months to get an opening for a first appointment in his practice. I took it because I had another doctor I could see in the meantime but most people would probably not have had the luxury of waiting nearly a year to get an introductory appointment with their choice for a primary care doctor.
10
A neighbor here in Kentucky recently visited France and somehow got sick there. A day or two in hospital, some prescription meds then 1-2 visits by healthcare workers while recuperating in his hotel. Then before heading home, he got a bill. He was shocked - it was only about $50!
17
The Japan system is pretty good. Its a kind of hybrid with all companies paying towards part of employee costs, usually about I think 30% maybe more. With non working people paying for or getting insurance from the government depending on their situation. It means that costs are kept down as there is not an incentive for private insurance companies to make profit and also that on the other side of paying for medicines etc govt and companies have an incentive not to want to pay much.
The service is excellent and the costs low in my experience . Low admin and no coverage worries
3
I have worked in healthcare for a long time, including jobs in insurance. It's always been my possibly paranoid impression that the entire insurance industry is aware of the difficulties of navigating the system, and they construct it to make care harder to access. It takes a particularly savvy and motivated individual to figure it out without having made a mistake first, and then paying dearly for it. Your article explains so well what I have thought for years: both private and public insurance are too complicated for the everyday citizen to decifer, and now they have become hopelessly enmeshed as well. We could do well by studying how it's done in other countries that have successfully kept prices fair and reasonable (or free), their standards of care high, and their enrollment process and navigation much less complicated while also operating in a free trade environment. Social programs and free trade are not mutually exclusive.
15
We switched from private insurance in the US to Italy’s national health service (Servizio Sanitario Nazionale) two years ago. So far the quality has been excellent, wait times minimal, & nearly all of it free (with the exception of a couple of extremely low co-pays, e.g. 6 euros for my son’s ECG so that he could participate in a sports festival—not medically necessary, and it was that much only bc we’re not in the lowest income bracket).
But one of the biggest differences is in the paperwork: there’s no paperwork here beyond what’s medically necessary (ie prescriptions). It really makes you think about, & despair over, the vast wastage that goes on behind the scenes in US healthcare. I also imagine that, for those with serious health problems, there’s the added benefit that you don’t feel as though you’re fighting with an unseen enemy, that one mistake in filling out a form might mean the difference between care and no care.
23
I do think most of the people who want "Medicare for all" don't realize what Medicare is like, and think it's free and easy. Politicians, if they ever enact a universal health care plan, may change the need for supplemental insurance and might correct some or all of the problems noted in this op-ed. Personally, I spent about $200/month for my Medicare premium, about $50/month so that it pays for more than 80% of my medical costs. This is affordable for me, but it isn't free and isn't affordable for everyone. The premiums may be less for those with lower incomes, but the cost of supplemental insurance may be higher than the deal I was able to get due to my particular job before retirement. But it's not like going to the doctor in Canada and not having to pay.
7
I live half-time in an Eastern European country that has excellent, caring doctors and slightly shabby but well-run hospitals and clinics. Paying out of pocket (i.e., not yet on the public health system) at the fanciest private hospital, I see doctors and specialists for $15-30 per 45-minute visit. Repeat, 45-minute visit. With a nurse in the room the whole time, helping. The doctors almost all speak English and I know from experience with my chronic health issues that I am getting up-to-the-minute care with full knowledge of the latest trends.
I had an MRI last week for $125.
Most important is the extraordinary difference in the cost of medications. I buy European-made prescription drugs for less than my USA co-pay had been - typically $3-5 each. This is for European-made drugs and not the Chinese and Indian generics that my USA insurance forced us to take.
Back in San Francisco, even with my excellent and very affordable Obamacare, I rarely saw a doctor for longer than 15 minutes.
It is literally a risk to my health to return to the U.S.
13
Another minor but significant gotcha: if your insurance company does not agree that a given test was “necessary for your diagnosis,” not only will it not cover the cost, but it will not reprice the test so that you pay the lower rate the insurance company would pay. That’s how I ended up forking over $242 for a $5 vitamin d blood test. As with most US health care billing, it would be impossible for me to know in advance that the vitamin d test would not be covered for my diagnosis.
14
One of the problems is that American government (and frequently non-government) bureaucracy is close to the worst in the developed world. Inscrutable language, unnecessary complications, disjointed government efforts, legalese, multiple state v federal complications... the list goes on and on.
8
Once you take social security when you reach 64 3/4 years of age, you are automatically enrolled in part A. My card came in the mail, and I purchased a supplement with the help of a group called SHINE. (Serving health insurance needs of the elderly). A volunteer explained what options were in my county.
Unfortunately, there is great difficulty in getting Medicare and social security disability if you are under 65. There are a few people who will fake a disability and continue to work under the table, or live a full life while collecting under these two categories. The cheaters have made it immensely difficult for those truly in need.
Medicare is not like a commercial plan which can have extremely difficult rules to follow. They have a rule book that spells everything out.
Why not expand Medicare in five year increments? First, to 60-65 year olds and so on down the line. Eventually everyone would be covered. Not perfect but for all those physicians who do not take Medicare it will give them time to adjust.
And a reminder, Medicare is not free. I pay over $225 per month (a bargain) for an excellent plan. So for a family it is still going to be a financial burden. There is help for low income seniors, but you have to be very poor to qualify.
4
As someone who actually worked in both systems ,I can share some perspective.
Both systems have drawbacks as many have noted,but if you ask the question which system works for the vast majority ,the answer is the NHS.
Politicians of all stripes have conned the American people into believing they have the ‘.greatest health care in the world’ and any change would be ‘loss of our freedom and liberty’
20
Dear Professors,
My insurance of 20 years got cancelled with Obamacare roll out in middle of a treatment regiment at Stanford. ( never found out why insurance that pays all costs no questions asked for treatment at Stanford would be deemed substandard) and I lost access to those HCP’s. Fortunately I turned 65 soon after, went on Medicare, bought relatively inexpensive private supplements, and can again receive care where I need to. Out of pocket again is zero. If you touch my Medicare I will not only vote for whoever is not you, I will even send them money. Act of self preservation.
7
One thing's for certain: America will never have comprehensive, affordable health care for all citizens as long as Republicans are in power. Vote them out.
24
When I reached age 65, 12 years ago, I signed up for Medicare A & B. As best I can recall I did it on the internet, and it was easy. A year later, the same for my wife. It's worked great for both of us (with the exception that I had to change from a specialty physician who didn't take Medicare, but who I didn't like much anyway). We've had injuries, my wife more so than me, that have been taken care at reasonable cost to us. (We don't have insurance to cover things not covered by Medicare.) Our B premiums are subject to a substantial surtax on account of our retirement income, but I have no problem with that.
We also signed up for Part D and have a private plan, of course, for that. It is completely opaque. Our provider is helpless when it comes to explaining things. However, I feel like we are getting value -- but no way to tell (thanks to Congress's writing of part D).
4
So the authors are spending a year in the UK. Wonder who's picking up all those extra taxes? Housing? Everything has a cost and, therefore, a price. Since they came from Georgetown, DC area, they're certainly part of the privileged elite.
The US has the broadest available types treatments compared to other countries. Things that other parts pf the world can only dream of. That is part of the problem. We are all forced to pay for these orphan disease treatments. In other countries these options are just not available.
Personally I'd be very happy with a single payer health care system. I'm tired of paying outrageous premiums with huge deductibles for a worthless plan. The only problem is it's highly doubtful that the powers that be would be able to do something like that correctly. After all look at what happened with the ACA. It's certainly not affordable and nothing was done to address the cost drivers.
3
Yes.
I had universal health care while in Israel. Those who know Israel will understand why I nearly fell off my chair when I realized that something in Israel was more efficient than something in the US. US healthcare is in my experience stunningly cumbersome.
I am back in the US, and also have a child with disabilities. He has Medicaid for the expenses that my job-based medical insurance doesn't cover. I must first say that it is wonderful to have Medicaid. But I have also run up against the dizzying options this article mentions, and I have wondered why tax dollars are funding all these private mediators. The program offers some babysitting. That is wonderful, because a special needs child can be a lot to take care of. However I have rarely successfully gotten a babysitter. To use the benefit, I must first choose one of a long list of private companies who manage the benefit. Then intakes. Then I have to look through a long list of private companies that provide the babysitting benefit. Another list for the music therapy benefit. And so on. Some of these companies look good but are disorganized; not much oversight. Once I choose, I have to get the management company and the babysitting provider to exchange forms and permissions and things. Then we all have to meet and fill out stacks of paperwork. Then it turns out the private company that provides the babysitting doesn't actually have any sitters. On to the next company. And so on.
7
"Medicare for All" does NOT expand Medicare as we know it today. M4A is single payer health care--all expenses are paid by the government, but all practices and hospitals are still privately owned. There are no premiums, co-pays, drug plans, or deductibles. The administrative hassles for patients and physicians are relieved.
Money goes to health care, not insurance companies.
Doctors are paid the same for each patient, so there is no restricted access based on insurance (yes, this exists). No one is uninsured.
Drug prices are lower.
Best bill to date: HR1384, introduced by Jayapal from WA. Hospitals are given a global sum based on past budgets and are not paid at current Medicare prices, which do not cover expenses.
Learn more at pnhp.org (Physicians for a National Health Program). Support HR1384.
10
With all the muck and resulting confusions, Democratic presidential candidates are missing the key, truly only, point about single payer.
It's this simple. In Great Britain, their single payer costs less than 10% of GDP. In the U.S. our convoluted system of greed cost nearly 20% of GDP.
The difference is private insurers and their greedy brothers in pharma, hospitals, equipment, testing......
Take them out of the U.S. system, and we'll save 50% on medical costs, and have better/more efficient care to boot.
Now, who wouldn't do that?
11
Another common argument I hear against going to a single payer format is, "under single payer doctors won't make as much money and how are they going to pay off their medical school bills!" Well, let's connect this overhaul of Healthcare with wiping out student loans and free up a couple of generations to pursue the healing and education of our American public without having to worry about carrying decades of crippling debt for the privilege!
In addition, doctors in private practice are often overwhelmed by the costs of running a business where half their time has to be spent on the very complex paperwork that goes into taking different health insurance plans. This often means 1) rushing through patients because the more you see the more money you can make to go towards aforementioned student loans and business costs and 2) doctors being driven away from GP, Family Practice, and preventative care because it isn't as lucrative and often can't support a local office practice. This is bad for doctors and bad for patients.
Single payer national Healthcare - we deserve to be treated like valuable humans in our country. It's time we demanded nothing less!
10
On two occasions in recent years, we had to ask for intercession by our Congressman (Adam Shiff) to correct patent errors by Medicare. In both cases, the agency reversed itself almost immediately. I'm not sure who to blame: the low-bid private contractors hired to actually review claims, the rules themselves that make Medicare more like private insurance in the goal of denying coverage, the incompetent direct employees of Medicare, or probably some combination of the three. In any event, there is no good reason at all for this mess. Adam Schiff has better things to do.
5
Before everyone runs headlong to something like the NHS, be aware of some of the issues. Most countries with "free" healthcare have much higher social insurance personal taxes to cover some of the bill. Most countries are paying ever more cash for its older longer living citizens who need ever more expensive medical treatment. The funding gap is filled by government debt. Free healthcare countries make difficult decisions on what drugs are covered even with their strong bargaining power with drug companies.
If Free heathcare arrived tomorrow, there would likely be crowds of citizens arriving at doctors and hospital treatment. Could hospitals and GPs cope? Many countries are investing heavily in preventative treatments to reduce the future cost of sick people. Can you exclude coverage from the rich who can afford insurance. How much will taxes have to rise. Does the US Gov/State cover the gap and what percentage. How can you pay for expensive medical staff. Who decides what treatments are covered for "free". Do you cover citieznes with illnesses related to obesity, smoking, alcoholics, class1 drug dependents.
Finally how do you get rid of the private insurance providers who will lose billions in profits? Lobbying works in the US.
6
@Stephen Doherty The mean total tax rate in the US is 37% with a range of 35% to 39.6%. The mean total in the UK is 45% with a range of 40% to 50%. However, if you treat health insurance premiums as taxes the mean total tax rate in the US is 47.2% with a range of 41.2% to 53.3% and the UK has a mean of 45.9% with a range of 40.8% to 50.9%. One covers everyone and the other does not. The US gets less bang per buck and fails millions.
4
You do what Canada does. As quickly or as slowly as you can . Why do Americans allocate their taxes to vast armies, and not to more socially desirable goals, ( just an example). Why do Americans smile at the trillion $ deficit this president has run up in two years, and still say they cannot treat their citizens as OECD countries do? And why do they, then think that they are ‘the best”? Beats us.
6
How to provide healthcare and pay for it is no doubt a real problem and I couldn't begin to suggest a solution.
However, when people say they support "Medicare for all", please make sure you know what you are supporting.
I have on my desk a "Medicare Premium Bill" sent out by the U.S Dept of Health and Human Services. The bill is for my premium payment to cover Medicare Part A and Part B.
The premium is $433.40 monthly. Now, I am working and the premium is calculated on the "ability to pay". But as has been pointed out, I'm paying this at age 66 (for coverage on just myself) after having paid Medicare taxes for over 40 years.
Additionally, I still have a monthly premium to pay for Medicare Advantage. Plus a premium for Part D drug plan and a separate premium for vision and dental.
So you shouldn't think that "Medicare for all" necessarily means either "free" or simple.
8
Americans should know that there is a middle ground with healthcare. You can still provide good coverage for those that can least afford it, while making wealthier dip into their pockets to at least pay partially for their health care. In other words, you can cover everyone, and yet still allow doctors to become rich which seems to be what American want.
2
Before beginning on Medicare, five years ago, we paid $35,000 that last year for my medical policy alone, excluding steep copays and prescription costs.
Today, I pay more than $12,000 a year for my Medicare, Parts A & B, prescription coverage (a farce), prescriptions alone (a bigger farce), dental insurance (fine as long as you use it for cleanings only).
My gross annual income nears $30,000.
We lost a third of our combined retirement in the 20 years since I lost my newspaper reporting job, with benefits.
Buy drugs from Mexico or Canada and they can't be claimed as a medical deduction. Use mail order there or here, and count on mistakes.
To Dr. D: I'd like to know what's nonessential care. Doctors are part of the problem, too. They force you to go to one specialist for your right pinky and another for your left.
They want to SEE you because they only get paid for visits now. So, because one of mine won't call, it'll have been three months without discussing - briefly - test results which showed "a bit of worsening" in one of my conditions.
This, after having promised my husband years ago and told me recently that he would call. Instead, nurse practitioners, who can't answer my questions, say, "We don't do consults by phone." I wasn't asking for a consult; just had a simple question.
CHANGE THIS SYSTEM! Single-payer, much less paperwork, less reliance on unnecessary computer-generated information and phone messages.
JUST GET IT DONE!
12
But, but, but, Socialism! Ronald Reagan warned us about this!
'Murca! Woo!
4
On the other hand my healthcare stocks fund has done very well. Thanks, Republican voters! Keep voting Republican, and don't forget to die before you get too expensive.
5
US discussing healthcare since the Clinton administration. 30years.
We can clearly say that Our health care system at this moment is not different than the Soviet government of 1980's.
This level of complexity doesn't stand against the money concerns. Final word is always said by money.
Our health care system consumes way more money than what it produces. a.k.a Soviet government in 1980's.
Collapse is imminent.
1
It is very simple to enroll in traditional Medicare, not hard at all. The complexity comes when you have choices, like for your supplement policy and part D coverage. If you are healthy you don't need either. And yes socialized medicine makes things simple, until they decide you can't get the care your doctor wants you to have or they pay so little that many doctors won't accept patients. No care might be simple since it is no care.
2
Tennessee treats its people a chattel.
Absolutely untrue .
So called socialized medicine provides better care and better outcomes at a lesser cost .
And Medicare is simple to enroll ??
You haven’t enrolled in it yet have you ??
2
"It had never occurred to us that it could be so different." and therein lies the problem. Americans simply have no clue how health care is managed in a civilized country. They think the catastrophe they live with is normal. If they actually had a clue, it is hard to imagine they would ever vote for anyone who did not declare the only sensible option is single payer.
17
One of Trumps more honest responses...telling the Australian Prime Minister that AU has a better HealthCare system.
Of course Trump has to lie about any and everything immediately bragged, “We are going to have great health care, very soon.”
Grifters are gonna' grift; and 'merica is full of Marks.
Bernie is right.
HealthCare is a Human Right. Not Profit Über Alles'
6
Medicare For All may have been a central theme at the debates; some that was simple misuse of the language. Medicare For All is by no means the same as single payer.
Medicare For All is an extraordinarily weak solution, appealing to politicians without the courage or the good sense to stand for a real system overhaul, one that would improve life for everyone, and provide superior care at lower cost even for those already insured in their own or employer-provided plans.
Medicare For All will be unwieldy, inefficient, more expensive, and far more susceptible to manipulation by politicians and corporations.
Medicare For All is not the same as single payer.
Medicare For All is no kind of answer.
Pundits, journalists, politicians who refuse to say precisely what they favor, and precisely how it will work do us no favors.
They are either seeking cover, unaware, or simply lazy. It will cost us dearly in the long run. We need to insist on exact, complete, clearly stated answers from all these jokers.
1
Medicare is just another deeply flawed system under a master deeply flawed system.
I am a volunteer Medicare Counselor with California HICAP which is part of a national network of State Health Insurance and Assistance Programs (SHIP). I meet with both 0ver 65 Medicare eligibles and folks under 65 who are eligible due to disability. I view my role as helping people navigate the maze. Most of the clients I meet with are about to turn 65 and they have the broadest range of choices, plus the ability to enroll in a timely manner. Passage of the BENES Act of 2019, which would establish a system to notify individuals approaching Medicare eligibility, would improve beneficiaries enrollment experience. This should be the first priority of the our legistlators and presidential candidates, not spouting vague terms like "...Medicare for all."
1
The SHIP program is wonderful! I contacted the local agency for help in navigating the Medicare options available, and they helped me research a and decide on the plan I wanted. I would encourage everyone who is near Medicare age to use this FREE service to find a good plan.
1
Original Medicare plus a good supplemental plan really don't have an administrative burden. Claims are processed by Medicare and forwarded automatically to the supplemental carrier. Very rarely have I seen a glitch in this process. When I had emergency surgery and follow-up chemotherapy lasting 6 months, I never saw a medical bill or a denial of care. That being said, such coverage is not cheap by any means. I give up other things to continue to afford it.
The Brits started their universal plan in the late 1940's. They are about 75 years ahead. We have nothing resembling a universal plan
5
If she’s in the NHS she’s in real trouble. It’s a calamity.
1
Please explain how so ?
I have worked and lived in UK and can attest to the functionality and the quality of care provided.
Just compare their health care metrics to ours here and you would understand.
And our overall healthcare expenditure is much higher and with worse outcomes than in any developed country in the world.
9
@J According to the Commonwealth Fund out of 11 countries the UK health system comes top, Australia second, then the Netherlands and Norway with New Zealand joint fourth. The US comes 11th which is a polite way of saying last.
4
It's real simple...insurance companies provide big campaign contributions and get what they want. Some countries are honest enough to call it what it is...a bribe.
Isn't America great?
7
This article is a start but is not enough. It is time for the media to step up the effort of educating the public about choices for a simple and cost effective healthcare system that is so desperately needed.
7
it's like US healthcare is a hijacked system built to confuse anyone attempting a logical approach to understand costs, coverage and available plans. Add Social Security offices into the paperwork process and you have automatic racial bias thrown into the mess. Try going into any SS office and get something accomplished.
I would like to thank our legislators for decades of neglect for the sake of allowing profit-taking on an unprecedented scale. They caved to corporate lobby that has effected every aspect of life in the US and they want to call it freedom.
6
I'm a Swiss citizen. Never had to fill any paperwork before, during or after a visit to the doctor, hospital etc. Just show my insurance card (non profit in Switzerland) card and that's it.
11
I suggest people read "The Nordic Theory of Everything: In Search of a Better Life" by Anu Partanen. The abstract - "A Finnish journalist, now a naturalized American citizen, asks Americans to draw on elements of the Nordic way of life to nurture a fairer, happier, more secure, and less stressful society for themselves and their children." A good and thoughtful read.
4
Every November, I spend an anxiety-loaded month trying to figure out what insurance will cover my medical needs - I am an cancer patient. I have never given up facing the illness, but insurances push patients to the brink. As others have already pointed out, why are we grown into this maelstrom of uncertainty right when we need to focus on getting well.
I am German and I never had to deal with a medical bill there, and the choice of doctor was free. Insurance was not cheap, but it worked. Shame on America for monetizing illness.
19
Well written article by individuals who understand the need for care and how administratively confusing health care has become since a malignant mutation of the 1980s Hillary Clinton health plan called " managed care" was allowed to kidnap patients and destroy the doctor patient relationship.
2
Perhaps it's time to stop using the word "system" to describe healthcare in the US. It hardly meets the criterion of an"interacting or interdependent group of items forming a unified whole...". My own experiences with healthcare, even though I had excellent insurance, was that it was burdensome and intimidating at the exact time I needed it to be otherwise.
12
Anyone who has examined the bill(s) from a hospital stay knows there are often invalid billing claims for services or drugs that were never given to the patient. One way the government could cut down on fraud is to give a portion of any savings to patients who report false charges. People who never read their bills would suddenly be scrutinizing even the smallest charge.
2
I have a private insurance plan through my employer and have enrolled in a Medical Reimbursement Plan to get reimbursed for copays and save on taxes.
I spent 6 hours the other day doing the paperwork required to get reimbursed for copays that I’ve spent over the last several months. In addition, more than once in the last few years, more than once either an insurance provider or healthcare provider has been hacked and my personal information has been compromised. Chasing after copays, reviewing insurance payments, on the phone with billing departments to make sure they have the appropriate information for billing is time consuming. Time that I would rather spend focused on cooking healthy meals or exercising, or just doing nothing.
I know a National Health Care system would not be perfect, but what makes the one we have now, better?
12
It isn't that hard to enroll, except, arguably, for finding the drug coverage that best fits the medications you're actually taking. Once you're in a drug plan and you've figured out how to deal with the website, you won't feel like shopping for a different plan and going through the setup again.
This would be solved by a standard formulary with standard pricing, which is basically how Medi-Gap coverage works.
The article didn't mention the biggest problem I faced when I enrolled in Medicare. I had to call a large number of doctors before I found one that I wanted who had an open practice.
Eventually, I got it all set up and now I couldn't be happier with my health care and coverage, with the exception of the prescription drug coverage -- I have to pay out of pocket quite a bit for one medication -- and I don't look forward to shopping for a new drug plan.
1
I looked into getting an advantage plan. The premiums almost doubled due to pre-existing conditions. Still there with Medicare.
1
I turned 65 last year and enrolled in a Medicare Advantage plan from a major insurer which is probably not much better or worse than most comparable competing plans. TBH, I came close to throwing up my hands when trying to pick the best plan. I have a law degree from Cornell, and was an associate for five years at one of the largest law firms in NYC, and I have great difficulty in deciphering the differences when comparing plans. How can average unaided American make meaningful decisions when choosing a plan?
13
This piece is spot-on. My wife is in enrolled in Medicare A & B, plus Parts C and D through an insurance company. The forms are dizzying, frustrating, and opaque. there must be a better way
8
We need: no networks, no copays, no deductibles, regulation of health care costs. Medicine as a service not a money making machine.
17
For some, it is a money making machine, unfortunately. But you’re right, it shouldn’t be.
3
So far I have needed medical care in France and Italy. In France in the late 1970s, I don't think I paid anything for an ER visit (pretty sure I had food poisoning); I just paid for two prescriptions -- well under $10 total. In Italy in 2004, a blocked Eustachian tube sent me to the walk-in clinic of a hospital in Rome. A doctor examined me, then sent me to an ear-nose-throat specialist, who prescribed two medicines. Total cost to me was less than $20.
I don't even want to think what those two treatments would have cost a non-U.S. citizen with no U.S. insurance.
Yes, I'm sure Britain's NHS isn't perfect, nor is Canada's system, nor is France's, Denmark's, Norway's, Italy's, Germany's, and so on. But the U.S. needs to stop viewing health care as a commodity and start viewing it as a public good. There will be disruptions, and we'll have to deal with them, but this needs to happen.
20
I have been a Medicare counselor for a few years now and can confirm that the current system is unnecessarily complex and burdensome. Medicare enrollment periods can be especially confusing and, in some cases, punitive and costly. There is no easy way to compare Medicare Advantage plans (there are 21 for sale in my area) and they are adding more benefits for 2020. Medicare is certainly not free in any sense of the word, between taxes workers pay and beneficiary premium payments , deductibles and co-payments. It would be nice if the candidates spoke to these issues instead of pandering. Let's get the current system fixed before any more health care adventures.
5
Why is Pamela Herd and her family using the NHS? Has she paid into the system, is she now paying taxes in the UK to support the NHS? I doubt it very much.
As a visiting professor to Oxford, she is not in the true sense of the word, a resident, and the NHS is a health system primarily for residents of the UK - although visitors to the UK can access emergency treatment.
Why has Ms Herd not taken out private medical insurance to cover her stay in the UK? (as any foreign professor/student visiting the US is expected to do) Why does she feel she is entitled to use the NHS? While she praises a single payer system she has not paid into it, which would only then make her eligible to use it.
So pleased she enrolled so easily, got her appointment within 2 days and her prescription for medication - which was 'free.'
.... and, of course, let us not forget the financial relief she felt.
The NHS is only free at point of service. British taxpayers have paid into it for years, a point Ms Herd conveniently ignores.
4
A visiting professor living in the UK for a term or a year is certainly a “resident” - residing and working, not visiting, the country. It has been a few years since I was a U.S. student in the UK, but at the time, the cost of getting a student visa included a surcharge specifically earmarked for the NHS.
5
@Paul Everybody legally resident in the UK can use the NHS but some non European nationals have to pay a $600 annual surcharge.
1
She knows that. She wants to pay into a similar plan in the US. Lotsa’ luck.
2
Is this is a good time for a citizen with a lifetime of experience with private insurance to answer the "gotcha" question posed to the Democratic presidential candidate by the debate moderator.? Yes, I want private insurance companies the heck out of my healthcare! Let them work their scams in some other industry where people's lives don't depend on them. Let them pay their CEOs and VPs multi-million-dollar salaries and perks with somebody else's money. Let their lobbyists go to work for some other big business. Let their stockholders invest in businesses that actually make products and provide services that improve people's lives, not profit from their suffering. Those fearless three who raised their hands and didn't backtrack are the only three I will consider for president. Elizabeth Warren, Bernie Sanders and Bill DeBlasio.
15
If you have classic Medicare you are still dealing with private insurance companies who bid to collect Medicare monies and distribute them to ether you or your providers. They process the claims sent to them. They are by law NOT IN YOUR STATE. And any other options like MediGap or advantage plans or Part D are private insurers. Fix this issue first please..
@Franklin Didn't know that. Yes, the government contracts with many private businesses to do things. The DOT doesn't actually build highways and the DOD doesn't build missiles and tanks. Under a Medicare for All program, I suppose the government could contract with insurance companies to shuffle the paper under very close supervision for Medicare for All, as long as contracts were bid fairly. However, whenever private contractors get in the mix, they'll be hiking prices. Government is good at shuffling papers. No need to contract it out.
This article lacks context.
Yes, it may be easy to sign up for British medical care, and that care may be "free".
But the overall standard of living in England is substantially lower than in the U.S.
Few families have two cars.
Houses are generally smaller.
Tube trains are not air conditioned.
You can argue which is better, but it is not a slam-dunk answer.
Those arguing how great Medical for All is are generally ignoring the larger question of *how* Britain's system is simpler and free.
There is a cost, but proponents of Medicare for All don't want to talk about it.
4
What an odd list of features describing quality-of-life. How about not having to worry whether an unexpected medical expense is going to bankrupt your family? What about not having to spend down your child’s college fund in order to cover medical needs that your insurance company deems not medically required?
Is not having two cars really a hardship? Or does it suggest thar mass transit is actually a usable option? When I lived in Manhattan in the 80s having a car would’ve been a burden, not a benefit.
23
@G Yes, houses are smaller in the UK because it's the size of Oregon and contains a fifth of the population of the US. Yes, the US has 811 cars per 1000 people and the UK only 560 but in Britain, an island, you are never more than 70 miles from the sea in a highly urban society with public transport which would make most Americans weep in shame. Deep line tube trains are not air conditioned in London because the technology to do so doesn't exist. Sub-surface lines of the cut and cover type have air-conditioning, account for 40% of the network and are far more modern than New York. It is true that average salaries in the US are higher. For men the difference is $6,700 and for women $12,200. Significantly more families have both adults working in the US which raises the median household income greatly in comparison to the UK. Health insurance doesn't pay for itself.
2
@G
Guess it’s preferable to have more cars and AC and then die/go bankrupt if you fall sick?
Not sure I understand your logic.
I do take your point of the NHS not being free(it’s paid for by taxes)
2
Our original sin in healthcare goes back to WWII. With wage and price controls in place and a staggeringly tight labor market companies started providing subsidized or free healthcare to attract employees.
70 years on you would think the business community would be the biggest advocate to put a nail in this burdensome coffin.
I once heard General Motors referred to as a healthcare provider that happens to manufacture cars.
6
Better question : why can I NOT opt out? I do NOT want it! Oh. Right.Insurance companies wrote the law.
2
Administrative obfuscation, deception, inefficiencies, and absurdities aside, there is one extremely important reality that neither the authors, the Democrats, nor the Republicans address: what good is insurance, private, public, single payer, Medicare, whatever, if there is no effective access?
Back during the winter, the Albuquerque Journal reported that the state's larges medical plan did not have a single primary care physician accepting new patients. Along with discussions of medical insurance, there needs to be discussions of how to encourage more people into the medical field, especially in primary care. Anyone who lays claims to lead our country needs to address that issue, if they are to be taken seriously when speaking about health care.
Around six to nine times every month I receive various statements concerning costs from my insurer. While I may not be particularly smart, I am not particularly stupid either. Not only are these statements truly incomprehensible but when I call Customer Service, the people at the other end can't explain what it means either. However, with each one or two pages of statement, I receive another four pages guaranteeing that I have a right to not understand the smokescreen in my choice of seven languages. Though the authors are clearly right about the counterproductive (and often absurd) administrative burdens for patients, the actual financial cost to the entire health care system of such is also substantial.
6
The United States custom has been to provide coverage for both essential and non-essential health care. And yes, there is considerable health care that is non-essential. Before any serious reforms in the US health care system can be accomplished, we must define the difference between essential and non-essential health care. A daunting task.
32
Best response ever.
3
@Doctor D What care that is actually covered is Non-essential and who gets to decide? Please be very specific. It does not cover say face lifts, and other optional type of things.
8
@Doctor D
Re: non-essential care
If someone keeps returning to the doctor for, say, 32 years with complaints of excruciating pain accompanied on occasion by loss of consciousness would this be considered non-essential use of care?
This is what I did for 32 years BEFORE I had surgery that resulted in a diagnosis. Before that all the male ob-gyns kept telling me it wasn't real.
I want a very clear specific detailed definition of non-essential care before I support this, not just some silly example such as face lifts.
14
Indeed Medicare is a complex maze that functions today only with the help of private insurance companies. The involvement of the private companies can not suddenly end without the entire system falling flat on its face. Those candidates who favor an MFA plan have to come clean about these facts, and have a plan to keep that from happening. That gradual shift to a single payer plan or "soft landing," as he refers to it, is what Pete Buttigieg is promoting. It is one of the many progressive yet practical approaches he favors.
2
Thank you for this important article. In addition to the points you and others raise, my personal frustration is with web sites that (when they work) present illogical choices with insufficient information. Calling the companies or the government leads to endless phone trees, long holds, and then starting over when you are disconnected. It’s also a missed opportunity that my medical history is scattered over many offices with no coordination. All of these issues are endemic across both the private and public plans. Years of political attacks on the government have made disfunction a self-fulfilling prophecy. Let’s hope a new generation of code-literate citizens will demand better.
2
The answer to the question is simple: A difficult process provides a barrier to enrollment. FDR and LBJ are rolling in their graves.
2
Thank you for an important article. A few responses:
1) I wish the Republican Party would read the thoughtful, powerful comments (it won't move them to change but I can dream!).
2) I am enrolled in Medicare A, B, D & F. I pay less each month than I did before I retired. Have had two major surgeries and have not paid a cent out of pocket. No co-pays, no deductibles. Zero.
3) My daughter has had a major seizure disorder since she was 18 months. She married a Brit, moved to London where she received excellent care. They moved to the states after six years and she went to the neurologist who had followed her since the beginning. As he was reading through British records, he stopped and asked, "You were a patient of Dr. X? He is considered to be one of the best neurologists in the world." I tell that story because so many in our country think the nationalized systems are somehow inadequate and the care is not good. Wrong!
4) I have a doctor friend who retired a few years ago from running a major medical center; we had lunch when he came through town. I asked him, "Phil, let me put the truth serum in you. How would you fix the health care mess we have in this country?" Without missing beat he said it would a blend of the English and Canadian systems.
I hope we move in this direction. If so, we need to be prepared for the onslaught of misinformation, half truths, and downright lies from the Republicans, big pharma and insurance companies.
7
Shall I use an expression that the charlatan-president often employs and refer to this Op-Ed as "fake news"? I say this because I know a thing or two about the NHS and have been following current debates in the House of Commons and from what I can tell the NHS is in a state of crisis. There's no denying that the IDEAL of the NHS is one that we can applaud but 90 days to see a specialist or elective surgery taking more than a year is not a system I care to emulate. We have the BASIS for a great system here in the US and Obamacare has made tremendous improvements in covering all Americans. What we need to do is STRENGTHEN it, not replace it. I do not support replacing Obamacare with something new nor do I support doing away with private insurance. We need to look at ways to improve what we have and guarantee that coverage is 100% for all, but we're in better shape here than they are in Britain IF one digs into the nitty gritty of how both systems work.
3
The most informative article I've read on the healthcare debate we're having. Especially, the illumination of the role of private insurance companies in Medicare. When I signed up for Medicare at 65, I didn't even consider the "Medicare Advantage" plans because I wanted nothing to do with private insurers and giving them a foothold to make their profits from the Medicare taxes I had paid all my working life. I don't care whether they offer free gym memberships or eyeglasses or any other enticements. And the for-profit Part D drug plans are just a crap shoot and a con. I want comprehensive, reliable and simple. I don't need "choices." I need insurance to pay the bills for the necessary and effective medical care my doctor orders. Why is that so hard to get in the United States of America?
9
The problem with health care -- like the problem with government -- is that both run on money. As long as there is a corporate interest in profit-making, money will flow to Congress and statehouses.
We cannot have a for profit health care system. We can't have a for profit government. And yet, they feed off each other to make a giant mess of both systems.
We need mandatory public campaign financing for elected office and we need a national health system that doesn't funnel billions of dollars into corporate coffers.
6
We have to note too what anyone who's been on Medicare has surely realized -- that the system is obscenely scammed by providers, hospitals, etc. There seems to be no oversight or competition. A radiologist will charge excessively for a simple x-ray but no one seems to restrain him and certainly no beneficiary will take the time to call Medicare and call him out.
1
Under Medicare the charge doesn’t matter. Charge $100000 for the Xray. You get paid the same.... nearly nothing. The biggest scam is patients demanding test after test and wanting to try “everything,” spending tons of Medicare dollars without any benefit to them or the system.... all because it is “free.”
3
@Ruby S Medicare will pay only a small portion of that excessive charge for a simple x-ray. Read your Medicare Summary Notice and see the actual amount paid by Medicare.
2
As a person who uses the NHS, I would say that yes it's easy to see your GP. But you have to find a GP who has open slots from the NHS. If you need to see a specialist like we did with our son, we're still waiting after 8 months to see a Neurologist. If you need an effective medication for your disease, it may not be available. Case in point, Okambri for Cystic Fibrosis is still not available. I love my GP, but please don't pretend that the NHS is perfect.
9
Medicare is great. I would suggest people not enroll in Medicare Advantage which has many disadvantages, not the least of which is that it involves private insurers. The private insurers will, undoubtedly, use the tobacco company playbook to confuse people about the wonders of Medicare. Don't be fooled. Medicare for All is what we should have.
5
I've wondered about the term "Medicare Advantage." These plans dazzle you with the concept of picking up all of your co-pays and deductibles. Actually, your "co-pay" for Advantage is your Part B monthly contribution, typically $135/mo. The "Advantage" part goes to the medical group that you pledge your allegiance to, dedicating all of your medical service (and Medicare payments) to them. Advantage: Medical Corporation.
Important Question: If Medicare service provider payments are so inadequate as many will have you believe, then why, come October when the annual Medicare re-enrollment rolls out, does almost everyone over 65 see their mailboxes flooded with solicitations from every major healthcare corporation hoping to capture your Medicare reimbursements via Advantage plans?
8
All that complexity generates jobs and profits. In a simpler system, those jobs and profits would disappear; the simpler it is, the more jobs, career paths, companies, investment opportunities, and value of current investments and job skills disappear. Making too much of this complexity disappear too quickly risks crashing the economy.
This is why the complexity still exists. Like the military-industrial complex, it is a giant make-work and make-investments scheme, paid for by everybody via health care that costs much more than in other countries.
Unless and until we have government that is capable of easing the transition, we are stuck with the complexity. As long as many of us believe that government is the problem, and as long as governmental competence is really a problem, we are stuck with the complexity. As long as the sources and beneficiaries of the complexity are embedded in government and able to sabotage or evade any transition as it unfolds, we are stuck with the complexity.
The companies that are involved with this complexity are ultimately as trustworthy as were the cigarette companies. Their answer to smoker's throat was menthol cigarettes, not the shrinking of their industry.
3
In Canada, way back in the early sixties, the federal government established a Royal Commission, headed by a Supreme Court justice, to study the whole issue of health care in Canada and make recommendations. The Commission traveled across the country, heard testimony from hundreds of people, and reviewed expert reports. The result: the Canadian universal health care system which, by the way, costs far less per capita than the US system, covers everybody, and delivers better results.
I know many Americans automatically reject the notion of learning anything from other countries' experiences, but couldn't you establish a non-partisan, politics-free, examination of your situation, and come up with some proposals for solutions? Then, once you have an agreed-upon set of facts, conduct the political debate?
18
It would seem that an agreed-upon set of factors beyond the scope of possibilities in the USA Today. And good luck finding a republican who actually wants to solve the problem rather than win a political game.
6
Medicare is a run by an agency of the Federal government. Medicare Advantage, with a confusing name, is run by private insurance companies and has a selective provider network, limiting choices for patients. I often run into people who believe, incorrectly, that both are variations of the same plan.
4
I am 71, I enrolled in Medicare at 66 and nothing could have been simpler. Took minutes to complete the online form. Perhaps enrolling for a child w/ disabilities takes more information. My understanding of Bernie Sander's Medicare for All is the all these covert private plan versions of Medicare like Medicare Advantage which is a private plan will no longer be available. My guess is that during a preliminary period of time Medicare for All is being installed there will be a period of time where people can decide on private insurance vs Medicare for All. Congress will design a transition and the rules for a Medicare for All plan. I expect a period of 4-5 years for this to happen. The private insurance companies are freaked out by the acceptance of the idea of Medicare for All. So many families are suffering w/ no insurance today. This should not happen in America. We are smarter than this.
4
Just imagine that if all the co-pays and insurance premiums paid in the country were added up it would be enough to provide millions with free healthcare. That's a number that's never mentioned.
3
It seems to me the complexity of Medicare comes from its being a mixture of government and private insurance and mostly from the inclusion of the private sector. I have a Medicare Advantage which involves a private insurer but the registration process is anything but complicated.
Dare I say if we eliminate the private sector part in the traditional Medicare with Supplemental insurance it will become much simpler? Or perhaps we allow a two track program: either Medicare without the private part or if one so chooses pick or keep their private insurance and let a clerk of a for profit company instead of a government bureaucrat stand between the patient and his or her doctor.
Notice how in the comments section, there's always Americans saying how horrible universal health care is in Canada and Europe, and other countries. Then there's a massive bunch of Canadians, Europeans, Australians and people from every other country on earth that has universal health care telling us it works.
I have no idea why there are Americans who are enjoying paying thousands of dollars for insurance that doesn't cover their actual medical needs, and who would be left to die on the streets if they lost their jobs and their employer provided insurance. I can only assume that the people opposing a natioinal health care system have never had a serious health problem or been unable to pay their premiums, co-pays, or doctor and hospital bills. I'll take the word of the people living in the countries that have a National Health Care system - I'd easily be willing to pay higher taxes if I actually got something in return. Especially if what I got in return could save my life.
18
For years I was uninsured due to a pre-existing condition, then was enrolled in Medicaid & now currently enrolled in Medicare.
I had a yr of legal training, specifically contracts, & worked for yrs as an editor & proofreader of contracts for several law firms. My sister is an accountant for the federal govt. We are both frequently bamboozled checking out insurance policies and medical bills for ourselves & for our elderly mother, a former RN.
Our healthcare system is designed to be opaque to everyone but insurance administrators. This should be a crime.
16
Money, money, money, again ask us front line staff the waste we see, mgmt does not want to hear it and FOR SURE the insurance companies don't.
2
This is ESSENTIAL reading. Our foolish healthcare system places meaningless decisionmaking burdens on us every day, taking hours of our time - time that a person in England, France, or Canada can spend in the garden or at the beach.
And you can add to that the hours spent arguing on the phone with company representatives, trying to get the coverage you have paid for. Again, citizens of other advanced companies face nothing remotely comparable.
What people outside of healthcare often don't understand is that the exact same thing applies to physicians and other medical practitioners, too. As a doctor, I have seen entire hospital social work departments spending almost all of their time negotiating with insurance companies. In other countries, these people would be doing actual social work!
So the problem isn't just the cost of our system, or the relatively poor health outcomes it produces. It is also the pointless waste of time that it requires.
Why would anyone in their right mind prefer this system over what our peer countries have achieved?
11
@Wesley Clark
I just had the wasted time a few weeks ago. About 50 hours, and it could have been 200 hours if I weren't lucky.
I'm on the ACA, with income pushing me between the expanded Medicaid half of the ACA, and an on-exchange plan fairly often.
So the complexity of the ACA dividing between the Medicaids (to 138% Fed Pov Level=FPL) and the on-exchange plan caused the switch due to inoptimal work at the MA agencies. They decided to rerun the determination of which half of the ACA with new, slightly higher FPL cutpoints mid year.
Well, I and perhaps 1500 other people in MA got thrashed from on-exchange to expanded Medicaid, with a few days notice. (Itself a medical-bill financial wipeout risk, but not the subject of this comment.)
The subject of the comment is, that to choose from new set of available plans, and find an available PCP, and check that local hospitals were in network, it was 50 hours of my time.
Insurer databases of who is in-network had errors and omissions. In the end, the insurers told me, to reliably see if a provider would be covered by them, I had to make calls to the billing office for each provider during business hours, and get all possible 10-digit National Provider Identifier (NPI) numbers that could be used on bills, and call the insurer, who would run all NPIs into the system to check.
Even that failed once, and an insurer and provider had to take a few days to iron out between them whether certain locations were covered.
Crazy.
a reminder how fortunate I am to be enrolled in the Kaiser Health Care program, with a CalPers contract.
small copays. comprehensive coverage.
1
I'm lucky enough to have had excellent insurance when I was employed thanks to both my union and the fact that I opted for the most inclusive, and most expensive version offered to me. Upon retirement, my employer's retirement health option also was and is excellent. Even so, the difference between the issues the author cites as a given in US health coverage have touched me as has the difference between the US system and those of other developed countries. This was brought home when we spent time in Denmark and a visiting friend had what seemed like the symptoms of a heart attack. We rushed him to the nearest hospital; upon arrival in the ER he was immediately taken to be examined. The extremely capable and kind staff ran many tests during the course of a day; happily they concluded at day's end that he was in no danger. They were willing to admit him for the night if he wished, but he opted to leave. Upon asking where to pay, the staff explained that there would be no charge--their policy when a US patient didn't spend the night. Their reason? They'd found that dealing with US insurance companies was so crazy making that it wasn't worth the time it took. They wished us well, and sent us on our way.
11
I wish everyone could read this. I'd like to add our story, which always seems to surprise people. We spent a year in France with our children. Our son caught his finger in a door and ripped off a fingernail, which required a trip to the emergency room. The emergency room visit, x-rays, hand-surgeon consult came to a total cost of 70 euros--around $100--and that was the charge for individuals outside the health care system. We paid on the spot with a credit card. The ER visit showed that the bone was broken and the nail bed required surgery to ensure that it grew back properly. The total for surgery, anesthesia, and being observed for that day in a hospital room (sent home by dinnertime) was $1000--again a rate that non-citizens would be required to pay. What on earth are Americans complaining about?
6
Herd and Moynihan's column brought back memories we have from 1986. We, too, had the opportunity to spend a year in the UK, and we were automatically covered by the NHS. Obtaining our primary care doctors couldn't have been easier.
Then I needed treatment and physical therapy for bursitis. A shot of cortisone and a therapist who made me move a frozen shoulder were quickly and seamlessly arranged. Within three weeks I had regained an arm. Followed by no bills. And we were foreigners! The administrative burden was essentially nothing.
On our return to the US, we had to go on fee-for-service care for abut six months before we could rejoin our HMO (Group Health), but in that interval my spouse needed a biopsy, "covered" by Blue Cross. Two PhDs, and we could hardly read the complex bills that poured in, complete with charges for services never delivered. We spent hours on administrative work straightening out the situation.
With great relief we finally rejoined Group Health and it was almost like we were on the NHS again. Since that time, we never left Group Health until we moved and went with Kaiser Permanente and now Medicare through Kaiser.
From our experiences, Herd and Moynihan have it exactly right. Administrative burdens matter, and the private insurance schemes are an expensive burden, not a help.
Transition to some sort of medicare-for-all should is a transition challenge: Cover everybody in the country with minimal administrative burden.
15
When my first child was born 40 years ago we were living in Paris due to my husband's job. When we told my parents we were expecting, my mother insisted I return home because she believed foreign health care was substandard & America had "the best healthcare system in the world"! She wasn't alone in believing that myth. My in-laws were convinced I'd get substandard care because I wasn't French. I got excellent, attentive pre-natal care, and delivery also went smoothly. I never got a bill. A nurse visited us 3x weekly for the first 2 weeks to see that breastfeeding was going well & that we were both doing well. We also got 4 weeks of household help for a few hours a day with cleaning, shopping, light cooking, etc. Also, no bill. Then after 6 weeks post-partum, like all new mothers, I got 2 months of 2x weekly, followed by another 2 months of weekly physical therapy. This helps a new mother regain muscle tone and prevents the postpartum bladder problems so many women suffer from. Here in the US, they suffer in silence due to embarrassment. Three years later, back in the good old USA during my second pregnancy, even though we were both employed and had insurance, we paid several thousand out of pocket for prenatal care &vitamins, another $3500 for the delivery & hospital stay & about another $1k for the nursery care for the baby. Needless to say, none of that socialist freeloading postpartum pampering or physical therapy. Single payer, folks. It ain't rocket science.
21
"While many other Americans continue to struggle with these problems, ours have mostly disappeared because we are spending the year in Britain. In its National Health Service, we found a system that did not demand an expertise in navigating bureaucracies. After 10 minutes filling out a few simple forms, we enrolled our daughter."
Well, sure, their effort was expeditious since all of the heavy lifting was done for them by Oxford University where they are Visiting Professors, apparently for a year.
If you're just an ordinary expat wanting to spend a year in the UK the procedure to join the NHS is a whole lot more complicated and paper strewn, as you'd expect.
More to the point, an example of Sanders' Medicare For All is the French system. There, if you were expecting to stay a year you would have only to establish residency, after a three month initial stay, at which time you would have no choice but to join the French national insurance system which pays for 70-80% of medical expenses. For the remainder you would have to take out private Supplemental Insurance all of which would cost about 8% of your income.
It works well for them providing one of the best health care systems at half the cost in the US even with private supplemental.
2
@GerardM . This just isn't true. University of Oxford didn't do anything; they don't need to! The process we had is the process anyone would have.
4
@Pam
I looked up the requirements for expats living in the U.K. which are available to anyone to read and it was made quite clear that sponsors provide the basis for the stay of those that are not applying for permanent residence who typically have go through multiple hoops.
What you are saying is that anyone who chooses to go to the U.K. have simply to sign a few papers taking all of ten minutes of their time and they’re into the NHS. That is simply not the case.
As for Oxford, of course they had a large part in your getting of a visa for your one year stay and, yes, there was a lot of paperwork which you never saw.
How do I know this? Because I used to have to deal with it when obtaining the longer term consulting services of foreign technical people. As for their medical, that was no problem because my company was self insured.
I've often read here the contributions of ex-pats and foreign nationals that provide interesting insights into the less complicated health insurance coverage systems they've experienced outside the US. Though no system involving human beings could ever be described as 'perfect' it strikes me that they are all superior for most people in most situations.
Our press here however always seems somehow to not adequately disseminate these positive experiences in a meaningful way that would help to change public opinion.
The false notions about how much taxes foreigners have to pay and how long the wait times are still allowed to be propagated out and we still suffer with a system in which profits for shareholders and executive salaries/bonuses are more important than changing our system for the better.
We still keep hearing even here in the 'liberal' columns of the Times disparaging commentary regarding the Democratic candidates proposals.
No, medical care, nor education or any of the other ideas that are being put forth by Democrats are free. But neither are tax cuts or annual 600+ billion dollar Pentagon expenditures. These are all value choices. Our economy generates a lot of wealth it's just a matter of deciding on what that wealth is applied to.
So to all you columnists and pundits, we realize that YOU probably have a well above average income and better health plan through your employer but stop disparaging a change from our lousy system which doesn't work well for most.
5
The complexity, including the ACA.
Look at this example for MA ACA.
There is a question of clawbacks for ACA expanded Medicaid.
The first is estate clawback for expanded Medicaid by states, which is permitted under federal law.
The second is clawback from living people who received expanded Medicaid when they, alive, sell their house. And as I understand it, the clawback could be not just a premium, but full uninsured medical expenses.
The MA ACA combined expanded-Medicaid / on-exchange application, at least the paper version, for those few who do it off line,
(https://www.bmc.org/sites/default/files/Programs___Services/Services/aca-3-english-3-21-19.pdf )
states (p. 22):
"To the extent permitted by law, MassHealth [MA Medicaid] may place a lien against any real estate owned by eligible persons or in which eligible persons have a legal interest. If MassHealth puts a lien against such property and it is sold, money from the sale of that property may be used to repay MassHealth for medical services provided."
but then, if you go to wonderful wonky lawyer Tim Jost at a Health Affairs blog from 2014 (https://www.healthaffairs.org/do/10.1377/hblog20140224.037390/full/ )
he says, no, they can't, at least they couldn't in 2014, citing very technical rules about PETI eligibility and MAGI Medicaid eligibility that not many specialist lawyers even know about.
What is this? We need an to pay an eldercare lawyer, or some deeper specialist, everytime we apply for the ACA??
1
One aspect of the Medicare system that shows the depths of Medicare's flaws is "HICAP". As I understand it, every county is required by federal law to have a HICAP counseling office to help Medicare users navigate the system, from choosing their Medigap or Medicare Advantage plans to filing appeals for denied or partially paid claims. However, there is little or no federal money to pay the counselors, so the offices rely on volunteers, who (in my area) are mostly retired lawyers and social workers.
Medicare is so complicated because every aspect is a compromise between Democrats, who want to provide benefits, and Republicans, who do not want to pay for anything, with additional input from insurers, Big Pharma and the medical provider industry. That level of complication is unfortunate, but it might be inevitable in our political system. However, given how complicated Medicare is, it is shameful that the counselors are not paid. Volunteers do the best they can, and some become very good. However, they cannot consistently do as well as a paid staff. As a result, many Medicare beneficiaries do not get the full use of the benefits to which they are entitled. Perhaps that is the desired outcome for politicians who are opposed to Medicare in the first place.
2
Memo to Democratic presidential candidates: "Medicare for all" should be designed not only to reduce expenses, but to reduce hassles. I am not unintelligent, but my eyes quickly glaze over when I have to deal with my healthcare insurance or hospital bills, which are almost impossibly complex and confusing.
As the authors write, switching to a public option or a single-payer system will have to be handled extremely well, lest government-adminstered healthcare be subject to attack. Just look at the pushback caused by the bungled roll-out of the Obamacare website!
4
Medicare per se is not at fault here. It's easy to sign up for Medicare. (I know from my own experience when I turned 65). What is a problem is the selection of and enrollment in supplemental and "Advantage" plans. With these plans you are at the mercy of the insurers, unless you live in a state with strong insurance laws and commissioners protecting the public. We need a national plan to remedy Medicare *plus plans*.
3
I am all for universal health care, and I don't see why it shouldn't be as uncomplicated as it is in some other countries. However, I am concerned about the people who are now employed by health insurance companies. What happens if great numbers of them are suddenly unemployed?
They will need to find new careers just as horse buggy drivers did.
3
@Concerned
There used to be many more people employed in the manufacture & promotion of cigarettes.
People who work in predatory industries are always at risk of having the ground cut out from under them. I'm not blaming these people, they need to work. But that's no excuse for the rest of us struggling & some of us dying because an entire corrupt industry needs to be reformed or just junked because it doesn't work.
7
@Concerned I have no sympathy for the insurance industry, but Concerned is right. Managing the transition from our current healthcare system to "Medicare for all" must be done well, or it will invite pushback. The U.S. government has done a poor job over the past 50 years of aiding workers in transitioning from an industrial economy to a post-industrial, service sector economy. And look at the results and the "populist" anger. As I say, I dislike the insurance industry, but simply outlawing it overnight and telling hundreds of thousands of workers to sink or swim is not my idea of progressive social policy. No workers deserve to be treated this way. (But, on the bright side, at least all those suddenly unemployed insurance company employees would at least have healthcare under Medicare for all!)
2
People will have to finally admit that our health care system is just plain evil. Insurance companies AND the government benefit from having such confusing, complex regulations and forms to constantly fill out and send in. Old people don't want to deal with such nonsense and just let it go, and thus everyone makes money.
4
Some people on private insurance may have amazing benefits. But when I was on private insurance, it was extremely easy to see the wrong doctor and get charged a fortune which I legally had to pay. Private insurance isn't always that great!
Once I made an appointment with a specialist. The group was in network. They took my insurance when I made the appointment and said it was accepted. They were listed as "in network".
The doctor in the group that we saw was not "in network", however, and we were not told this.
We got a bill for over $800 for a routine 45 minute visit, no way out of paying. Had this doctor been sick that day and had I seen another doctor in that group, the bill would have been minimal.
This goes on with many procedures. So unless you have Solid Gold insurance, be prepared for this kind of monkey business, it happens all the time.
This has also happened with dentists who claim "we are contracted with your plan" - translation - we are not in your network, but we will mislead you into thinking we are.
Politicians, why not talk about these issues as well? The corruption, the misleading, the overcharging?
I am just glad neither one of us had to go to a hospital, and get charged $80 for a Tylnelol while unconscious! Doctors visiting you that you've never met, popping their head in, then racking up more big bills!
Plus who know how many thousands more because we went to Hospital A instead of Hospital B? Talk about this, to "average" Americans, please.
7
If you think the insurance business is going to give up their iron rice bowl (Chairman Mao) without a fight then you probably don't remember Harry and Louise in the early 90s. Assuming they receive 25% of healthcare dollars, they stand to lose well over $3B annually. The insurance lobby will do whatever it takes using their paid staff in DC, Congress, to stop any major change. Expect the pharmaceutical and medical lobbies to join in as well. This is a fool's errand.
5
Finally, someone had the intestinal fortitude to write the truth about Medicare. Having gone through it with my parents, It is a bureaucratic nightmare, filled with dozens of terrible free-market "choices", holes in coverage, deductibles, out of pocket costs and reams of paperwork on a monthly basis.
Medicare covers 80% of some things, not everything. The other 20% is your responsibility to pay or to private supplemental insurance to. There are over 15 "choices " you have to make for coverage of that extra 20%. Even with private insurance, your claims can still be denied. You have to buy separate, extra coverage each for prescriptions, for eye care and for dental. These 4 extra plans cost quite a bit of money, so many seniors have to go without coverage and consequently, adequate medical attention.
What America needs is a comprehensive, affordable, single payer plan, (which covers everything), such as Medicaid for all. Once one reaches the age of 65, there should be little to no cost to the health care consumer. Raise taxes, drop high deductible, costly insurance premiums. It's less of a financial burden in the long run.
6
Raise taxes equally on everyone I assume you mean? And imprison anyone who works or employs off the books, fakes a disability or is here illegally?
1
Since the political left, from the time of Lenin, has embraced bureaucracy as government by other means, it is strange to read liberal univeristy professors arguing that the solution to a problem is not more rules and more bureaucrats.
1
I started preparing two years ago to enroll in Medicare and Social Security benefits. I attended seminars by SS employees, read a highly recommended book, clipped newspaper articles, twice spent hours at my local SS office writing reams of notes, and pelted older friends and relatives with questions about the maze of options and the frighteningly expensive consequences of making a mistake. Only then did I feel I at least had a glimmer of an idea what to do when my husband retired last month and we both had to go on Medicare (I am self-employed and lost my share of his employer coverage when he stopped working). Like another reader of this article, I'm a lifelong editor/writer and can usually figure out what a piece of convoluted prose is trying to say, but nothing prepared me for the confusion I faced, or the endless phone calls needed to understand, choose, and secure appropriate coverage. And after paying into the system all my working life--including the employer's share of FICA tax because I'm my own employer--now we get to start paying for it all over again, forever. Plus I take only two medications, and one of them isn't even covered. Thanks heavens for Good Rx. The U.S. health care system is demonstrably, and shamefully, both the most expensive and the least effective in the industrialized world--and it doesn't have to be. There are just too many powerful people benefiting from our pain. This must stop!
13
@EA Seven years ago I made an appointment with a guy at the Social Security office in Pasadena, Texas. He was polite, professional and I was in Social Security and Medicare in less than an hour. The written documents were "kindergarten" compared to the specifications, designs, and EPA regulations I dealt with in engineering hazardous waste and superfund remediations.
1
@Burton I'm glad to hear this! I found the people at my local SS office to be the most helpful and professional--and the best informed--of any of the dozens of people with whom I've interacted in my quest. I hope we're paying them enough for the great job they do.
2
@Burton
The person I dealt with at my SS office when applying for Medicare was a rude obnoxious bullying bureaucrat who basically refused to answer any questions. The next time I was there, the administrator I saw was outstanding. It's the luck of the draw who you're assigned to see.
3
While watching the early moments in the movie "Yesterday", I thought that there would be a much different scenario if this was placed in the US (besides the more obvious incongruities of location).
During the hospitalization of the main character, everyone was relaxed and living life. There would be a good chance that this would be a different story in my country. The whole family would be under immense pressure and the odds say that it could be very possible that this family may eventually face homelessness due to medical costs (with or without insurance).
In addition, I feel that this scenario could explain some of the explosive violence that has become more commonplace in our neighborhoods.
3
Tying health insurance to the work place was a consequence of the wage freeze enacted during WWII when FDR & Congress created Social Security and gov't supported health insurance. Over the years, unions have forgone pay increases for improvements in employer-funded healthcare. As healthcare costs have increased, so have employer per worker costs driving up the cost of American made goods. In order to eliminate private health insurance, any plan would have to provide guarantees that a large percentage of employer savings will be passed along to employees in the form of higher wages. If both business and unions buy into such an arrangement, the US may finally be able to rid itself of the employer-provided health insurance albatross. A consequence of such a plan could also be that US manufacturers' costs will be decreased and consequently the cost of US made goods would decrease making them more competitive with foreign manufactured goods. It would be a win-win-for US manufacturers, workers and consumers. Yes, the Americans would pay higher taxes to pay for the gov't taking over healthcare insurance, but they would have lower costs for healthcare, and higher incomes to offset these higher expenses. As this article pointed out, the administrative burden to the patient, to the healthcare system and to the provider of the healthcare insurance would also be less - all big intangible "pluses". Important issues to be addressed in any discussion of "medicare for all".
5
I broke my ankle on a vacation in the English countryside. We drove to the nearest town with (NHS) medical care. We entered the A & E as it's called. (emergency room) I spent 5 hours with my grossly swollen foot elevated propped up on a plastic chair waiting for a doctor who bearly spoke English to examine it. There were many other VERY sick people waiting. The x-ray tech asked my husband (not a doc) what he thought about the film results. The x-ray equipment appeared to be vintage WWII. They gave me an ace bandage and 2 paracetamol tablets. We then drove to London, found another NHS hospital where they gave us an "air cast" to stabilize the foot and suggested that we fly back to the States because it appeared badly broken. There are private clinics in London, but by that time I'd had enough of English medical care. Fortunately, the airline gave me space to elevate my leg. I finally got home, had the broken bones set and recovered the use of my foot. We had the resources to cover these unexpected expenses. Everyone doesn't. Don't be fooled by government-sponsored health care. It will end up working just like every other government agency works. Do you want to bet your life and your families' lives on that?
6
@Mel Leave the bruins alone in the future
1
I have worked abroad. Everyone talks about “better outcomes” without any data. Your experience is typical for “free care.”
@Mel Those darn bear-English doctors!
1
All of the points made are spot on. It's a hassle to decide what Medicare Advantage & supplemental drug plan to purchase so as not to have significant out of pocket costs.
However. I was uninsured for a decade+ in the 1990s because a pre-existing condition prevented me from buying insurance. With several chronic ailments, I spent more than 50% of my monthly income on doctor's visits & medication & was forced to ignore treating lots of problems because I couldn't afford to.
Several of my longterm doctors treated me for free for years after I lost my previous insurance. Their caring & generosity saved my life.
Eventually I went bankrupt & lost my home. It's taken 19 yrs to recover from the damage, which was significant & will affect me adversely the rest of my life.
I became eligible for Medicare 2 yrs ago. It's a godsend. I need never again ignore my health because I can't afford to be treated. A number of my Medicare doctors are the same doctors who treated me, & my retired RN mother, for years. The newbie doctors have been excellent.
Those who oppose Medicare for all because they want to keep their private insurance may the catastrophe awaiting them if they lose their private insurance. If Medicare for all replaced all other insurance, their doctors would likely accept Medicare & they could still see them.
The benefits of Medicare for all are so enormous I fail to see why anyone but insurance companies & hospital corporations oppose it.
6
I will say, having lived in Australia where we never saw a bill for healthcare, and now back in the States wading through private insurance documents, asking doctors offices to "re-code and re-bill", I find this article right on in terms of its comparison to the burdens associated with private vs public health care plans.
8
If we can do nothing else to bring down health costs can we please regulate drug prices. American should pay no more than the average paid by the British, Canadians, Germans and Mexico. IF the price is fair for them, its fair for us. This would lower health costs dramatically. And before you cry for the drug companies, most drugs are based in part on government research (NIH, Military, etc). We paid for this research, why can't we get a better kick-back for the people who paid the bill.
5
The problems with single payer:
1. How much will it pay doctors? Medicare currently pays too little.
2. What will it pay for? Medicare currently pays for way too much care that is not really necessary. MRIs of 80yo knees? No problem, but no benefit. Extended hospital stays for the elderly to do “everything” at the end of life? No problem. But no benefit.
3. We have way too many people not contributing. Working off books, faking disability. Illegals. Maybe you’d get some support if you addressed that?
Biggest issue is #2. Until we address it head on, all reform is doomed.
1
THIS! The article resonates with so many because of the difficulty of navigating the Medicare process. I recently assisted my husband with his Medicare enrollment. We started six months in advance. Between his private insurance plan under my name and the confusing Medicare process, he nearly was not get enrolled by the first day of his 65th birth month. Add to that the change in Medicare numbers (why would SSNs were used in this day and age is beyond me), my spouse had two Medicare IDs for a brief time. Depending on who I spoke to at either Medicare or my private insurance, I could be given different and sometimes conflicting information. This system is broken, both works in favor of the medical industrial complex in this country.
4
AMEN!!!
2
Our complex healthcare financing system sucks 30 cents from every healthcare dollar and that still does not account for the time and effort spent by patients and their families in dealing with our broken system. And we have had this so long that we think it is normal until someone lives in another developed country and finds that they have figured out a better way to finance healthcare. Politicians tell us that changing our system to a simpler single-payer improved Medicare for all would be too disruptive. Yes, it would be disruptive to the private insurance industry and all the bureaucracy it creates. But for the rest of us it would be like a breath of fresh air.
6
Our disabled son will be enrolled in the Medicare system in December. This by virtue of my entering in December 2017. The two year waiting period is driven by the inane rules of the SSA giving benefits to all disabled, some of whom are presumed to be temporarily disabled.Our son is totally and permanently disabled. There are no reviews. Why would we wait 2 years? SNAFU. That's why. He continues on Medicaid ( different rules) and some providers do not accept Medicaid. Even when December arrives, he will become "dual-eligible" with unnecessary complications. Most elected officials do not even know what we have endured. The reason is simple. They just don't care. Why? Neither your child nor ours will vote. America is going backwards.
4
I am a 76 year old who is truly concerned about our Country's future. We used to be the "can do" country, and now it seems we have degenerated into a "can't do" country.
We can't seem to fix health care, we can't seem to fix climate change, we can't seem to solve our immigration problems, we can't seem to curb our military-industrial complex, we can't seem to fix infrastructure, etc. etc. My generation (baby boomers) have royally screwed up our once amazing country by allowing greed and corruption to nearly destroy it.
Now we need to do whatever we can to fix it before it is too late. My best hope is Elizabeth Warren who is one of the few presidential candidates who is smart enough and dedicated enough to possibly do just that. And, many thanks to Bernie who pioneered her path!!!!
6
People who think the N.H.S. is a model for medicare for all should read " This Is Going to Hurt: Secret Diaries of a Junior Doctor" by Adam Kay. This is what happens when a national health program is under funded. You have health professionals who are worked to the bone, giving in some cases dubious quality of care. But it's free! My friend just sprained her ankle on vacation in Scotland, and had to walk barefoot over hospital floors that were covered in blood. She was there for over 5 hours because there should have been 4 doctors instead of 1. She was treated and told to walk on it as much as possible. When she got home she went to her podiatrist and found out that that advice may have screwed up her tendons. Forever. But it was free! She thought that was great, at first. But evidently you get what you pay for.
5
@CatPerson
It is underfunded because the Conservative party is implementing a deliberate long-term plan to open the NHS to privatisation and insurance, all happening largely under the radar.
Before the Tory/Liberal Democrat coalition took over in 2010 the NHS had the highest public approval ratings ever.
Everyone here in the UK knows the NHS is not "free", it is taxpayer-funded and FREE AT THE POINT OF SERVICE. The NHS is the third rail of politics here. Polling has shown over the years that people of all political persuasions admire and appreciate the NHS and would be willing to pay MORE in taxes if that were necessary.
What is really necessary though is to get the Tories out (and remain in the EU but that is another column).
10
@Joan This is a very important comment and very true the first paragraph is particularly true Many Americans know about the Brexit business The Tories hope to use Brexit to privatise the NHS possibly by bringing in US health insurers (believe it or not) Teresa May when interior minister drastically cut police numbers causing a huge increase in knife crime among black and Muslem dealers and addicts with the intention of raising social tensions .The two contenders for the new PM are both nonentities.Tragically the Labour party is led by a totally out of touch trades union man who has no chance of being elected...what a nightmare...
1
In a true free market economy our health care system would collapse under its own mass of opacity and pricing. Americans should pay close attention to the cost of their health care and not just the cost of their insurance premiums.
Try walking into your MD’s office and asking them for the cost of the service they’re going to provide you before they begin. Overwhelmingly they can’t.
Case in point. I needed an eye pressure check and asked local MD to perform the test telling the office I’d be paying in cash. Walked into the appt and was immediately asked for insurance info. Told them I was going to pay cash and asked the price. The staff acted like that was a most unreasonable request and said I had to present insurance info to be treated which I politely declined. Finally saw the MD who told me my request was unreasonable I should let insurance pay. Actually told me he didn’t work for me! MD finally asked if $40 was a good price, asked mind you. I asked how long his practice would be around without people like me, his patients!
Americans should demand transparent pricing of plainly labeled procedures, items, and prescriptions used in the course of their care. Then all Americans can make truly informed decisions about their health care.
7
Thee free market of healthcare was destroyed by Medicaid/Medicare/managed care paying fixed and different rates. No competition because most people fall into one of those three. Get rid of fixed pricing guaranteed third party payment and you will see prices come way down.
I've heard people worrying about the subsequent unemployment of all the insurance workers if we have Medicare for all and cut the for-profit insurance companies out of the loop.
Tell that sad story to the manufacturing sector -- the steel and auto industries, etc. -- and to the coal miners.
Let the white collar insurance workers relocate, re-train, whatever it takes to find new employment.
There, I said it! And it's not like there would be no insurance industry left. Auto, home, life, etc. Spare me the tears.
8
“You May Owe”. I have insurance thru my employer. After a recent visit to the doctor which included bloodwork I have been bombarded by letters from multiple labs saying “you may owe”. These letters don’t reference any tests in particular or even reference my primary doctors name but they do include an additional envelope just in case I want to make a payment on what I may owe. It all feels like a scam to me. I will happily forgo my employer supplied healthcare when National Health finally arrives in the USA. The movie a decade ago by Michael Moore “sicko” is still relevant. For profit healthcare in the USA must be eliminated or any expansion of Medicare plus private options will die the death of a thousand cuts just as ACA and Obamacare have been undermined by the right wing corporations who make billions in profits on our illnesses and provide mediocre care at best.
9
The most amazing thing about healthcare in Italy, where it is a right, written into the Constitution, is not the low cost or good outcomes, but the almost total absence of hassle. Everyone gets a health card that entitles them to everything the system offers. There is very little other paperwork. I have never received a medical bill in the mail here. Visits to my family doctor are free. Before visiting a specialist there is a "ticket" to be paid, almost always less than € 50, sometimes only 25 or 30. Surgery, emergency room services, cancer treatment, heart bypasses, hospital stays, etc. are free.
There can be fairly long waits for certain diagnostic exams and non-urgent surgery, but a little patience and planning usually does the trick. If you want a particular specialist to diagnose or treat you (as opposed to going to the doctor assigned by the computer) you can arrange a paid, private visit for about 2 or 3 times the cost of the ticket, and probably get your non-urgent exam or procedure right away, or at least sooner, but it is still so much cheaper than in the US that cost is just not an issue.
The main difference is that you deal exclusively with doctors and hospital employees, never some insurance company claims person trying to deny coverage.
This is how everyone does it except us (we Americans). We must be idiots!
12
@David in Le Marche I needed what would have been prescription medication the last time I was in Italy. I was able to walk into a pharmacy, consult a pharmacist, who spend a good 15 minutes talking to me about my issue, and walk out with the pack of pills I needed for about 8 Euro.
3
A great plan but Republican voters believe exactly what Republican politicians and Fox News tell them: your government (which is most often run or controlled by Republicans) is your enemy, it is impossible for it (the Republicans) to do any good for you, and if it did, that would be socialism, an evil from which Republicans solemnly pledge to protect you.
5
Bear in mind, American cousins, that here in the UK we'll soon be welcoming your private health care vultures. With the post-Brexit economic collapse the National Health Service will wither on the vine. Anybody over there who fancies making a quick buck, you heard it here first.
4
For me, four words sum it up: “Private profits over people.”
4
Great article. Unfortunately the headline on the front page will garner less readers because of the reference to their daughter when the article is about the failure of Medicare.
2
And, on top of all this, guess what... if you have "original Medicare" and the Plan F supplement (by far the most popular), it's going away for new applicants come Jan, 2020. Naturally, the czars of the US "SickCareSystem" want to get rid of the most popular supplement. For those who currently have the Plan F supplement, the "risk pool", will quickly decline and premiums will skyrocket! "Risk Pool"... what a term, risk to who? Of course the risk of interest is for the InsCos.
As a first step in cleaning up the mess, Ky needs a new senator.
9
This is an excellent article. Having moved to Canada for work about a decade ago, I too was pleasantly surprised with how simple and easy getting care is here. No struggle with pre-approvals, no claim forms to fill out, no deductibles, no co-pays, no bills at all for any service covered by the government (which is most essential services other than prescription drugs, which are still covered via private insurance in Ontario).
My experience in Canada has convinced me that single payer is the best approach. Private insurance just creates complication and cost without providing any real benefit. I am sensitive to the fact that the US has a huge private health insurance industry, funded largely by employers, and dismantling the industry and the employer-funding system would be highly disruptive. But whatever we do, simplicity should be a primary goal. While there were many good things about the ACA, one of its primary flaws was its complexity. The US Medicare and Medicaid systems are also too complex. Healthcare needn't be a Rube Goldberg machine. Single payer if done right—as it is for the most part here in Canada—is the simplest system possible, which is why those Democrats who raised their hands to get rid of private insurance are right.
326
@617to416
And I should have mentioned—there is no choice of plans. The government covers everything essential, and everyone is in exactly the same plan. You don't have to enrol or worry about picking the right or wrong coverage. Everything essential is covered automatically in the single comprehensive plan the government provides for everyone. This, maybe more than anything, makes it simple.
129
@617to416. Just wait for the huge bill that will arrive in your mailbox showing the amount you still owe, say, for a hospitalization. Without supplemental insurance it's left to you to find the money.
@617to416 I'm sure that employers would be very happy to get out of the health care business. Imagine, employers might actually hire people full time (instead of workers having to have 3 part time jobs) if it means they don't have to provide health care to full time workers.
25
People like their private insurance until they have to use it. The vast majority of people do not have to use it so the vast majority are happy with their insurance
This piece points out one rarely discussed problem with our system-it’s unbelievable complexity. Even worse this complexity falls upon people at the most stressful time in their lives-when they are sick and need to focus on their treatment and recovery
Finally, the best reason for a complete overhaul of the system is it’s complete failure to control costs. I don’t think this is possible without either a true single payer system or a very heavy regulation of the private insurance industry
308
@sr: Obamacare totally, utterly and completely failed to control COSTS.
As a result, things got exponentially worse after its inception in 2014.
Drug prices are HIGHER THAN EVER BEFORE. There are fewer options and plans, and higher costs and premiums.
No reform can possibly succeed without COST CONTROLS.
16
@sr My former private insurance plan was far better than Medicare. Drugs are costlier and copays are higher. I do agree that Advantage Plans are horrible. I used to try to warn my patients to avoid them when I was still working as a professional nurse.
I doubt there would ever be enough conservatives in Congress who would vote for mandatory single payer. And, not even Bernie has done a convincing job of explaining exactly how his free for everything plan would be effectively financed. Call me skeptical at this point that we will be able to fix the mess of a health care "system" that we currently have.
7
@sr I use my employer-provided private insurance. A lot. It covers almost everything, with small co-pays - $20 for doctor visits; $10 for medications. My "network" is large and excellent and includes one of the best hospitals. When I do have an "out-of-network" charge it has never been more than $100. I have almost no paperwork. I dread what will happen when/if I have to go onto Medicare.
7
When I hear "Medicare for All," and I speak with people about their concept of this, I get their interpretation as meaning that Medicare for all means "free medical care." Medicare IS NOT FREE. Those of us who receive Medicare have paid into the system for years. We also pay $134/month for Medicare part B (taken out of ur monthly Social Security), and then, we pay for Medigap insurance, or, in my case, $128.80 monthly for Medicare advantage as well as co-pays for some specialists and some prescriptions that are not "on formulary." THIS IS NOT FREE. I don't mind paying for it, but I wish these candidates would explain that those of us who receive it also pay for it. When Medicare is called "an entitlement," it makes it sound as if we're freeloaders. We're not. We don't have our hands out. We also contribute. I worked in healthcare for almost my entire career, and I know how complex it is. I know about the tricks the insurance companies and providers pull. I also know about fraud in the Medicaid and Medicare systems. We need affordable health care for all people, and citizens of this country need to realize that we need to pay for it, whether it's through taxes or through insurance companies. Nothing's free. But something's got to give.
335
@Zander1948Actually what one pays for Medicare Part B and Drug Coverage I guess it is part D depends on your income and many pay much more than you but the income brackets top out at a quiet low ceiling. Two years ago they dropped the top rate bracket down over $55,000 and they started taking as much out of my Social security for Medicare as they would do for Mitch Romney and other Billionaires. They added a bracket last year making it a bit more progressive but not much.
13
@Zander1948 You have not "paid into the system for years." This is a common misconception about Medicare and Social Security. These are "pay-as-you-go" systems: the Medicare and Social Security taxes you have paid while you were working were paying for the health care and retirement benefits of _other people_ ... you were _not_ making a down-payment on your own benefits.
5
@Zander1948
Well said - and often forgotten in the argument against "Medicare for All" - it's not a giveaway and it's not free. Like you, I pay a Part B premium, a Medigap premium and a Drug Coverage (part D) premium. And I pay out of pocket for vision and dental.
Whether it's Medicare for All, Single Payer, or a Public option, they're all roads to improving the current situation which is a national disgrace at present.
20
Hi. If I were a young person starting off, I'd consider learning a foreign language well and looking to emigrate to Europe. It is much more family friendly. Parental leave is provided. Medical care and education are basically free. Taxes are high, but family life is secure. This is a good bargain any day of the week, in my book.
5
I have had MC and a private gap plan for 6 years with only a Tb skin test not covered, because I needed it for a new job. I requested it.
This article very briefly mentioned the English NHS, and it’s much simpler patient-centered system. Our broken tediously burdensome profit-centered healthcare system is the laughing stock of the rest of the industrialized, civilized world.
I had a chance to partake in the German healthcare system and never saw a bill. I was in a hospital for 2 weeks and had physical therapy afterwards for 8 weeks.
The media owes it to Americans to more thoroughly describe how much better off people are with universal healthcare as practiced elsewhere. Everywhere else. Yes, there will be more taxes, but the reward is worth it: greater longevity, better outcomes (the US has some shameful outcomes statistics), much much lower collective costs, particularly in regards to medicines, no more healthcare system anxiety and stress, no more healthcare related bankruptcy, and no more confusing bills. In many cases, no bills. The power of the medical industrial complex and it’s political enablers have driven us into third-world status, due to our Supreme Court sanctioned political corruption.
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@Moses It's because of our Supreme Court-sanctioned political corruption that we must eliminate the private health insurance industry altogether, as in Bernie Sanders's plan. If private insurers are allowed to play a role, as they do in some other countries such as Switzerland, they will corrupt the system through legalized bribes, and we will still be left with the most inefficient, unjust medical system in the world.
34
@Moses
Couldn't agree more. To understand how we got here, and what to do about it now, read just released "CODE BLUE: Inside the Medical-Industrial Complex" available everywhere @ www.codeblue.online.
8
@Mike Magee
I think you mean https://www.codebluedoc.com
8
Seven years ago I visited an NHS hospital emergency room in London because of pain from a slipped disc. Nobody asked "How will you pay for this?" The receptionist asked my name, birth date, and address. Nobody asked for proof of my identity. A triage doctor saw me immediately, asked some medical questions, and took notes. I received specialist treatment within an hour. I left later than day with a month's supply of medications. There was no charge for anything.
4
I have given up on getting medical care for two reasons. Even though I'm on Medicaid because I'm unemployed and have no source of income it's too confusing to sort out what doctors I can see (most of whom are not local), what medication I can actually get, and where I can go for treatment. Our wealth care system has succeeded in creating such a complicated maze that it's no longer worth the time and energy it takes to figure out what one is entitled to versus what one needs.
I don't need surprise charges. I can't afford them. I don't need to be made to feel bad for being unable to afford medical care or dental care. I feel bad enough about being unable to find a job even though I'm 60 and have years of experience in my field. In fact the reason I can't find a job is my age and experience.
I am hoping two things. First, if Trump is re-elected that I drop dead. I cannot live another 4 years with that man in the White House and McConnell doing his best to ruin our lives. Second, if I don't drop dead I'm hoping to be able to afford hospice care when I do contract a serious illness. Like most people I've paid my taxes and my premiums. I'm tired of being forced to settle for third best when it comes to health care in America.
Note to the wealth care industry: you've won. I hope you're happy that thousands of us will die because of the prohibitive costs of the premiums, deductibles, and everything else.
7/5/2019 9:24pm
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Hen3ry,
I hear you. My daughter teaches AP calculus. She can’t figure out her medical bills from a recent relatively uneventful childbirth. And she’s actually got what’s considered ‘really good’ insurance. It’s insane.
Hang in there. We all depend on your erudite comments on various articles.
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@hen3ry my sister is 64 and right now I hope she makes it to Medicare age. She has navigated the system well for decades but now has no insurance and can't afford antibiotics she needs. She earns too little to pay premiums. Rent and food are all she can afford on minimum wage.
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@Bmcg ~
"Rent and food are all she can afford on minimum wage."
It's a wonder she can even afford that since the Federal minimum wage hasn't been raised in 10 years. Thankfully some states have initiated increases.
42
As an American expat I have lived in the US and in the UK. In the UK, you call up the doc; they see you within 2 days if it's not urgent. If it's urgent they see you immediately. No charge. No paperwork. A small charge for a prescription. Outstanding care. That has been my experience (decades) of the NHS. There are also private-medicine options available to me if I want them.
My US relatives have had what most would regard as excellent plans. Even so, they spent $500 a month on prescriptions. They received mountains of paperwork, including duplicates and mistakes. In hospital visits they were charged $100 for an aspirin. Their doctor's office - most of whose patients were elderly -- one day decided that all appointments had to be made either online, or via a computer answering service (you call, the computer answers, then calls you back; you talk only to a computer). Elderly patients, right? Trouble with vision and hearing, right? It was brutal.
The medical industries have spent a lot of money on lobbyists and TV ads, trying to persuade Americans that single payer healthcare is bad. So far they have succeeded. What I see is massive opioid addiction and people who rashly took medicines (encouraged by TV ads) that later turned out to have bad, sometimes very dangerous, side effects.
So - whatever. My fellow Americans, vote for what you prefer. I know what I prefer.
9
Switching complexity to the ACA, there is a set of problems, not well publicized, coming from the split of the ACA into two halves: Medicaid and expanded Medicaid for people up to 138% Fed Pov Level (FPL), or an on-exchange plan.
The problems depend on how each state does eligibility, which is extremely touchy, due to complexity of the laws.
One source is that the state may not have been adept enough in synchronizing Medicaid/expanded Medicaid eligibility with the ACA's whole year estimated MAGI based on start of year FPL points. Medicaids have traditionally used monthly, and there seems to be a tendency to update FPL cutpoint in April. (These are accidents waiting to happen, that the people running each of the 50 state Medicaids are over their heads to manage well.)
I've had 3 discontinuity of coverage type issues for me, here in MA on the ACA, around switch of halves of the ACA. (Two of them when the state agencies switched me, unpredictably, between halves of the ACA, on about 6 days notice. I was just notified 5/25/19 that my on-exchange plan would be turned off 5/31/19. This is a problem, because I could have been in the hospital for a few weeks, in-network hospital, surgeons, approved procedures for the old plan, but not the new. Potentially bankrupting me.)
Further, due to estate recovery on expanded Medicaid, the state needs to give an option to decline and get non-subsidized exchange, with a few month notice, when it switches people. They don't do it.
I am on Medicare and keep getting more and more of my benefits through mandatory private insurance. I have to deal with several companies and their denials of care. The government part is easy.
Bernie's single-payer is the only way to straighten out this mess. Even then, we will have to deal with profit greedy big Pharma, hospitals and physicians.
3
I am at a loss to understand why it was so difficult to enroll in the Medicare insurance plan. I did that in half an hour. The MediGap policies have pretty much standard benefits and the cost is about the same across the board, may be a difference of few dollars/ month. One has to spend a little more time picking the Part D coverage based on individual needs.
My beef with Medicare is that it is inordinately expensive. I pay more for the Part B supplement and Part D than I paid for insurance while working . And that is after paying few hundred thousand dollars in premiums all through the working life.
Good luck with Medicare for all!!
2
I’ve been on Medicare for just over six years. It covers my medical costs nicely, except for prescriptions. My Part D carrier refuses to pay any portion of the costs of my five generic medications. Why ? Because I use a “mom and pop” pharmacy which can’t afford to fill prescriptions at a loss. Large pharmacy setups like CVS, Costco, Walmart, etc. do take the losses to get you into their stores. My generics cost $14 each, saving the carrier $70 each month. This loophole needs to be closed.
2
@Michael J
Agree. I had to quit using an excellent small pharmacy and switched to Walgreens because of this. The small pharmacy, which has been in business for over 70 yrs, was outstanding with the most knowledgable pharmacist I've ever known. I hated to lose him.
2
An anecdote:
I was living in London when a friend of my girl friend showed up one Sunday night with a high fever. We rushed him to the local hospital. The ER was dark and dinghy and empty. There was a widow with a woman behind it. We were sent to an examining room and in a minute a doctor showed up. He treated my friend and handed us two prescriptions. He said the pharmacy was around the corner.
I handed the pharmacist the scripts and in five minutes had the drugs, I then asked, "Where do we pay?"
"Pay?" she said, "There's no money in this hospital."
"You don't understand, " I said. "We are not British citizens. We are just guests."
"No, YOU do do not understand, This is England. This is a hospital.. We treat sick people. We treat all sick people, Brits, Frenchmen, Chinese, even Americans. And that's all we do. We just treat sick people."
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@Len Charlap
Yes, that is the NHS! Worked there and been a patient there. Spent 3 weeks in a hospital after a bad accident and did not have a penny to pay for that.
It would have ruined me had that happened here in the US.
27
@Len Charlap Wow!
1
While I don't doubt the authors experience, I believe that the positives of the US system are not always called out.
Fact is, the US system performs well overall. Especially for those that advocate for themselves. When working with a single provider system like the NHS, it is near impossible to advocate for yourself, ask questions, make complaints or just move on to another doctor.
In the US, when hospitalized (even when indigent) you can mostly depend on a semi-private room, CAT scans and MRI's on demand.
I urge the authors to see if they get semi-private hospital rooms or general ward, and they should certainly look into wait times for physical therapy.
When it comes to paperwork, it's a fact of life. Anyone who works in a bureaucracy shrugs this off and handles it. If its not medical care its car insurance or immigration paperwork.
Recently, I had occasion to apply for Obamacare in preparation for a move to the US. I started the application online but when hit with a question, I called the 800 number. I was immediately put though to a person who answered my eligibility questions and helped me through an application. I eventually chose different coverage, but HHS emailed me multiple times and then sent a letter reminding me to complete my enrollment. Had I wanted, I would have had a policy in a few clicks. This is not an uncaring system even under President Trump.
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@David
"In the US, when hospitalized (even when indigent) you can mostly depend on a semi-private room, CAT scans and MRI's on demand."
CAT scans and MRI's "on demand" are NOT a good thing. Any test should be based on clinical need.
And the "indigent" will either be refused at the door, or will be sent a very large bill.
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@Joan It's absolutely against the law for a hospital to turn away the indigent who need emergent care.
Once clinical need is established, I want my MRI NOW. It saved my life.
@David
I assure that you are in the minority. It is not the government exchanges that are the problem. It is the insurance companies and the god awful relationship they have with health providers. Do not forget that Trump and his minions want to decimate what you think are the good things in the ACA.
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Retired NY State manager here. My professional and academic expertise was health care finance and policy. After a year of health problems covered by Medicare and a secondary plan, the stack of paperwork was two inches thick. My bills and coverage had become so overwhelming, so incomprehensible, I was sure I was developing dementia.
Then I spoke with a friend who heads up a small religious order with many retired sisters and very little income. She said she'd finally had to hire a company to do nothing but sort out their Medicare claims.
So I found myself a Medicare Advantage program. It may not save money but all I have to handle is a co-pay at the time of service. They still send me buckets of wasteful and repetitive paper every month, which I throw away.
The financing of the health care system can be as complex as all the sources of funding want to make it, but it should happen like making sausage -- all the mess happens behind the scenes. "Single payer" could mean that everyone has the same basic benefits, all providers can participate. And nobody loses the farm.
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Medicare is indeed a paperwork nightmare. As difficult as getting into the program and related private insurance is, getting out is as much a nightmare. My wife turned 65 last year while I was unemployed, so we signed her up for Medicare and a Medicare Advantage plan. Then I got a job with health insurance. To drop out of Medicare, you have to give 30 days notice and you pay for a full month at a time - no refunds for partial months. Call Medicare and they tell you to call Social Security. Call Social Security and they tell you to call Medicare. The line at the local Social Security office is always around the block. Medicare lost her disenrollment form and continued to charge us for 3 more months. It took a call to our US Congressional Representative to sort it out and even then it took a month. When we finally did get through to someone local, they told us basically to not send the disenrollment form to the address on the form - send it to the local office.
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What about Medicaid for all?
Here, I thought re-registering & navigating plans, submitting tax/income documents every year with ACA was exasperating. (And has grown much worse after 2017 inauguration, dare I observe-- to the point where my 2 siblings dropped coverage entirely.) Medicare sounds like an absolute nightmare!
The answer is easy: with NHS you have zero choices, zero. With Medicare, you can take traditional Medicare, a supplemental plan or an advantage plan. If you don't know what you want, there are plenty of sources of advice. Americans like to have a choice, not to have the Government dictate to them what their choice should be.
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@skeptic
"The answer is easy: with NHS you have zero choices, zero. With Medicare, you can take traditional Medicare, a supplemental plan or an advantage plan."
With the NHS you don't need "choices" because everything is covered.
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@skeptic In the UK anyone who wishes to take out private insurance can and they can use a private hospital. Many of the specialists in private hospitals are NHS consultants making extra money.
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Let me assert that the President was actually exactly correct in what he intended to say, but he omitted and jumbled a few words.
He meant to say "Who knew any country could succeed in taking so many missteps, over such a long time period, as to make health care so complicated?"
(I'm pretty sure.)
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On the score of simplicity, I can say this much about my own Medicare plan. It covers Medicare A, B, and D for the Medicare B premium. It has no deductible. For an additional $20 per month, I get optical, dental, hearing, and wellness coverage. All told, for
$155 a month, I get as close to complete healthcare coverage as one might want, under a plan with a 5-star rating.
It took me 20 minutes to sign up. As for that maze of options that the American system throws at you, why bother?
My question: Why isn't this arrangement, which is available to me within the contours of the current US healthcare system, available to everyone else, or at least to everyone over 50 or with a pre-existing condition?
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If every citizen gets the same high level of coverage, and we eliminate the middleman profiteers, health care should be able to focus on the actual care, without the paperwork hassle and the money terror. C'mon! This isn't rocket surgery! Why do so many of our fellow Americans want to deny care to anyone? Incredibly resentful and covetous. Yes, we all have some responsibility for our neighbor, and they for you. Isn't this what used to set US apart? It USED to. Want to get that back? I do.
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So, ever try to audit any of the statements you get from Medicare, Part D, and gap insurance? I did and you can't. All the numbers are made up and meaningless.
For example, insulin cost ten times here what it does in Canada. Clearly, the US numbers are bogus
For a second example, in the end, I get only a 20$ charge for something 'costing' 2000$. Clearly again, all phony numbers.
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How does Medicare cover a child? Wouldn't that be Medicaid?
I am a retired engineer who has dealt with many complex issues throughout my career. I am fortunate to have a wife who is a retired Pharmacist who, each year, wades through the "Part D" maze.
This often means we have a new Part D private insurer each year, and due to our differing prescription needs, often have different Part D insurers. I know she saves us money by wading through this maze, but I can empathize with other Medicare recipients who do not have her expertise.
Private insurers are evil, greedy, non-productive parasites on our health care system. Kamila should not have backtracked on her position that private insurers should be eliminated.
Want to fix health care? We first need to get big money out of politics.
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Every other major country in the world offers free health-care to its citizens except, of course, the richest of them all, too busy amassing fortunes for its top 10%, the USA.
Time for a change !
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Consider the Swiss system.
Switzerland went the route of allowing private insurance companies to provide the payment structure for national healthcare. Participation is mandatory, and policies are subsidized for those who can’t afford insurance. Insurance companies must offer the basic government mandated policy on a non-profit basis, and charge one rate for those under 25, and one rate for those over 25, with no difference in rates for anyone with a pre-existing condition. Rate are set by the government consulting with insurance companies: in the event of extraordinary or unforeseen costs to insurance companies the government will kick in extra funds.
“Only those insurance providers who comply with the requirements of the health insurance law and are registered with the Federal Office for Social Insurance may provide compulsory health insurance (CHI). The main requirement being that no profit should be made from compulsory health insurance activities” http://www.euro.who.int/__data/assets/pdf_file/0003/96411/E68670.pdf
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Looking into Italian citizenship, you can buy supplemental health insurance for about 800$ year but many recommend not to buy it.
I was told regular insurance was so good the supplemental was a waste of money. USA USA USA...
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Paying for American medical care is nothing short of bizarre compared to Europe, Japan, Australia and New Zealand.
If you're a child there can be CHIP. Or your parents' health plan. Or the emergency room (and your parents stiff the hospital and thence the taxpayers with the bill). Or just cash to the family doctor.
If you're an under-65 adult there's cash to your GP. Or your health plan pays for it. Or Medicaid. Or the emergency room (and you stiff the hospital and thence the taxpayers for the bill).
If you're over 65, there's Medicare. Or maybe Medicaid. Or cash to your GP. Or your health plan, if you're lucky enough to have retained it from your job. Or the emergency room (and like your children and grandchildren you stiff the hospital and thence the taxpayers for the bill).
And politicians and insurance and drug companies tell us that we don't need a single-payer national health plan because what we have is far more efficient than the rest of the First World. God bless America!
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What America needs and what it will get are two very different things and the only reason is greed.
The AMA, the doctors' union, wants to keep its members' inflated incomes and so do the doctors, who love their patients so much, as long as they can keep their bloated incomes in the meantime. American doctors earn three times as much, on average, as their counterparts in other countries with single payer systems. Indefensible.
Then there are the drug companies. Oh, Big Pharma, how we love and need your drugs; and you, just like drug dealers everywhere, once you have us hooked, have got us for life and will bleed us dry, with your indefensible prices and regular price hikes. They defy economics and public outrage, but richly reward your investors.
Then there are the insurance companies themselves. These are the true leeches on the back of productive society. They serve no useful purpose, except to cream off 20 to 30% of all health care dollars. What are they good for? Nothing; apart from making denial of coverage their holy grail and feeding the maw of their investors, that's what!
So here we have this unholy trinity of vested interests, determined to avoid single payer at all costs, so they can keep riding this gravy train. Sadly, as long as Americans keep believing that America is the best at everything in the world, this will not change, because if you're the best why would you change anything?
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I am glad to hear from people who have experience with universal health coverage like in the U.K. Few days back there was someone here on NYT arguing that in the U.K. and Canada people have to be on long wait lists for doctor's appointments or bribe someone and the US private health insurance was best in the world.
2
It's a massive headache by design.
2
A quite from my Sales Manager in the Car Biz." In confusion there is profit."
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Other nations have realized that death should not occur for treatable conditions - we haven't.
USA has systems in place to benefit corporations over people. The Medicare system is prohibited by the government from negotiating drug prices (which all regular insurance companies do) - thereby costing the taxpayers. How stupid is that?
As long as people don't understand the concept of insurance (everyone pays a little for the benefit of the community) they will continue to suffer from high medical bills and a complicated system. People have been unwilling to promote healthcare for all and keep voting such measures down.
Every other advanced country has a better system than us but people here keep pointing out problems with those systems without realizing how much better off they are while ignoring how badly we are doing. People here do not get the treatment or drugs they need because they can't pay for it or file for medical bankruptcy when they get bills they can't afford. That is unheard of in many countries, even for the poor people.
4
Medicare is such a burden compared to European systems and yet them Dems think just expanding it to everyone won't cause problems……
Hmmm. Interesting.
As many other commentators and I have written before, America needs to study the approach used in Germany, the Netherlands, Israel, Belgium and Austria. Insurers offer a range of different benefit packages in terms of deductibles and co-pays, but what is and is not covered is the same across all plans. Everyone gets a health status-adjusted voucher to pay for all or most of their coverage. Enrollment, billing, and payment systems are the same across all insurers - reducing the paperwork burden to patients, hospitals and physicians.
Thanks for exploring this topic in a bit more depth than most writers these days, who for some reason rely on fear-of-universal-plans to simplify arguments for American readers. We do need to advance beyond private insurance profiteering and related abuses, which have only worsened with time. Their lobbyists are likely behind much of the misinformation being broadcast about universal plans here and abroad. They've even managed to engineer a fake universal "trick" version as a talking point for the obstructors in the so-called Republican party!
Thanks for writing this. Now let's press candidates about what they would do about the problem.
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Yes Medicare for all. Recently I went to the foot doctor. I had a planters wort. Remedy,freeze it. Come back again and freeze it. But he did not like the way I walked. He took exrays of my feet and gave me an ankle soft material brace that was impossible to put on unless you followed the orgami instructions that came-with it.I call this Medicared. Unnecessary procedures to pad the bill so the doctor can make more money. Take that away from doctors and I am all for a single payer system.
I doubt America can attain the benefits of a universal single payer health care system until the civil service can competently design and deliver programs at realistic cost.
Canada spends about 10.5% of GDP on healthcare for all. America spends about 17.5% for it's system. Where does that 7 % go?
I had a triple by-pass done a few weeks ago and all I had to do was pull my Manitoba Health card out of my wallet and present it when arriving at the hospital for the surgery. That was it. The administration of the system is that straightforward generally.
If Canadians wanted more bells and whistles on our healthcare programs we could spend far more money on it and still have a much cheaper system than America. Many countries like the UK and Germany have even cheaper systems.
By the way, if the Democrats don't solve the cost problem first I'd hesitate to support any proposal they make.
Just think, America could have great healthcare for all AND eliminate it'd debt and budget woes.
4
It is un-American to prevent private businesses like insuranc companies from profiting from the opportunities afforded by the illnesses and accidents suffered by their clients. This is the United States!
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It's such a mess because it's run by the government. Do you know of anything they run that isn't a mess?
I'm a retired fed gov't employee. Once we've had health care for 5 years we keep it, even when we retire and they continue to pay for a portion the premium.
I have the opposite problem of most; good health care, I have Medicare A because it's free, reasonable co-pays and good prescription coverage so I don't need Medicare B. The doctor's offices practically swoon when they see it. They start lining up the tests they can schedule And the office visits. I've actually have to put my foot down and say no. I'm a reasonably healthy 68 year old who has no need to run to the doctor every 3 months or take every test known to man "just because" it's covered. I don't know what crazy amount they charge the insurer, but I have actually ceased going to a couple of medical practices because of this. I only used Medicare A once for a 2 day admission a year ago;; Medicare and my insurer are still fighting over who pays what; a year later!
Two-fold solution. Streamline the enrollment process and get the government out of it; but at the same time, take the profit motive away from the provider so it's not "more more more'. Providers must and should be able to support themselves and their office and staff, but not get rich.
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I went to the hospital in Frankfurt this past week. Financially, I was in the worst possible position going in -- foreign, uninsured (in German terms), and at the emergency room. An EKG, numerous blood tests, and a short 4 hours later (less time than this takes Boston), the doctor handed me my bill. 86 Euros.
She kept apologizing for how 'high' the bill was, while I just stared, wondering where the missing zeroes were. (And German healthcare is, among other Europeans, considered pricey!)
Our country can and should implement this. But it won't, for as long as greed and profit are valued over human life.
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All states REQUIRE insurance if a person wants to drive. Most people do not have accidents and if they do, incidence rates are low. Most claims are for damage to the vehicle (not bodily harm). Yet we cannot figure out a proper medical insurance system for our own lives.
Other countries have figured out that healthcare coverage is a service, not a for-profit industry. We haven't. People are fine with requiring insurance for driving (because they claim driving is a choice, but really it isn't for most the USA). The same people are dead-against requiring insurance for our own lives.
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Most states require a car owner to have insurance so 3rd parties are protected. They could care less if you insure yourself.
I have dual citizenship and lived in the UK for 30 years. In the UK I never once - not once - had to fill out paperwork to get medical treatment, other than medical history forms. I never saw a medical bill except for glasses frames and some elective dental work. The care was at least as good as anything I've had in the U.S., and the lack of administrative hassle was probably in itself a reason why my blood pressure readings were always normal. Oh, and my tax levels in England were very much the same as they are here. Americans, you will truly have no clue how badly you are being treated by the U.S. "system" until you've experienced what another country can offer.
15
I moved to the Netherlands a year ago. I pay a little over $100 a month for health insurance that covers everything except dental, vision, physical therapy, and some "alternative" medical services like chiropractic (those can be covered with supplemental insurance). Everyone here pays the same monthly premium, except lower income people who are subsidized.
I had a choice of several insurance companies, but they all offer about the same thing for the same price, so the choice wasn't hard. Since then, I've had several trips to the doctor and two medical tests, with no bills or other paperwork. None.
Yesterday I picked up a prescription at the pharmacy and, as always, was not asked to pay a penny.
It just doesn't have to be so complicated. I believe that if more Americans knew how much better the system can be, they'd start clamoring for it. That is, if enough people can get over their freakout about "socialism."
(And, by the way, my taxes aren't very much higher here.)
8
Elizabe3th Warren captured it, the business model of a health insurer is to maximize profits. This means charging as much as possible and paying as little as possible. The confusion and obfuscation is all part of paying as little as possible.
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@Alan White
Well said. I see you are from Toronto, so you have not been subjected to the endless propaganda from Big Pharma, the health insurance industry and for profit hospitals. I've read that a 400 bed hospital in Toronto requires only three people in the billing department while hospitals in the US require one billing person per bed.
3
I have a Master's degree and so am used to research and complex written material. I am also still working fulltime and thus have medical/dental/vision insurance through my employer.
I have tried several times to wade through my Medicate options while doing retirement planning. It's a nightmare. Frankly, I'd almost rather keep working than try to make those decisions - and then having to keep reviewing them over and over again every year.
1
"Medicare for all" is a shorthand way of explaining single payer to people who have been scared by right-wing horror stories gleaned from British and Canadian tabloids. Everyone knows someone who is on Medicare, and enrolling in original Medicare is the easiest part of the process.
I am currently on Medicare, and although the private Medicare Advantage plan certainly reduce my out-of-pocket costs, it also contains inexplicable booby traps, such as lack of coverage for shingles immunizations, something that every senior is supposed to have.
Having made the transition to Medicare plus an Advantage Plan in recent years, I can attest to the relief I felt when I was no longer paying $400 a month for a policy with such a high deductible hat insurance coverage never kicked in.
Private insurance serves no function except to increase costs, as the company takes enough of a cut to ensure lavish pay for executives, even in supposedly "non-profit" companies, and to employ an army of people whose only function is to find reasons to deny coverage.
The only people who like private insurance are insurance company employees and those who have been grandfathered in to old-style, full coverage policies. The rest, providers and patients alike, would be happy to see it go--or at least to be put in a straitjacket, as it is in those countries that use private insurance to achieve universal coverage.
3
You are correct, dealing with Health Insurance Companies is an ever-changing minefield. It appears to be designed to guarantee that the actual patient would obtain the worse healthcare possible, why? The simple answer may be that the more monies left on the table are taken by the winners, health insurance companies and their ilk. Why are there no universal forms, why are there not universal consistent coverage? Why are the accepted drugs coverage ever in flux. Why are there some far away people making decisions for Hospitals and Physicians affecting actual patient care in accordance with the bottom line? Supposedly this is the freedom to have healthcare that each individual can afford, too bad if you cannot afford healthcare.
So, there is no comparison with Healthcare available by must other Nations in the world. The American hybrid is about money and not patient access or care.
2
@Carol
Because the resources are finite and the bottom line is very important---Sometimes the answer is no, you can't have all the healthcare you want.
1
I admit that navigating the health care bureaucracy can be frustrating, but the authors place most of the blame on Medicare based on personal anecdotal information. I would like to know the source of the statistic that 44% of Medicare related costs are paid by private insurers. Don't know where that came from
I'm on Medicare, and I just don't see where it's all that complicated. There have been a number of changes to Medicare that give beneficiaries more choices/options than they had 20 years ago. I believe these choices work to the advantage of most people. However, some people don't like to make choices, and they want an employee at the Social Security Office or call center to make it for them.
I worked in Medicare marketing for a couple of different insurance providers, and I can tell you that Medicare is complicated!
I don't know how anyone who doesn't work in the industry would ever understand it. The formulary changes often. There's the donut hole. Costs vary by region within the same state. You have to know when to enroll or you'll get a penalty.
And, does anyone who espouses Medicare for All understand that Medicare doesn't cover everything?! There's no coverage for vision or dental. Hearing aids are extra too and they're not cheap even with coverage.
I've encountered seniors who were given the wrong advice and didn't sign up for Part B when they were eligible - one man would have had to pay a penalty for the seven years he didn't have the coverage. Why are there penalties? Who does that serve?!
6
Problems with Medicare are not the fault of the government. Medicare has gotten complicated because our elected leaders have voted to let the private sector sell their unnecessary & expensive product & corrupt the system. Their idea is that programs like Medicare Adantage will eventually be the the Single Payer. If we don't stop them now and that means not going with these other half measure plans from some of the candidates, they'll become even more entrenched & impossible to get rid of. And by the way, Sanders is the only one to be trusted to fight for this since he's been consistent for decades.
1
The Bernie Sanders approach calls for effectively eliminating private insurance, including the private aspects of Medicare
I think that the answer is rather obvious.
Enrolling in Medicare was not a problem for me, at age 65. It might well be more of a problem for those applying on something other than a straight age basis, such as a disability application.
So far, it seems to be working as planned. Occasionally, a doctor has opted out of Medicare entirely, but many, if not most, still accept it.
The Part D coverage is an exception. I think it's still worth the cost, but one must check beforehand whether any new drug is covered and, if so, what tier it's assigned to. Lots of copays with Part D.
Enrollment is easy when you have a single payer system and everyone is covered. This may be surprising, but only to Americans.
5
exactly: "medicare for all" is a very misleading slogan. yes it is available and relatively lower cost than some all-private options. but you still have to navigate the choice process, nothing is guaranteed, to have "full" coverage you still have to pay additional (minimum around 5K/year, or more) into the plans, premiums go up every year (harder as one gets older), and private companies are pushing the advantage option maybe to get the government out of it.
having had private insurance when working at an unseen cost (pretax payroll benefit), it's a LOT easier than navigating medicare upon retirement - which is why most people who have employer coverage don't want to give it up (they haven't faced getting old yet either). if i didn't turn 65 and have to sign up for medicare in order to avoid various penalties i would gladly have skipped that part of paying to plan to die and wondering what mistakes i made in choosing the plans i did... and what kills people financially anyway is dental (not covered), as one gets old...
1
I've been enrolled in Medicare for three years. I guess I'm fortunate. I'm happy with it. I've found the whole experience to be relatively painless. The first two years I had Medicare with a Medigap F plan. This was in rural California where for some reason premiums are inexpensive (one year my wife paid $1.00/month for a Silver Plan through the ACA). There was only one insurer. Back in NYC, I now have a group Medicare Advantage Plan. I haven't experienced any red tape and have gotten excellent care.
1
Consider the principle that no one should profit from another's pain, illness, or disability. Private health care "insurance" supports greed and profit, not individual relief or recovery from sudden injury or a pre-existing condition.
We have models of public/private school education, which derive from public taxes or, by choice private finances, but even the latter are classified as non-profit institutions.
Consider the billions we tax ourselves in the name of defense, national security, and aggressive war machinery.
It it right to disproportionately prioritize national defense over the human right of health care?
1
At age 66 I just had my first Medicare interaction for a simple hernia repair.
I have no supplemental so I'm sensitive regarding co-pay.
Up until my surgery this past Tuesday, I spent 2 weeks with Elmhurst Healthcare, 4 different areas, 3 different billing departments, no one would, or seemingly could tell me what anything cost. Either they outright refused or kept referring me to another department until I went in a circle, back to the first area.
Not encouraging.
4
It is easy to get health care in the UK because everyone is allowed to have it. It is hard in the United States because not everyone is allowed to have it.
2
The article identifies the Medicare maze, but doesn't propose alternatives other than moving to the UK.
The American problem with health care and other interstate issues is fundamentally structural, without easy fixes.
America is an interstate nation burdened with an anachronistic federal structure of 50 ill-proportioned states. Medicare and other national programs, and American commerce and industry, in general, must navigate a maze of 51 politically-entrenched, tax-imposing bureaucracies.
The way forward is to recognize that Medicare is the platform that we will build on, then proceed to expand and refine it within the constraints.
First, offer Medicare coverage at age-based, cost-adjusted, Obamacare-subsidized premiums to those not currently eligible for Medicare. This is the starting point for national health care.
Second, subtly transition the Medicare Advantage insurers from private insurers to cost-competitive Medicare contractors. This will provide the clerical resources required to expand Medicare.
Next, absorb the other federal/state health care programs like Children's and Medicaid into expanded Medicare. Require employers to offer Medicare-equivalent health care coverage to employees.
We can never achieve the cost-efficient, hassle-free health care of UK's national health care. We are stuck with the administrative burden inherent in our federal structure. We are stuck with private health care providers that require claims processing.
3
@AynRant
Excellent suggestions.
I guess I'm an anomaly, but when I turned 65 and signed up for Medicare it was relatively easy. Going onto the Medicare website and signing up takes just a few minutes. Choosing my Medicare Advantage plan admittedly took a little bit longer, as I read through the offerings in my area and made my choice, but I didn't find it burdensome. It was no more difficult than when I was working and I had to choose my medical plan from all the versions offered by my employer. I have a couple of preexisting conditions that I take medication for, so it was important to get a good prescription plan. I did, and in the three years I've had it, my premium has gone up just $20 for the Medicare Advantage plan, and I had no burdensome bills to pay when I had surgery last year. Just my expected deductible. Maybe signing someone up who is younger than retirement age and has special needs has different requirements, but I certainly haven't found anything difficult about Medicare.
These authors are right on! This is an important article. I hope politicians and other Americans take note.
1
Prior to his death, my husband had cancer for more than 5 years. He was covered by Medicare (A, B, D) and a supplement. Through surgeries, ongoing chemo, radiation and immunotherapy, we never received a bill or encountered an extra expense. Everything was covered. Yes, we paid monthly premiums in the range of $350 - 400, but that was a bargain compared to the costs of his treatment. Yes, it took me some time each enrollment period to sort through the options. But I am grateful for Medicare and for the years of quality life he had because of it -- and a great oncologist. If Medicare-for-all offers everyone the choice to buy into the system, perhaps with the option of private supplementary policies, Americans would be better off than they are with most employer-based coverage.
2
The VA Hospital system gets a bad wrap sometimes, maybe deserved in some cases, yet for the majority it provides excellent support and top notch care. This system could be scaled over the next few decades to help all Americans have a baseline of quality care. Medicare for all could easily use this system to provide a sustainable level of care.
I recently turned 65. Although I have medical insurance from my spouse's employer, I had to apply for medicare in case I need to switch to it in the future. I was impressed at how complicated the system is - it is absolutely byzantine, opaque, cryptic, user un-friendly. Even after a two hour walk through session, most of the 30 or so attendees were still not sure what was the best option, among 12 or 15 maybe, was the right one for them. Many of the "options" provided the same coverage, but for different prices.
That aspect of medicare should be fixed, and it should be made into a simple public option plan that would be available to all, affordable, and give private insurers something to compete with.
3
My wife and I are retired but even Medicare for
All is not salvation in the US. I have also lived under the
French system. In the US we both pay for Medicare
B, roughtly $200 for both. We have a Medicap policy F, $700. Dental Insurance is another $90. Lonterm care just went up to over $200. Medicare D is another $200. Total monthly medical insurance coverage is roughly $1400 a month.
Even with Medicare for All how would average people get by?
Thank God for our penions of over $100.00 a year;
I have Medicare (A&B), a Medigap Plan F, and a Drug Plan. Yes there was paper work and decision making.
I pay for Medicare B, and the Drug Plan, directly from my Social Security monthly payment. I pay about $250/month for Medigap Plan F.
I NEVER see a medical bill. I pay NO COPAYS. I have IVIG every four weeks which is billed at $15,000. That's $15,000 13 times a year. The $250 a month Medigap Plan F is the biggest bargain I've ever found.
I went to Urgent Care this week, and was then sent to the ER. I had test after test, excellent care: diagnosis, bronchitis, pneumonia and a partially collapsed lung. I paid nothing, just present ID and insurance cards.
My Drug Plan isn't perfect, but I know I have a much greater benefit than I pay in the premium.
Medicare works. A single payer plan works. Perfectly? No. Nothing is perfect. But our current multilayered, Profit making, medical insurance company driven system is a disaster.
3
It is contra-intuitive to have medical insurance/coverage associated with employment; especially since in today's fluid job and insurance markets. Contrary to Barack Obama's statement, and his best intentions, even if one wanted to, it is virtually impossible to keep health insurance one likes - due to job changes, changes in insurance policies and employers' unending search for (from their view) optimal plans. From my experience, signing and re-signing up for ACA plans requires huge time expense to follow insurance coverage, cost and the constantly changing participation medical service providers. Furthermore, one is never certain that services of the medical team members in case of a procedure in a (participating) hospital are also covered. Ditto Medicare.
Probably the most appropriate approach to dealing with this nightmare is to
- totally divorce health insurance market from employment
- provide decent coverage for every one -- on a national or state level to be paid mainly from tax equaling the employers' premiums for the employees health insurance (so called "employment benefit") as well as from the employees additional required insurance premium payments.
-allow everyone who wants it to purchase additional (Cadillac) insurance
-diminish the role of health benefit managers and private insurers (who thrive in today's convoluted market).
-
3
I have been on regular Medicare with a gap policy through AARP for eight years and I have never had a single problem. I signed up when I turned 65 without the slightest setback.I have never been turned away by a doctor. Every bill is paid. I go to the doctor and walk out the door after my visit without the a question or demand for payment. Before making negative claims about government run Medicare, talk to people who actually use it. Yes, if one chooses to go through a private insurer, I am sure there is all kinds of red tape. Just remember the Congressional testimony of insurance CEOs, one of whom said forthrightly, "We are in the business of collecting premiums; we are not in the business of paying claims."
2
Sorry, but I couldn't disagree more. When I first signed up for Medicare I had to interact with the Medicare call center several times, it was a frustrating mess. I signed up for a medicare advantage plan with Aetna, with $0 premium and $0 prescription cost ( for the meds I take). The Aetna people are great and go out of their way to help me understand coverage and providers. I have a website that I can do a side -by - side comparison of coverage's for end of year planning. I'm am surprised a professor is using paper to do the comparisons. I dread the thought of ever having to deal directly with medicare.
The MAJOR problem with healthcare in our Country is that there are too many overpaid "administrators" responsible for the high cost and the regulatory burden of medicine (government and private). Sadly, physicians often get unfairly scapegoated for these problems. If you look at the data, only 15 cents per healthcare dollar goes towards physicians' payments (includes salaries and ALL surgeries and procedures of doctors in private practice). Therefore, healthcare in the USA will still be expensive even if physicians would work for FREE. In the USA, "administrators" increased 3000% in the last 20 years; doctors 200%. There are 10 administrators per doctor. We (patients and doctors) are supporting a cadre of parasites with each medical consultation. Most lay people don't know these facts. Some "experts" advocate a one payer system to solve the ailments of healthcare. However, "Medicare for all" or similar government run systems are NOT the solution. Every other developed country in the world has universal health coverage but only some of them have single payers. Germany, Switzerland, the Netherlands, Japan and others DO NOT use single payer systems. Some of them used single payer systems and later abandoned it; the stagnation and bureaucracy ran their healthcare to the ground. The best alternative is to return control of healthcare to physicians instead of the current situation in which healthcare is run by business people and government bureaucrats.
3
Finally! "Medicare for all" makes for a snappy slogan, but is meaningless without clarification.
Because standard Medicare pays only 80% of most medical costs, most seniors buy additional insurance ("Supplemental" or "Advantage" plans). The premium to cover the remaining 20% and other services not covered by Medicare can cost 55% - 350% or more than the Medicare premium.
For this you get the privilege of having your healthcare supervised by bureaucrats more interested in cost savings than health, the joy of navigating a maze of options during the yearly sign-up periods, and the comfort of knowing you are paying for countless middlemen cutting deals with providers, insurance companies, pharmacies and drug manufacturers--with each of these entities trying to maximize their bottom line.
Single-payer with plenty of oversight and regulation is a better goal.
5
We need basic universal healthcare, and access to physicians. But while everyone is focused on the insurance companies, where are the providers going to come from?
In today's NYT there's an article about "middle class" struggles, with student debt, housing, education savings for children, and retirement savings. So what about these physicians who come out of medical school hundreds of thousands in debt? How are they going to provide care when they can't pay their own bills?
We have to rebuild the system from the bottom up, including some sort of free medical education for qualified students who will then devote a number of years to a medical corps, to serve the community and pay back loans. They should also be paid a decent wage. They won't get rich but they won't be crippled with debt.
2
While health plans are in the news about high and confusing health care costs, which is a real problem, the 800-lb gorilla in the room remains hidden from public policy discussion.
And that is the fact that Medicare has and continues to pay for the training of nearly all physicians in this country and has allowed the proportion of primary care physicians to be no more than 1 in 3 physicians. The 2 of 3 or more are specialist physicians who are dependent on and friendly to expensive medical procedures mostly done in hospitals.
One of the main reasons why Britain’s National Health Service is affordable is because they have at least 42% of their physicians in primary care and their medical procedures per person are far lower than the U.S.
The most interesting part of the lack of awareness and discussion of the role of Medicare in training physicians. It can’t be because it is not important.
3
I agree strongly wih Blackmamba that America is not a civilized nation.
Last year I heard a person telling my pharmacist (at an independent, old-fashioned drugstore) about how bad the National Health in England is, and in Canada as well. As I have Canadian friends, I knew this was nonsense, and I spoke up. Everyone, pharmacists included, argued with me -- even thought I explained to them that if you had a serious problem in Canada -- rather than the desire for an elective procedure -- you would not go "on a list" but be cared for promptly. Yes, the taxes are higher, but the coverage assures the excellent health care that should be a human right.
On a bus tour of Montreal that included many visitors from the States, the bus driver explained why Canadians value their health care system.; my friends agreed. At the time Hillary Clinton and Ira Magaziner, were busy -- during the first year or so of the Clinton administration --devising a voluminous, unreadable health care plan, my husband quipped that all they needed to do was ask Germany and other civilized nations to fax over their plans, and use them as a model. But big pharma and the insurance companies don't want that.
Do you ever think about the incredible waste of money that goes into the endless, extremely expensive TV advertising of Big Pharma products that "you should ask your doctor about" (as if your doctor shouldn't be the one to tell you)?
4
@Judith Remick Only two advanced economies allow the advertising of prescription drugs to the public and one of them, New Zealand, is considering joining everyone else.
1
In both health care and education, the combination of a government program and private financial institutions (insurance companies and banks) the end result is that most of the government benefit ends up accruing to the financial institution in the form of profits. The student/patient ends up paying about the same out of pocket as they would have if they paid the costs straight up. It ends up just another corporate hand in the government's pocket.
I sympathize with those who have to deal with the forms and complexities of the choices they have but as I have always said there is probably a good reason as to why those forms were created and its called FRAUD. Simplistic solutions like Single payer will be no different. There will always be unscrupulous medical providers as well as beneficiaries that will try to "play" the system so controls will still be necessary.
While I totally agree that health insurance companies are the problem, I fervently hope that Democrats not try to eliminate them from the proposed fix to healthcare.
This is for two reasons.
First because these financial giants will immediately start airing misleading TV ads, radio spots, etc to scare the American public. We all know that most people do not read a substantive article on an issue but get their information from TV and talk radio. It will be easy to scare the people and get them to vote against their best interests.
Second reason is that eliminating insurance completely will put huge number of people out of jobs. Even those lower down the totem pole in the insurance industry will not want to vote for something that eliminates their jobs.
I think that to start with the solution advocated by the authors of this article is the way to go. It helps people choose the best insurance plan for them, thus reducing their anxiety and also gradually reducing the insurance companies profits because they will not be able to rip off people as they did before. Eventually health insurance companies will cease to exist once they are no longer as profitable as they are now.
I am 86, and have been without ANY insurance since 1/1/19, because I tried to get out of Medicare Advantage and return to regular Medicare. Somehow the for-profit giant insurance company running my Advantage plan couldn't get me off their plan and back onto Medicare.
It took me a few months to figure out my shiny new Medicare card didn't work, and I started with the hours-long phone-calls to the Company, who blamed my retirement company and Medicare; Medicare blamed the Advantage company, and my retirement company blamed the other two.
After three months of promises, "Don't worry -- you'll be back on Medicare in 3 to 5 business days," I threatened to sue the Advantage company. Then I got through to a higher-level person who (gasp) actually gave me her phone number and last name! She called ME twice! And I got a form letter from Advantage on telling me I was off their program since 12/31/18. I sent that letter to all those to whom I owed medical fees, but so far none have been paid, and they are leery of re-submitting because there is a limit on those attempts.
The last Advantage promise, made 40 days ago, was "It will take up to 30 business days for Medicare to receive the information we sent them." Medicare has not yet input me into their system as of yesterday. I AM UNINSURED.
3
This. I moved to the UK 20 years ago. I remember the first time I went to the doctor, and then stood at the receptionist's desk until she asked if I needed another appointment. I said, how much do I have to co-pay? She looked confused. I went to the pharmacy and left with my free birth control pills (that i had been paying $30 a month for in the US back then). I thought someone would stop me from leaving. They didn't.
I've had major surgery, my spouse has had major surgery, my kid's been to the ER, and the level of care and consideration was top drawer throughout. (The food was awful IMHO but he liked the hospital food, so....) The NHS and its staff are the real crown jewels of the country. Happy 71 years, NHS!
5
Once upon a time there was affordable health insurance: it was not a government program but a non-profit: Blue Cross and Blue Shield. Today I have Medicare through a non-profit which is a really good plan: compared to all the other plans. It costs a fortune for doctors and hospitals to negotiate the health care payment market today. Prices have risen to cover the cost of collecting payments for care. Private investors paid off the state legislatures in each state to be allowed to take the "Blues" private. That's when costs began to rise and rise and rise. When you have a private, for-profit, company controlling health care access you are going to have increased costs. Costs have increased beyond any ability to pay (except for the 0.1 %).
It's going to take nationalization of health care to get things back to a reasonable level and probably nationalization of medical education too. We can take two easy steps: first we need to add serious health education required in every junior high school. Wonderful plastic models that come apart for both anatomy and physiology! Sexy bits included. Second we need to provide subsidized birth control to every woman who wants it: only wanted children should be conceived. Save a huge amount of suffering: families and babies suffer if a child is not planned and wanted. Save a huge amount of money: medical & obstetrical care, psychiatric care, childcare, child protective services etc.
Save suffering too.
2
NHS is designed to provide people healthcare. Medicare is designed to make it look like people are being provided healthcare.
It's that simple: profit-driven healthcare is not good for anyone but those who profit from it.
3
I have just completed my first year in retirement with Medicare part B, supplemental insurance and drug coverage from private insurer. To say it is a headache is an understatement. I have also experienced health care in Europe as a visitor. 29 euro to see an emergency room doctor and receive a prescription. At minimum, we need better regulation of plans, allowable profits and better rules for medical tests which are routinely used to generate profits not necessarily linked to health outcomes. The manner in which electric utilities were regulated since they have an monopoly position in the communities should apply to health care. At least the Democrats are discussing health care options, although not as clearly in terms of issues as the authors here discuss. The Republican position seems to be "not what the Democrats want" and nothing else. While most of the discussion among Democrats has been single payer versus modifications of the current system to "make it better".
I would like to see an evaluation of the Swiss system, a highly regulated private insurance system with every resident, citizen or non-citizen required to purchase a policy. Profits of the insurance companies are limited by government regulation to control costs to residents. A former academic colleague of mine lives in Bern with his Swiss wife and has nothing but praise for the system compared to ours.
3
Single-payer is the only reasonable answer to the healthcare question. The Frankenstein system we have created makes insurance company CEO’s rich, but it doesn’t do anyone else much good.
Every modern country in the entire world has already figured this out... every country except one. Then again, we’ve spent the last few years proving in all sorts of ways that we’re not a modern country.
4
Getting care for our Autistic Spectrum son was similar too what the authors describe. He still can get help under our insurance (thanks to the ACA) but he will soon be 26 . We are not looking forward to that birthday.
3
American are a peculiar lot. The reason Americans haven't got healthcare for all is because the government agreed to insure those where profit for insurance companies are impossible.
There is nothing more damaging to the public welfare than the public paying the healthcare costs of those where the healthcare is most costly and benefits the least.
I cannot imagine why America decided to let the public purse take care of the elderly when productivity and efficiency would dictate investing healthcare dollars in the young.
I remember the Titanic and the calls for women and children first. Too many women and children died because old powerful men knew the signs and demand women and children first didn't apply to them.
1
Everything they said is true, but really worse. Unlike any other contract, Medicare providers (Insurance Companies) can change terms, conditions and costs when they want. Its not a yearly contract, its a perpetual guessing game. While companies can change important terms you can find another company only once a year. This year my insurer won't cover cough syrup, nor the amount of sleeping pills my doctor prescribes. The government doesnt play life or death, the insurer does. And it isnt cheap. Have fun at 65.
2
One day people will realize the basic truth about private insurance: it is a for-profit business. This means taking in more from premiums than you pay out in coverage benefits. Put another way, for private insurance to stay in business, they MUST REFUSE claims. Even if every claim were valid, a calculated percentage will have to be refused.
What's worse, the more claims they refuse, the more profitable they are.
Now, would you trust such a system to reduce their shareholders profits if you or your child's life depended on it?
4
I am both a recipient of Medicare and, as a psychologist, a provider. Dealing with Medicare in both of these capacities has been pleasantly smooth and significantly less complicated than dealing with insurance companies.
As a provider of services, I am out-of-network because I found insurance companies unnecessarily complicated, dishonest and enormously frustrating to deal with. On the other hand, interacting with Medicare has been, overall, smooth and straightforward, with the added (and very appreciated) benefit of being able to easily access actual human beings to assist me. As a Medicare recipient, I have been similarly pleased.
I simplify my life by simply refusing to deal with insurance companies. I know that with insurance companies, I would be paying for huge CEO salaries, many layers of administrative costs and salaries, and huge advertising costs.
Medicare reimbursement to me as a provider is half of my regular fee. I’m fine with that, though, if we had a single-payer system, that rate might need to be increased to make professions in healthcare viable for younger people with education debt and starting/ middle of adulthood life expenses.
If we took the high executive salaries, layers of administrative costs and advertising out of health insurance, the system would do what is supposed to do — provide affordable quality healthcare for everyone. I vouch for Medicare on both ends. It works just fine.
3
I am sympathetic to arguments in favor of Medicare for All, eliminating private insurance. But I am not willing to take the risk that staking Democrat's chances to take the White House, Senate and retain the house on this position which too many Americans worry is a radical solution. Better politically: add a "public option" to ACA or another of the incremental steps to reduce the level of uninsured and move toward better control of costs.
Finally an article about what some of us seniors have been thinking all along although the author leaves out the maze of expensive monthly premium private insurance supplement plans the remaining two thirds of seniors on Medicare take out.
3
I am all for a something better then what we have now but the costs of healthcare in this country is staggering. I am hearing a lot of promises about single payer with little explanation as to how we could fund it other then "make the Rich pay their fair share" and do away with private insurance companies. The bottom line, Healthcare is extremely complex in both delivery of services as well as costs.
If you want a simpler system via single payer, be prepared for massive change in expectations as well cost controls that will be necessary to prevent massive deficits above what we have now. All of the other nations that have national healthcare have their downsides as well and we don't hear much about those. I for one would like to hear the complete story of those other systems in order to make an informed decision before we head down that road.
Given all the entitlement ideas floating around the Democratic world such reparations, guaranteed income for all, living minimum wage and a current deficit of around 1 trillion a year, it seems incredulous we can afford any or all of this.
I am skeptical...
1
@TH Of course all systems have issues but in short Europeans, Australians, Japanese and many others have universal healthcare, live longer, have far lower infant mortality rates and nobody goes bankrupt or gets turned away. Finally government expenditure on healthcare in most of those countries is about the same as US government expenditure on healthcare. The American healthcare system is a scam.
3
The answer to the question as to why it's so hard here and so easy in the UK and elsewhere: "Private Enterprise". There are just some things that the free-market private enterprise just can't do well, and health care is one of them.
4
I agree with the authors and virtually all of the responses. But I am troubled by suggestions to call any replacements "socialized medicine". The Trump people and the private insurance industry have conspired to frighten people into thinking that anything "socialized" will eventually lead to Russian tanks invading our country. We need a new term. I suggest "Medical Security". We already have "Social Security", a system that since enacted in 1935 have allowed millions of old people, plus widows and minor dependents of people who have died during their working years to continue to live their lives in dignity.. We mustn't forget that during the 1930s, the Republicans also called Social Security a socialist threat to the United States and the beginnings of bolshevism in our country. As people have accepted "Social Security", they will learn to accept "Medical Security" as American as apple pie and the 4th of July.
5
@JerryV YES! Words matter!
1
The NHS, for all its faults, was always intended to work. Medicare has been designed/redesigned and operated to maximize profits for private companies and to discourage users from seeking treatment (the real meaning of expressions like "having skin in the game"). Of course the NHS works more straightforwardly. A shame that the authors and their daughter are going to have to go back to U.S. healthcare.
1
"We had anticipated the financial relief that can come from a single-payer system, but not the administrative relief. It had never occurred to us that it could be so different."
And therein lies the evil genius of the Republican marketing machine. They have convinced a sizable portion of Americans that the healthcare system we have now is the only possible system we can have. Want to make changes? It will bankrupt America. Want to curb obscene profits by insurance and drug companies? That's socialism. Other countries have systems that are working? It's un-American to consider solutions that don't originate in the U.S. of A.
In the meantime, those same people buy their prescription drugs from Canada or England, and have loved ones who rely on Medicare. Unfortunately, there's no treatment for cognitive dissonance disorder.
4
Trying to manage the US medical system and not be swindled is a Herculean task.
Every thing you hear are intertwined with outright lies.
Americans are beings thrown into healthcare meat grinder.
You can’t mix healthcare with profits. It’s that simple.
I thank Sanders for helping move us towards something normal.
2
It is worth mentioning that the system is complicated to navigate, though frankly that’s mostly on the front end. I can’t speak for Advantage plans, but regular Medicare—though it involves four different pieces—works great once it’s set up.
For those that don’t know, for the full Medicare option you need Part A (hospital care), Part B (non-hospital care), Medigap (insurance beyond Part B coverage), and Part D (prescription drugs). There are a number of options for the last two, trading off higher premiums for additional coverage. However once the choices are made, the Medicare number gives access to all benefits. Even the private Medigap coverage is invoked automatically for expenses beyond Part B. Part D is provided by insurance companies, so you have to think some about in-network pharmacies.
So called Advantage plans are private insurance plans replacing Part B, Medigap, and in some cases Part D. Choosing between regular Medicare and Advantage plans involves extremely complicated comparisons of benefits that are probably impossible to do. Anyone reaching Medicare age is deluged with ads for Advantage plans.
Some of the suggestions in the article have been done for both Medicare and ACA—particularly standardizing benefits. The state where I live, Massachusetts, has further reduced the number of options.
The two biggest problems:
- Not all doctors take Medicare.
- There’s no notion of family plan. When I retired, we had to patch together coverage for my wife.
1
Right! Perhaps after the current paroxysm of regressive politics (in my view, based on White Fright) subsides, we can get to actually governing this country with a view to meeting real, urgent challenges. And yes, just like all the other developed liberal democracies of the world, greater priority must be given to "the general welfare" and "liberty and justice for all," both of which are begging for attention and support. This week we celebrate Independence, but we remain so dependent on unfair, arcane, outmoded, thinking and policy. We can't have the best political candidates because you now have to be wealthy and crazy to want to serve. We can't make rational decisions about Defense because there are vested interests that don't want to lose their gov't contracts and communities that don't want to lose associated jobs. So pork-barrel projects get funded and/or continued past effectiveness. So the bizzarro healthcare "system" works for the well-off but few others and Medicare and Medicaid fraud by providers is not effectively addressed. AND the immigration and refugee issue remains in turmoil and not rationally managed. We are better than this. Make America Great. Period. (For the first time, for all.) Liberty and justice for all!
'It had never occurred to us that it could be so different.'
Perhaps this is one of the reasons that the US does not have a modern, well functioning health care system.
People who have never known anything other than the private insurance based system find it difficult to conceive an alternative even though most European countries have a 'Medicare for all' or various hybrids of it. In the internet age where information is so readily available, perhaps this suggests that Americans are living an' information bubble'.
4
We can start by banishing the notion of "shopping" for insurance. You can't choose an appropriate plan when you don't know what your future health needs might be. It's a huge, stressful waste of time.
3
I pay $135 for Medicare Parts A & B, $29 for Part D. Medigap Plan F provided bu AARP United Health Care runs $193. $357 provides me with complete coverage. I have had only one bill from my GCP for an initial Medicare physical for $43.25. I have yet to pay for any medical procedure or office visit or even received a bill. A fair premium paid for by all will help solve this medical care dilemma. It is quite obvious that the billing confusion and plethora of plans is a ruse to pull the maximum money from clients for the least care than can be afforded. I find the current system available to the general public to be a form of cruel and unusual punishment for the non-crime of being sick or trying not to become sick.
2
Truly, don’t knock Medicare, or the NHS, unless you, personally have used them.
I consider myself a wee bit unique as I am American, am old and am on Medicare. I also worked in the U.K. for five years when I was younger and was on the NHS. I LOVE Medicare. I have many anecdotes of Europeans and Canadians working short periods in the USA for the international company who employed us. They mostly had a version of an NHS back in their countries. They came here and were truly amazed at what we Americans put up with. At the prices we pay. As my Canadian-trained doctor here in California told me recently, she initially had the hardest time understanding that in America, the insurance companies call the shots.
We put up with it and while I hope Medicare lasts for me, I worry about my daughter’s young family, all years away from a Medicare that might not be there anyway.
4
The proof is the US spends over 17% of GDP on healthcare - the UK, 10%. I suspect that 7% ends up as pure profit. It's trillions of dollars, every year - imagine if it was spent on infrastructure, or defence - it would triple the defence budget.
And that extra money buys an inferior system and lower life expectancy. The NHS doesn't have co-pays, or deductibles, or invoices. If you are poor, your travel costs to hospital are refunded, prescriptions are free.
I can't imagine living with the US system. It sounds evil.
4
I call it Medicare Disadvantage.
Even as a physician myself, I found it incredibly confusing when comparing the various Medicare plans when I became eligible and still do so.
Of course, the reason for making it so confusing is for insurance companies seeking to make a buck. They aren't running all those ads or sending out all those packets suggesting you change to their plans out of some charitable instinct on their part although it would be easy to think that that was their sole motive.
As to the difference between here and Great Britain, a number of years ago I was bitten by a dog while visiting there. I went to an emergency room at a local hospital. I was seen at least as quickly as in any U.S. hospital and didn't need to fill out insurance forms before being seen or receiving a tetanus shot. The only questions I was asked was regarding my health and not any on how I was going to pay.
And, by the way, it's interesting to me how many people who haven't yet reached the age for Medicare think that it is completely free. Many are often shocked when I tell them I pay over $300 a month so that I'm fully covered (and even on top of that I still pay a deductible both for medical services and medications if I need a drug that's not yet available as a generic.)
5
I don't dispute that medical insurance coverage can be horribly confusing. In our (my wife, son, and me) experience obtaining coverage for medical expenses while covered solely by a private insurance company (hint first two letters of name BC) was a paperwork nightmare (procedure X code Y covered then randomly not covered until appealed - BC well known in the medial profession for denial of coverage in hopes claimant will go away). We shifted to well regarded local private HMO and all such problems went away. Continued in that HMO's medicare advantage plans with same experience. Go to Dr/emergency room/hospital/pharmacy - get "product" pay known copy end of story. Only bug has been occasional changes in Rx formulary (e.g. what's covered in what tier) but issues relatively minor.
I’ve scanned many of these comments that precede mine.
- first, about quality, affordable healthcare being a right. In the U.S. all of our “rights” are defined in our Constitution - speech, assembly, religion, arms, etc. The day that the U.S. voters add “quality, affordable healthcare” to that list, it’s not a “right.”
- About healthcare in general. I’ve always had good, affordable, access to healthcare. Most everyone I know has had the same. In the U.S. we have a (multi-tiered) healthcare delivery system - it’s a great system for most, a good system for some, and a not-so-good system for others.
- #1. We have people insured by "the government" - The many tens of millions government employees (federal, state, county, & local), defense contractor, Medicare & Medicaid, veteran, & probably many more that I've missed, all have government (i.e., taxpayer) subsidized health insurance and good access to healthcare
- #2. We have many millions of private sector employees working at large, multi-national, & medium-sized companies that can afford to offer employer-subsidized health insurance and good access to healthcare
- #3. And then we have everyone else - small companies and individuals that can't afford to purchase insurance on their own without significant subsidy (that matches what federal and large companies with benefits can afford to provide) and access to good healthcare.
Our challenge is, how do we assist group #3 without harming group #s 1 & 2?
1
@Brian, you folks and your strict interpretation of everyone's rights....AR-15s aren't mentioned in the constitution either; Neither is asphalt for roads, women's votes or many many other things we now know about. We have been given a system of government that, unlike others, allows for the free flow of ideas, and we used to be proud of it.
But here's where you lost me: "I’ve always had good, affordable, access to healthcare." Congratulations; we can see why you'd be scared of new ways.
2
Systems function exactly as designed, especially bureaucracies. Sick, elderly people and weary caregivers swim the hardest in our Byzantine health system. They fight and call and study against things they cannot see and cannot know. And yet this is our health system. It’s an expensive battle for care that leaves many patients feeling small and exhausted. The power in this equation has been handed to a middle man who takes his cut. Maybe you will be too tired to object.
3
Hear hear!
I wish someone could point me to thoughtful discussions/analyses of the potential "unintended consequences" of what sounds superficially to be such a simple solution.
I myself wonder about how not fixing all the underlying problems (I had not thought about the bureaucratic ones. Thank you for that!) with overdiagnosis, cookbook prescribing (i.e., matching "pill to ill" without really thinking about or exploring the more complex systems interactions and lifestyle issues at the root of the problem) and unnecessary procedures/surgeries. I suppose this is where the payors decide what gets paid for when-- and what/when not, but I see alot of bad medicine/lazy medicine and unnecessary procedures in the Medicare (and VA) population/s.
So somehow Healthcare Is A Right needs to be tweaked to competent/thoughtful/non-dependence creating Healthcare Is A Right.
America's main problem (and, yes, we have many) is the belief that whatever America does is best. So many here in the US are completely insulated from the rest of the world by their sounding boards - like minded neighbors and their antagonists over at Fox News. There seems to be this lack of a driving force for knowledge here, and a presumption that no country in the world could possibly do anything better - EVER!
The healthcare system in this country is so broken and so backward. I lived in Japan, was automatically enrolled in their health services system, and saw a doctor with no wait, no forms, no preapprovals, no co-pays, nothing. I got a prescription for the equivalent of $3.
Wake up, America!
7
This article is right on target regarding the wasteful boondoggle that is the bureaucratic side of health insurance in the USA. I have lived in the USA and four other countries around the world. For most business and consumer situations, the transparency and speed of information in the USA are #1, so it is truly strange that the opposite is the case with health insurance dealings. Of course the larger problem in the USA remains denial of claims, or even lack of coverage, for so many Americans. But it is also a big, not small, problem that even when insured (as I was) it is just about impossible to know what exactly you are getting in dollar terms (ie, precisely what insurance company payments to expect in relief of medical charges) in exchange for the large amounts of money shelled out for insurance premiums. The authors are also right that in the USA the paperwork morass causes confusion and errors even for insurance company CS staff, and of course customers. I cannot understand why this "industry" is so out of sync with the standards of other developed economies AND the generally transparent and efficient standard of other consumer experiences I had with businesses in the USA. This problem calls for sharp, deep reform to remove an unnecessary, wasteful and stressful burden from individuals, families, businesses seeking insurance for employees, and indeed American society as a whole. It is not anti-American to criticize this aspect of the USA; it is pro the American PEOPLE.
1
OK - you're in Britain - I assume you read an occasional paper or listen to the BBC - so you will have heard the concerns over the NHS and 'free' medicine for everybody.
Yest it is easy to register for services - the mundane stuff - like actually delivering those services in a timely fashion to everybody is the challenge
How do you think they will handle:
1. A budget that increases by an order of magnitude every decade after adjusting for inflation
2. The fact that a full THIRD of gov spending is now on healthcare and that is accelerating
3. The fact that KPI are being missed every year and emerg performance is getting worse every year despite spending more money.
4. A rapidly aging population (up to a 25% over 65) will increasingly grab all avail Health resources as they consume six times the resources of a 20 year-old.
I could go on and the BBC certainly does but a simple question is if the average american is willing to give up his private plan for medicare for all and in reality medicare for none
3
This is an unwarranted attack on Medicare. The word "burdensome" is a lie, designed to create fear.
No Medicare recipient would use this word to describe coverage.
2
@David Henry Actually, yes, —yes we would. And I am on Medicare.
1
I had heard that Medicare was not for the weak or sick. It takes a strong, determined person to penetrate an opaque system that uses the term "donut hole" to describe the prescription plans that are available.
I reached out to Medicare customer care agents and professional insurance agents for help when I was unable to figure out which of the many different configurations of Medicare coupled with a private insurance company's Advantage or Supplemental plan would be right for me. I received a different solution from each person I spoke to.
Medicare is built by people who have the best of the best medical insurance (for life). Good luck to the rest of us - and beware of the donut hole.
2
Remove anything related to healthcare from Wall Street ( Big Pharma included of course ...) and you solve most of America healthcare related problems.
Healthcare is not a commodity to be traded.
4
Living in Canada now for more than a decade, coming from the socialist Kingdom of the Netherlands where for some obscure reason (supposedly it would reduce health care costs) they adopted a Obamacare system involving private insurers but under heavy (Socialist!!) government regulation. I can say now that I prefer the single payer system of Canada which almost obliterates administration although many have an additional health plan often provided by employers to cover health care costs and dental care not covered by the single payer system. An issue may, however, be the wait times for elective treatments, but when push comes to the shove you will get your necessary treatment. When I read this article I do not understand the system at all, seems way too complicated, and I am extremely glad to live in a country which Americans might consider socialist. Indeed, I do not need to fill out forms and I do not need to check various insurance providers for the best coverage. In the Netherlands, the health care costs, including health insurance premiums plus the amount of administration did actually increase substantially after the adoption of their Obamacare type of system.
5
@Theo Van Der Kwast - Good points. In terms of wait times, when my husband had to wait 4 months for hip replacement surgery here in the US, I checked out an Canadian government website that listed the wait times for every major surgery at every Canadian hospital, plus an average for the country. Average wait time for hip replacement in Canada? 90 days.
I notice that most Americans assume there's no wait time in the US. That's not remotely true.
3
You have to get there from here, and not enough of America wants to go there.
Drop this pie-in-the-sky total remake, and focus on something doable, like expanding Obamacare and offering a government option where there are not enough alternatives.
Half a loaf is better than none. Getting universal coverage is the main goal, not some specific method. After that is established, we can look to improvements in administration.
What might work for 35 million Canadians or 66 million Britons does not necessarily scale up to 330 million Americans.
1
I am a 65 year old doctor. The process of enrolling in Medicare part A was ridiculously complicated. I consider myself intelligent and educated. If I can't understand the Medicare process it means the process is not understandable.
Every other developed nation on earth has some form of national health insurance. They all spend less on health care and have better objective health outcomes. Are they all wrong and we're right?
14
@Jon Tolins I spent hours trying to choose my Medicare part B and part D insurances. Even though i work in health care this was a shocker. Now I spend hours reviewing my medical bills. Trying to figure out a hospital bill requires hours and knowledge of health care coding. And this is retirement? It's another job, unpaid.
4
"We had anticipated the financial relief that can come from a single-payer system, but not the administrative relief. It had never occurred to us that it could be so different."
It is the dispensing with unnecessary admin that makes the NHS one of the most cost-efficient health systems in the world.
4
The health insurers--one of myriad narrowly defined private-power interest groups--write the rules. And they are, as it were, effectively in charge. I saw the same thing for many years in the financial services industry of which I was a part.
2
“While many other Americans continue to struggle with these problems, ours have mostly disappeared because we are spending the year in Britain. In its National Health Service, we found a system that did not demand an expertise in navigating bureaucracies. After 10 minutes filling out a few simple forms, we enrolled our daughter. Within two days she had an appointment and a filled prescription for medication, which was free.
We had anticipated the financial relief that can come from a single-payer system, but not the administrative relief. It had never occurred to us that it could be so different.”
Ms. Herd and Mr. Moynihan are lobbying not only for simpler healthcare but simpler administration.
We hear you.
Just yesterday I read (here) that Trump and Republicans are building a huge election war chest. Big business, namely healthcare, are lining up to defeat things as they always do, with billions of dollars.
The Baby Boomers got us out of Vietnam, created the Internet, and gave us Star Wars.
Millennials, Gen X, Y, and Z’ers, ITS YOUR TURN!
Healthcare is a fundamental right of modern societies. Get out there and emulate Britain, Norway, Denmark, or Canada. Make Healthcare happen!
I’ll never see government sponsored healthcare in my lifetime but you kids can make it happen!
Against all odds, Make it happen! Vote for yourselves!
VOTE DEMOCRAT!
10
Wow! How one paragraph can destroy the conclusions of an excellent description of the administrative complexity and burdens of our health care financing system that has made our system so expensive while falling far short on performance.
The single payer model of an improved Medicare for everyone would fix this expensive administrative nightmare, but then these highly qualified experts state that an incremental alternative to consider would be to use the government to standardize plan options yet make sure the plans vary to allow for comparison shopping.
We did that with the metal tiers in the Affordable Care Act. That fixed almost nothing, just as adding a "public option" will not correct the defects in the system.
We desperately need the single payer model of Medicare for All (Jayapal and Sanders) if we truly want affordable, high quality, accessible care for everyone. Herd and Moynihan obviously know that, so why did they have to wreck their brilliant article on our administrative boondoggle by throwing in a gratuitous suggestion that consumer-directed insurance shopping might be an effective option? It would recover none of the hundreds of billions of dollars in administrative waste that uniquely characterizes the U.S. system - funds that could be used for patient care instead.
3
Here is another answer: Stop complaining.
Instead, focus on what you have, and how rare it is. Until the past 70 years the idea of medical insurance was something that no ordinary people could even dream about.
Yes, it can be complicated. You are complaining because it is complicated? Like you are entitled to "easy?"
You have health care, and insurance to pay for it. So what if it's confusing. 99.999999% of all humans who have ever lived would be so grateful for what you have.
This is another in the NYT's long-running series of creating an entry into the victim sweepstakes. The Times doesn't get it that its approach is not helping solve problems, but is adding to them. Make people mad, and make money from people.
4
@Travelers So basically your argument is that Americans should be grateful for their overpriced healthcare because cavemen didn't get any at all.
45
@Travelers But when easy is easily possible and we can see that easy is taken for granted and easily available in other countries, why work so hard to reject easy when easy would be easier?
15
@Peter
One type of argument that I have zero respect for is the one that begins "basically your argument" and then says something ridiculous, and then gets upset at what they just wrote, not what I said.
What I AM saying is that insurance coverage is basically a Rorschach Ink Blot test, like most of life is. You look at it and project either your happiness or unhappiness onto it.
The NYT wants us to always see unhappiness in these ambiguous situations. All they seem to pick to write about is where they can find a victim of our great big bad society. And readers of the NYT groove on it--they love to be angry about victims.
Let's start with these folks here. They have insurance. They won't go broke because of their insurance. That is a GOOD story. They can get all the help they need for their child. What a blessing.
They aren't entitled to "easy." They aren't even entitled to health care for their child. But they DO have health care for their child. What an amazing thing this country has done for them. Truly amazing. And worthy of much praise and gratitude.
The author makes very good points, especially regarding the private insurance sector's involvement in Medicare. It's unlikely that we will end up with a system that eliminates the private insurance industry, certainly in the near term. The trick, therefore, will be to secure the cooperation of the insurance industry as we try to make health insurance more universal and affordable. Alas, that industry is more likely to sabotage such an effort if history is any guide.
3
Amen...you shouldn't to be a CPA to figure out medical bills. Even with medicare, I spend hours sometimes trying to make sense out of an accounting system that defies ordinary logic.
2
My wife and I are both physicians. Our employer offers us a robust choice of private medical insurance plans, for which we are grateful.
But trying to figure out rationally which of those plans makes the most sense for us is a Sisyphean task. Neither the representatives of the various plans nor our providers could answer (at least in any way that I could understand) whether particular services were covered, which providers were in-network, or even such basics as how deductibles are calculated. And those questions don’t even address the structural ambiguities for which there is no answer or immediate remedy, for example, the fact that our in-network hospital staffs it’s emergency room with a private group of emergency physicians that is not included as a preferred provider.
After many hours spent trying to decipher which plan offers what, I basically ended up closing my eyes and throwing a dart at the spreadsheet of offerings on the board. For those readers who are worried about the government bureaucracy of healthcare, which is a legitimate worry, I urge you to take a look at the opacity of private insurance. It’s not any simpler.
6
Access to quality affordable healthcare is a human right in any civilized nation. America is not a civilized nation.
Private healthcare insurance is in the business of collecting premiums and denying and limiting claims in order to increase the profitable return of shareholders.
Standing between you and your medical professional healthcare primary care physician is some loathsome bureaucrat looking for a raise and a bonus.
362
@Blackmamba
Or a JudeoChristian one. For-profit insurance is the moral equivalent of usury -- to profit from the pain of others.
27
@Black mamba
How do you explain the presence of a private health insurance market in Canada? It also exists in Great Britain, Australia, and France.
A maxim of strategic planning is to identify the events or circumstances you would least like to confront and then put assets iin place to address.
As to to health insurance this mandates you review the public option and ask - Is it complete or incomplete? Then if necessary, go to a market to transfer the risk if possible.
The foregoing is a game theory strategy in negotiation.
5
@Dale C Korpi - Canada has private health insurance available through companies such as Blue Cross et al but it is for dental services, massage therapy, chiropractic services etc. and these policies are available through employers and to individuals at a cost. Core medical services are covered by our Provincial governments, funded at the Federal level.
Our medical system works quite well. Yours does, too, if one has enough dough to pay for it and was healthy when they enrolled in their plan. For profit core health care is a disgrace.
56
This is an excellent piece. This jungle of paperwork is hard enough but imagine trying to navigate the bureaucracy when your illness is mental and the process simply ramps up the stress when you least need it. It’s an exercise in institutionalized cruelty. The insurance companies use their procedures to drag out claims to the point where many people, as their accountants know, will simply give up.
I’m a transplant from the UK but my 97-year-old mother still thrives in her own flat in the North of England. She has been a beneficiary of the National Health Service since its post-WWII inception. She has never filled in an insurance form. She doesn’t even know what “medical insurance” means. As a Medicare recipient here in New England, I get excellent health care, probably better than at any time in my life. I have some small supplementary coverage to fill in the gaps, but my experience, including a number of serious procedures, has been smoothing sailing with no hassles.
My heart goes out to the sick and elderly and non-native speakers who have to navigate the current insurance system. As politicians start to address this vast problem, I hope that can factor in the burden of navigating the bureaucracy. It’s almost like treating someone for a respiratory disease while insisting they breathe in diesel fumes while they are waiting.
5
I retired four years ago in reasonably good health. My Part D coverage costs $80 per month. My doctor recently prescribed an decades-old generic medication that has helped me tremendously, but my plan tried to charge me a ridiculous $96 copay on top of that premium. My doctor’s theory is that the two or three companies that manufacture that generic have agreed to charge an inflated price—because they can act with impunity. I now go around my plan by using Good Rx coupons to pay much less in cash for the same medication. I can only imagine what those with serious illnesses have to pay for non-generic, newer drugs. The system is broken because of “administrative costs” and outright greed. I’ll take the German/British/French/Canadian system any day.
421
@Paris. Thank you for telling like it is. I think we ought to embrace the European or Canadian system and can’t quite understand why we are not pushing for that. I and others in my family are highly sensitive to most allopathic medicines, so I have to be careful. The older ones that now have become generic, are better in many ways for folks who are sensitive. I had a similar problem with a natural thyroid medication. I could take the synthetic one for hardly any copay, but I am allergic to it. The natural one stated out at $8 a month and now is $23. Other co-pays for simple medications have gone up to $90 just as you have shared. The other countries you have mentioned, also support alternative medicine and medications. We do not; I almost died in the hospital from the medication I told them not to give me...so I try not to go near any hospitals:-)
22
@Dorothy Scotteni You be careful. Managing your healthcare based on your own gut, or the opinions of people with medical degrees from Google U is a prescription for disaster. There is no "alternative" medicine. There is only proven medicine and medicine that has never been proven (or has been proven NOT to work). Your anecdote proves only that people make mistakes. Even professionals. But somehow, the clerk at the health food store never makes a mistake, right? By the way, since "alternative" medicine producers (multi-billion dollar industry) are not required to publish any details about their products that they don't want published, you will never hear about the failures in the snake oil business. Ironically, the "alternate" medicine producers are now mostly owned by Big Pharma.
19
@Mitch4949
"Proven Medicine " includes Thalidomide , DES,
Vioxx , Celebrex, "Fen-Fen "and any number of medications that have caused disastrous results.
I am a "DES daughter " as are my two sisters and one of my brothers. Fortunately, the prescribing doctor died after my younger brother was born, sparing my brother and his children from the effects of DES exposure.
DES had no positive benefit. Eli Lilly continued to market and sell it long after it knew that DES caused cancer in those who were exposed to DES in utero, which was before I was conceived.
One of my sisters could not have children due to DES exposure. The other has a "T-shaped uterus"
which is a hallmark of DES exposure. She was able to have 3 children ,while there is an eight year gap between her first (live) child and her second, during which time she had multiple miscarriages and delivered a full term baby girl, and a seven year gap between her second and third child due to multiple miscarriages.
DES is known to cause stillbirths, infertility and miscarriages to cause other serious medical conditions, including cancer in DES mothers and daughters. DES exposure is affecting "DES grandchildren. " & DES great grandchildren. "
Do you know of any alternative medicine that resulted in babies being born without limbs, & /or with flippers for arms as did Thalidomide ?
3
I'm "old". My entire adult life I've been self employed. I've always paid for insurance that rarely has paid for any healthcare until Obama's plan which does at least force the insurers to pay for some preventive care. Even that has been nothing but a money maker for the legalized racketeering that is the insurance business model. I want socialized medicine as good as the UK or Australian governments provide their citizenry.
The US system of profit centered health care is inherently corrupted by the participation of insurance companies influence over care. Its a fact that having private insurers in our system whether or not they claim to be non profit, adds 20-30% of cost to our healthcare with absolutely no benefit to the patient.
302
@Alan. Perhaps you should ask someone from the UK why they also buy private insurance.
1
@Alan Only 20-30%? More like doubles it. We pay about twice as much as other developed countries and get about the same health outcomes, or even a little worse. Oh, and our life expectancy is actually declining.
4
@Jackson
About 10% obtain private insurance of which 1/3 get it employer-provided. Not sure of the relevance of post since so few actually have private insurance.
3
Yes! The “administrative burden” of dealing with insurance bureaucracy is ridiculous. And it remains even with Medicare as all of us over 65 can attest. Not to mention the additive costs of Part B premiums, supplemental and drug coverage. I have found the vaunted Medicare program to be a huge disappointment - financially as well as administratively. America needs a “Manhattan Project” to solve our healthcare crisis once and for all. Meanwhile politicians bicker about the Betsy Ross flag and bring tanks to DC.
11
@Concerned MD - Traditional Medicare is the best insurance I've ever had in my life - and I had what was considered "Cadillac" insurance through my employer. If we had Medicare that covered prescription drugs as well, it would solve most of the problems. And fwiw, a lot of seniors don't realize that if they sign up for Medicare Advantage, they'll face a limited network of providers, will have to have pre-approval to see a specialist, etc., whereas in traditional Medicare we can see any doctor and use any hospital we want, and no anesthesiologist or other doctor is "out of network."
Fwiw, the CBO says if seniors tried to purchase a Medicare-equivalent policy on the private market, it would cost them $20,500.
1
It's a nightmare navigating Medicare and a Medicare Advantage plan. If you call your private insurer to see if something is covered, the person answering the phone might not give you the correct answer. I racked up thousands of dollars in out-of-network charges, which someone at Aetna told me would be covered. Then there are the rx plans. A drug might be tier 2 on one plan, tier 4 on another. The difference could be hundreds a month in copays. How are we mere mortals to make the best choices? BTW, I was a copyeditor and proofreader for 40 years and am used to teasing apart difficult prose, but none of this makes sense to me.
449
@Wonderdog
The mystery of what Medicare Advantage or Medicare Supplemental Insurance will cover is actually quite simple: they will only cover things that Medicare itself covers. In other words, they are parasitic, not symbiotic, in nature. "Advantage" merely lets an assigned group capture all of your Medicare visits and payments. "Supplementals" for the most part pick up the 20% that Medicare doesn't cover or, more significantly, castastrophic events like cancer medications.
Prescription drugs are another matter -- they are a mess. Such is the legacy of a system that Bush W. left to Big Pharma to design.
A single-payer system will address most, if not all, of these issues. However, given the enormous financial consequences of any changes in the healthcare industry, the transition to single payer must itself be managed as a gradual process. A good first start: lowering the Medicare age to 62 to match early Social Security. Trump himself has pledged to lower drug prices, but his heart isn't in it since there are no marginal populations to demonize.
117
@Wonderdog,
Sorry for your frustrations. If it makes it any easier to deal with, just know that it isn't just your Medicare/Medicare Advantage plan. The moving goalposts, administrative and customer service difficulties, etc that you describe - it's exactly what I see all the time, with any sort of insurance plan, with myself, my family, and as a physician, in patient's lives. Our health system is incredibly complex, and the fast-paced world keeps changing the rules all the time. Good luck.
29
@Tim Clark: I never understood why Obama didn't do that, it's so simple and a "no brainer". Medicare and SS were DESIGNED to go into effect TOGETHER.
SS without Medicare isn't very good, because your SS check is probably not remotely enough for a private policy.
Lowering SS to 62 would have been popular, simple, non-controversial and cost relatively little as most people 62-65 are still in relatively good health.
Instead Barack Obama called to RAISE the age for BOTH SS and Medicare to 70!!!
NOT KIDDING! look it up!
9
I'm a Canadian. On the back of my driver's licence is my "Personal Health Number" which I show to the doctor's office receptionist or the local hospital. I don't recall filling out a form - ever - to access the health care system. Go with single-payer America, you won't regret it.
698
@Daryl
I'm an American living in Canada. I can vouch for everything Daryl says. Canadian healthcare is simple, easy to use, and free. And, no, despite what Fox News tells you, the waits are not bad and the quality is quite good.
What's not to like?
139
@Daryl
Easier said than done.
America's legislative process is run not by taxpayers and their representatives but by lobbyists representing insurance companies, pharmaceuticals, medical equipment manufacturers, medical provider associations, hospitals - have I forgotten any others?
In other words, "health care" is a for profit business.
And so is Congress.
That is why Sanders and the progressive Democrats are as likely to make single payer or any major changes take place as Trump was to repeal the ACA.
49
@Mimi
The republicans only ever said "repeal and replace" There was no plan. You are right about the lobbyists and the insurance companies, and there is another tier between the pharmaceutical companies that needs to go away...and not to forget, many of the insurance companies now own the drugstore chains, and I was wondering what happened to our anti-trust laws? I would think they'd apply here. Thoughts?
32
I call the authors attention to an an article pertinent to your discussion which appeared almost thirty years ago, in the August 31, 1989 issue of The New England Journal of Medicine, entitled “Health Care Rationing Through Inconvenience” by Dr. Gerald W. Grumet. More timely than ever ,It provides a well organized listing of the roadblocks employed by insurers to delay reimbursements.
6
@Dreamer9 Thanks for this! It's absolutely correct.
I hear comment saying we need to get rid of private insurance and also praising other countries healthcare.
“Basically, every single country with universal coverage also has private insurance,”. “I don’t think there is a model in the world that allows you to go without it.”
"Other developed countries routinely use private insurance to fill in the gaps of their public plans or to offer patients a way to get to see a doctor a bit faster."
1) there are some countries that require all citizens to enroll in health coverage run by private insurers. These insurers typically compete in a market with strict rules about what they must cover and how much different medical services cost.
2) there are some countries where private insurance supplements public insurance. It’s quite common for Canadians and Europeans to purchase supplemental insurance that covers things that the public plan won’t.
3) there are some countries where private insurance complements public insurance. In these places, residents buy private coverage to gain better, faster access to benefits that are covered in the public system.
2
The tumor called "greed" has to be excised from our health care system. We need to evolve from a system that exploits the sick, injured and dying to a system that humanely cares for them. I work in education. Isn't it odd that we have the same tumor/greed where students seeking a better life and future are exploited by the "student loan debt trap". Yet, those who propose remove of these exploitationist tumors by implementing national health care and affordable college education are called "extreme". I would call them humane. Funny, most every other OECD country (e.g. England per the op-ed) manages to do it, but the USA can't?
2
Medicare Advantage only covers individuals who are Medicare eligible.
Enrolling a family of five would require an entirely new program. Even if the individual rule were changed, the cost of enrolling each individual would produce bankruptcy.
Medicare For All is an attractive idea ... but it is a mere slogan that conceals the fact that a whole new program has to be constructed and legislated.
1
This article is right on the money. I have volunteered as a Navigator / Certified Application Counselor for the ACA since 2014. Figuring out where a person or family belongs in the system is a large part of what I do. It is not simple, even for someone like me who does this all of the time.
The worst cases are those folks whose income is unpredictable during the year. Independent contractors, small business owners, and even hourly workers with changeable hours or work. One month they should be on Medicaid, then they make a bit more and have to sign up for the ACA. Or they get work for a while and are on an employer’s plan but then get laid off and have to go onto the ACA. Some of my clients bounce on and off the ACA depending on the season. Our office has to have specialists in the ACA, Medicaid, Freecare, and Prescription Drugs. Another agency handles Medicare assistance.
In the 5 years I have been involved with health insurance I have learned lots about what is wrong with our system. The fragmentation of it is one of the worst things. Whatever system we end up with, it should be ONE system for everyone. Employed, unemployed, young, old, etc. Stop making life more difficult for folks. We can make life easier if we want to and changing this one thing will go a long way towards that.
14
One aspect of the current medical situation,not directly mentioned in this article,but deeply corrosive to medical care, is the pervasive financialization of the system. People do not interact directly with their physicians or hospitals,but,through intermediaries in the billing department. These departments seek to maximize returns by cleverly billing procedures into the most lucrative billing strategies. Specialists in the arcane area of “ coding” are critical figures in hospitals and group practices. A similarly distortive feature in medical care is the effort to control litiginous vulnerabilities. Thus the requirement to complete meaningless survey forms recording previous medical issues..forms which replace clinical interviews with check lists but represent documentary proof of history reviews. Another instance of formalistic protection is the ubiquitous forms addressing client privacy and absolving practitioners from liability.
Medicine has become a business and it’s primary goal is to increase revenues for clinicians and their multiple facilitators.
22
@Thomas MULHERN
Excellent points. But let's not forget the role of ambulance chasers in the cost and management of our healthcare. TV commercials from lawyers abound, trolling for potential clients to sue doctors.
5
@Dave - Studies of countries with universal health care show there are very few medical malpractice suits there. One reason is that while in the US, someone who's permanently injured by medical malpractice has traditionally been uninsurable, so financial recovery must include enough money to cover that patient's medical costs for the rest of their lives. In a country with universal health care, all those expenses are automatically covered. I've also read that in countries with universal health care, the system is thought of as "ours," so that any lawsuit is perceived as harming all the other people covered by their health care system.
Thank you for pointing out the integration of private insurers and Medicare that the presidential candidates conveniently ignore. Anyone who has signed up for Medicare can attest to the confusion and angst, wondering if they chose the right plan. Medicare for all means private insurance is still required to fill in the gaps. If they want to propose something different from Medicare as we know it, then call it something else.
11
@Dave Your point is well taken. "Medicare for All" would be much better than nothing, but still inadequate for people who can't afford supplemental private insurance. It's a great sounding slogan that provides cover to politicians who are too timid to propose real, ground breaking solutions.
4
One has to ask what is all the paper work for? Is it to prevent fraud? Is it for liability protection? Is it to ensure best practice? Is it to find lowest cost therapy? A new system has to address all of these questions to eliminate the paperwork.
10
How is it that the proponents of "Medicare for All" are unaware that doctors need not participate in Medicare, and that Medicare's reimbursements are so paltry such that "Medicare for All " would translate into Medicare that is worthless to all ?
One democratic candidate understood this. He shared
a hospital administer had told him that his hospital would be forced to close if all patients were insured under Medicare, due to Medicare's low reimbursement rate, and that the same would be true of all hospitals.
Those doctors who continue to participate in Medicare are able to do so because private insurers reimburse at a higher rate than does Medicare. If "Medicare for All "is enacted, they will opt out in droves.
Why do people expect doctors to agree to have their incomes slashed ?
What percentage of individuals who believe that M.D.s should agree to have their incomes slashed, are will to have their own incomes slashed ?
My guess is that the answer is :0 %.
6
@DJS
For some odd reason folks seem to think that because they might need to be seen by a doctor, that doctor should give it to them for free if necessary. Very odd.
Just because you might need something doesn't obligate anyone to give it to you.
This piece starts with the author spending hundreds of hours picking a plan. I want proof and a full accounting of all those hours. I've never and I don't know a single person whose ever had to spend that amount of time choosing a plan.
Maybe it's easier in the UK, but I'd rather be here than there. If you want to reply on how you've spent hundreds of hours, don't do it unless you have proof that it happened. And I'm not a tea partier, I'm a D who would likely agree with you on most issues.
1
My sister, who is 70 yrs old with COPD, and her husband, who is just over 70 -something and has a chronic cardiac disease, spend many hours trying to find the right Medicare drug coverage. My sister has told me that her pulmonologist will prescribe a particular inhaler that is covered by her Medicare D plan; only to find out the following year that inhaler has been dropped from her plan. This continual change in coverage costs her either hundreds of dollars per month to continue on that prescription inhaler or many hours of looking through the Medicare D prescription drug lists for a plan that covers her prescriptions and her husband's prescriptions. Maybe not hundreds of hours; but I'm sure with the frustration of the search, it feels like it!
7
@Clelland Green, while I can’t say I have logged hundreds of hours, I will attest to having spent more than 40 hours...and I’m not done. And I have worked in the health insurance industry for most of my career. Depending upon your market, you may need to compare the costs and benefits of as many as 6-7 different insurers each of whom have as many as 8 different plans. You have to weigh the costs and advantages of a supplemental plan against a straight advantage plan...and against your anticipated needs. Then you start the whole process over with prescription plans. It’s a tedious and time-consuming chore with different layers of monthly premiums, copays and out of pocket maximums. I’ve had relatives who selected drug plans based on their needs only to have the plan drop their med off the formulary — nothing they can do except wait until next year. Yes, it can take many hours and is very complicated, especially if you have an existing, chronic, or complex health condition.
3
@Clelland Green I believe she spend over 100 hours. One call to Medicare and I was on hold for 1 hour and 5 minutes. I have spent lots of hours trying to figure out what I need for my personal situation and I am not even eligible yet!
3
There is a common link between our immigration and health care policies and it is cruelty. And cruelty is not a bug of either system, it is a feature.
If insurers make it cumbersome to get care, we will ultimately seek less and they will get to keep more of our money.
If refugees are systematically mistreated in ways approaching torture, we will get fewer immigrants, ostensibly leaving more of the pie for the Americans now here.
Both examples ignore the very real benefits of improving health and immigration policies. People who are well-cared for will inevitably live longer and pay more health care premiums than they might otherwise. People ultimately permitted entry to our country while being treated as we would wish to be treated ourselves will be less vulnerable and less likely to live in the backwaters of our economy.
The status quo diverts our energies to being our personal health care claims agents, diminishes our world standing and lets us watch good food rot in the fields and orchards for lack of harvesters and gleaners.
15
If health care is a right, then wellness choices in one's lifestyle (diet, exercise, and stress management) should be a responsibility/obligation. After all, others are paying in taxes or insurance premiums to cover much of the costs. Moreover, end of life support mechanisms and health care should be well managed. If these realities were imbedded into the American consumers of health care, there would be ample resources to handle the rare diseases and other expected health care issues that come upon us.
1
@Hpower How, precisely, does your "personal responsibility" mantra fit with people who have a genetic disorder, a seizure disorder, liver disease that is NOT from alcohol use, slender people with sleep apnea, non-smokers and children who develop cancer, healthy women who develop eclampsia during pregnancy, those who get brain-injured from a stroke or accident, and so on?
How many taxpayer dollars would you devote to sorting through the medical records of every ill person in the country in order to mete out affordable insurance *only* to those whose personal lives pass muster according to your rules?
Would a brain-injured person not get treated if you could prove they should have driven more carefully? Would a child with epilepsy have to forego care if a vulnerability to seizures can be ferreted out in the parents' DNA yet they, lacking in Personal Responsibility, neglected to have a full genetic workup before deciding to have a child?
You might assume that penalties for poor "wellness choices" would apply only to other people, never to you or someone you love. You might get a very big surprise.
7
@Hpower - Do you know how much it would cost to micromanage the lifestyle choices of every single person in the country?
It's like that old commercial that goes:
Cost of micromanaging everyone else's life: trillions.
Satisfaction of kicking people while they're down: priceless.
1
The author never said those things. But in England, too fat means no elective surgery. Cigarette taxes go to 75$ per pack. Motorcycles have a huge tax. You get weighed at your mandatory preventative health visit. Don’t show up, whopping fine. BMI too high, huge fine if weight not x percent less at mandatory 6 month follow up.
Great freedom comes with great responsibility.
One of the key point in this article is "the sizable role private insurers already play in Medicare is largely overlooked, even as they cause substantial administrative burdens for beneficiaries" I think this must be an example of the Deep State, I hear some folks talking about. Medicare already has a large amount of Private insurance companies involved and making money in "Government" healthcare. In the UK you have a simple choice, take government healthcare for all paid for by general taxes on everyone, and/or if you do not like government healthcare buy private inurance. American Healthcare has become so complicated that it is hard to understand for the vast majority of the populations. This is its biggest strength, because only seriously ill individuals, a tiny portion of the populations, ever get ensnared in the complexity and costs of American Healthcare.
American Healthcare is like the famous Rube Goldberg machine, a system that has evolved to accomplish a simple task in the most complex (and expensive) way possible. Making a simple problem complex, and hard to understand ,inevitably benefits the administrators of that system not the purchasers of it.
16
Medicare is a convoluted tangle of paper thanks to the fact that one never knows who is supposed to pay for what, and according to which rules, and whether the rules have been correctly applied. Beyond that, it only covers individuals, and its coverage is sculpted to a geriatric population. If applied to a young family as is, it would bankrupt them.
Creating Medicare for All is the probably the most complicated of all possible "solutions" to the healthcare crisis. It is a mere political slogan, and it does not enhance any candidate who bandies it about as a shortcut.
8
@Sequel As someone who is, thankfully, moving from my wife's employer-provided insurance to Medicare next month, I couldn't disagree more. The Medicare Advantage plan I have selected is straightforward and will save our family almost $100 a month. And, as opposed to the previous plan's complicated and incomprehensible language about what is and is no covered, and what copays, and deductibles might or might not apply, Medicare is a breath of fresh air.
5
@Sequel - You don't say whether you're on Medicare or not. I've found Medicare to be far more straightforward than my "Cadillac" employer coverage. It's simple if you're on Medicare. Medicare is always primary. It pays 80% of costs, after which the supplemental plan picks up the agreed percentage of the balance. Some supplementals pay 80% of the balance, some pay 100%. The only complication comes in choosing a supplemental drug plan that covers the drugs you need to have covered.
Please find out how the Brits do it. The paper work in the US system drives me crazy. My primary care doctor just retired not bec he cannot do his doctor’s job but bec he is sick and tired of the paper work that insurance companies have created for him..and I heard that he is not alone. I wish candidates address these problem.
38
As a 72 year old person I have to say Medicare is rotten insurance. First of all its not free and it only covers 80% of the cost of care. I pay around 300$ a month for OK coverage with a 35$ co-pay per office visit. I must enroll in something once each year which involves checking the doctor and hospital networks along with the drug formulary. If you want true Cadillac insurance that is really free lets get Medicaid for all, now that's something.
5
@Thomas Renner
"I must enroll in something once each year which involves checking the doctor and hospital networks along with the drug formulary."
No. You have chosen to do so. You have been lured by insurers into believing that you are saving money by purchasing a Medicare Advantage Plan.You have volunteered to limit your choice of doctors by doing so.
Had you enrolled in original Medicare, which would enable you to see any doctor who participates in Medicare. you would not have had to check doctor networks once, let alone every year.
You will expand your choice of doctors if you switch to original Medicare.
If you switch to original Medicare, and purchase a supplemental policy , you will pay no copay per visit.
By law, every insurer who sells supplemental insurance must offer identical benefits.The sole difference is the price. AARP/ United Healthcare is the least expensive plan that is sold in New York.
"If you want true Cadillac insurance that is really free lets get Medicaid for all, now that's something."
"Cadillac Insurance "?!
Are you unaware that most doctors do not participate in Medicaid ?!
6
@DJS. I haven't been lured into anything. If I do as you suggested I also must purchase a drug plan, dental plan, vision plan and gym membership which brings the price up to around 600$. See how complex it really is.
2
@Thomas Renner
I had responded to that which you wrote." I pay around 300$ a month for OK coverage with a 35$ co-pay per office visit."
You would pay a $0 copay under Original Medicare.
Your statement : I must enroll in something once each year which involves checking the doctor and hospital networks along with the drug formulary." is incorrect.
Medicare is health insurance. not dental insurance, vision insurance ,and certainly not gym membership. I find it odd that you consider gym membership to be a "must" , while some supplemental insurance companies pay for gym memberships.
You are limiting your choice of doctors. A number of top doctors accept original Medicare and no other form of insurance. When the day comes when you need to see a doctor who does not participate in your plan, but who participates in original Medicare, you may regret your decision.
If you're happy with your Medicare Advantage plan, that is wonderful.
2
It’s hard to implement a medical insurance system for all when since Obama’s 1st term the GOP has done its best to undermine all efforts to address the problem.
25
You will need to persuade the 80% of Americans who don't engage with the health care system who rate their experience with the system as good or better. They vote. They love the idea choice, too. Those folks are my friends and family, btw.
Also, you will need to teach that 80% a new word they have never heard before. It's a humdinger. They might hear it from their doc; or their therapist; or their pharmacist.
Do you know what that word is?
No.
6
We have a Medicare Advantage plan through my wife’s retirement from a public school. All of our current providers take our insurance. This year, the premiums went up ten dollars a month. Our insurance carrier wants to send a nurse at no cost to go over our health needs. For years, we have been hearing about waste fraud and abuse in government programs. My guess is that having private insurance carriers pay providers instead of government bureaucrats, is a cost savor. If that provides profit, but lowers government outlays that is fine. Our population is aging.Entitlement programs are going broke. We need innovative ways to prolong and maintain these programs for seniors and expand access to everyone without a government take over. Medicare Advantage and the ACA do just that. Dems, are you listening?
1
NYT op ed: The Fake Freedom of American Health Care
By Anu Partanen, March 18, 2017
This Finnish journalist moved here after marrying an American.
Quote:
“The point of universal coverage is to pool risk, for the maximum benefit of the individual when he or she needs care.
The point of having the government manage this complicated service is not to take freedom away from the individual. The point is the opposite: to give people more freedom.
As a U.S. citizen now, I wish Americans could experience the freedom of knowing that the health care system will always be there for us regardless of our employment status.
I wish we were free to assume that our doctors get paid a salary to look after our best interests, not to profit by generating billable tests and procedures.
I want the freedom to know that the system will automatically take me and my family in, without my having to battle for care in my moment of weakness and need. That is real freedom.
So is the freedom of knowing that none of it will bankrupt us. That is the freedom I had back in Finland.”
and
"What passes for an American health care system today certainly has not made me feel freer. Having to arrange so many aspects of care myself, while also having to navigate the ever-changing maze of plans, prices and the scarcity of appointments available with good doctors in my network, has thrown me, along with huge numbers of Americans, into a state of constant stress.
82
I read her book and have always marveled at how great the Finish system was BUT she still moved to the US. She had a choice and she came here with our “terrible “ healthcare. In this era she followed her husband is not an acceptable reason.
1
@Rich Murphy: Yes it is, because you don't know her circumstances.
May I remind you that in Finland they speak Finnish, which unlike the other Nordic languages, is totally unrelated to English and is considered one of the hardest European languages to learn.
Even in the U.S. Foreign Service Institute, which puts its students through intensive language courses that run six to eight hours per day, it takes a full year to reach "professional competence," that is, the ability to function as an employable adult, in Finnish, compared to six months for Spanish or French.
Many people have studied French or Spanish in school. Almost no one has studied Finnish, so they are starting from zero, as Ms. Partanen's husband would have been.
1
Medicare for all means we all pay at least $500 per month for coverage. On top of what we paid in over the years and on top of taxes. Biggest sham going, but the only game in town.
5
@Rainy Night I pay $500 per month now through my employer, who, as per the W-2 box "12 DD", pays another $16,000 a year on top of that.
Please let me pay $1000 bucks per month into a national healthcare system instead (read: no longer paying through my employer, and negotiating an offset for the $16,000 my employer will save under the new system) if this means my health insurance is truly portable, i.e. no longer tied to my employment, with low deductibles and co-pay, whilst ensuring that all Americans are insured regardless of income to boot.
Thanks.
16
@Rainy Night - The average family insurance plan costs $28,000 a year in premiums and co-pays, excluding deductibles. For far less than that in taxes, we could cover everyone with coverage as good as or better than we have now. Everyone who opposes paying taxes for healthcare seems to assume we'd continue to pay all the out of pocket costs we pay now and throw additional taes on top of that. That's totally untrue.
For those with employer coverage, the average employer spends $12,000 a year per employee, and takes that amount right off the top of what you'd otherwise be paid. If the average employee got an additional $12,000 a year in their paychecks, they could easily afford to pay less than that in taxes in order to have universal healthcare.
1
Do you reap the benefit of your employer no longer offering a pension? Of course not. There is not an employer in the US who will take that 12k and give it to the employees.
Medicare is so far from perfect, it deserves our urgent attention. Trying to help my relative sign up for medicare for the first time was a big shock. What was supposed to be a relief - finally, better coverage - was transformed into a stressful, confusing task that is still unfinished - I couldn't figure it out after several sessions of reading detailed policy information.
Any system that is so confusing and opaque causes suspicion and concern. Medicare for all will entail some overhaul of medicare, to correct for huge flaws, such as no mental health services in the basic coverage. Since when does turning 65 mean you don't need mental health care anymore?
17
Yes, the authors are right about the administrative burdens, though the actual financial cost of such is also substantial. Around six to nine times every month I receive various statements concerning costs from my insurer. While I may not be particularly smart, I am not particularly stupid. Not only are these statements truly incomprehensible but when I call Customer Service, the people at the other end can't explain it either. However, with each one or two pages of statement, I receive another four pages guaranteeing that I have a right to not understand the smokescreen in my choice of seven languages.
Administrative obfuscation, deception, inefficiencies, and absurdities aside, there is one extremely important reality that neither the authors, the Democrats, nor the Republicans address: what good is insurance, private, public, single payer, Medicare, whatever, if there is no effective access?
Back during the winter, the Albuquerque Journal reported that the state's larges medical plan did not have a single primary care physician accepting new patients. Along with discussions of medical insurance, there needs to be discussions of how to encourage more people into the medical field, especially in primary care. Anyone who lays claims to lead our country needs to address that issue, if they are to be taken seriously when speaking about health care.
41
Our whole medical system has been corrupted by insurance companies. These companies are not there to assist anyone but to make profit. They gamble on who will get sick and how much it will cost. They change rules to cheat and confuse both providers and consumers.
One example: Last year I made sure to go to an approved physician. The physician was aware of what procedures/medications were covered. What she and I didn’t know was that the lab she sent specimens to was not in network. The insurance company refused to pay and told me I should have asked the doctor what lab she was sending it to and then checked to see if it was in network! Really? “Doctor, before you send that sample, I need to call my insurance company to find out where you must send it... I’m on hold now with them so I’ll let you know as soon as I get through...”
Uff da!
50
@Pat
Great point and often overlooked. I had exactly the same experience. So yes, it is the patient’s responsibility to insist that labs and diagnostic test facilities be in network. Further, it’s helpful to have a list of in-network facilities ready to give to your practitioner.
2
lost state administered plan for self employed (republicans killed it because some very sick babies cost it a lot)...at the exact time my medicare kicked in. i went to 2 seminars, talked to many experts, the maze was absurd, choosing meant predicting what could go wrong in the future..no one knows that. i started with advantage plan, with one of the highest grossing insurance companies, it was like an hmo, their docs, their permission before seeing a specialist, their high copays, so i switched year 2 to traditional medicare, plus supplement with private insurer because medicare pays only 80%, plus then was also required to buy a drug plan, [which i really did not need] or be penalized...so my premium cost far more than my drugs, which lucky for me were inexpensive. i chose not to take social security for 5 years after qualifying so every month i paid the medicare premium, the supplement premium, and the drug plan premium. i was paying nearly as much as the state administered self employed plan i had before going on medicare! still, it is affordable and i get to see the doctors i want but figuring out what plan to use was insane.
12
"It had never occurred to us that it could be so different."
That is the Democrats' challenge: communicating how much more easy and efficient health care be—as it is in most of the rest of the developed word.
We need great communicators.
C'mon candidates, let's get to it!
9
The question, overall, is a simple one. Should health care be considered a business first and foremost; or should health care be considered a social good? If the former, then it is the needs of business and enterprise that take precedent. If the latter then it is human need that is paramount.
Which society would you have America be folks? Make a decision because what exists now is a mix-mash of byzantine legalese process-wise, one that tries to have it both ways. It's basically untenable when confronted by an average American, and a bizarre construct when viewed by the other competitive nation-states who seem capable of supporting their citizens in better fashion than us.
John~
American Net'Zen
11
How much of the cost of health insurance is related to the change from mutual companies to publicly traded ones for most insurers over the past few decades?
8
Read a Medicare explanation of benefits and think again about expanding it. Just changing the 89/20 formula will increase Medicare expenses by twenty percent, just for current recipients.
It always has to be complicated, doesn’t it. Why not make Medicaid available to all, with premiums based on income and assets. The only takers will be the desperate, and universal Medicare will become as bad as Medicaid, when doctors will be paid Medicare rates for all their patients.
Incidentally, where does the Constitution permit the federal government engage in the business of medical care?
2
@J.Jones
The is federal government is engaged in any activities that promote the welfare of citizens. These activities do not need to be mentioned in the Constitution, and are a net public good.
7
@J.Jones-----"where does the Constitution permit the federal government engage in the business of medical care?"
So the federal government should wash their hands of taking care of veterans and any of our seven branches of uniformed (that include Public Health Service) active duty service personnel? No medics in the battlefield?
Should they also dump Indian Health Services, TRICARE, Medicare and Medicaid too?
1
My wife and are I retired in Spain. We have private insurance coverage here. We pay less for our coverage here than my employee share for employer-provided healthcare insurance when we worked in the US. Most importantly, when we really needed the insurance, we have received excellent service. My wife has had extensive medical care, multiple hospitalizations and countless procedures. Our co-pays have been modest, much less than what I would have expected in the US. For example, out of network genetic analysis cost us only Euros 12 (about $15). We haven't had even a bit of trouble getting timely authorizations. Sure, once or twice, we had minor questions, which were quickly answered to our satisfaction. Spain, in the very top tier of population longevity, has excellent healthcare service, professional and caring. Based on our experience, it also has excellent insurance coverage for those like ourselves that require private healthcare insurance. Most Americans don't realize how much better healthcare services and coverage are delivered in other countries, as is pointed out in the article.
46
I'm a veteran and my health insurance premiums are zero. I applied for coverage once when I retired in 2009. I buy my medications with cash on line to save money. When I worked my employer paid $120.00 per month and I paid $900.00 per month and $25 copay just get a prescription written for a drug costing $3.00 for 30 day supply. My wages were frozen in 1980 and my health insurance costs were slowly transferred to payroll deductions.
2
Medicare, or any government program for that matter, will remain inefficient until lobbying is made completely transparent. Service providers write the rules and regulations. That process must come under greater transparency and scrutiny. Otherwise, we will continue to discover problems only after we have paid the consequences.
7
Once you're onboard in Medicare, switching supplemental insurance plans ain't so easy-you are always subject to underwriting and can and will be rejected if you aren't a good prospect. How many 70-year-olds have no pre-existing conditions?
19
Promises from the “progressive” (socialist) Democratic candidates: Medicare for all, including illegal immigrants. Free college tuition. College loan forgiveness. Reparations for blacks and gays. Guaranteed basic income. Federal job guarantees. Free everything for everyone. Federally mandated school busing to achieve integration. Open borders.
Medicare for illegal immigrants will immediately multiply several-fold the number of foreigners who try to enter this country without going through the lawful application process.
All of the fabulously wealthy US individuals and corporations together do not have enough money to pay for these goodies year after year, and even Bernie Sanders has admitted that taxes would have to be raised on the middle class just to pay for Medicare for all, not even including illegal immigrants.
As Margaret Thatcher aptly noted, the problem with socialism is that sooner or later you run out of other people’s money.
If all of these give-aways, especially Medicare for all, are planks in the 2020 Democratic platform, we are doomed to four more years of Trump as President.
10
Phasing out parts of the medical insurance industry will put people out of work. In this country, we do not give people much help making career changes, and often the help is offered by private companies that are more interested in making money than in helping people acquire new, marketable skills. So private insurers and their employees will go to great lengths to keep their industry going, including donating money and promises of votes to legislators, and painting their existence as necessary to a robust, competitive, reasonably-priced, nonsocialist health care system.
So far, our private insurance companies have been very successful at this. Their success is at least partially measured by how much medical care costs in this country as compared with others.
9
After three years of utilizing Medicare Advantage, the last two of which with Humana, I am done. Let's just say that Medicare Advantage is great if you never need treatment. In the event that you do need diagnostics, prepare to wait. The authorization system employed by Humana is byzantine, requiring the general practitioner to coordinate with the specialist and the ubiquitous 'clerk' at Humana. Thankfully, I will be moving out of the network area soon and will be eligible for traditional Medicare where the profit expectation is secondary to providing effective diagnosis and treatment. Bye, bye Humana. You need to get out of the Medicare 'business' once and for all, along with United Healthcare and the other Medicare parasites.
23
@Norry
Why did you remain on MA if you were unhappy? You had three months every year in which you could switch back to traditional Medicare. You don’t have to move to change plans during the open enrollment period.
My husband had an MA plan administered through Humana and they also administer my Tricare plan. I have no problem with them.
1
I have "traditional" Medicare with a gap policy bought through AARP. While it may not be the cheapest arrangement to buy, it has saved me an enormous amount of money because of no copays or deductibles for services covered by Meidcare. Through a cancer diagnosis (with two surgeries), back surgery, kidney stone, broken ribs, and assorted other ills, it has been completely simple and streamlined, and apart from premiums (about $400 per month, for each of my wife & me) and moderate drug copays, I have had essentially no out of pocket expenses and no paperwork or other hassles. Many of us will be very resistant to a change in these types of policies.
9
@Mike
My goodness, rather costly. Makes me glad I live in a welfare state: heavy taxes yes, but healthcare costs spread: easier to bear for everyone.
11
@Mike Does your estimate of cost include the amount deducted from your Social Security check for Medicare? My husband and I added up what we pay for health coverage as retirees over the age of 65. Suffice it to say our medical insurance costs are not cheap and certainly not "free".
1
@Marcia Robinson Berg
I come from Canada but have been living in the US for 25 years. Ordinary citizens pay just as much tax in the US as they do in Canada, but the difference is what we get for it. In the US we get a bloated military industrial complex and trillions of dollars of tax breaks for the rich. What we pay for health insurance, and then what we have to pay for actual health care (two entirely different things) is in addition to our hefty taxes of all sorts.
1
As an insulin diabetic I as of 2018 may choose my pharmacy for insulin dispensation but not my pharmacy for testing supplies, needles and syringes. The pharmacy for these is rude and inefficient. In some cases the cannot order them meaning I have to pay for them online at a fraction of the cost Medicare bills insurance. I therefore stay all year by ordering them onlien at my expense by stayign wihtin intiial coverage because my pharmacy bills medicare about ten times while often refusing to dispense what is paid for so I have to pay twice once for online and once foe being billed for dispensed supplies the pharmacist insist cannot be dispensed,
1
My previous employer offered a private plan designed to best cover the needs of those on Medicare. So I chose that plan and it does just what it said it would do. No deductibles, no copays, and a small charge for outpatient and inpatient care. And it took me 5 minutes to figure out that this was the best plan for me.
I don’t have any rare diseases. But I suspect that they always complicate things and not everything would go as well in Britain as the first appointment.
I’d encourage you to take a look at the Australian health care system, while not perfect, it does work well.
While every Australian is covered by Medicare, a good proportion also have private health insurance, myself included.
Private health insurance is purchased by the individual, not their employer. Those without private insurance are well catered for and only miss out on some of those nice to have benefits.
The government subsidise most drugs and other services such as radiology and tightly control prices to ensure the public purse is not gouged.
I think the major difference is that we don’t allow health care to be used as a lucrative commercial venture, by those providing the services.
26
LET'S TELL IT LIKE IT IS! The structure of all insurance is based upon shared risk. Which is a form of gambling. But since the era of Ronnie Ray Gun, the gamblers expect to be paid off with good quarterly returns on investments. What's weighing down the consumers and government is the enormously wasteful administrative costs inflicted by the insurance companies which they describe as "quality control." What that means is the quality and quantity of quarterly earnings. None of the quality has to do with the efficiency with which the funds are managed. Overpayment for bogus management is strangling how medicine is practiced and paid for in the US. Strikingly, it is NOT the government that causes these logjams, but PRIVATE INSURANCE that pads its bottom lines with wasteful administrative procedures. I'm not going to gamble on the casinos run by the medical insurance scam artists are going to give up the ghost. Because they're most certainly NOT going to give up their rip-off profits. We could learn a lot from other countries that have successful models of universal healthcare. We have needed to use French healthcare. I think the forms for the ER are about 2 pages. Here in the US the consent to treat forms can run 20 to 30 pages. And that's just the beginning.
20
I’m modestly familiar with the NHS and other European healthcare, but being covered by Medicare system and private health insurance (through my former employer), I’m much more familiar with them and the way they work together.
What my wife and I have had for some years now works well together. Years of tangled billing, repeated billing for service already paid before Medicare ended when I took coverage under the Medicare system and some years later for my wife.
Medicare makes life simple for both providers and patients. If Medicare behind the scenes is complicated, it is pretty simple up front for the patients and usually for the doctor.
My drug coverage comes from my private insurance which is better than the Medicare version because Congress made such a mess of it in 2005, in particular barring competition for drugs.
I watch the orphan or out of patent drug prices start skyrocketing because we have a broken RX drug system in general and specifically in some areas such as orphan drugs cheap to make that are subject to monopoly pricing.
But having watched the charade and lies about the ACA and health care generally from the Republican Party for the last decade, it’s difficult to be believe we can make any progress in this critical area with the current Senate and the Current GOP with its deeply dishonest approach to all these issues.
13
@jmc You make the following statement- " Medicare makes life simple for both providers and patients ." As a physician, this could not be further from the truth. For physicians( we are not providers and we resent the term), it has become a nightmare and you as a patient are likely shielded from some of the complexity by your doctor and his/her staff. The behind the scenes workload to get paid a relatively meager wage is what has made many physicians stop taking Medicare or at least new Medicare patients. Private insurance companies are not any better. The authors of this opinion piece are spot on when they say that the administrative hurdles in US health care must be markedly reduced.
29
We could minimize the confusion, calls, and paperwork if Medicare actually offered adequate coverage. There is so much that Medicare disallows that people are forced to have private insurance. The last thing I would want is "Medicare for all" as it is currently constructed, with no private insurance.
7
I am surprised no one has mentioned Kaiser Health Care. I am a very happy Kaiser Medicare and Advantage Plus patient. I was a happy Kaiser patient before I turned 65 and still happy with it; and it costs less now that it is deducted from my Social Security check. I feel the Kaiser model is excellent: as it is a not-for-profit model, with the MD members participating in administrative decisions concerning patient care. I have one chart for all the different specialists that I will see. That makes it simpler and safer for me. I have received excellent care both in California and Oregon Kaiser facilities.
I also do my part to exercise, eat a healthy balance of fruit, vegetables, protein, and do volunteer work to keep myself healthy mentally and physically. Kaiser has a very strong prevention program for all it’s members thru education programs and advertising encouraging healthy eating and exercise. My health club membership is paid for by my Advantage Plus premium. As a model for reasonable, effective, and accessible healthcare, I will be encouraging our Democratic candidates to look at this model very closely. It will be a difficult and contentious process to work out a truly effective and affordable national framework to simplify and our healthcare challenges. A Commission representing all the healthcare entities could meet and work out a network of regional entities that would deliver healthcare to those regions on a not-for-profit basis. Private/ Government collaboration.
10
@Peter Gum
I have a similar experience with Kaiser both pre- and post-65. But the system may not be scalable to the national level. I'm no expert, but there must be regional differences that make it hard to replicate the success Kaiser has in attracting good staff and good patients beyond its western base.
3
The final sentence on the bottom of all the various Medicare Supplemental policies is "Subject to change".
On a monthly basis we find our drug costs and reimbursement constantly changing. I have tried to nail down our costs on a spreadsheet and find there are virtually no constants. Every refill costs differently and the reimbursement is different.
Changing policies for better drug coverage is a waste of time and energy, just as you finish computing your costs for the drugs you need..., they move them into a different tier with a different percentage of reimbursement and you have to start over.
15
It’s a terrible situation for patients and providers ( but not Congresspersons).
Private insurers are robbing monies
HHS and CMS are expanding burdensome regulations and only adding costly bureaucracy to Medicare and Medicaid programs
And We do not have a functional government to develop a reasonable solution.
2
It's not just a financial and administrative burden to deal with insurance etc etc etc when sick, it's bad for our health. The psychological and emotional stress of dealing with hospital bills takes its toll. On top of this, hospitals shame patients who don't keep up with bills, send them to collection and sue them, even though they do not enter into healthcare contracts freely. It can't be measured perhaps but it's worth a lot in terms of reducing stress and anxiety to get rid of all these financial mine fields in healthcare.
39
Our system of medical care is broken. It is over twice as costly as any other system in the world with poorer outcomes and fewer citizens being covered. It is now a for profit system that measure quality not in lives saved or years added to life expectancy, but in the number of forms filled out and check boxes clicked.
It cannot be reformed because too many people are making a living at shuffling papers and generating confusing documents. It will implode. At that time, we will hopefully be wise enough to look to other countries for information on how to put together a system that works.
Until then, wear your seat belt, eat moderately, exercise, live within your means and stay away from the medical system.
28
Because of my husband’s service (active and reserve) for more than two decades, we have been fortunate to have coverage from Tricare for life. Kept all our doctors, no paperwork, no copay, and rarely a bill. We are healthy so can’t attest to what would happen should one of us become seriously ill. But I do count us very lucky.
9
I understand that millions of people will lose their jobs if we get rid of health insurance. Perhaps they can re-trained as coal miners.
41
The real Medicare for All plans make this very simple indeed. Everyone is automatically enrolled, and medical care is paid for without patient involvement. Done.
7
@Christian Haesemeyer That's basically the same as the NHS in the UK. I've been transported to hospital in an air ambulance, cared for in the ICU and then moved to a rehabilitation facility. No bills at all.
9
Thank you for this!
I'm in my fourth year on Medicare. I was shocked to learn that if I didn't also have private insurance, I couldn't afford one day in the hospital, even after Medicare pays their 80%. Luckily, I have Medigap coverage through my former employer, so I have only three choices instead of dozens. Still, every so often I have to get on the phone with doctors' offices and the insurance company to get them to straighten out a billing error because something was filed as plain Medicare. And I can't just pay my copay at the doctor's office, as before, because instead of a fixed copay it's 4% of a number that isn't what the doctor charges, but rather the Medicare-approved charge. It generally ends up being less money than the $20 I used to pay, but it's another check to write and mail.
Oh, also, my pension is protected by law, but my employer-sponsored medical insurance could be taken away at any time.
So, count me as someone who'd be delighted to pay more taxes if they went into social services instead of wars and tax cuts for the rich.
143
@Brian Harvey
A pension? What's that? ;)
2
@Brian Harvey
If you have 4% fixed co-pay, you don't have a medigap policy. A "medigap " policy pays 100% of the 20% which Medicare does not cover.
In terms of your pension, it is protected by law if your former employer remains solvent. If the company goes out of business, you will be out of luck.
2
This is so exactly right. One of the great things about the NHS is that you never even have to THINK about this stuff. And when your health situation changes, that's covered too. My husband needed spinal rehab and his neurologist simply sent him. He ended up at the best spinal center in the country. No paperwork and we never paid a dime. He could just focus on his recovery.
Another area comes to mind where the US needlessly complicates things - taxes. In my six years in the UK, I only once had to fill out a tax return, when I was self employed, and it was ridiculously easy. Since then, every year I struggle with my US tax return (complicated by my foreign income) but never touch a UK one. My employer gives my salary data to the revenue office, automatically deducts my taxes from my wages, and that's it. If my salary changes, the rate gets automatically adjusted. The US could certainly boost compliance and lower IRS costs by doing the same.
54
@Elle Your point about the IRS is a good one. That's why legislation was written and passed that *explicitly* forbids the IRS from doing something like what you describe the UK as doing. Why? Because companies like TurboTax make a killing off us.
4
Would doctors be willing to take the pay cut they would have to, in order to switch to an affordable single payer system like in the UK or Canada? The average US's medical school student's debt is around $400,000 dollars by graduation. Would taxpayers be willing to pay up to 40% or 50% of their income to support free healthcare for all, as in socialist countries? Finally in those countries with universal health care, gun ownership is significantly restricted - otherwise no government would be able to freely support the trauma services. I personally think universal healthcare is a much better, but I would be happy to live with gun control, and pay a higher rate of tax. Not everyone would.
2
@SCL
Not sure where you get your information from, but the costs of healthcare in countries like the UK, France, and Canada (is that which ones you are thinking of?) are nowhere near 40%!
I agree we would have to do something about student debt - but medical education costs in these same countries is also free or minimal.
Of course, a re-allocation of how the US allocates its resources in this direction might mean less tanks and aircraft carriers
11
@SCL I think you exaggerate the tax rate in the "socialist" countries. It can be as high as you say, but not all of the tax revenue goes to universal health care. Much of it provides for the same things as US taxes do, defense, infrastructure, police, education,pensions and the like. But it also provides child care, disability care and insurance, higher education at no cost to the student, vocational training the same way, and so on.
Then, if you look beyond the nominal US income tax rate to include state and local taxes, the gap in tax rates between "socialist" countries and the US narrow considerably. The US citizen pays high taxes for low value, unless you think a bloated war machine is a great buy.
25
@SCL Government expenditure on healthcare is basically the same percentage of GDP in the US, UK and Canada. Somehow two of those countries have universal healthcare free at the point of use and one doesn't and the one that doesn't has its citizens paying 110% what the government does on private insurance.
4
This is a mis-characterization of the Medicare Advantage option (and the other options). It is as simple as 1-2-3. The programs offered resemble regular ppo's or hmo's, and you renew your choice every year. Premiums can range from zero to about $150. This is for medical coverage, and hospitalization. And it is perfectly optional; you can also chose straight Medicare with no premiums but with less coverage. These are very simple choices.
The Medicare Advantage options are offered by private insurers who have contracts with Medicare, and must follow guidelines. They compete with each other. Prices are very good, coverage quite adequate, and ... is fully optional. Could it be tweaked? Of course; everything can be tweaked, and always is.
Humans just have to be smart enough to know a good thing when they see it. Unfortunately, we often aren't.
Medicare-for-all, based on this model or one similar, is a slam dunk.
3
@Feldman
To characterize 'Medicare Advantage' as "simple as PPO's and HMO's is also a mis-characterization . If you listen to what most people are saying PPO's and HMO's are not nearly as simple as they should be. They all charge and pay different prices for the same procedures and they will never tell you why. Trying to compare different providers -even with expert help- is enough to drive a sane person to mental health doctor.
5
I use my employer-provided private insurance. A lot. It covers almost everything, with small co-pays - $20 for doctor visits; $10 for medications. My "network" is large and excellent and includes one of the best hospitals. When I do have an "out-of-network" charge it has never been more than $100. I have almost no paperwork.I know _many_ people whose experience is similar to mine; we all dread what will happen when/if we have to go onto Medicare.
1
@WZ
I’ve been on traditional Medicare for several years. It is no more difficult for me than the employer-provided health plans. I still have a broad choice of doctors and medical facilities, and with supplemental insurance, I don’t pay larger copays/coinsurance.
In my experience, Medicare is quite confusing to navigate, but no more so that my private insurance was before.
5
@WZ How fortunate you are, for now. But what happens if you become too sick to work and lose your job, and therefore your excellent insurance? Perhaps you are young and healthy and feel invincible, but accidents can strike when you least expect them. And then you will find yourself in the you-are-on-your-own medical insurance jungle.
I can assure you that most of my friends couldn't wait to become eligible for Medicare and the peace of mind that came with it after battling private insurers for many years.
Medicare isn't perfect, but it could be if it included all of us, covered 100% instead of 80%, and dumped the private insurers.
10
The authors should give us more info on how the British health care system is easier and cheaper for them.
We get a line or 2 on other countries in the Times once in a while. But since the US is the outlier among modern nations, the Times, an international paper, should do a series on how average people pay for and use their HC in dozens of countries, for generations.
That would be news we could use. Esp for the 2020 election, crucial as it is.
Instead most of our media is obsessed with constant updates on how much donation money the 2020 candidates are getting, and how their poll numbers go up/down.
We need comparisons of each 2020 candidate's proposals on reforming US health care, and then compare those proposals with how other systems operate---Canada, EU, Japan, etc etc.
Make them respond to this data and evidence---what do those countries spend, who spends it, what do they get?
And also compare the conservative parties abroad, who don't destroy their universal HC systems, vs our GOP who want to destroy ACA, because profit is the highest value in the US.
How do those capitalist democracies operate where profit is not the highest value, but citizens' well being is respected by their govts? Please explain that.
31
@Meredith In the UK system, the health-care workers work for the government on salary. There are many complaints that the salaries are much too low. Certainly they are much much lower than comparable salaries in the US.
1
@WZ
It's true what you mention in the UK and I think in France, but not in other countries where health-care is available for all, e.g. Switzerland, Germany
3
@Meredith
As an American resident in the UK for the last 40 years, i can tell you the NHS is very good, universal healthcare delivery system which only came into existence post-WW II. All residents enter through their local "GP' (general practitioner) who are salaried but they and the specialist "consultants" can and do take private patients, often paid by supplemental private health insurance. And drug prices are negotiated so kept low, with most paying a small co-pay. It is paid for with a combination of a social security "tax" contributions supplemented from general tax revenue, delivering a very high quality of care by international standards yet only costing about 10% of UK GDP. Look at the DeLauro "Medicare for America" bill now in the House to see a pragmatic solution.
8
I am closing to the Medicare age and therefore have been trying to learn the system. I was amazed at the complexity and insufficiency of Medicare as the health care system.
I have two basic questions about Medicare. First, I am not so old yet but overwhelmed by the complexity of Medicare. I am wondering how older people are dealing with such complexity. Second, I thought Medicare would cover my health care issues, but it seems not. Why do we still need various extra things from private insurance companies on top of Medicare? Although it is better than nothing, the current Medicare system does not serve well the elderly.
Originally, I supported the idea "Medicare for All" as a general concept, but after learning Medicare, I do not support this idea anymore. Medicare is not a good system, which is too complicated and expensive with the need of an extra insurance. Why?? What's the point?? We just need a single-payer system.
11
@old lady The answer is as people age, they don't do it themselves, all this process gets done by others, often their children. Having navigated it for two parental units now deceased and still navigating for one 92 year old, it is crazy. And to boot, dealing with two states, and now my own - a third state.
You are absolutely right, "Medicare for All" doesn't cut it because 1) it doesn't do away or even cut the complexity. And 2) it scares too many people who through their unions or employers have navigated a relatively smooth system with lots of benefits they like.
Trump famously said "who knew healthcare was so hard?" I don't agree with him on anything else and on that I do because it is. What's more, most of the candidates don't understand the issue. They have their gold plated government systems that are single payer for them. For example, John Delaney argued on a morning talk show that Medicare takes care of it all, and the specific Advantage plans are paid for in the Medicare premiums. With that kind of ignorance in a candidate, not to mention the greed and lobbying of the insurance companies to keep their piece of the pie, it is going to be hard to get a decent solution I'm afraid.
We, as citizens and taxpayers, must stand up for common sense solutions and punish the politicians who work against our collective interests and take payoffs.
6
@old lady
I just turned 65 and it's not as big a deal as the authors would like to make of it. Unless you are still working and have large employer coverage, you should sign up for part B [outpatient] and Part D [prescription drugs]. {Part A is what you have been paying Medicare taxes all your working life}
Parts B and D are optional, but if you do not sign up for them within three months of becoming eligible, there is a 10% per year penalty for every year of delay after you sign up, for life.
Alternatively, you can sign up with Medicare and then choose a Medicare Advantage plan which covers A, B and D, frequently for no additional premium over the $135 for Medicare part B.
It is no more complicated than selecting an insurance plan if you work for a large employer.
If you do not choose a Medicare advantage, but go with traditional Medicare, you can also choose to purchase a medigap [sometimes referred to as a Medicare supplement] that will cover most of your deductibles as well as the 20% co-pay, which has no out of pocket maximum in traditional Medicare.
There are many insurance brokers who will take you through all of your options for no charge, but you should select one who is not affiliated with a single insurer. Like, don't call the AARP number, which will limit you to a single insurer.
3
If a Medicare for all program is implemented, and the amounts paid to providers remain the same, you will see a shortage of said providers very quickly. There's a good reason why many practices state "no new Medicare patients," and it's not because the paperwork is that difficult.
There will have to be a re-calculation, done regionally, to allow reasonable payments to providers for services rendered without the influence of large insurers skewing the numbers. Everyone knows providers over bill to sidestep the amounts allowed under the current system, both for commercial insurance and for Medicare. This shouldn't exist under a new system, but providers can't survive if what little Medicare pays is the same as it is now.
6
@Eric T
The amount Medicare pays providers, although they complain it is less than the cost of care, is substantially higher that what countries with various versions of single payer pay their providers. So the magical savings of eliminating bureaucracy are not going to force the big hospital chains to reduce their pricing.
1
"Medicare beneficiaries are left feeling overwhelmed....Even health care experts struggle when they hit age 65 and need to enroll."
Very true--as a medical writer specializing in medical insurance and drug reimbursement rules, I still had to visit an insurer to learn that "Medicare Advantage" is a misnomer and good old medigap policies are the best option.
Even Bernie Sanders, who one would expect would be an expert by now, made huge mistakes in last week's debate. Asked if he'd raise middle class taxes to pay for healthcare, he blithely answered, yes since they'd pay "nothing" for Medicare.
I nearly fell off my chair: Medicare pays for much but you still face deductibles, premiums, medigap premiums, and Part D costs.
Healthcare IS complicated, operating pretty much like a Rubik's Cube. There are so many combinations and unintended consequences, it makes your head spin. That said, it's still the best system because the government sets prices.
Candidates had better master the details, or Trump will reduce their proposals, to one-word lies (socialism). Americans can't afford that any more than voting for the other party that offers no plan at all.
33
@ebmem It really depends on the concept of physician choice. When Medicare Advantage in the state of Massachusetts was explaiined to me by Tufts Healthcare, it was run like an HMO. You had "circles of care" and referrals, and a lot of paperwork to see a nonnetwork physician. For someone living in Massachusetts with its richness of teaching hospitals and great doctors, this was a No-go. At this age, one is prone to illnesses and surgeries, and to have to fight to see the top surgeons was not appealing. I know that Medicare Advantage plans, also called Medicare Part C, vary widely from state to state based on the hospitals and physicians one wants to see. Also, because they are still considered an "experiment", it 's always possible they will be cancellend. About 10 years ago, CMS started to cut back on the number of plans offered, because they actually receive more from the federal government than traditional medicare. In return they were supposed to provide more tightly managed care, even partipitating in quality studies for CMS to evaluate.
In reading the posts here, MA plans (Medicare Advantage) greatly vary from state to state in terms of quality and customer satisfaction.
4
@ChristineMcM
Under Bernie's plan, Berniecare has no deductibles or co-pays, as opposed to the 20% co-pay with no out-of-pocket maximum of traditional Medicare.
For people who do not travel much outside of their state of residence, and the local in-network providers are satisfactory, Medicare Advantage is a much better deal than traditional Medicare, plus a medigap plan plus a part D plan. It frequently has no premium plus has a $6000 annual out of pocket maximum, which beats the no out-of-pocket maximum of traditional Medicare.
1
Between the money taken out of social security for basic Medicare and the Supplement insurance plus the part D the cost for my husband and I is about $1000 a month. I had no idea when figuring out our expenses post retirement that we'd have such a large health insurance bill. It is certainly much larger than my monthly contribution to my employers group plan.
6
@rainbow
The Medicare tax you paid during your working life covers part A, hospital insurance less a 20% co-pay. You pay no premium in retirement for part A.
The $135/month each for you and your husband covers 25% of the cost of your out patient care. [Doctor visits, lab fees, imaging services not part of a hospitalization.] If your income exceeds $160,000 per year, you will pay more than the standard $135/month to keep the taxpayer contribution in the aggregate at 75% of the total cost. If you are collecting Social Security, this premium will be automatically deducted from you benefit. You are also responsible for a 20% co-pay with no out of pocket maximum.
Your part D premiums cover 75% of the cost of your coverage with the taxpayer subsidizing the other 25%.
You have elected to buy an optional supplement to cover the bulk of your 20% co-pay.
The reason your premiums are so high is because even with the price controls on services, the average Medicare beneficiary is getting $20,000 per year of benefits. That's $40,000 per year for you and your husband if you were paying full freight for your care. The $12,000 per year you and your husband are paying is a bargain.
The problem in the US with medical costs is the price hospitals charge for services and the seven figure salaries charity hospitals pay their executives.
11
@ebmem
What’s the MEDIAN amount of care received by Medicare recipients? Averages are skewed by the very few very high cost beneficiaries.
@rainbow Another factor is that older folks use the medical system more, and thus tend to have much higher medical costs and bills, which insurance (includingMedicare) has to cover
Your experience with Britain's National Health Care system is exactly the right model to mention. The UK manages to meld a NHS with a private health care system seamlessly. We do not have to re invent the wheel, but simply take that system and improve it.
More than 40 years ago, I was fortunate enough to spend two months as an American medical student in London and ever since I have been watching American medicine catch up to what the Brits were doing then: Everything from hospitalists and specialists in the hospitals with general practitioners and midwives in the communities, to a different way, a less expensive way, of treating gastro intestinal bleeding, to techniques of cardiac catheterization, the Brits were doing then what we have finally come around to doing here now.
The Brits, like people everywhere, are never fully satisfied with their health care but, like the Canadians, they would never trade their system for ours--for good reason: theirs is simply superior to ours.
We have been marketed into delusional thinking, first by the AMA, 40 years ago and then, when the AMA came around, the commercial insurance companies got in on the act.
A public option with a private system running side by side works for them; it could work for us.
62
@Claudia I know many British citizens and, of these, I have never heard one of them complain about the medical care they receive in their home country; in fact, they report satisfaction and from their reports to me, it seems quite easy to use and free of the bureaucracy which is so maddening in America.
13
@Claudia
More than 40 years ago you were not tempted to move to London. What you are not mentioning is the low pay received by doctors in the UK. Half of the physicians employed by the NHS are junior doctors, what we call residents: licensed physicians working under the supervision of senior doctors. Pay has deteriorated to the point that most ERs are not open evenings and weekends because even with shift differentials the NHS cannot staff them.
You also omit the long waiting periods between having a generalist refer to cancer specialists and the delay for treatment, which is why cancer survival rates are much worse in the UK as in the US. Six wees to get an appointment for evaluation with an oncologist and another six month delay before treatment begins is not a good plan.
The meld of the NHS with private insurance means that the rich get good, but not great care. For the poor and others who cannot afford private insurance, not so good.
5
You're absolutely right. For this country, like Britain, a hybrid system of government and private insurance supplements is the easiest and most cost-efficient way to go.
3
I turned 65 this year, and Medicare has been awful. My coverage is not sorted out five months after it started.
Medicaid in comparison is wonderful. I have a lot of experience with people on Medicaid. No problems, certainly not by comparison.
This can be done right, and it is called Medicaid for all. The role of private insurance in Medicaid is to contract with the government for service to large groups. They compete, and the government bargains.
5
@Mark Thomason When I lived in the USA, medicare worked well for me. I had two major illnesses requiring hospitalization and chemotherapy. Medicare plus a good medigap policy covered all costs and the medical providers filled out paperwork on their end. Of course the medigap policy was expensive and now is around 300 dollars per month, plus the amount that I pay to medicare through deductions from social security income. In sum, I found medicare plus medigap insurance to be the best I had ever had in my life. The government paid their share right away, very efficiently, the private insurance medigap took longer but it paid eventually as well. Anyway, the providers were accustomed to this difference and did not bother me and just waited for their payments.
3
Thank you for shedding light on the complexities of Medicare. It's no silver bullet as many of the Dem candidates seem to either think it is or want their followers to believe. I did my research and talked to knowledgeable people before settling on a Medicare plan a few months ago. So far so good. But it's difficult to figure out on your own because Medicare does not pay for everything and there are private insurance companies drooling to get your business through supplemental plans or Medicare Advantage. Insurance companies are indeed a major part of Medicare. No candidates explain the flaws. It's better than no insurance but we can do better.
7
Medicare Advantage, run by private insurance, is a scam. They are refusing to pay medical claims so they can make more money. It sounds good with all the extra benefits but in reality many hospitals and doctors do not even accept Medicare Advantage.
24
Medicare Advantage plans are a big con, designed to shuffle Medicare dollars off into insurers' laps. They often sound good to individuals because they come with a gym plan and other extras, but the individual seldom makes such use of these as to justify the insurers skimming profit from a public benefit.
The for-profit benefits Bush 43 conjured up -- a nice bonus for Pharma -- make both government and retirees hand over monopoly and/or rigged drug profits to the big political campaign donors in the Pharma sector.
25
When I go to the Doctor now, I bring a printed copy of my insurer's formulary. What my doctors want to prescribe can be at odds with my insurer's choice of drugs for treatment.
For the most part they chose generic drugs, which removes cost issues. Fine with me as I don't want to enrich big pharma, and generics have been tested in the general population, and found safe, as opposed to drugs advertised during the national news.
What really disturbs me is that insurance companies are in essence prescribing drugs without ever seeing the patient. If a physician did this it would be considered malpractice.
13
Very informative, thank you. You do realize the outsize power this Medical Industrial Complex has in Washington. Maybe one solution is to burden them with the paperwork, i.e. reduce their offerings in Medicare to, say, three plans and consistent for all providers. So everyone makes a small profit. Yes, I know this is a bad word but our system is not designed for a sea change unless all voters demand it.
Let the private insurance system thrive in companies until their customers, companies figure out they save money by canceling their contracts and asking employees to sign up for some Government provided Healthcare. Besides very large companies are self insured and just contract out the paperwork to health insurance companies.
If the political will for change is sustained over 10 years there will be change.
Totally agree, the current system is much to complicated. AND it needs to be pointed out that those of us with pre-exisiting conditions are NOT protected in our Medigap plans --after our initial 6 month enrollment period, if we change Medigap plans they can charge us much more or even refuse to cover us, just as other private insurance did before the ACA. Now that I am on Medicare I have LESS protection than I did on private insurance under the ACA...and my meds cost more because the Republicans stopped Medicare from being able to negotiate with Big Pharma.
I am in favor of Medicare for All -- but only IF it is a simple system which allows negotiated drug prices AND protection re pre-existing conditions for all.
6
The writers note there is a lot of untangling to do and provide some basic and good suggestions. I support a single payer system, with a government structure (like the Center for Medicare/Medicaid Services) taking over the administrative function the insurers now fill. I also think we need to build on the solid foundation of privately delivered services - so more a Swiss/German model.
BUT, there are also tangled relationships on the administrative side: it will be complex to mesh a public system with the VA services or Tri-Care or for any medical network (hospitals and doctors) to rejigger their systems to work effectively in a new system. Even once a commitment to change is made, it will take several years to implement it. It will likely take some pilots in "test states" to figure out what approaches will work.
Do ask candidates (for state and federal offices) to address HOW they would implement such a change. Ask your party the same questions as they develop a platform.
4
Yes, it's been a shock to see that Medicare is so complicated because of the insertion of private, for-profit insurance companies. I thought I was going to finally get rid of them and all their needless layers of complexity.
38
Bernie was the first to call for Medicare For All, and he's still got the right idea for the most part. But I would suggest that we adopt the "German Plan" whereby everyone pays a premium based upon their income level and that gives them total healthcare coverage - no "options", no loopholes, no complicated rules or formulas. But, for those who have the money and want "gold plated" coverage, they can buy private insurance. This would benefit the most Americans, and increase the overall health of the nation.
Yes, there will be indirect costs, mainly significant impact to the private insurance and pharmaceutical companies, and these will have to be addressed. That said, most companies that currently provide health insurance to their employees would be relieved of that significant expense. That could lead to being able to hire more workers, raise wages, and/or expand their business.
And while some people's taxes might rise, their health insurance premiums will vanish, and almost everyone will come out ahead on a net income basis. And that increased income will enable them to spend more, thus raising company profits and tax revenue.
By clawing back the obscene profits of the health care and drug industries, we can use that money for more productive uses, either by individual Americans, government programs, or private businesses. Over time, adopting MFA will be a massive benefit to everyone.
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@Kingfish52 If the employers were freed of the expense of providing health insurance for their employees, then their employees would have to pay ... either directly or through taxes. If the employers were not taxed and did not raise salaries then employees would wind up paying a lot more.
@WZ.
If employers no longer were paying health insurance premiums, how hard would it be to require that those previous costs be distributed equally to all the employees?
The rub is that currently no one pays tax on those insurance premiums. If that insurance money were instead paid as wages to employees, then state, Federal and FICA taxes would be deducted from it. (There are ways, thru the tax code, though, to eliminate much of that extra tax burden on employees.)
Lastly, this would level the playing field, so that everyone with private health insurance is paying its huge cost with after-tax dollars. With premiums for those millions of people no longer being tax-subsidized by the rest of us, the nation is one step closer to being able to fairly decide what’s the best system for everyone (rather than “is MY ox being gored?”). How outrageously expensive private insurance is would finally be painfully obvious to all who have it.
4
If we want to return to growing the middle class, we must make decent healthcare affordable. We may be able to still afford the system that is in place at this moment, but unless fundamental changes are made, fewer and fewer Americans will be able to afford health insurance and drugs in the coming years. This cannot be put off until whenever. Let’s make America great again by introducing decent healthcare at an affordable cost.
Medicare for All can be that plan.
30
Thank you for writing this. Yes, figuring out what each plan will and will not cover is incredibly burdensome. But, the authors didn't mention the other administrative headache: at least with a Medicare Advantage plan, or an ACA exchange plan, if the provider or the insurance company makes a mistake resulting in the patient being billed for services that should be covered by insurance, it is up to the patient to straighten it out. The providers and insurers have battalions of lawyers and bean counters, but the sick or recovering patient must make sure they do their jobs correctly. Otherwise, the patient may end up being relentlessly harassed by collection agents.
I have not heard any elected official or candidate address the administrative burdens on often very sick patients. A tiny step in the right direction is the Hassan-Cassidy bill in the Senate that will move in the direction of reducing saddling patients with surprise medical bills from out-of-network providers that slip in to treat patients while they are incapacitated in an in-network hospital.
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"The Bernie Sanders approach calls for effectively eliminating private insurance, including the private aspects of Medicare. "
Given what the Authors say in the rest of the article, why do we need an alternate plan?
Let's go for 2 + 3 = 5, not 7 or 4 or 14 or 23 or 32.
9
Drug costs! Nothing will work if they are not brought under control. Allow all Americans to buy their medications on an international market. Simple, easy effective!
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@Scott Bisbing Our patent system, and the excessive protections it provides pharma giants, is a major reason for this. Some estimate that costs would drop to pennies on the dollar for many medications, since we already see that in Australia and India, identical meds are often hundreds of times cheaper.
Medicare "Advantage" plans are an Orwellian misnomer. What they are is "disadvantage" plans. My husband and I were stuck with an Advantage plan for a single year, 2016, because his former employer changed their program. It was a nightmare, impossibly complex, even for me, and my career in Human Resources means that I am far more able than most people to navigate complicated benefit verbiage. Even more disturbing is that this absurdly labeled Advantage plan precluded us from using the two hospitals in Los Angeles, UCLA Medical Center, and Cedars Sinai, that provide quality care for complex conditions.
As soon as we were able to extricate ourselves at the end of the plan year, my husband and opted out of our subsidized coverage from his former employer. We now pay several thousand dollars more per year, have traditional Medicare with a supplement and a drug plan, get quality care, and have few issues. We are extraordinarily fortunate to be in a position to make that decision without bankrupting ourselves.
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@eleanor - I tried a Medicare Advantage plan for a year, then switched back. The huge disadvantage of MA is that there is only a small number of physicians & hospitals that take it. NONE of my 6 doctors would take it. All, of course, took Medicare like over 90% of the doctors in the US.
Most MA plans (like mine) have co-pays and if you doctor is out of network, they can be HUGE. They were supposed to be cheaper than classic Medicare, but have turned out to cost taxpayers 15% MORE.
The Medicare for ALL proposal eliminates all deductibles, co-pays, limits & provide dental. eye care, better mental, etc,
They can do all this and still save a bundle because:
Medicare has much lower overhead.
The compliance costs of doctors, hospitals & patients of Medicare is way lower than that of the 1,500 different private plans with different & secret byzantine rules. This is a saving alone of over $500 Billion each & every year.
The costs & medical data now kept secret by the private insurers will be public so an entity can gather data, analyze it & make recommendations based on medical reasons, not profit.
All of the above is supported by decades of data from other countries, e.g. Here are the per capita figures for health care costs in 2016 in PPP dollars:
US - 9507.2
Austria - 5227.3
Belgium - 4839.8
France - 4500.4
Germany - 5550.6
The Netherlands - 5385.4
Switzerland - 7919.0
Sweden - 5487.5
Denmark - 5199.3
UK - 4192.5
Canada - 4643.7
OECD Average - 4003
38
@Len Charlap: regular Medicare has co pays too and deductibles. Medigap covers those, except Part B, BUT....you have to pay a monthly premium that is $350 or so ON TOP OF Part B, which is $135 or $485 PER PERSON. A married couple would pay $970 a month. That's a LOT -- almost $12K a year.
I cannot speak to the Advantage network in NJ, but in my region....Advantage plans offer both of the two top teaching hospitals with all the top nationally recognized doctors at those hospitals, and all their local clinics and branches. WITH NO MONTHLY PREMIUM vs. almost $1000 a month for a married couple.
2
@eleanor: any Advantage plan that you signed up for, had to have given you a list (or access to a website) with all the doctors and hospitals they are aligned with.
It's EXACTLY like a typical employer PPO plan, where you have a network of participating doctors and hospitals.
You probably did not look at this, and wrong assumed "it's Medicare so I can go anywhere". That is not true.
Advantage can offer you NO PREMIUMS but the drawback is you agree to their NETWORK.
If you had your heart set on Cedars Sinai or UCLA, you should have ASKED ABOUT THIS UP FRONT.
BTW: the first time you sign up for Advantage, you have 90 days to change you mind and return to regular Medicare with no penalty or surcharge.
1
I agree with the letter saying that personal stories are not very helpful. Expertise is surely needed. But surely the simpler the system (one without profit motive), the lower the costs.
The personal story of the person with Medicare and AAUP private insurance was of interest. No problem for that person.
Myself, member of that group of older, retired, folk with several expensive illnesses, for whom about half of Medicare is paid out, have the same story. I never think about the cost of my very expensive coverage. Somehow, Medicare plus, secondarily, my private insurance takes care of almost everything. Medicare and the private insurer work it out without me, except for maybe a few hundred dollars per year. I'm sure I have received 'standard of care', and I don't understand the NYT opinion piece about all the complications with having Medicare, private insurance, plus a serious health condition. Not my experience.
9
Try being disabled before age 65 and being forced on Medicare. I have a rare disease that is genetic, causing me to be unable to work. My mother and grandmother have it among others. So off I go onto Medicare from private insurance. The the quality of my medical care decreased dramatically. Both hospital care, at the hospital I’ve been at many times simply because I’m also asthmatic, and Dr care. Did you know that as a Medicare patient you are required, if you go by ambulance, to go to the hospital that is closest to you that can provide the care? Even if that hospital is well below national standards. Did you know that as a Medicare patient, unless you’re determined to be somehow in critical condition, you are placed in a room with just a curtain and you can stay there for days. In my case just outside of a noisy ER. Did you know if you’re on Medicare and you move out of state, that most states will not allow you to change your Medicare plan? You’re required to keep the same Medicare plan that you obtained at the time you 1st became disabled. Did you know that if you are disabled and want to obtain a Medicare supplement policy, offered by private insurers, that pre-existing health conditions are considered? My rare disease wasn’t considered but asthma was! I pay almost $6000 a year for a supplement policy. I don’t think Medicare is for everyone unless you are unable to obtain private insurance. Unless some of the more archaic Medicare rules are changed.
21
@Bella I hear you. I'm sorry too. What's worse is that we treat every sick person this way: badly and as if they aren't deserving of care. It doesn't matter if you served your country, if you've paid your taxes, nothing. America has become a country run by and for the rich.
What all of us need is a rich uncle or to win the lottery. What all of us want is a life that is not devastated by the costs of caring for ourselves due illnesses we have no control over, or do. The idea that a man shouldn't be forced to help cover a woman's prenatal care is laughable. How does he think he got here? I could cite more examples but I won't.
I wish you luck and peace.
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@hen3ry
Thank you for your kind thoughts. I wish someone would write a well researched article on the pitfalls of Medicare compared to most private insurance!
5
@Bella - You talk of "the same Medicare plan". Are there different Medicare plans? As an 80 year old, I only know of one.
Perhaps you mean Medicare Advantage.
4
I am amazed that Democrats want to repeal Obamacare and replace it with some unknown system. Most people who are not on Medicare incorrectly think Medicare is free, covers everything, and does not have copays, deductibles and penalties for joining late or dropping out. Surprise! I pay over $4000 a year for Medicare and supplemental insurance to cover what Medicare doesn’t. I pay an additional $2,500 per year for long term care insurance. Medicare doesn’t cover long term care. You also may need to change doctors. If you drop Medicare and want to rejoin, you pay a much higher premium, for life. That’s not how Obamacare works. You may not be able to get supplemental insurance if you have a pre existing condition. And there are those Medicare limitations on drug coverage. If Democrats push Medicare for all, Republicans will publicize the truth about Medicare and Democrats will be voted out of office.
3
@Richard Winchester - Bernie's proposal solves ALL of these problems--no co-pays, deductibles, etc.
It's IMPROVED Medicare for All.
6
@Len Charlap Thank you for saying the word IMPROVED. The complaints about Medicare are a result of the privatization of the public system through legislation that has allowed the industry to sell their supplemental plans, driving up costs and burdening patients. An improved Medicare for All/Single Payer system without the unnecessary role of the middleman's outrageous costs - 30% vs 2% for Medicare, CEO salaries, pharmaceutical costs etc., we would still come out ahead paying more in taxes. Just call premiums & out of pocket costs taxes too. They would no longer be necessary. And keep in mind that 30 million have no insurance & many are underinsured. We pay for that with very expensive emergency care. We can & must do better. Both the Jayapal & Sander's legislation can take us there.
2
No, it is not how Obamacare works. For Obama care you have to pay 6000 dollars per year, plus 4000-5000 as a deductible. Expenses are also growing every year. So forgive me if I am not enthusiastic about Obamacare. Moreover, you have to pay if you can not afford to have insurance, which sounds quite ridiculous.
This article shows frustration but sheds little light.
Medicare-for-All IS single-payer. By definition. Current Medicare (dis-)Advantage (govt-subsidized private insurance) would disappear. There can be no opt-out "if you like your private insurance"; we need those taxpayers' revenue in the one big plan. Their employers could give them a raise or a tax-advantaged contribution to a pre-tax "cafeteria plan". You can't opt-out of property tax because you have no kids in public school; you can't opt-out of supporting the local police and fire departments. A "Public Option" gradualist approach won't work because: (1) As the new fake one in Washington State, it is thru private insurers, not govt; (2) A single payer-Medicare-for-All needs the revenue from the private competing plans to succeed financially.
The health insurers and their elected and running-for-election supporters know this; that is why they talk up gradualist approaches. But the healthier, wealthier people with private insurance must be in the same plan for the whole thing to work: their revenue (premiums; co-pays; employer contributions), their doctors, their clinics, their hospitals.
16
All this sounds familiar and most of the issues should be addressed--the overpriced bureaucratic overload, the overpriced tests and procedures, and the over-sale of almost anything called health care.
It is true that cost reduction has been needlessly impaired, but one thing appears missing: increasing funds for social safety networks by greater taxation of those who can afford it. Instead our hyper-partisan representatives make exaggerated promises they can never keep (at least for now) or they cut taxes for those most well off and work across generations to cut access.
There are many ways to get the money to begin repairs, however they might occur, but not if our own log-jammed government blocks most all attempts to improve social contracts.
Personal testimonials will not fix the mess. We are short on compromise, insisting on partisan slogans to save us. Might be nice to rely on some real expertise--whether or not it amounted to the sudden overhaul of our current system. Most everything here, however heart-wrenching, is just too simplistic.
Arguing all this out in full public view at inception is not only agonizing, it is likely impossible in the current world.
2
I have has Medicare with an AARP supplement policy for 10 years. Have never had a problem . Have had one lab test when I was told it may not be covered. I wanted test anyway. Billed $ 145 no problem.
16
@Carol Kern
Same for myself and my husband. Medicare plus supplemental insurance and we never have had to pay an out of pocket penny for procedures and doctor visits.
When we retired we had the help of a health insurance advisor from the state of Texas. She took all of our financial information and worked out a plan for the two of us and it has served us very well: Medicare plus a Supplemental (not Advantage). We have a Humana plan for prescription drugs and this pays for our meds.
Other than wishing we were younger, we have no complains.
The political situation--meaning the overwhelming lobbying power of the insurance industry and medical equipment and drug companies--makes the possibility of health care reform to a single payer system very low, probably nonexistent.
This is why I have written about a Medicare for whomever wants it/public option buy-in as a reasonable initial political compromise position, with a place for private supplemental insurance not unlike what occurs with Medicare now. For the economic stability of the nation, the tie between medical insurance and employment status needs to be severed, and a buy-in would in time, I think, accomplish this--a lot of people and employers would opt in, as the huge younger pool and governmental non-profit status would enable considerably lower costs (though I'm sure there would need to be some premiums, co-pays, and considerably more progressive taxes).
However, this piece does make the important point that this cannot be accomplished without significantly more government regulation of those private insurance companies, including as regards their administrative complexity and waste. We might wind up with a hybrid German/Swiss/Australian type model, which would still be a lot better than what we have now.
If I were a politician, I'd be holding out that regulation as a trade for allowing private companies to participate at all--it's a bargaining chip to exchange for not immediately pushing single-payer/Medicare for all. I suggest we use it.
11
@Glenn Ribotsky - 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.
2
But how you will find the public option? You can not so it through premiums, because they will be unaffordable. What other sources of revenue can you suggest?
As I understand it from friends who live in Germany, the private plans cannot duplicate what the public essential plan provides. Their supplemental plans look nothing like ours and are highly regulated. If you opt out of the public plan, it's difficult to re-enter the public one. No one goes bankrupt in any of these other Single Payer or hybrid systems. We need to scrap our profit model for a humane one that actually improves outcomes. We've been brainwashed to believe we can't survive without a private system.
10
I think this article confuses people. First you show a picture of someone who is working on their daughter’s insurance. MEDICARE does not cover under 65 people. Second you only talk about the Advantage plan which requires you to use medical services in the Advantage Plan network. I have Medicare and l have used a Supplement Plan which has no network and l can use any medical service as long as they take Medicare. I have used this system for 8 years with no problem. Please report all of the options and not make the article one sided.
34
@GARY HOLLOWAY
I'm glad you're happy with your insurance--what are you doing for Part D drug coverage? This is where it can be extremely difficult for most people, since you have to be able to anticipate what drugs you will need for the coming year in order to make an intelligent choice, but your insurer can change their formulary at any time while you can only change plans once a year. Incidentally, people younger than 65 who are on kidney dialysis are covered under Medicare.
13
@Andrew I don't have Medicare D coverage (I am now on Medicare due to disability) and my $2k per year prescription bill from when I had employer sponsored coverage has dropped by well over a third. A mixture of Good RX, the State of Virginia sponsored discounts and Kroger aggressively seeking lower cost suppliers are the reason.
1
Gary, Medicare is not limited to those 65 and older. Persons of any age who are determined to be seriously disabled for 2 or more years or who have certain medical conditions may also be eligible.
16
Medicare part B premiums are income dependent.
If on disability and on Medicare, it matters which state you live in. Depending on the state, you may be able to purchase a medigap plan, but then again, maybe not. Even if you can purchase a medigap plan, you may or may not incur a hefty surcharge. This piecemeal approach for a Federal plan does not make sense. If you have an expensive chronic illness, you may have to move just to make ends meet. Medicare for all will just increase the number of frustrated people unless the plans are truly seamless and consistent across the country.
3
@R - Bernie's plan would be truly seamless and consistent across the country. There would be only one plan and it would treat EVERYONE the same.
7
@Len Charlap
Better take control of the Senate next year then. Even with a President Sanders, Mitch will not bring a single payer bill to the floor - ever.
1
This article is spot on--the current Medicare Advantage "system" requires one to be clairvoyant to know what illness you might suffer from in the coming year and what drugs/treatments you might need to regain your health. If not, you get to do battle with your insurance company for the care and drugs that you need. To make things worse, insurance companies can change their formulary for drugs at any time but you remain stuck with them for the rest of the year.
121
@Andrew It's not just our medical system that requires clairvoyance; don't forget our retirement "system." If you're fortunate to have the option of an employer-based system, the first question the advisor asks you is, "How long do you think you're going to live?" We need single payor health care and *strengthened* Social Security.
3
Universal affordable, quality, readily available healthcare may be a dream come true some day, as various options are on the table. The great advantage for a non-profit system is that it lowers administrative costs...so more resources are available for the care, preventive and curative, of patients, young and old; no financial questions asked (other than the physician-patient relationship). Mental/psychiatric care would come out of the shadows, and health education a must...so we may find personal ways to stay fit 're' diet and activities. For all this to occur, the employer-mandated coverage of health care system may need to be gradually changed towards universal public care, trying to find ways to make use of the current private market expertise. No need to invent the wheel.
6
Get the private insurance companies out of delivery of health care.
They are in business to make money and they increase their profits by denying care not delivering care.
350
This an excellent article and fixing the maze should be the first priority of any Medicare expansion. How does any well intentioned policy maker expects people with chronic illnesses on fixed income to plan the out of pocket cost when switching to Medicare?
50
How will they reduce the burdens involved in dealing with the interwoven public and private insurance systems that provide our health care coverage?
Well it's easy. Don't do it.
An abominable hybrid of public and private is bad genetics.
Private insurance is combative, antagonistic by definition. Its purpose is to deny care wherever possible by means legitimate or fraudulent. It succeeds because our courts presume corporations are trustworthy and people are not.
Funny, because there are no bigger, more pernicious welfare cheats than corporations.
Public care, Medicare, operates on similar presumption, more or less so depending upon who's in power at the moment.
Like mega-banks, public systems present as caring and open; the "We Care" syndrome that consumes billions of dollars annually promoting banks engaged in fraud, or outright criminal behavior.
This isn't an indictment of those who work within the confines of these systems, many of whom have deep and legitimate care for their patients. Their hands are tied, their efforts consumed with justifying decisions, their armamentarium cramped by concerns for cost or ungodly profit.
Medicare for all is a weak-tea solution, destined to fail and to signal the end of public options for decades, if not forever.
An attempt to work with private insurance is to invite political and economic perfidy, corruption, continuation of the failures of American medicine.
Single payer for all, plain and simple, is the only way.
184
@oogada: Keeping a little private insurance can be worthwhile, because the rich will always want to pay for better treatment. The private insurance that all but the super-rich need to do this can substitute for all or part of the payments from the government, making the rich effectively subsidize the poor.
@oogada
"Single payer for all, plain and simple, is the only way."
It's the way to ensure that doctors opt out en masse,
leaving Americans with worthless single payer insurance. .
1
@DJS What will they opt out too? all of hte first world nations they might want to move to also have universal, non-profit systems. Doctors do fine in Canada, England, France, etc.
6