We need to completely restructure the system for Seniors and severely disabled adults so it is realistic, sustainable, and tiered to meet a wide range of specialized needs. Dumping all the funding into HCBS home care “in the community” is a poorly thought out political game, not an actual continuum of care that is desperately needed. Assisted Living and congregate settings do not need to be “institutional” or “warehouse” people. In many cases, especially for those with fragile medical needs or behavioral issues, these options are by far the best solution. Well managed and funded Assisted Living choices are less isolating, provide better care, and streamline services. Sticking our heads in the sand by claiming that these options are “not in the community” and convincing the public that “everyone is better off at home” is false and misleading. Our mentally ill population has largely been homeless now for decades. Aging parents of severely autistic and often violent adult children are crying out to deaf ears for help. Siblings of Seniors with dementia can’t be expected to care for their loved ones at home when they have health issues of their own. This isn’t a wonky old house. It has booted out it’s most vulnerable people many years ago and it will completely collapse if we throw more money at it without looking at the deep structural issues and explore a full array of residential options that will meet a wide variety of needs.
As a builder I can tell you (and almost my entire cohort will agree) that when a house is a cobbled together mess, with a cracked foundation that was not designed for what it's supporting, and your objective is to build a functional, energy efficient home, it is ALWAYS less expensive to tear down the decrepit mess and start from scratch. That said, not everyone wants or needs the same house.
Some folks want a 10,000sf architectural showcase that will cost millions and take years to design and build, and are willing and able to pay for that dream house. Most folks just want something well-built and functional with no frills, and are perfectly happy to live in a cookie-cutter development of 1800sf raised ranches and capes. And many folks want something in between.
The system we have now is a disaster, like a town built before zoning regulations. It's an ugly mess, and ridiculously expensive to maintain, but there's no need to tear down the entire town, just those houses, and neighborhoods that have fallen into total disrepair, and are beyond saving.
Let's do what every other sensible, industrialized nation in the world has already done with healthcare and give everyone a decent place to live, and let those who can and want to pay for something better do so. It's already happening anyway with "concierge healthcare."
I’ve experienced Sanders’ “new house” in Toronto and would take it any day of the week, even with a good income and employer-sponsored health insurance.
Run a study on how much the average doctor/hospital would save from getting rid of nearly ALL of their administration garbage. Deduct all of the total profits from all of the health insurance. There’s your starting point for pricing under Medicare for all.
Canada literally already does this. You can look up the entire price list for everything. We need a new house for our American solipsism as much as a we need one for our healthcare.
ah - the metaphor. I love metaphors.
The house is always a good one. The problem with this metaphor is a house devoid of the infrastructure required to power the lights, drain the waste is just a structure - so it's a good starting point.
Healthcare falls into the category of a complex system, in contradistinction to a simple system in which an entire discipline is devoted to: systems theory.
"Complex systems are systems whose behavior is intrinsically difficult to model due to the dependencies, competitions, relationships, or other types of interactions between their parts or between a given system and its environment. Systems that are "complex" have distinct properties that arise from these relationships, such as nonlinearity, emergence, spontaneous order, adaptation, and feedback loops, among others
When you tug on a single thing in healthcare, you. realize it's connected to everything else."
The book's single principle is this:
A complex system that works is invariably found to have evolved from a simple system that worked. The inverse proposition is also true: a complex system designed from scratch never works and cannot be make to work. You have to start over, beginning with a simple system. – Galls Law
Should healthcare be equal for everyone while food, education and housing is not? What separates healthcare as its own unique category?
Perhaps this?
When you have your health,
you have many problems,
When you don’t have your health,
you have but one problem.
5
The author makes the common mistake that the financing and delivery of health care are the same. They are not. You could build a single payer financing system that covers a large bedroom for those with chronic illnesses and a closet for those who are largely healthy. People read these cutesy articles but end up even more confused. The progression suggests that Kamala Harris's plan is even more radical than Bernie's, but in truth it is still unaffordable because it forces one to prop up a private insurance industry which next year approaches $1 trillion dollars. The only plan that allows quality health care at an affordable price for EVERYONE is single payer financing.
4
Would anyone have set out to design and build the house we now have ? Of course not, and no further changes and additions came remedy that. It would be easier and less expensive to clear it out and start over, knowing what we now know.
1
Charming and informative article. My biggest beef with the Medicare for All conversation is that many people do not understand that yes, their taxes would go up, but in exchange their employer-paid premiums would cease. This was not clarified in your article. Bernie made a good point last week that if the GM strikers had Medicare for All, their employer could not take it away as GM has done.
1
All of these plans are about financing of medical care. This mind set has allowed medical care to consume health care. Until the public and policy makers understand the difference between health care and medical care we will continue to have problems with health,
3
There are ppl who are happy with their health insurance plans, resulting from collective bargaining agreements, provided through union contracts at no cost to members. Often union and governmental retirees have supplemental plans to Medicare at little to no cost for the remainder of their lives. They do not want their houses trashed nor their taxes raised. The option to retain existing insurance coverage should remain in full force and effect, coexistent with a governmental plan for anyone who chooses to opt into it. The costs of health care itself: services, pharmaceuticals, devices, etc. should be consistent (regulated) and posted.
2
My wife and I find our health care through a government plan called Seguro Popular that does not charge, provides many services and free drugs.
The system is overloaded and underfunded, is not able to fulfill 100% of its obligations, but does give care to many, many people. We are more than satisfied with the system and happy to buy anything that the system does not have available, such as medicine, surgical devices, etc.
At the same time several private hospitals operate here, but their patients either pay from their own pockets or with private insurance, exactly like in the United States.
So the public has a choice. We opt for Seguro Popular because we believe that money and medicine do not mix. San Miguel is rife with tales of abuses, usually financial, committed by private practitioners and hospitals.
Seguro Popular is a low budget, co-responsible organization that emphasizes prevention. Their primary goal is to cure the patient, to treat him so he can leave the hospital as soon a possible. Terminal cases are sent home.
Slowly Seguro Popular is becoming accepted by those who have always relied on traditional medicine.
For the United States, it might be a more acceptable plan because the choice is up to the user of medical services.
Jerry Davis
1
"there could be unanticipated cost overruns in the construction"
A better way of describing these plans is "the democratic candidates are downplaying the cost overruns and say it that it will all be paid by the wealthy, when in fact it will be paid by every working American."
I am okay with universal health care, but I want the candidates to be honest about what it will cost and what we will have to give up!
2
Has anyone investigated European healthcare systems? I lived under one for a few years a little while ago, and was automatically included. I paid a little, my employer paid a little, and the government covered the rest.
Even as a non-citizen, I could walk into any doctor's office, be sent to a specialist or a hospital if necessary, and then take my prescription to any pharmacy where I bought drugs (many of them made in the USA) at super-low prices or free, including refills. And I never paid any other bills.
I'd like to point out that no one had any serious complaints, people were healthy and missed fewer days of work than we do here, and did not think their taxes were particularly onerous. (They did not have to spend hours trying to decode medical/hospital biils, either)
As for the situation of providers in this system, every doctor and pharmacist I ever dealt with did not seem to be suffering financially, and the government was far from bankrupt.
Similar systems have been popular and successful in many countries, all over the world. I see no reason why one might not be successful here, were it not for the apparent mandate to enrich doctors, hospitals, medical organizations and the drug industry, which is to be congratulated on the success of oxycontin, I suppose.
We should consider such a system.
8
@Susan H as someone who was an expat for 8 years, I have experienced multiple healthcare systems in Europe and Dubai, all of which were better than the US in terms of universal coverage, affordability and access with as good or better outcomes. Many people have done reviews, studies, analyses of other western healthcare systems (check out T R Reid Healing of America). We have the knowledge just not the political will nor the moral impetus to change our system.
6
In their Homes illustrated, Margot Sanger-Katz and Tim Enthoven describe the Sanders’ dream house but fail even to mention a house in their own backyard: The New York Health Act (A5248, S3577).
The little house in New York might become the Saskatchewan of America, showing the nation how such a plan can be built. It won the approval of the centrist Rand corporation last year which declared that with a graduated income on earned and unearned income 90 % of New Yorkers would save money over what they are paying for healthcare now.
This house would address the problem (cited by Sanger-Katz) of under compensated medical practitioners by setting up a commission of healthcare professionals which would determine reimbursement fees and insure that doctors and hospitals will get proper pay for their services.
A recent study in NYS shows that 40% percent of us with insurance are “underinsured, avoiding doctors and delaying prescriptions. This drives people to ERs when they are much sicker, much more expensive to treat, much less likely to regain full health. One more reason for American’s terrible health metrics relative to the rest of the world.
The average family with employer-based insurance pays more on premium contributions than on food for a year, more on healthcare premiums plus out-of-pocket expenses than on rent and mortgages. We need affordable healthcare housing in New York.
1
@Barbara Estrin
In their Homes illustrated, Margot Sanger-Katz and Tim Enthoven describe the Sanders’ dream house but fail even to mention a house in their own backyard: The New York Health Act (A5248, S3577).
The little house in New York might become the Saskatchewan of America, showing the nation how such a plan can be built. It won the approval of the centrist Rand corporation last year which declared that with a graduated tax on earned and unearned income 90 % of New Yorkers would save money over what they are paying for healthcare now.
This house would address the problem (cited by Sanger-Katz) of under compensated medical practitioners by setting up a commission of healthcare professionals which would determine reimbursement fees and insure that doctors and hospitals will get proper pay for their services.
A recent study in NYS shows that 40% percent of us with insurance are “underinsured, avoiding doctors and delaying prescriptions. This drives people to ERs when they are much sicker, much more expensive to treat, much less likely to regain full health. One more reason for American’s terrible health metrics relative to the rest of the world.
The average family with employer-based insurance pays more on premium contributions than on food for a year, more on healthcare premiums plus out-of-pocket expenses than on housing. We need affordable healthcare housing in New York.
I don't think this is a good metaphor. No one is proposing tearing down the house. With Medicare fo All the owner pays one contractor for some upgrades that increase the value of the home. The owner also doesn't have to deal with multiple subcontractors and no surprise billing.
1
@Ernest Ciambarella Tearing down the house and going to government run healthcare means Health Insurance businesses are no longer required. Perhaps Medicare for all would required purchasing supplemental insurance from insurance companies and that would mean they would still exist, but carved out to a skeleton. Will they even think to stay in business. And then you have the Mayo, Cleveland and Johns Hopkins of the world, treating patients worldwide with rare and complex diseases. What happens to them?
1
I guess the people who have workplace coverage with a for-profit insurance company have never lost a job or quit because of circumstances beyond their control. That's when you fall into the fiery pit of our patched-up health insurance nightmare. If you've ever been there, you would jump at the chance for a Sanders/Warren government insurance program that has nothing to do with your employment status. Losing that employer-subsidized insurance at the same time you lose the paycheck that pays your mortgage, car and credit card payments, your cell phone and internet is a cruel feature of our broken insurance system. Just for fun, Google what coverage is available to you in the breach between jobs and how much it will cost you without your employer picking up most of the tab. Read all the fine print about who "qualifies" and who doesn't. And remember that no job in America is ever secure. There but for the grace of God.
6
@abigail49 I worked for a for-profit insurance company, and they systematically ejected anybody who had a potentially costly health problem. They also filled new jobs with temps/contractors and hired FT only from 20-30 something candidates. Health systems are not much different, profit or non-profit.
1
What no one will address is the elephant in the room with respect to either overhauling the ACA or starting anew. If you currently have Medicare and have had it since the inception of ACA you are aware that many Doctors, who do not wish to take on more Medicare patients than required for the simple reason Medicare doesn’t pay them as much: in my opinion that is the main reason and argument in favor of doing away with private insurance entirely, what good is an “ option” if you can’t get appointments with Doctors, in many especially rural areas, you can’t get an M.D. at all and are relegated to nurse practitioners at best. The argument that so many jobs would be lost if private insurance was done away with doesn’t hold water, those jobs would be replaced by much better government jobs in support of single payer: the bug losers in thus case are insurance honchos pulling down mega million dollar a year salaries for not doing a lot more than shuffling paper and denying claims, good riddance. Yes taxes will go up but it stands to reason that if health insurance costs are cut in half to approximate those of other developed nations it would be logical that your tax increase would be considerably less than the premiums, copays etc. etc. etc. in addition to the fact that you don’t have an axe hanging over your head knowing that you are one serious illness away from the poor house no matter that you have paid the insurance premiums enriching executives for decades. Tear it down.
6
Actually, while purporting to present an objective metaphor for the health care coverage debate, Sanger-Katz distorts it. In fact, the house is in much worse shape than pictured. She doesn't note that while some 70% of people live in the house, many are getting rained on through the holes in the roof, not to mention sick, poor, and in debt. She doesn't picture the people starving and dying out on the lawn.
If the metaphorical house showed access to health CARE instead of simply health insurance, it would look a lot different. People don't really love their health coverage; what they love is having access to doctors and other health providers when needed. They are afraid that a different way of paying for health care would take away what they already have, because reports like Sanger-Katz's distort what single-payer health care really means.
If the house represented health care instead of health insurance, everyone would be living in a different house built around their health care needs. No one would be left out on the lawn. And they'd be paying a lot less for their health care homes than they do now for insurance to insurance companies who only partly cover them, deny them care and medications that their doctors prescribe, and often leave them in medical debt.
I wish the Times would picture that alternative!!
7
I favor keeping what we've got with renovations. Tearing apart the whole system can and will lead to unexpected problems. We need to fix it a little at a time. A universal plan would be like tearing up a highway because there are potholes. Traffic would come to a standstill and who knows how long it would take to finish the project.
1
Best, most coherent discussion of the options I’ve seen. Wish all the candidates could do quick courses on both the European ‘mixed’ systems and the history and current structure of Medicare and related private and public insurances.
1
The assumption here is we want ANOTHER HOUSE. Today’s current house has 70% of Americans overweight or obese. 50% of all American children have been diagnosed with a chronic illness.
We need to build a system of prevention and disease reversal. We need to build a health system that includes the food companies, pharma, medical, insurance etc. Let’s build a system so Americans are healthy.
1
@twizzy Stop blaming the sick to divert attention and divide people when we all need to work together on providing and paying for medical care for all who are sick and injured. No one is immune from all disease and injury, no matter how healthy their lifestyles. And no one deserves to suffer needlessly when any kind of remedy is available.
1
The real problem with healthcare is that it is unaffordable for too many people. Insurance is the system we use to make it affordable. Our present kluge has proven completely ineffective at controlling costs. It follows that proposals that keep so many parts will do no better than the ACA has.
The reason so many people like their insurance is 1) they don't know how much their employer is paying for it and 2) there are so many bad situations out there, they feel lucky everything is good for them, without realizing it may just be because they haven't yet fallen into a coverage hole, like out-of-network providers
4
All we're really talking about is how to pay for the medical care all our citizens need. I submit that the middle class is getting soaked and cheated by the present payment system. First, they pay state and federal income tax for Medicaid for the poor, working poor and disabled, for public health clinics, for indigent care and uncollectables at public hospitals, for military veterans and government employee insurance, and for subsidized private plans on the ACA exchanges. Then they pay for their own private insurance with no government premium subsidies (except exemption from income tax on their portion for employee health coverage.) In short, middle-income people, as private sector employees, small business owners, and self-employed individuals, are paying taxes to subsidize insurance or provide direct care to millions of their fellow citizens and getting nothing but a small tax break, if that, to help pay their own bills. Medicare for All would eliminate the private insurance premiums and out-of-pockets and replace these with a tax, but for once, the middle class would actually get something for the tax they pay. It's about time.
6
The house is not the problem. The problem is the dragon being fed by its dwellers. That dragon is the billed price of medical products and services. Either slay the dragon or put it on a strict diet. Not one of the listed plans directly addresses the dragon's diet. As long as the US billed cost dragon dwarfs the other dragons of the world, there will never be a way to satisfy its appetite. Rearranging the house is like rearranging the deckchairs on the Titanic. Ineffective.
8
Rural health care is beset by cost-ineffectiveness, price opacity that remains even with the arrival of the overall bill, bankruptcies galore (personal & community hospital), poor employer sponsored insurance coverage when there is an employer other than oneself, lousy primary care reimbursement, limited drug pricing competition, difficult/costly access, huge outcome disparities, corporate-profiteering (e.g., facility coded lab testing and imaging), price rises locally while city- folks get price decreases, lack of outpatient internal medicine expertise for the care of serious chronic medical conditions, unaccountable care by hospital systems especially in ER's, incompetent Health Information Technology, a vastly under-insured public suspicious of guvmint solutions, a hardworking lot of folks disgusted by "their" money being spent to subsidize the poor while their premiums go through the roof, a pinning for the good ole days, beset by all the chaos created by monthly changes that make no sense to any sensible person, an open season where the bulls-eye seems set on them, and a frugality that begets aghast at THE DEBT implications of proposed solutions. Do ANY of the Democratic presidential candidates understand why their solutions are rejected by a very large number of rural folks?
1
The comments to this article seem to be mostly in favor of a Sanders/Warren type plan. If it is so popular and could potentially offer very good coverage, then why not move toward it? The answer as most everyone knows is our government does not act or legislate for for the needs of average Americans. It almost solely exits for the needs of the wealthy. Ms. Pelosi does not want a tear down as she gets donations from pharma and insurance companies.
5
Politicians often use the short-hand "health care" when they should be referring to "health insurance". Too many people have been made wary of "government health care" – which is not something anyone serious has ever proposed.
6
@Hoagie Hill Japan's explicit price controls are roughly emulated in other countries via the use monopsonistic systems. Monopsony, meaning "single buyer" is the flip side of monopoly. A monopolist sets prices above free market equilibrium. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other. More competition among sellers generally leads to lower prices. However, more competition among buyers leads to higher prices. In the health insurance industry the beneficial effects of more insurance companies competing for patients are far outweighed by the adverse effects of insurance companies competing for doctors and hospitals in their HMO plans. This is misunderstood in debate on health care reform. With health care, more competition among insurance companies on balance results in higher prices.
Focusing attention on the insurance companies, which are simply intermediaries between the doctors and the patients, was a tragic error. It would like trying to solve a problem of high energy prices by focusing on gasoline stations. Only if the government sets prices can health care prices be controlled. Controlling prices does not automatically result in longer waiting times. Japan and Switzerland generally have shorter waiting times to see doctors than does the USA. ..
http://seekingalpha.com/article/1647632
4
I am a physician. The time and frustration involved with arbitrary and inconsistent insurance hoops set up against both patients and providers is ridiculous. The inefficiencies just about all are to save insurance companies money in ways that have very little to do with optimizing people’s health. Profit/growing the insurance company should not be the goal. Healthcare should be a human right that government manages — just as government manages most of education, roads/infrastructure, defense, etc.
21
@David. Thank you. Now please explain this to your colleagues. Particularly those who understand the insurance company motives as well as you do. Yet, fear the lose of their Mercedes and beach house.
6
Certainly doctors can be greedy but I don’t know any that are in cahoots with insurance companies. The ones that are rich (relative term, I know, but the ones with money to easily spend on luxuries) are either in specialties that get reimbursed highly (typically procedure-intense vs brain/patient-rapport based) or those not reliant on insurance.
As others have pointed out, billing is set up knowing the only ones paying the non-adjusted charge are the ones without insurance. Insurance companies have contracts that only allow a certain charge with the difference called “adjustments” then there is whatever portion the patient is expected to pay. Look at you EOBs. The system is already set up to cover costs of those who cannot pay with inflated charges elsewhere. More inefficiencies with the goal of profit vs ultimate goal of patient health.
I could keep blathering on. It’s such a huge mess with so much waste. Universal health care is the only real solution. Health care should not be a privilege. Making it so is wrong but/and just stupid and inefficient. Employers, employees, etc will almost all save so much money/heartache/uncertainty, way more than increased taxes.
5
@David I was not implying that physicians were in "cahoots" with the insurance companies. Far from it. Since they must battle with the insurance companies constantly-- negotiating rates, advocating for their patients-- not to mention all the time, staff and paperwork it takes to manage all this with multiple carriers.
What I was referencing, all be it sarcastically, (my apologies) is that among physicians I know socially there seems to be this overly wrought fear that should universal healthcare become the primary way patients are seen and treated in the US, the result will be lower fees for their services, loss of control over what they can charge, and, ultimately, a reduction in income.
If physicians like yourself will advocate more for effectively, and vocally, with the government for universal care then maybe you'll have a seat at the table when it comes to fee schedules, more reasonable prescription costs, and ultimately better healthcare which will result in healthier citizens.
2
My dad was a medic in the army in WWII. When I had a sore thumb, he would ask me to show him how far I could bend it. Then he would ask me to show him how far I could bend it yesterday .... In making decisions on what to do and how, he generally followed the values of WWWBD (what would Wallace Beery do?). In other words, his health care plan would have amounted to a bottle of iodine and a stick to bite down on when they set (or sawed off) your leg.
Today, America somehow spends over $10,000 per person per year for health care, so I suppose, on average, a health insurance policy for a typical household of 2.6 people would cost $26,000 per year IF anyone was actually paying for it. A lot of this cost is being passed on to future generations and they are going to be sick of paying for it long before they die. If they're lucky, America will magically turn into India in a couple decades and many of them will get just enough health care to keep working until their kids take them in.
So, the lesson is: if you want your kids to take care of you, don't run up bills they can't pay.
3
A crucial thing missing from this analogy, the catapult that periodically flings unlucky souls out of the house and into medical bankruptcy. Only a complete rebuild rids us of that cruel implement.
Most Americans don’t understand that we are one of the only countries that allows medical bankruptcies, but this fact is crucial to understanding the need for more dramatic reform. More than lack of coverage it is medical bankruptcies and fear of them that keeps people from getting appropriate care. This is part of the reason our health outcomes are lower than every other rich country, and many poorer ones besides.
We already spend more on healthcare than any other country, but right now you can’t buy a guarantee your family will never be bankrupted by cancer or dementia at any price. While a national health system will increase taxes, if it is implemented like any other country in the world it will bring down individual yearly costs, while providing a piece of mind currently unavailable in our cruel system.
7
@Dan M In the USA we have attempted to deal with the combination of inelastic demand and unregulated medical care prices in various ways. One method of keeping medical care expense as a percent of GDP to "only" double that of other developed countries was to have a significant portion of the population uninsured and denied medic care in some circumstances. Obamacare reduced the number of uninsured and untreated. However admirable this may be from a humanitarian perspective, absent price controls, it will exacerbate the cost problem. The existence of large numbers of uninsured (conscripts in the war against rising medical costs) did moderate the growth in health care costs.
As long as medical prices are set by market forces, the inelasticity of demand will force market prices inexorably higher. In a "mixed system" with both free-market and controlled health care prices like the USA, prices inexorably are driven upwards to the market level as long as demand is inelastic. Prices such as payments from Medicare that are "controlled" have to be increased continuously with legislation such as the "doctor-fix" to stay competitive with market prices. Medical prices can only be effectively controlled either by direct price controls as in Japan or with systems where everyone gets care for "free" from the government (Canada, UK). In those countries only the extremely wealthy can chose not to use the government paid health services ..."
http://seekingalpha.com/article/1647632
Yearly health insurance contracts drive bad, short term, health care decisions by insurers.
The ACA was designed to keep costs low through the individual mandate. Luckily for ACA fans that has been zero rated making ACA healthcare attractive to voters - but if the ACA stands it will have to tackle rising costs again and then will be a liability for Democrats once more. Singapore copes with this because every citizen is aware that they are surrounded by bigger nations and so always pull for the state.
Public options appear to struggle with doctor driven pricing incentives
Medicare for all would allow all hospitals to link care to long term insurance, would remove a lot of stress from citizens - but all controls would be in the hands of politicians!
Health care policy is hard!! Otherwise a solution would have been found long ago. (http://www.robsstrategystudio.org/awfcashn.htm)
2
NYT you really have outdone yourself with this stupid analogy of explaining how to fix our broken healthcare system. Our house is unlivable.
7
We seem to be perfectly willing to tear it all down and build anew in our military, with, say, the F-35 for a trillion plus dollars.
But somehow, it’s too complicated to do the same thing to get a health care system that is at least at parity with what the rest of the developed world, and increasingly, a lot of the underdeveloped world takes for granted, and has done so for thirty or more years now???
That is true and absolute collective insanity!
8
A recent NY Times article showed how building our system of attaching health insurance to employment was tinged with racist beliefs. Anything that is created from poison is doomed to fail and should be thrown away and rebuilt.
9
It is so easy to destroy something and very very hard to build it.
1
Adding another floor onto a house with a cracked foundation and dry rotted sills is asking for trouble.
9
Number 1 health care cost in the world ? USA !
US health care quality rank world wide ? 34 th.
French health care cost rank in the world ? 38 th.
French health care quality rank world wide ? Number 1.
7
When will the NYT stop repeating the ridiculous lie that people like the health insurance they have now. That's only true if they are already covered by Medicare (in combo with supplemental insurance). The only people who like their health insurance now are the ones who have never had to use it, so they have not encountered all the hidden barriers and costs, including hard to obtain pre-authorizations and surprise billings. And they still have to contend with the fear that if they lose their job they can lose their insurance (i.e. recent examples of Amazon workers and striking GM employees). This assertion also covers over the fact that something like 80 million people who have insurance are under-insured and thus reluctant to even access needed health care. The NYT has an obligation to stop repeating right wing talking points as if they had validity when it is clear they are nothing but lies.
10
@Jeff Sher I am a die-hard progressive. I am quite pleased with my employer-provided health insurance coverage, and I have had to use it quite a bit.
2
@Richard. That’s great it works for you, but It’s truly tragic that there isn’t some form of basic care for all US citizens, regardless of their employer. I hope you don’t suffer the changes I experienced with my last employer- after the 2007 recession, he decided all employees would start paying half of the premium, and denied it amounted to a pay cut. At the same time, he was importing major architectural antiquities from Bali for his second house in Hawaii, the employees be damned. Thanks to Obama care, I was able to quit, and become self employed.
5
Nobody who has ever lived in a weird old, leaky, drafty, house, and then moved into a normal, funcional house, has ever moved back. You might miss some things about the old house, but you don’t move back.
8
Perhaps we should have nationalized malpractice insurance to bring down the cost to doctors. Also we should insist on more people being allowed into the profession of medicine all to put downward pressure on cost.
In East Asia (S.Kor, Taiwan, Jap)there’s a commission that operates as a price setting forum w/ health care providers on one side & health care payers on the other (in Jap & S.kor these are private insurance cos). This commission sets prices for all procedures & devices. This is the market mechanisms that GOP (in bad faith) argues for - they wouldn’t like it because it works & works well pushing costs down.
The health insurance company’s role is simply to act like banks - they hold the money.
There is a central administrative processor - who w/draws the money from the insurance company & pays the health care provider.
You go to your doctor to fix a broken leg. He fixes it. The price for fixing it is, say, $250. When you leave you present your card to the doctor’s admin person. They process your claim w/ the central admin processor. The central admin processor withdraws $250 from the insurance company & deposits it w/ the doctor.
This is the only way to have any role for private insurance companies. They shouldn’t have any say in whether your doctor gets paid.
Can you imagine going to the bank to w/draw $250 & them asking what for? Then you say to fix a broken leg. Then they say “I’m sorry you can’t have the money, your leg doesn’t look that broken.”
8
I say tear down and start over.
7
It’s a tear down....no doubt whatsoever.
4
Anyone notice Bernie is as much a chaos candidate as trump?
Tear down our government.
Trump replaces it with his buddies, so does Bernie.
Either way, the vast majority of us are losers.
3
The USA is the last holdout with market-priced medical care not only because of any inherent conservative or free market ideology. Rather, as the wealthiest nation that ever existed we are the last ones who can afford it. Switzerland was one of the last advanced economies to abandon market-priced medical care. It is arguably a greater bastion of conservatism than the USA. Switzerland's women were not granted the right to vote until 1971.
The reason that no nation, including the wealthiest can allow markets to set the prices of medical care indefinitely is that demand for medical care is inelastic. Demand for a good or service is inelastic if a percentage increase in price results in a smaller percentage decrease in the quantity demanded. Basic economics tells us that sellers facing inelastic demand will continuously raise prices until prices reach the elastic portion of the demand curve. Consequently, in every developed country in the world, all goods or services with inelastic demand have their prices regulated by government. Medical care in the USA being the only exception.
Health care is one of the very few things for which the sellers face inelastic demand. The prices of all other goods and services facing inelastic demand in the USA are regulated by government. Retail electricity service providers face inelastic demand. Consequently, their prices are strictly controlled by all governments worldwide, including the USA..."
http://seekingalpha.com/article/1647632
6
People who believe in the Warren, Sanders and Harris plans, should also believe in the tooth fairy, the Easter bunny and Santa Claus. The government cannot run the Post Office in the black and in many cases it's a monopoly. In San Francisco the government thanks Nancy with a billion dollar a mile subway extension and so it is $55,000,000 over budget and will open a year late. So give the feds the chance to run the whole medical system--a simple task over all. The Times ran a story a few months ago in which a Columbia prof of health care suggested the way for us to go
would be to follow the German system which has extensive use of private insurance like ours.
Our current system costs too much as medical employees from the hospital janitor to the CEO all earn much more than in other countries. We also increase costs by allowing lawyers to suck money out of the system daily. If you think politicians are going to have the brains and the guts to say no to health workers at every level and to cut off lawyers, you must believe in more fictions than the tooth fairy and the Easter rabbit.
1
US healthcare, like virtually all of America, is pigs at the trough, nosing in and pushing each other out, in endless pursuit of spiraling profit. Welcome to capitalism.
7
Where's the Trump plan? You know, the one he promised years ago that would replace the Affordable Care Act, cover everyone and everything, and cost almost nothing. I keep waiting for it.
4
There is a very simple, and good, reason that "tear down and build new" is the only way forward: the current system is FOR-PROFIT. There is no way to compromise on that point. As long as profit is the driver in the system, it will supersede patients. That is inarguable, and that is why we need to have a new PATIENT DRIVEN system.
As for the polls that show that so many people love their current insurance, I'd like to see them. In particular, I'd like to see a poll on the question: "If you could replace your current plan with one that covers everything, with no exceptions, no deductibles, no co-payments, no out of pocket, and that would result in a net yearly savings to you, would you be for it or against it?"
There are two big lies being touted by those against MFA: You'll lose your healthcare. Your taxes are going to go up meaning you'll have less money in your pocket. These lies stick because they're simplistic and they imply a threat to people's security. But they are demonstrably false, and the media ought not to be spouting them as fact, giving them implied credence.
Another lie of omission by the media and other MFA opponents is that it will cost so much, but they neglect to mention how much the current system costs and will cost going forward. In fact, on balance, MFA is cheaper. To use your house metaphor, the current system is a "money pit", where trillions are sunk and no improvement seen.
It's simple: For Profit = Against Patients.
6
Tear it down and start over. There is soooo much money being made by soooo many people in health care in the USA. Just look at all the fancy new hospitals and medical office buildings being built. Rural health care is failing, and urban health care is getting so expensive. New prescriptions costing a million dollars for one dose, and insurance companies saying ‘ok, we’ll pay that’ because the policy holders continue to pay the premiums. 20 years ago monthly premiums (employer+employee) were 500, 10 years ago, 700, now over 1000. 10 years from now that will be 1500. At what point will we say enough? Buying drugs from Canada and going overseas for surgery are not the answer. Stop reimbursing crazy amounts for prescriptions and medical helicopter transportation at 100,000 a ride. I could go on and on......for profit health care will bankrupt us all. Institute Medicare for all and take the excessive profits out of the business model. We can’t afford this anymore.
5
My brother is a politically conservative dentist in the south. I live near his clinic and rent an apt. to 1 of his employees. Saturday my brother asked me where that employee is because she called in sick Thursday- Friday. So a couple hours later I spoke to said employee in my back yard and asked if she's OK. She explained that she's been on the toilet for 3 days due to Crohn's Disease for which she said she had health insurance until early last year when Trump disabled the rule that insurance companies must cover preexisting conditions. Said employee also said that she cannot afford the $2-3000/bottle of steroids to give her temporary relief, and that she owes the local hospital over $20,000 in unpaid medical bills which she will never be able to pay back. So this episode represents a microcosm of our healthcare system - rich conservatives like my brother have fought Obamacare since Obama was inaugurated, then got his wish when Trump ruined Obamacare, then this lady lost her health insurance and therefore access to medical care, so my brother lost money on surgeries and other dental procedures that said employee would have assisted in. LOSE - LOSE - LOSE for the conservative dentist, the sick employee, and healthcare providers who have to write off more bad debt. And I won't be surprised if said employee ends up in bankruptcy. So yes the US healthcare system is a teardown as is our entire federal government under Trump.
9
This is a completely, incoherent model-which mirrors many of the proposals from Democrats. In each case the author says the tear-down model would "cost more". I am so tired of people who don't understand the problem writing articles that purport to describe it.
How can France (Switzerland, Germany, and many others) provide an essentially private system that covers everyone at about half the cost of the US? By focusing on PRICES!! You DO NOT continue to let them (providers) set prices at whatever level they choose in a non-competitive, inefficient market.
4
@William McLaughlin
So where are the proposals from Republicans that would fix it.
I agree with you. We must focus on prices but I would add eliminating the 20 to 30% or more of worthless treatments would also reduce overall cost significantly.
The biggest problem is that most Americans don't like to be told no even when it's in their best interests; especially when it's in their best interest.
It's a tear-down. Medicare For All, is the only step forward. There comes a time when every old institution is backward and antiquated, and must be replaced. It's time for the "Cadillac" health plan, not a patched-up system that leaves millions of people out.
3
@ChesBay I hope not. My parents are on Medicare and have limited options for providers. Many doctors are not accepting Medicare patients. I would hate to be forced into that system.
2
Re: Medicare For All/Single Payer:
The wrong questions is being asked by the press and the competing candidates: "will taxes increase to fund your plan?"
Of course they will, it's obvious. The answer should be: "yes, taxes will increase, but you won't have medical costs anymore, just like a majority of western countries. You won't have huge medical bills to pay, no deductibles, drugs won't be exhorbitantly expensive-nobody's family will have to go bankrupt because of health care costs. Ever."
I, frankly, would gladly pay more in taxes in order to have my healthcare costs covered. I think the trade-off will be more than worth it. And if voters actually thought about the reality instead of falling for the fear mongering of POTUS/Rep, they would feel differently. People are not in love with their insurance, unless it doesn't costs them anything or they have the resources to pay for it. They may love their doctor-let them keep their doctor, for heaven's sake. But health care companies should not profit off sick people. It's immoral and inhumane. And high blood pressure should NOT be considered a preexisting condition-practically everyone over 55 gets it to a degree.
The candidates who support this concept need to stop being afraid of the "t" word, stop being baited by the MSM, and start telling it like it will be. Now, start educating the public. This would be a game changer for our society-health care financial security would be a giant relief for millions.
3
@Lisa Merullo-Boaz
I take it you're o k with doctors, hospitals, equipment providers, Pharma, medical suppliers, & various fraudsters to make big profits?
Let's start fixing that first because otherwise they will explode when "it's just from the government — it's not hurting anyone."
Here we go again, when it comes to what to do about both healthcare and guns, many the answers are all around you, (and guns ARE tied to healthcare) yet, for some reason, Americans seem to have the strange inability to deal with the simplest of these concepts.
Americans have been haggling about healthcare since Harry Truman was President, with fewer people being covered every year, things are gradually getting worse. Guns are an issue the vast majority of Americans want serious action taken, yet, as the carnage continues,the politicians do nothing. Why? It is all about the money and it "infects" politicians in BOTH parties to the point for fear of losing that money they will do what is in the best interest of their corporate donors at the expense of everyone else, i.e. "democracy no longer exists in America".
You want something done about it? Quit making excuses and start electing politicians whom are unencumbered by corporate money and are fully committed to doing something about BOTH of these vital issues.
3
Most Medicare participants think that Medicare claims are administered by the federal government. They are not. By law, claims are handled by private companies under contract-- typically, the same companies that handle private insurance claims. The difference is that the people administering Medicare don't care if the claims are justified. That's a big reason there's so much fraud in the system. On the few occasions, I've answered Medicare's open invitation to question claims, the people I talk to don't care. One even said I was foolish because it didn't cost me anything. Medicare for All is an invitation to more fraud. If anything, Medicare should contract with private insurers to run the program at their own risk -- much as is already done under the Medicare Advantage program.
2
@Richard
Fraud in Medicare is down to $50 Billion s year — before Obama got in it was running about $90 Billion a year but they closed some gasping holes quickly. It's also costing billions for the HHS & FBI efforts to combat the fraud, convict and jail some of the cheats and sometimes get some of the money back. That fraud is just for the relatively small Medicare programs. Imagine what it would be for programs covering the whole country!
That's to say nothing of the expense if running the programs, vetting the doctors, hospitals etc... setting fees in consultation & all the other stuff. Bernie thinks the costs of Medicare is just the 3% of processing the claims
In the last debate Andrew Yang talked about lifting the mess off the shoulders of small business so they could cocoon what they know about , same goes for large corporations, not to mention all the individuals that have to figure out what to buy and then often struggle and fight insurance companies, not to mention medical facilities of all levels wasting time. Lifting all that off our shoulders would be a dream. In the 1970’s I lived in Canada and health care was wonderful. Coming back here the insurance system seemed amazingly barbaric.
2
Here's the thing. With the current level of blatant corruption in US government, *any* attempt to revise the American Health Care System will only make it worse.
IMHO, things should be left alone until some basic improvements in the money-driven corruption of government can be made. Do you think insurance companies are going to take this lying down? In a money-driven shootout between the public and insurance companies, who do you think is going to win? In a money-driven shootout between healthcare corporations and the public, who is going to win?
Why do American drugs purchased in the US cost 3x what they cost elsewhere in the world? Show me that the government can fix this one, simple little problem. Until you do that, trying to fix "American Healthcare" is a recipe for disaster.
1
@Rufus. As a matter of fact, in the early 2000’s, there was a bill in Congress to allow drugs to be purchased from Canada and other countries to help alleviate the continuous rise in prices. It failed, as Congress was bought off by the US pharmaceutical companies. Until there are price controls, and systemic oversight, the profits over all mentality of the industry will always win. When you look at what the Sackler clan has accrued by means of the opiate epidemic, it’s undeniable the US system is rotten to the core.
People who say MFA is going to cost more than what Americans are currently paying for private insurance, don't understand how MFA works.
MFA is non profit. So the tax increase would be roughly half what people are currently paying for private insurance. Which people would no longer have to pay, still be covered, and get to keep the difference in their pockets.
Frankly I'm bewildered by people who think Americans can't do what every country who's switched to MFA has already done.
3
There is something illuminating & also derisive about this explanation. Being sick, frightened, in pain, facing death seems more dire than an old house metaphor. Imagine a child with a treatable infection, temperature 105, unable to get care.
The other flaw is that the 'pay higher taxes' detail perpetuates the confusion about actual cost to everyone.
A better explanation must show current out-of-pocket expenses vs added tax to specific brackets.
The good part of this modeling is the visual notion that we all live in a healthcare system together. Even though many rich people fear having to enter grubby public clinics with the rabble (mostly wrong as all the same hospitals & offices would remain- and most already accept Medicare patients)- having 30 million uninsured means having squatters sleeping on the floor of our home...freeloaders who crank up our private insurance premiums and allow sick people to spread disease and create public health risks.
While most Democrats favor an incremental expansion of Medicare, most small & large business would be better able to compete globally relieved of providing benefits. The main advantage of employer-based health insurance has been their ability to negotiate economies of scale with private for-profit insurers. Medicare4All or an expanding public option does exactly that - but eliminates billions in CEO salaries, profits to shareholders, marketing, benefit denying clerks and inefficient hospital empires.
3
It’s an apt metaphor if one looks at it from a cost standpoint. But the real issue is how does one view heath care. As tort law or as a right.
Those who view it as tort law argue that they should not be responsible for other people’s negligence. My neighbor, they argue, is overweight, smokes, and sits on his butt all day. If he gets sick, it’s his fault, not mine. As such, any system that forces me to pay for his or her health care, whether through taxes, premiums, or other means is unfair.
Those who view it as a right argue that everyone gets sick sooner or later. Whether one’s individual lifestyle contributes to that sickness is a minor issue among more important ones. We are all humans, we all get old, and we are all mortals. Thus we will all need healthcare sooner or later.
Individualism vs. the common good. It’s that same old American debate.
1
With horror stories of $60,000 appendectomies and the like this is a vital industry that needs regulation. Tight regulation. Like the airline industry ran perfectly fine under for many years.
The greed of this industry did it in. Health care costs are now so completely out of whack to be laughable.
5
Health care is one thing, health care insurance.
The former is good but not great.
The latter is an unqualified and absolutely thorough disaster by any objective measure.
This can be fixed by erasing two words from the legislation that created Medicare:
“Over 65”
2
The American people recently went through the conversion to the Affordable Care Act, I doubt they are ready to go for a completely rebuild. Moreover, much like the problems of inacting the ACA, any effort to build a new plan would take way from the needs of reforming the broader economy.
The senate and the electoral college, which are vital to win in the 2020 elections, single payer would cause candidates to struggle in marginal areas. Even the platform could be used to generate fear of single payer
Rather than always being obsessed with single payer, advocates for universal coverage should look to Germany and The Netherlands which both have hybrid systems that work and could easily be made from the pieces of the ACA. The important thing is generate a new univeral healthcare plan with very low co-pays and very low out of pocket.
People are not rational. Hence, we should be informed by Chuang Tsu's "3 in the Morning".
A man who fed monkeys with chestnuts said to them:
“Three portions in the morning, four in the afternoon.”
All the monkeys got angry.
The man then said:
“Alright, four in the morning and three in the afternoon.”
All the monkeys were pleased.
The food and the quantity had not changed,
And yet resulted in anger and happiness,
All because of the different arrangements.
Therefore the sages incorporate the two concepts,
Don’t even try to debate truth and falsehood,
And maintain the principle of natural balance.
This is what we would call the dual approach.
1
The U.S. has tried the incremental approach for 40 years. Did it work? Heck no. Every time they patch it, they add another layer of bureaucracy and costs. Not only is the system even more complex than before, it's far more expensive and covers an even smaller percentage of the population. And, the progression of improving life expectancy has REVERSED.
That should tell you that this long troublesome journey has been WORTHLESS. Sticking with the current system or playing tgge same strategy to fix it will GUARANTEE failure. We know it because we have all lived it already.
The only people who are against starting over are those with conflicts of interest making money off the current mess.
2
I do not see why those who like their health insurance cannot simply keep it, while those who have none or none they can afford to use cannot be put in a special health plan devised by the government.
2
A wonderful way to depict and explain the various choices presented to the American voter.
1
This pretty well says it all and illustrates why health care expenditures are so much more expensive per person in the US than any other developed country. Yes, we all want choice and control of our health care - but the cost is killing us and is NOT providing better outcomes than elsewhere. Shame on us for being so blind to real costs and poor outcomes for so many.
2
The Elephant in the Room or the House is " private insurance" a zillion-dollar for-profit business which helps the insured to avoid or postpone death and disability. This is a a for-profit industry and a fifth (?) ( a groing share) of the US economhy.
About 10 percent of all expenditures for health or to avoid or postpone disbility or death) is those over age 65 and for certainn "covered" groups, e.g. military veterans. More zillions of coverage of those with jobs comes from employed persons'' organizations, whhich are buying "insurace" (coverage) from private, for profit insurance companies.
The U S istthe only "advmnced" cpuntry in which health care cost coverage is provided mostly by a private industry.
Using public funds for coverage of health care costs would require increased taxes, paid by all taxpayers. Most of whom are healthy enough and/or young enough not to need "health insurance" from private comnpanies or from government programs such as Medicare. The increase in taxes for all (persons, families,organizations) requried to covere health cre costs for those who need such coverage would be an increase in taxes for everyoine but no paymentsd to private insurance conpanies for health care cost covrage.
.
This is not "socialism," any more than it's "socialism" to use tax monies to cover thecosts of fire departments, highways, and government itself.
The Patient Protection and Affordable Care Act aka ACA aka Obamacare began as the conservative Republican Party free market capitalist alternative to the failed Clinton Administration Hillary Clinton led healthcare effort.
Thus there is no public option nor limitation on the costs of drugs, medical devices, hospitalizations, treatments and procedures.
Access to quality affordable healthcare is a human right in any civilized nation. America is not a civlized country.
4
What would be the best solution for changing medical care? Stupidly, there is no public discussion about outrageous costs for medicines which bear no pragmatic value, and worse, some care, especially based on genetics seem only for the wealthiest. Added to this are ludicrous salaries for medical doctors, nurses (recently) and hospital stays which result, all too often, in infections, almost impossible to cure because of poor planning and simple modern cleanliness techniques. Patients are so afraid of viral death - especially the elderly - that they forego needed hospitalization. Add to this are the outrageous insurance and other corporate profits mainly enjoyed by high-level executives. The unfairness in medical treatment is tightly bound in outrageous greed - a symptom of a dangerous, but not an incurable free-wheeling economic system that over-rewards the most fortunate of privileged citizens, and corrupt politicians. In such an economy we need institutions that can be trusted to judge just "how much, is too much". I believe in our economic system strongly. However, without checks on basic flaws in complex economies that blend many errors - not only avarice, but indifference, inertia, and other factors that must be weighed in the emotional business that healthcare can be. Medical treatment has many faults that seem to be stuck in a hopeless jumble. This can be strongly taken care of judiciously and with empathy leaving the current system alone, but far, far more sternly.
1
It’s hard to develop an effective analogy until The NY Times editors and reporters insist on clarity and accuracy in differentiating the health care financing system from the health care (delivery) system- this article is about the financing system only- at most, the financing system acts like the building plans for the actual health care system’s “homes” - and it has produced a gated community that is rotting from within, while excluding the people who need shelter the most. To fix it, we need a more inclusive neighborhood plan (financing system) plus more effective and efficient houses (delivery systems).
2
Go Big! or Go Home!
That is my Universal Healthcare message to American voters.
Think! how Republicans have relentlessly worked to dismantle Obamacare. Think! they won't relentlessly attack any progressive changes to healthcare profiteering?
Think! again.
America's healthcare system exists because BIG money lobbyists own current and past Congressmen. That big money is funded by Big Pharma, Big MedInsurance, Big AMA, Big Hospital consortiums.
Those lobbyists also invest enormous sums of money in PAC's and think tanks to confuse the voting public. The Big's will move mountains to defeat anything but small cosmetic changes affecting healthcare and their monopolies.
1
Unless a Democratic president can make the change via a "national emergency", it ain't gonna happen without a sweep of the Senate, which currently looks iffy.
@Tom. Americans are fools if they keep the senate in the republicans control. The GOP has proven time and again they have no interest in trying to improve the system, and would tear down what improvements have been made through the ACA if they could. They are the party of the rich, for the rich, and nothing else.
In our current system sick people pay and they pay not only for health care but for a whole army of gatherers and sharers whose job is to keep people from getting needed care.
2
Teardown! Good health care in America exist only as illusion. If you become seriously ill and can not work you have no safety net.
2
How about just stealing another rich nation's model?
Target, say 8% of GDP or the equivalent demographically speaking (for example Germany's people are older on average and the same for Japan: so their %-GDP will be higher than we can achieve).
Forget the analogies. Pick a better model, from that build reasonable targets and start executing. We can do better than many of these other rich nations. We just have to learn from them and start.
2
This is a no-brainer, for those with brains and without an agenda, or vested interests. Ask any person currently on Medicare:
“ What is your most valuable asset ? “. For all but the top ten percent, they will immediately claim their Medicare coverage. And they are absolutely correct. No, it’s not perfect, but it sure beats the alternatives. Now, imagine every American receiving the same coverage. No more parasitic Insurance companies, with hordes of workers specifically tasking with denying claims. Imagine the power of one entity negotiating with Big Pharma, for reasonable Drug prices. Imagine the feeling of safety and security, for every Parent.
WE can do this. It’s the American PEOPLE, NOT Corporate profits. That’s my America. VOTE 2020.
4
@Phyliss Dalmatian Then why do ⅓ of the people on Medicare choose a privatized version — that is they sign up with a private insurance company for their Medicare plans ?
They are called Advantage Plans or Medicare C. They have the limits of the Insurer as to which doctors and hospitals etc. Same old ... ⅓ choose.
Instead of a house, you should have depicted the United States healthcare system as what it is, a sky-high gold-plated corporate tower of systematic greed and sociopathy that consistently delivers the greatest healthcare rip-off in the world at 17% of GDP, skimming an extra $1 trillion in annual corporate subsidies vs. the healthcare systems of civilized countries.
Each year, America pays an extra $1 trillion in corporate fat and profit to get a worse overall health outcome than its OECD cousins.
American healthcare is an ongoing economic crime against American humanity.
Tear the corporate tower of golden profits to the ground and build a human system modeled on the successful systems of Canada, England, France, Germany, Japan, Taiwan and Switzerland.
No need to reinvent the wheel.
Just abandon American failure, greed and sociopathy and declare healthcare victory.
Countryand Healthcare Costs as a % of GDP
United States 17.2%
Switzerland 12.4%
Germany 11.3
Sweden 11.0
France 11.0
Japan 10.9
Netherlands 10.5
Norway 10.5
Belgium 10.4
Austria 10.4
Denmark 10.4
Canada 10.3
United Kingdom 9.7
Australia 9.6
Finland 9.4
New Zealand 9.2
Spain 9.0
Portugal 8.9
Italy 8.9
Iceland 8.6
Slovenia 8.6
Chile 8.5
Greece 8.2
Ireland 7.8
Korea 7.7
Hungary 7.6
Israel 7.3
Czech Republic 7.2
Slovak Republic 6.9
Estonia 6.7
Poland 6.4
Luxembourg 6.3
Mexico 5.8
Latvia 5.7
Turkey 4.3 %
November 3 2020
5
The debate is NOT about America's health care system.
Isn't now. Never was.
It is about America's health insurance system.
3
3 key misses in this otherwise great analogy: one, a group of rundown homeless people loitering in front of the house (44 million unsinured). Two, the big “tent city” in the house’s back yard (38 million underinsured). Last but not least, the unimaginably large graveyard of people who died unnecessarily and early due to lack of insurance or being underinsured. Add these, and the complete tear down of the current “system” seems inevitable
2
Americans need to to two things, to figure out, on their own, whether a hybrid healthcare system or a fully funded through taxation system is the best solution.
They need to do the research themselves, by examining every analysis possible, to determine who is telling the truth and who is lying to them.
I'm 70 years on the planet; I've done the analyses, examined all the truths and lies, and can unequivocally state that a Medicare for All system, funded through a payroll tax paid by mostly by corporate America, with a portion paid by workers, will save 100's of millions of dollars annually, cover everyone, and no one will ever have to fear being without medical care again.
See following study excerpt, and link -
"Previous estimates suggested that Medicare for All would save $2 trillion. But it's even better: a new study finds that Bernie Sanders's bill would save $5.1 trillion — while providing universal, comprehensive coverage."
https://jacobinmag.com/2018/12/medicare-for-all-study-peri-sanders
The second thing Americans need to do is, sent Trump and his Republican partners into oblivion November 3, 2020, and take back their destiny, and the future for their children and grandchildren, by electing either Bernie Sanders or Elizabeth Warren as our 46th President.
These two simple and necessary moves will restore the American dream, and this recurring Trump nightmare.
2
@Mel Farrell
Excuse typing errors, especially the last sentence, which should have ended as follows -
"... and end this recurring Trump nightmare"
1
@Mel Farrell. Trump isn’t the only one that needs to go- His evil enabler Mitch McConnell and gang of sycophants will have to be canceled as well.
2
Why not just look around at the systems in place in Europe, Canada, Japan, etc., and choose the best one?
5
Ironic--in the U.S. many people want to maintain a 'class system' for medical care. We may talk American 'equality' but we have more class division today than other advanced democracies--also capitalist, but more regulated by govt elected by the people.
Some people, afraid of 'big govt', approve of those with more money getting better medical services. Those that can't afford it can just adjust to worse health, insecurity and anxiety.
This underlying class system is hardly discussed in the media,ignoring how dozens of nations for generations financed medical care for all---they don't see insurance and pharma profits as 1st priority.
The journalists reporting on our medical financing battles have excellent secure health insurance policies they can easily afford.
Our media ignores the blockage to equality--the financing of our elections by big insurance/pharma. They pay the bills for our biggest expense--- campaign ads on media , that swamp our voters and bring profit to media.
Contrast with---per Wikipedia--many countries that ban paid campaign ads on their media, "to prevent special interests from dominating the political debates." They all have health care for all.
Such weird, exotic, foreign customs -- in paying for elections, and medical care---aren't discussed in our media.
Then our Supreme Court protects big money in elections as 'free political speech', muffling the 'speech' of the citizens, and thus blocking progress in our democracy.
4
Us voters need to know the basis for comparing any proposed new system to the old one. What are actual healthcare costs?
I can't help wishing that news reporting would educate the public on how much the current costs actually are with employer-based healthcare insurance. It's definitely quite a lot. We need some national statistics, if journalist can pry the data out of the profiteering Healthcare and insurance system.
3
I like the house metaphor. At least it simplifies the argument to some extent and makes "building a new home" for healthcare less scary. There aren't many Americans who wouldn't willingly give up their old house for a brand new one with all the room they need, the style and layout they like, and various modern features, especially if the new, bigger, better home will cost them less than it would cost to maintain, repair, remodel, retrofit, and expand their present home.
One problem is, most Americans don't know how much their present healthcare is really costing them, especially if their employer pays the biggest part of their premiums. What the employer pays is thousands of dollars they never see in their paychecks and don't get to spend as they choose. A report by the Kaiser Foundation says that employees of big companies with health insurance benefits are now paying $7726 for family coverage, including their share of the premium plus deductibles and co-pays. Their employers are paying $15,159, for a total cost of $22,885
That's what the cost of "maintaining" the "old house" is and it keeps rising year after year. The Kaiser report found that private insurance costs rose 56% over the last ten years -- faster than wages and inflation.
Smart "homeowners" should know these facts before they choose a healthcare plan.
3
I keep telling people, check Box 12 DD on your W-2... it’s eye opening
3
@Hendrik Fischer Thank you! Yes, the information is readily available to every employee who "loves my private insurance and wants to keep it." It may be good coverage, but what it is costing you? There is no such thing as "free" benefits. Your employer pays for them instead of paying you in wages and salary.
2
The most important goal should be to make certain that everyone has health care. The ACA was a reasonable move in that direction. The republicans have done everything in their power to make it a failure. Medicare for all is a worthy goal, but the current liberal litmus test support of it shows a lack of understanding of the political viability of pushing for it. A well designed public option which also extends protection to those who cannot afford medical care is an easily explainable and easily defendable position. I firmly believe that people will flock to the public option and render private insurance obsolete except as a boutique industry for the wealthy. Since the most important thing in this election is to take back the Senate and remove the malignancy from the executive branch, I do not wish to see an overreach that will cost union and middle American support.
1
This is an interesting metaphor, but I think it misses one big issue with the tear-down and rebuild approach: there’s no reason to think that the new “house” would come out looking uniform and pretty. In fact, recent congressional history suggests that it would be just as ugly and jumbled up as the old house. Congress has trouble holding a serious debate and performing even their most basic responsibilities these days, like passing a federal budget. Does anyone really trust them to “tear down the house” and make a new one? Does anyone really think that would turn out well? If so, you may want to remember the crazy process that ensued when they created Obamacare, and that was a drastically smaller change to the status quo than all these Medicare for All proposals. I’m all for making improvements to our healthcare “house,” but I have a hard time believing congress would do it right.
4
It appears to me that most of the proposals to reform the U.S. healthcare system are over-engineered, perhaps a bit like the U.S. tax code. Perhaps the proposals also stem from an absence of understanding of healthcare systems elsewhere.
Europe doesn't to have a single model. Sweden's model is engineered very simply: single payer system with multiple (unlimited) providers of your choice, with regulated prices. Healthcare is not “socialised”; only payments are “socialised". There is a deductible, around USD25 per visit (ER visits cost USD45) regardless of treatment or surgery provided. If admitted to a hospital, the daily extra cost is USD12 (yes,12). Annual cost for prescription medicines is capped at around USD250: beyond that, no charge. Costs for visiting doctors are capped at USD150 per year: thereafter, no charge. Dentals are without charge until the age of 23. Maternity care: no charges. All benefits are tied to being part of the national population registry.
And at what taxes? Fortune/wealth tax is 0%. Inheritance tax is 0%. Gift tax is 0%. Property sales gain tax is 20%. Maximum income tax rate is 55%, middle class earners typically pay less than 30%. VAT varies between none and 25%: saving rewarded, consumption “punished.”
Is the largest challenge reform in the U.S. an absence of a “community of values” in the society, a sense of togetherness and shared values? Without it, it may be unlikely to find broad public support for a single payer system.
7
@Rebus Americans are not even willing or able to look at other working health care systems .
They are locked up in their world of what it is is what it is .
A forclosed world of no thinking that is the general social attitude for everything in the USA .
1
Something that never seems to get mentioned in any debate or any article is the utter lack of price transparency.
Hospital services, lab tests, medical supply prices, medication: The cost for these need to be up-and-center, yet it's conveniently hidden away.
9
@John
I can't help wishing that news reporting would educate the public on how much the current costs actually are with employer-based healthcare insurance. It's definitely quite a lot. We need some national statistics, if journalist can pry the data out of the profiteering Healthcare and insurance system.
1
@John That would be communist !
Don't even think of bringing your communist ideas to Americans .
@As-I-Seeit. Perhaps a look at the number of column inches occupied by health care providers, insurers and ancillary corporations feeding at the trough of the current system would aid you in understanding why the current reporting is as it is? Money, it always come down to money.
For order of business is to take the power away from the insurance and drug industries through heavy regulation. Check, Liz Warren. Next, cover everyone. I don’t care how. As to who pays, who has all the money? Problem resolved. Funny how we never answer the question who’s going to pay back all that borrowed money when we’re showering tax cuts on the rich and corporations.
7
I really like Andrew Yang's approach. He is for a comprehensive medicare for all approach, but would not entirely eliminate private insurance like Sanders. As Yang explains, the medicare option would be much less expensive, and companies and individuals would not want to keep paying more for lesser services, and risk losing coverage because of losing a job, so in reality, almost everyone would go to the medicare for all route, other than a few very rich people where price is no object. Americans like choice, so it is better for everybody economically incentivize moving to single payer rather than just forcing.
A public option should be paid for by taxes, not individual monthly payments because otherwise, you leave out millions of poor people that cannot afford it.
4
A lot of fantasy going on here. 2 things:
1) I have yet to see an HONEST answer on how it is going to be payed for. Corporations aren't going to pay for it. They own enough of congress to make sure that doesn't happen. Or they will just relocate their profits to a tax haven and give the US a single digit salute. Corporations aren't to increase people's wages by what they save! They'll just pocket it and expect what they no longer pay to pay to come out of the employees pockets. Anyone who believes otherwise should note the increase in productivity versus the stagnation of wages. NO the Corps aren't going to pay for that's fantasy. And there isn't enough ability to raise taxes on the wealthy to pay it. Their capital would be out of the country before the ink was dry on the law. The question you see isn't the percentage of GDP or sheer numbers, IT"S OUT OF WHOSE POCKET? And I still haven't seen an honest answer.
2) For all the talk there will still have to be what will effectively rationing. Every treatment, every test, every medication will have to be weighed in the balance. Can the cost of this treatment or medication be justified against what we can afford? And yes that is pretty standard question in other places with universal healthcare. Be careful what you wish for folks, if your dependent on so called orphan drugs or expensive treatments? They may not be justifiable to whoever ends up deciding but pretending everything will be covered is fantasy, don't think otherwise!
1
@Stephan, sorry the rest us want to fight for what is ours. And I fail to see why rationalizing care is a problem. If you want to sit there and give up, that's your choice. Don't expect others to do so too.
2
@Stephan Medical prices are controlled in various ways in the rest of the developed world. In Japan, all medical care prices are listed in a book, thicker than the Manhattan telephone directory. The prices set in the book are usually less than a third of those in the USA. Japanese insurance companies are private as are most doctors. Japan spends less than a third per capita on medical care than America. However, the Japanese are greater consumers of medical care than Americans. They visit doctors and hospitals more often, have much more diagnostic tests such as MRIs. They also have better health outcomes as measured by all metrics such as life expectancy. They also wait less for treatment than Americans do as Japanese doctors work much longer hours for their much lower incomes.
Japan's explicit price controls are roughly emulated in other countries via the use monopsonistic systems. Monopsony, meaning "single buyer" is the flip side of monopoly. A monopolist sets prices above free market equilibrium. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other. More competition among sellers generally leads to lower prices. However, more competition among buyers leads to higher prices..."
http://seekingalpha.com/article/1647632
3
I hate to say it but this analogy is pretty lame. It reminds me of some architectural fix where a screen is erected over the original facade so the building looks modern but is still an old wreck.
Everybody wants the same thing, healthcare at its finest without bureaucracy or limits, and hopefully for free. People always say you can have any two: quality, access, and low cost. However, right now we have mixed quality, difficult access, and high cost, so we know we can do better, much better. People unfortunately possessing human nature, it is probably best to remove the cost from in front of the access by putting into the tax code.
Sanders' and Harris' model does change Medicare from its present configuration. I wonder how many people realize that. But the change is not extreme; it just increases the coverage of the original Medicare and eliminates the part B. It converts Medicare into Medicare Advantage but without the insurance companies. Once that is done the only additional changes would be to shift people into it, something that could be accomplished over a number of years.
6
@Elwood
Medicare Advantage plans are currently run by private companies (Humana, United, etc) who collect the Medicare premium for each participating patient, jacking it up by hiring teams who 'maximize' coding to increase funding. They also maximize profits by maintaining a network of providers who accept a certain capitated reimbursement rate for services, limit which facilities patients can go to and create strict medication formularies. If this indeed what Medicare4All is, then the American people need to know this.
2
@doc007 If you take away the Medicare Advantage insurance companies and their coders, you have what Sanders and Harris are proposing. Of course, since the network is now not limited by insurance companies it is much, much better. As far as medication formularies are concerned, this may be a sensible thing. As a physician I see too many "new" drugs which are not any improvement over the older, cheaper, out-of-patent ones. The FDA will approve a new drug which does the same thing as an old one with no significant improvement because they have to under the rules. In any case the Medicare proposals are definitely different from present "classical" Medicare.
I have private health insurance through work for 20+ years (and so many of my classmates from 97). No one is happy with the coverage.
We do have peace of mind that we have coverage; but every time we had to use it; it hasn't been a pleasant experience.
There is always a long wait(few months for my Autistic son to Brain Specialist) even with the so called good insurance.
We always pay way extra money into co-pay at every visits including lab reports.
Our total medical cost for my family of 4; 26000(premiums , includes my cost and my company's) and roughly 2K on top of co-pays ; medicines etc.
I make good money (well above 300K) so it's roughly 8% of my yearly income.
I wouldn't mind 8% or more of my income towards single payer; if it guarantees me even equal care; because I will have peace of mind that I will never loose it. Currently I will loose this insurance if I loose job.
Why can't we make this simple..? I have paid yearly premiums for 20+ years and I am still under stress for health of my family..
14
As a US physician who has worked in other systems (currently in NZ), I would say there clearly needs to be a rebuild.The Australian system would be a palatable model fro the US. Including guaranteed free public health insurance for everyone (some modified version of medicare if you have to call it that); options for private insurance if you want it; and most importantly price controls. Without price controls (which nearly every other country has) we are doomed to ever expanding profiteering, health care simply does not work as an open market for some very obvious reasons. We should be able to move our costs from 18% of GDP to around 12% GDP and still have excellent care...everyone else does.
17
The most practical solution to healthcare is better health -- the most radical departure. Whether any of the proposals set forth, above, or reversion to unregulated market care, all presume the bloated, expanding cost of treating systemic disease. Research shows systemic disease largely caused by the fat, salt and sugar-rich diet foisted upon us ... and by whom??
8
@Taylor
Part of this problem can be blamed on the social construct of how and by whom health healthcare is administered.
Patients are completely dependent upon the 'all knowing physician' for 'care' and 'expert information'.
As a physician, I also have 'scolded' patients for referring to Dr. Google, yet as a nation we have done nothing to provide patients with a national, accredited, easy to navigate website with more in depth information about medical conditions, expected standard of care, and recommended screenings and vaccinations. Instead they are completely reliant upon the expensive system of quarterly visits when a lot of medical conditions could be dealt with more effectively and efficiently by self-monitoring tools and proper health education without requiring face-to-face with an expensive expert.
If we are serious about tearing down the system, these are things that needed to be addressed as well.
3
Medicare is unsustainable even as it exists today. There is no way that we could maintain this system by adding everyone to it. I understand the argument that the net costs would decline for almost everyone, but that still fails to control the escalation of costs of delivering quality health care. I think it best that we try to regulate the insurers, like utilities, add a public option and force hospitals to operate like Mayo and Cleveland Clinic by making the costs fully transparent and end the for profit models. This is complicated, but incremental changes to eliminate the for profit insurers is the only route that gets one there.
3
Amen. I have no objection to everyone, including doctors and hospital administrators, getting paid a fair wage for the work they do - which should be a lot for really skilled medical practitioners. But our system seems to be a "for profit" industry, rather than a "service" industry.
There are a few really good examples in this country, in particular areas, and some have been mentioned in these posts. I'd suggest looking into the Geisinger hospital system in Pennsylvania as a model. It even sells its own insurance at fairly low rates, I believe.
1
America is too sclerotic and too divided for a major public policy initiative on almost anything, and health care reform is the biggest challenge of them all.
While the costs and failures of the system may be a burden to many, those most affected are mainly not politically active. It is only when the system becomes intolerable for a critical mass of people - that is, a political supermajority - that change will finally come.
Sanders or Warren candidacies may fail because Middle America finds them too radical; and if either wins 2020 the Republicans will stonewall them anyway. A Biden plan will be tinkering, and Trump is a grandmaster of doing nothing.
Change in 2050, maybe. Not now.
1
@r a So many problems that Americans are unable to resolve or even apprehend conceptually : health care, education, guns and violence are just the first ones.
Problems that have been resolved in Europe since decades.
3
@r a
Reality is so depressing.
1
@Peter No it is the lack of sense of reality that is depressing in the USA .
The American Dream . It was first written by a French guy in 1784 and he was kicked out of America .
My google search produced these results: the first health care plan in the US was private insurance from Franklin Health in 1850. The US citizens pay the highest cost for health care in the developed world. We rank 27th in quality of care and results. So we have had private health insurance for some 170 years now in the US and still cant get it right. Our house must be the rundown rat trap on the block as all of other developed countries have achieved a form of universal coverage and at a cheaper price. In addition all of their citizens are covered and do not face medical bankruptcy. There were 530,000 medical bankruptcies in the US last year more than the population of Atlanta. We have had 170 years to get this right. We all know what is sad about doing the same thing over and over again and expecting different results.
22
Most discussions focus on payment systems having national scale. Health services are delivered locally. For the sake of affordability both costs and quality of outcomes from locally available goods and services need to be accessible. Additionally, give the consumer financial incentive to draw from the shared pool of health care dollars wisely. To minimize anti-competitive behavior, the organizations living off of public expenditures need to make the nature of their financial relationships transparent. Our existing marketplaces (funded in whatever fashion) could be more efficient.
2
Private health insurance is mostly paid by employers because they get a tax deduction, which is a government subsidy and a non taxed benefit to the worker
Medicare for all would save more money in premiums than cost increased taxes on the whole system. That is one reason US spends much more money on health tan aby other country.
In Europe insurance profit are kept very low and the system is much more efficient since there are rare denials.
If voters want to pay more for private care, that is the capitalistic way, but everyone deserves good care as a right and the government needs to support that choice too
7
Old houses are money pits, charming but ultimately unaffordable to maintain. So is our private health insurance racket. We need to scrape this system and build one with modern utilities, insulation, wiring, etc. LEED buildings save money; so will single-payer Improved Medicare for All.
10
Fixer-upper, not a teardown. It's possible this growing, giant, our healthcare system, can be improved without drastic changes.
Obamacare is a great plan. If Donald trump hadn't been elected, the damage done to it wouldn't have happened. And it is mandatory not to reelect Donald Trump. All we need is a public option to compete with private healthcare plans, to help everyone get covered. Gradually cost will come down. In about decade we could transform the healthcare system into a single-payer, Medicare for All system. Meanwhile we can avoid doing any harm to the existing system, which is important.
Once a single payer system is fully in place the healthcare cost will be about 12-14% of GDP, which is enough. Some waste maybe unavoidable, otherwise the cost could be 10-12%.
Elizabeth Warren/Bernie Sanders plan maybe, not necessarily, too disturbing, and may scare voters as well, with the result that Trump maybe reelected. That's the most disastrous scenario. It's unwise to take a chance on Warren, who is surging. She's a very smart hardworking woman and sincere too. The country doesn't owe anything to any candidate. Nobody needs to "rewarded."
Instead of thinking who deserves to be nominated & elected, we should think of who is the best to beat Trump. If that can be achieved, everything else will fall in place. My money is on Pete Buttigieg. He's exceptionally gifted. He can beat Trump. He's progressive enough.
2
In order for public option to work it needs to be cheaper and cover more. For that you will have the money how do you get this money? through taxes, meaning that some people will have to pay both premium and taxes. The second question is how do you estimate how many people sign up for public option and what kind of people are they in term of health. That estimation is necessary in order to determine how much money you need, but again if the public option is so good more people will sign up and that will require more money, meaning more taxes, because now you need to cover more people. It will look bad, if program require the tax increase every year even if it is justifiable. That's why Medicare is more workable solution That and ability of Medicare to control cost what public option could not do
1
@yulia
Hello, Yulia, I haven't read your comments in whole though I have seen many of them.
Let us face it, There's no easy solution to our mixed up healthcare system. While we offer solutions, more important than that is how the voters would react to it, which decides whether Donald Trump would still be our president after Jan 20th 2021.
What I have gathered from the writings of people is that "adding" a public option is the least disturbing, and most appealing to voters.
Medicare for All, with eliminating current employer based health insurance is the most disturbing & least appealing to voters. Furthermore, this plan offers the greatest chance for reelecting Trump.
As for paying for it, I would suggest 3 additional marginal rates, 40% on over $1 million, 45% on over $5 million & 50% on over $10 million. All incomes over $1M should be treated alike. Most would not object to this though only 1 or 2 rates will be put into practice.
I would also raise corporate rate to 27-28%. A gradually rising financial transaction tax is good, for a variety of reasons, which may not materialize. Payroll tax should be cut on the first $20K to 1-2%. Raise the cap, preferably eliminate but reduce it again to 1% on over about $250K, to be less unpalatable to the rich. I would also very much want a gradually rising gasoline tax to reach the mean European level in 10 years, which also may not work out.
2
@A.G. It is great, but in order to know if that is enough we will need calculate how much the public option will cost. For that you need to know how much premium it will have, how many people it will enrolled, how much coverage it will offer. Without that we will not know if that it will be enough money to afford. Moreover, if it doesn't bring the healthcare cost, the number for sure will go higher every year to maintain affordability Beside, don't you want other programs as well, like lower the tuition, affordable child-care, improvements of public schools? The public option is much less defined, and it is by the design because otherwise , everybody will see how complicated it is and how fragile it is.
The Sanders analogy is not entirely correct. He wants to phase in Medicare for All over a period of four years, covering a new portion of the population each year. That's like tearing down a part of a building while keeping the rest of it intact temporarily, which is not uncommon for a large construction project.
I don't see what the point of choice is when every choice is likely going to be worse than Medicare for All. But I do recognize that achieving such a radical change in the US is going to be an incredibly difficult job.
1
"A tax-financed system would mean big changes in who pays what for health care, and how."
As someone with 30 years experience in union contract negotiations for wages and benefits I can assure you that it is always the employees that pay for health care as the employer always factors out the cost of health care from any potential wage increases.
From an insurance industry analysts report I know that a single payer system would cost me about a third of the employer based system and cover everything and everyone with no deductibles, no co-insurance, and no co-pays.
To see how other nations pay less for more health care than the U.S. see T. R. Reid's "The Healing of America".
8
As a physician and a patient, I find the metaphor totally misleading. We already have a house for everyone. It's the system of doctors and hospitals and drug companies we already have. The question is how to pay for it.
Our military and vets are already in a separate house with its own in-house docs, paid for completely with our tax dollars.
For everyone else, the problem is how to cover the rent and pay for contractor time and materials. Private insurers want us to 1) pay them to negotiate the rates and 2) provide indemnity insurance to cover expenses and 3) make a profit.
They negotiate the best price for all this so they can sell the package, mainly to employers, sometimes to states(Medicaid) and sometimes to individuals thru Obamacare or separately.
To keep the base price low, they leave out some providers and repair costs, just like when you buy an extended warranty for a used car (You!) At least since Obamacare, they have to sell you a decent warranty with a minimum of surprises.
But no matter the policy, the basic house still exists. If you strip away the 15% insurance overhead, you get savings to house everyone. Less paperwork for providers saves more. Negotiating with the strength of 320 million buyers gets a better deal for everyone, enough to get rid of all the deductibles and copays. You get to go to your choice of doctors and hospitals.
The acid test: ask doctors if they prefer Medicare or the current mess, they choose Medicare. I do. You should too.
8
@Harlan Kutscher
Why do you think Jeff Bezos and Bill Gates “waste” money by hiring a health insurance company to run their health care programs?
1
@Sebastian Cremmington
They are big enough to be self-insured, so they probably use the insurers as what is called "third party administrators" (TPAs). The TPAs negotiate rates and handle the claims. The TPAs exist to save the companies money through negotiated discounts and denials of service.
TPAs compete on the basis of how efficiently they can handle the paperwork and argumentatively how cheaply they can manage the care to keep costs down, but they don't pay for it. The companies that are self-insured are large enough to see if the TPAs are earning their keep.
Fundamentally, the only real reason companies even need to hire TPAs to do this is because their employees want health care and they need to offer the benefit.
For smaller companies, the insurers actually pay for the healthcare itself. Obamacare lets insurers keep 15-20% of premiums.
For most companies offering health care to employees is a necessary but losing proposition. Employees are not happy when networks or co-insurances, deductibles, maximum out of pocket expenses and share of premiums are increased to save employers money.
Look, I was the president of a multi-hospital physician association that marketed its own provider network to employers. I know how the system works.
Finally, as someone who's bought insurance and used it, if you really like your insurance, you've probably never really used it, been really lucky to not need it, or are wealthy enough to be in a boutique practice.
Stay healthy!
If one wants to abolish private health insurance then Medicare for All (M4A) actually makes more sense to implement at the state level. So in a state like Vermont one would start by getting state employees and university employees to hand over their health care spending to Green Mountain Care (GMC). Once GMC proves it can deliver health care better and more cheaply than private health insurance companies then all of the other employers will get on board. Why Senator Sanders hasn’t provided the leadership to implement a M4A program in Vermont is beyond me.
3
I'm a 75 year old on Medicare with supplemental by United Heath Care. I love what I have and would wish it for everyone in the United States.
But when the candidates talk about "Medicare For All" they are leaving out one very big fact; and I honestly don't know if they are just not addressing it or don't realize it.
In my area of the country (Eugene, OR) I have several friends that are now becoming eligible for Medicare, and many others that have been on Medicare but their doctors are retiring and they need to find new providers.
And here's the ugly fact that must be dealt with:
None of them can find a doctor that accepts Medicare because the payments are so low they can't survive financially - or surgeons would need to take a huge hit in their income.
Bottom line: most of my friends are uninsured although they qualify. And they are scared. And frustrated.
Is this only my area, or does this exist throughout many areas of the US? I don't know. But for my friends, it's a moot point because they don't have a doctor.
This is not unfix-able. But it must be addressed by every candidate that is offering solutions. I hope this will be addressed at the next debate. Lives depend on it. For everyone.
7
That problem will be solved in Medicare for all, because the doctor will be not able afford not to take Medicare patients, otherwise they will have no patients at all.
3
@Jamiev- It must be your area. I've been on Medicare for nearly 10 years now and not even once have I had any problem finding a doctor, specialist, or hospital that would not take me. I live in San Diego.
@yulia
Plenty of doctors take no insurance now. They are doing just fine.
Think how long the government will hold out when people see that Doctors and hospitals say they won't sign on at the proposed rates. Bernie's whole plan is just a bunch of made up numbers. He's never tried to work with any groups of providers to see if it will work.
I love this. What a great way to explain things. However, my question is, when people say they love their existing health coverage, are they the ones who go for a flu shot once a year, or are they the people who have been treated for long-term debilitating issues such as cancer, diabetes or Parkinson's disease? Just asking.
10
There’s a massive metaphor here. If the ground where you are building the home is in a flood zone or shall I say full of diabetes, obesity, heart disease, and autoimmune diseases you are one hurricane away from wiping out whatever you put in its place. One cannot safely or logically build on a fault line or flood zone. Meds won’t solve foundation problems. Each additional pill causes another side effect requiring another pill, next thing you know you’re on 25 pills. The water table will overflow, flooding the house no matter what structure you put in its place. If we do not address these issues there will never be any “affordable healthcare”. Someone please start writing about why our mortality rates are bad why we have out of control diabetes and what the costs of poor food choices are to our healthcare system. Most of this is caused by obesity. As our waists grew so did the number of pills, tests, doctors visits, disability claims, mental health problems, cancer, and knee replacements. There needs to be an adult in the room addressing our foundation issues both logically and with solutions. Not one of these politicians will address or discuss this while every doctor is screaming for help.
3
@Location01 A lot of the problems are because the doctors are handing out all the pills rather than lectures & information sheets covering diet, exercise and instructions pertinent to a specific problem.
Doctors get paid to give tests, to have visits, to do procedures. Doctors need to, through their associations, lobby for payment for time to talk with patients & to set them to talk with dietitians etc.
Doctors need to take some of the responsibility for what they do.
The American health care system is broken and nothing but a criminal enterprise at this point. Hedge funds buy up air care services and charge rates no one can afford except the wealthy, Big Pharma will soon price itself out of the market since no one can afford the drugs anymore, hospitals have hired high wage administrators pushing the cost of care out of sight, and doctors, nurses, pharmacists and the staff that actually provides the health care are left out. Phase in new systems that control costs like the rest of the civilized World and actually provide care.
14
I've had Kaiser for the past 17 years and am now retired but not yet 65. I'm in good health with no issues aside from osteoarthritis in my knees (advanced) and sometimes nagging hips. I'm not in pain though I'll need replacement (or not funded stem cell) soon. My plan calls for a $15 copay per visit and $10 prescriptions though I hardly use that only a very occasional antibiotic or pain med. Everything else is covered 100% and I pay $140/month while my retirement system pays the other 75%. My point is this: everyone should have this type of coverage with a similar price tag. Now when I was employed my share was a 50/50 split so I paid $280/month and my wife paid the same (our son has long been an adult) so between the 2 of us we paid $560/month which given everything else seemed palatable. So here's the idea: means tested per month bill with a cap of $500 month for any family with kids; otherwise $125 per month for individuals over 21. For that price all visits and care is provided with no additional costs. If you fall below the poverty line there's a sliding scale where no one pays less than $100/month total. Wealthier folks also have a sliding scale and monthly costs capped at $1k/month for family and $300 per individual with incomes over 500k (?). Excess costs to the system are funded through a revamped tax code and elimination of waste in all areas including medical and the biggest culprit--the war department aka military spending. Obviously there's more to figured out.
1
From a policy wonk/economics standpoint, it's clear that a single-payer system would be more equitable and ultimately cost the nation less because cost controls could be more effectively implemented. Yes, some people would pay more in taxes, but those costs would be offset by reducing or eliminating premiums, co-insurance amounts, and co-pays.
At the same time, individuals worry about change and losing what they have, so from a political standpoint, allowing some private insurance and/or a more gradual transition might be more saleable.
What's important to bear in mind, is that even if 2021 brought us a President Warren or Sanders, the bill that finally lands on her or his desk would represent a legislative compromise, as Republicans and moderate Democrats weigh in during the legislative process.
Candidates' platforms should therefore be viewed as expressions of their values and goals, not something that would magically go into effect immediately. There will be time for debate and compromise. It's an argument for not getting too mired in weedy details yet.
Instead, the question for each of us to consider now is: What sort of health care system should we be headed toward?
2
@catstaff
As a healthcare provider, I favor a single payer system which is so much simpler. I have too many patients who are unable afford their current insurance and so sometimes go without, a very risky proposition. I still remember listening to a report on the radio being given by a reporter on the BBC back before the Affordable Care Act was passed. They were trying to explain to their listeners in the United Kingdom how in the U.S. if you lose your job, then you lose your health insurance. That is just wrong. Let's pay more in taxes or buy fewer F35 bombers and ensure that all Americans are covered, so that a trip to the hospital doesn't risk losing your house.
12
@J. Brian Conran, OD
I also favor single-payer, as it happens, and I've held that position for decades.
But as a someone who holds a doctorate in policy, I'm aware that my tolerance for policy details goes beyond that of most folks. That's why I think getting too far into the complexities of the various health care proposals might not make a lot of sense at this point.
But for those who are interested, Kaiser Family Foundation has a side-by-side of the myriad plans.
2
@catstaff
Thank you for your input. I am reminded of a colleague who paid for 2.5 full time equivalents in terms of staffing (100 staff hours/week) just to process their insurance claims. I think a single payer is the only sustainable, humane way to go. But as the saying goes, the devil is in the details.
2
No one is going to turn a switch and shut down the current system.
Of course it has to be after the metaphor of a fixer-upper. So we can find ways to maintain peoples' coverage while expanding it to others, and driving down costs. A public option can get us to medicare for all.
Affordability has to come from changes in US drug market regulations, including length of patents and pricing on drugs no longer under patent. What has happened in the insulin market is cannabilistic capitalism, making ability to pay a life or death choice for the poor.
7
@howard
So the problem you would run into with the public option is that the way costs are reduced is to have low reimbursement rates. I could see providers refusing to accept M4A for fear it would undermine the group market. So if no providers accept M4A it won’t deliver very good health care. The reason providers accept Medicaid and Obamacare is because the programs are limited to people that otherwise couldn’t pay, but if well-off Americans started showing up with policies with low reimbursement rates providers will revolt.
2
@howard It is all very confusing. And that is why pickpockets like crowds.
3
Simplicity is good, so the metaphor is good in that way. However being very abstract it misses out on practical worth.
Here are two simple direct measures that are worthy of consideration:
"A single medical billing code system nationwide." Huge complexity and cost reduction. Makes price comparison easy. (The reason it is not like that is because it enables obfuscation and opportunist gouging).
"Choose your own doctor." What Obama wanted but couldn't get because the HMO's don't want that. If the patient can choose their doctor and medical services freely, they will choose value for money and cut out the middle man, lowering costs overall.
Depending on how it's brought out, a public option could embody those choices and force the private options to cut prices and restructure to compete.
To stay as close as possible to Margot Sanger-Katz's analogy, the public option would build a new open marketplace where doctors and patients could do business without the artificially inflated costs present in the old closed high wall castles where the lords take a fat cut out of every interaction.
10
@Craig H.
Trying to get the private options to cut prices would be like trying to get the oil companies to reduce gas prices. There are too many ways they can get around it. But the more people you have contributing to a public plan, the lower the cost per person.
1
@Craig H.
A lot of doctors don't take any insurance. They charge much more than the insurers would pay. Private insurers generally force the costs down. I don't know which lords you mean. Maybe you think of frauds? They are much more in Medicare than w/ private insurance. The small Medicare program now loses ~$500 Billion each year to fraud. M4A, covering the whole nation wd be ripe for a whole lot more.
For me the problem comes down to this: most of these plans talk about who's going to pay. I don't hear a whole lot about what we're paying for. Our entire perspective on what health care is and should be is messed up - it's primarily about symptom reducing and attempts at cures more than it's about dealing with root causes. We're way too optimistic about pill-popping as a route to wellness.
We could start by subsidizing organic farming of fruits and vegetables and removing the welfare we pay for wheat, corn and soy, all of which cause inflammation, which is at the root of most of our sickness, both mental and physical. We pay to make poisonous foods cheap, then pay for (or go bankrupt over) the illnesses they cause.
12
This is a wildly mischaracterized description of the problem. At the core of our system are a stack of costs - hospital costs, provider costs (physicians, nurses, etc), drugs, administration, liability, insurance, regulation, etc that in total =2 to 3x what other first world countries spend for the same or better outcomes. All restructuring plans fail at the most fundamental levels to restructure the underlying costs. The singular villian in the system is presumed to be insurance costs. It should be noted that 50% of insured is already controlled by the government programs and they have hapless in driving out costs. To your analogy, redoing the house with the same costly materials, give control of maintenance and upgrades to the government and watch how fast costs explode
3
Who controls the money, controls the cost. The small companies and individuals could not control the cost, they are too small to make any differences. The big companies are more influential but not much, because they do not occupy very significant corners of market. If the Government occupies the market , it can dictate the prices just pure by power whom it will pay. The other route is regulations. Bernie's plan will automatically set cost reduction, all other plans will have to have some regulation in order to bring cost down
3
@yulia
Yulia: Pay attention. Chris just said the government pays for, controls 50% of the market. That hasn't brought costs down.
I guess you weren't around or paying attention when the ACA was fought over. You really think Bernie will be able to pass his draconian law and impose it on our entire health care system?
Private health insurance is like leasing a car you can never pay off. It looks nice sitting in your driveway. But if you want to do more than drive to the mall, the dealer charges you extra for going over you mileage restriction. And if you ever need a vacation, forget it. It breaks down completely.
12
The Bernie Sanders plan does not tear down - it expands the care part of Medicare. It will probably cover close to one hundred percent of healthcare costs. Once we are all together on this, we can turn to finding cures for diseases and encourage healthy living. Much of our poor health we bring on ourselves. A modern approach is to streamline care and find ways to prevent illnesses.
6
@Phyllis Mazik
Bernie has the best plan and I support it completely because I am taking care of my parents and my young cousin who has dementia.
I had to become a medical doctor and specialist in the billing system because it doesnt end. I am not putting my family in a home so they can be dead in two weeks.
I dont know why keeping people healthy in this country is like having a job, nothing is easy, its complicated and the services that you get sometimes you could do without..
All these people who love their private insurers maybe if they had competition they might not be so arrogant with telling you no we dont cover that. Dealing with the dementia organizations are a joke and they just suck you dry for money.
Like cancer the health care system just eats you and eventually you give up and die..
1
As a physician I share to anguish that most Americans experience living with this health system. And while there is justifiable concern about a single federal system, the VA does well - compared to the private sector . . which is not saying much.
But I would emphasize 2 fairly obvious issues. First, people with money or good union insurance really do have "luxury" care, in comparison to other industrialized countries. It's a simple fact of the enormous inequality of our country, and they will have to lose some of that - who they will refuse to do, and will have to be dragged kicking and screaming. It won't happen all at once. Same for public education, etc. And given the financial power of the health industry (largest sector of US economy . .) they will make that resistance successful - for the near term.
Second, while costs, chaos, egregious drug price gouging, etc are intolerable, quality is probably a bigger more fundamental concern. It's an open secret that average quality of care is way way below not only what is acceptable but what is possible. While simple universal access to affordable care is a true emergency, in some ways managing quality is even a more daunting challenge. For a variety of reasons, medicine has been able to avoid taking up that challenge - compared to air travel, fire safety and any number of other fields. The science of quality in health care is still in its infancy.
15
If Union member are so attached to their plans, they could always by supplemental insurance that upgrades the Medicare to luxury.
2
@R Cooper
I lived in Australia and even when I had a union healthcare plan for an advanced job I still felt the Australian care was better.
Ever been to an ER outside the US?
2
@R Cooper This is the most perceptive comment I have seen on this topic in a long time. The quality of care in the U.S. is superior to what we have in Canada, but you need a good plan and some money of your own to afford it. If you’re well-covered, the list prices for medication are essentially irrelevant, since they serve mainly as a revenue transfer mechanism between Big Insurance and Big Pharma, neither of which have any real interest in the patient’s well-being or the functioning of a free market.
The U.S. system can obviously be improved, but it’s essential to start with a clear grasp of how it currently works. It’s also worth remembering that government medical procurement will most likely look a lot like military procurement, with its six-hundred dollar toilet seats and thousand dollar hammers. Anyone who thinks that “medicare for all” will lower prices is thinking in a very wishful way.
4
Continuing the housing analogy, a greater challenge is the neighborhood the house is in. Redlined into high stress, unsafe and blighted neighborhoods, experiencing persistent discrimination and isolation with limited opportunities for good education, meaningful work and healthcare access are major health challenges not fixable by health insurance. Addressing adverse social and physical environments would reduce medical care costs and health inequities. Put money where it matters.
3
In my own experience, as one enrolled in a large corporate employee plan, that then merged in retirement years with Medicare, health care and health care insurance have been fine. The same, I gather,is true of government employees. The problem lies with the rest or our populace who do not have such large group plans available to them. Could this not be remedied by opening the government group plans to all -- with premiums payed fully deductible for tax purposes to individuals as well as employers? Would it not be sensible to build on what we already have?
10
@Penseur Obama proposed that before, but the Govvies did not want the population at large into "their" system. However, there is no good reason why the Federal Health System infrastructure could not be used for a parallel system . In the Federal Health System, the government specifies the benefits, cost sharing and participant monthly payments . Participants are allowed to select from dozens of national and local health plans. There is no reason that the government could not use this same system for nongovernment citizens, with specification of benefits, etc, but a different risk pool. Just a matter of programming....
3
There are several problem with this arrangement. First of all, how much you plan cost? I had the plan through work but when I wanted to insure my family our premium went up to unaffordable level, because the employer pay part of my premium but not my family. With such arrangement, many people outside of plan will not be able to afford the insurance, they will need help. If help comes from the Government, it needs to get the money somehow, most probably through taxes. But in this case, people who have health insurance will have to pay premium and taxes. Moreover, the Government pool of patients could be much sicker and therefore most costly. And another aspect, this arrangement to itself does not being down cost of health care, or even insurances. Of anything it encourage healthcare providers to charge more.
1
@Penseur. Would you have enjoyed a much less expensive Medicare option with the savings returned to you as a higher salary.A public option is fine as long as large corporations don’t decide to pocket the difference
We have a minimum wage to keep our pay from going through the floor. We should have a health care minimum wage for the same reason. No American worker should be driven into bankruptcy by their medical bills. No one should be allowed to fleece us.
So, to the question of "tear it down or fix it up?" The answer is, "replace congress!"
10
After avoiding Kaiser Permanente for most of my life I spent 1.5 years in my employer based plan until I moved six months ago across the country to a different insurer plan.
I concluded after my first visit and every one thereafter that this is how health care should be delivered.
They own their hospitals, labs, imaging, pharmacy and, employ physicians and staff. They have satellite facilities in smaller towns.
Guess what happens when you run it all? The goal is to get you back on your feet so you can “thrive”. And yes, so money is saved.
Fast forward and I am now in a traditional system where the physician wants me to return for additional appointments, imaging is thousands of $, and I’m still not better.
There is a better way to deliver health care.
14
@Mary Dube
This is why having a single-payer insurer while still maintaining a fee-for-service system will do nothing to keep costs down nor to motivate 'cures' vs keeping the patients circling through the medical gauntlet. There are parts of our system other than the insurance that need a complete tear-down. There are huge problems with data collection/sharing, disease management and lack of patient autonomy that need fixing just as much as who is footing the bill.
2
It definitely will because Medicare sets the prices what is willing to pay.
1
A beautiful way to explain this, one in a long list of excellent articles on health policies from Ms. Sanger-Katz. I wish more people who read her stuff, as well as the many excellent discussion throughout the Upshot section.
Thanks.
2
We need Healthcare reform but we also need Health Insurance reform; one we can depend on. Let's be clear. Healthcare represents 16% of our GDP and it needs a safe and dependable funding mechanism or our future as an industrial power will dim. What kind of thriving venture can afford to lose 16% of its revenue to a greedy few? Private insurers have failed to deliver healthcare we can depend on and those who support them are destabilizing our economy. We need to fully fund our healthcare industry it's one of our most vital growth industries. We can do that best if we have Medicare for all with private options added when needed.
6
I’m not sure who loves their private insurance, but my family is not one of them. It’s full of loopholes, copays, coninsurance, and long wait times on the phone. At least with a Government plan, we can vote out politicians if it’s mismanaged. With private insurance, the consumer has no recourse since employers now typically only offer one plan.
18
@Rojo
I don't know anyone who loves their plan either. I can't think of a time when I knew anyone who did.
1
@Barbara I'm fine with mine. I have used it a lot, having more conditions than I cd list. The real problems are "under the hood" so to speak. You see the insurers. They are the face that covers the mess beneath. M4A will just cover it over till it sinks the ship of state. It has no cost controls.
"The teardown candidates think everyone’s housing costs should be financed by taxes instead of direct payments."
This article, like most writing on the subject, inaccurately characterizes Medicare as a purely government-paid plan. While taxes do indeed subsidize the program, subscribers pay premiums on a sliding scale based on income, and also must pay co-insurance of 20% with no out-of-pocket maximum, saddling subscribers with the need also to purchase not-so-cheap private supplement plans to avoid financial calamity should they incur a major medical expense.
Medicare is more a nonprofit, publicly run insurance company with low overhead and enormous bargaining power than a "free" taxpayer funded entitlement.
8
It doesn’t characterize Medicare as anything of the sort. It explains how guys like St. Bernie want their system to work.
1
I disagree with the basic premise of your metaphor. Currently 1/3 or people in the United States with health insurance are covered by government programs including Medicare, Medicaid, Veteran's Health Insurance, and others. Only 2/3's are covered by private, for profit insurance. We have clear, substantiated, long term evidence that government run health insurance is popular, works well, provides choice, and is less expensive than private, for profit health insurance. We already pay taxes for it. So we have two houses, to use your metaphor. Should we get rid of the one that doesn't work as well and expand the one that is proven to have better outcomes and is more cost-effective? Or keep both? That's really the choice. By expanding the program that we know works better, the overall cost for most people will be far less than what they currently spend. Everyone will covered. Everyone will have choice of doctors and hospitals. Noone can be denied. And the paperwork will be greatly reduced. This system is paid for with taxes instead of taxes, premiums, and co-pays. But the nut of the matter is that most people will get better healthcare for far less money. The real question is how to transition from the current system to the new system with the least disruption. I'm sure there are many approaches that are valid. That's my two cents.
13
@Julie Marsh
You need to define what is meant by "a plan that works better"-does that mean is 'cheaper' for the patient or has better medical outcomes? These are very different issues.
As far as I know, there is no data out there comparing Medicare vs Private insurance patient outcomes. Suffering medical errors is the result of a system wrought with issues and has nothing to do with who the insurer is but more about a lack of standardization, problems with data collection/sharing and having a system that allows voluntary as opposed to mandatory safety protocols.
3
Sounds more like "Bath fitter", you know, where they put the shower and tub liner right over the old, moldy fixtures giving the appearance of something shiny and new while hiding the dirty mess just below the surface.
There is a big difference between 'affordable health insurance' and 'affordable medical care' and none of those proposals fix the actual problems with US healthcare.
Changing who pays for health insurance from private companies to the government doesn't affect how much doctors, hospitals and pharmaceutical companies will charge for their goods and services, they will go ahead and keep charging what the market will bear rendering either system unsustainable.
Or are doctors going to be paid a salary instead of fee-for-service like they are with the VA system (and European countries) in order to keep costs down? Or is it possible that some doctors are just going to refuse to accept those with Medicare4All, just like some do now with Medicaid and Medicare and have cash only VIP practices creating a two-tier system.
How would the 'everything is free' system deal with the overutilization it would create?
As much as I think a single payer system is the only way to reduce costs by being the only game in town, there need to be more details regarding how they would deal with the current fraud that exists in Medicare, how they will deal with over-utilization and how they would prevent healthcare providers from refusing to honor government insurance.
4
@doc007
The problem for doctors with having a cash only practice is that only a few could actually do it. Most people with health insurance currently could never afford the costs of treatment out-of-pocket. So where's your market? Answer: You don't have one.
1
@doc007 when MfA is the only game in town, the provider costs are fixed by what MfA pays- there is no refusal to honor MfA! “Medicare fraud” is insurance company propaganda. Once the risk pool for MfA includes EVERYONE, the costs for everything drops significantly. Of course, then you don’t have millionaire doctors, and insurance company CEOs, and all the other healthcare profiteers.
@Doug There are quite a few doctors now who are cash only. I have one doctor and one therapist who are. It would be nice to have my insurance help out but so be it. I have not found others to meet my needs in these areas.
I realize not everyone cd do this but I must. I don't do movies, concerts, trips, etc,
I don't see how you can have both a public option and private health insurance. That would mean that you would still have all the administrative costs that we currently have.
You would have to have staff to code each procedure, people to approve or disprove procedures, and various marketing and sales people.
1
@jimgilmoregon But we have that in Europe. Most every country here has a public and private insurance option. As an American living in Portugal I am required to carry private health insurance even though I am now also entitled to the public system. The difference between Europe and the US is the profit motive for drugs, surgery, and general healthcare. My husband just had knee replacement surgery. Had excellent care, two nights spent in a private hospital with all subsequent tests and physical therapy. Our cost was 440 euros.
2
@jimgilmoregon In Canada, as in all advanced countries outside of the U.S., we have a mix of public coverage, supplemental private coverage, and direct user-pay. Taken as a whole, there is universal coverage, with better coverage for those with good employers. Treatment can sometimes be long in coming, but no one has to face medical bankruptcy. Statistics show that the quality of care is better on the average than it is in the U.S., but not as good as can be had in the U.S. on a top-tier private plan.
3
I'm a cancer survivor. Back when I was ill, my union-negotiated health insurance paid all but about $300 of the bill, which I stopped totaling once it hit $100K. Despite having what is now known as "Cadillac" insurance, everything was a fight. Need a PET scan to check for mets? My oncologist's staff spent hours on the phone justifying just why in the world we'd need to know if my cancer had spread beyond the primary site.
That was just the first fight of many. One of the things that I find most confounding is that there are people out there who claim not to want "the government between me and my doctor." But they're apparently perfectly happy to have a for-profit, accountable-to-no-one-other-than-stockholders entity between themselves and their doctor. At least we can vote for govt representatives, when was the last time your health insurance company asked you to vote on the next CEO?
The following ten years were characterized by a cascade of side effects, mostly from the radiation. Just after I made it through that period and after the Great Republican Recession, the coverage changed drastically. The current system of co-pays and co-insurance would have bankrupted us. I was lucky. Now I'm hoping for two things: to make it through the next 8 years until I hit Medicare age (for me that's 67) and that Medicare will still exist in 8 years and hasn't been turned into a "block grant."
The only people who "love" their private health insurance are those who've never been sick.
62
@pedigrees. Glad to hear you successfully fought Cancer. Best wishes for the future!!
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I won’t purport to know what you have gone through, but I do have a child on the Autism Spectrum — and as such I have had my share of fights with insurance companies. I’m not a believer in Single Payer, but as I see it: we might wind up there if the men and women who run and work in health insurance don’t shape up, and fast! Every denied claim, every argument, every increase in premiums or deductibles is a nudge towards Single Payer. The people who will lose their companies and their subordinates who will join the ranks of the long term unemployed need to know this.
3
@pedigrees Medicare age is still 65. Full retirement age, to collect social security, is what's gone up.
The first and second drawings represent a major aspect of what is wrong with out healthcare system. There are just too many programs, with concomitant red tape and government waste in administering them. We need just two programs, the VA for medical issues unique to veterans, and a second for everyone else. To fix our healthcare system, we should start out with a consensus of what we want it to do. Just as there is a partisan divide on everything else, there is a partisan divide on this. I have seen many comments in various forums to the effect of, "Why should I have to spend my hard-earned money in higher taxes so some slacker can take advantage of the system?
I can understand why Nancy Pelosi wants to just tweak the ACA. That is her baby, and she may not want to see it discarded for something else. Since she is very wealthy and powerful, she may not recognize what ordinary people must go through to get private insurers to pay out on claims, and the limits private insurers place on choice of doctor. Even without Republican sabotage, it is not working optimally for too many people.
6
The question is how much is the US willing to do get everyone into affordable health care. This will cost lots of money and many interests will be forced to give up favored positions for the good of the whole.
2
Let's take the metaphor a step farther.
Let's say that we elect a person who has a great plan for a big, brand new, efficient house. It is ideal, all the bell's and whistles. Granite countertops, glass tile, glamorous stone tile in the built for comfort bathrooms. But... they cannot find a contractor who will agree to build it, let alone a bank that will float the loan.
Or we have a plan for an extension, and it is a bit odd, the kitchen ends up in the basement and all the bathrooms are small and unglamorous, but there's all the basics. But... you can get a couple contractors to do some work, maybe put in the bathrooms using cheap tile and fiberglass, and a few people to finance a small part of it, and then get a few more contractors on board as you go along.
The plan depends a lot on the availability of willing bankers and contractors.
That's the reality when listening to how to overhaul healthcare. It isn't the plan that matters, it is the ability to execute. Plan the big glamorous house all you want; but you'd better have the contractors and banks ready to roll. Whose plan is closest to that reality?
2
The author seems oblivious to the cost problem of alternative plans. The 'new house' option may well reduce health expenditures to the 10% of GDP level that comparable countries have, rather than the 18% US now suffers. Fixer-up options retaining insurance companies and autonomy of pharmaceuticals in setting prices will likely fail to reduce the inflated size of the health sector.
9
We could let the states experiment with different models and then see what works and what doesn't in different situations. ne size does NOT fit all.
4
@kcbrady There is diversity within states as well as between. Would you force individuals to move to other states for a better plan. We tried individual state choice before 1861. It didn't work out.
4
Making rapid, large changes to institutions, unless required by an emergency situation, rarely is a good idea. Similar to healthcare, it would be nice if we could cut our military spending in half and use the 350 billion dollars a year to fix the many problems our country has, but we can’t do that in one year. Such a change in spending would have to occur gradually over many years, because a lot of people would be impacted. I am for the gradual approach. Fix Obamacare: make it better and maybe over time the entire “house” will, in effect, be replaced.
2
Living in Canada, it seems so simple. People don't have "insurance plans." We are all covered; we have GPs, and from there we can get referred to any specialist we need. Rich or poor, we all get referred to the same specialists and have access to the same care. If you need an MS specialist, here you go. There is no such thing as a doctor who doesn't take insurance. And my taxes are almost identical to the ones I paid in California.
We do not have drug coverage, however, unless you make less than a certain income. But it can be purchased, as can extended health benefits for things like physiotherapy and dieticians. For most people, these extended plans are affordable, and they are almost always offered as benefits by employers. So yes, private insurers do exist here and they do make money.
Drug prices are also regulated, so they rarely become sky-high. I remember asking about Lyrica when I first moved here: the non-insured price in BC was $387/month. In California, it was nearly $1000.
For Americans who think universal care is impossible, look at the healthcare costs and outcomes. They are better in Canada. Those are the facts. The system is not perfect, but it is absolutely better than in the US, which I dealt with for 25 years.
I would never want to go back to the madness of doctors who don't take insurance, inexplicable bills, doctors fighting with my insurer, or losing a job and having to pay more than the mortgage in private insurance premiums.
Just do it.
77
@Northstar5
Well said. As for me, a son has had two open-heart surgeries, one as an infant and one as an adult; I myself have had open-heart surgery. These plus innumerable other healthcare supports through the years have been received with little expense other than parking fees.
11
A real tear-down is an exercise that would not result in anyone's good health. The System, and far too many people would be in turmoil. As it is most of us, I admit to being one, are clueless about the nuances of our plans. We only learn them when confronted by them...if ever. "But I thought...?" we say to the receptionist handing us a bill for what we thought was covered under a comprehensive plan.
What we need are many small fixes. Some can be quick and only in place to help bridge various gaps and minor tear-downs, then go poof after a deadline. We need some bigger fixes that are comprehensive, and make grand changes. Like a serious Rx price reduction, subsidiary plan. Negotiate all we want, the US Rx Co.s still run the pricing tables.
Mostly we need a Dem party that can communicate the changes they want/will make that make sense and do not result in more questions then answers. That are not vague and easily fall prey to even the laziest of the Repubs counter-attacks. They need to get ahead of the Repub Spin machines and Trump TV...by saying, "you will hear X, but they are lying, this is what is real...(fill in blanks)"
But then, we need a Dem party that can actually better communicate and do a far better job of messaging then they do now. In that aspect, we need a tear-down.
2
@Boregard Americans never understood the ACA before it was adopted because Obama and Democrats did a terrible job explaining it and of course, It's a miracle it squeaked through Congress. Why Democrats can't get their message right about M4A is a mystery to me. It's almost like they don't want it to succeed.
1
@abigail49
Agree. It sure looks that way.
Here's my take. Repubs tell their base and regular voters what to think and how to vote. Dems take a more respectful approach, but nonetheless stupid approach...and expect their voters to do all the footwork, fingertip work these days, and get the necessary information they need to side with them.
Which is too often to direct them to their websites. Where its a ponderous mess of vagaries and when its there, dense material.
HRC kept referring voters to her website. Whatever the question, tough or softball, she give a cursory answer, then say there was more info available at her website.
Which is why I think Warren is getting more and more interest. She's talking in a more detailed manner, which the regular old campaign advisors seem to think voters don't want to hear. Might have been the way it was pre-2016, for many voters, (give me the basics!) but I know I want to be intrigued enough to go followup with a visit to their website.
But the bottom line is Repubs tell their base what to think - about the candidate and the party agenda - and Dems leave it up to their base to figure out what to think about the candidates and party agenda. Which I blame on the DNC. Perez is not the man for this job.
@abigail49
Because M4A is a myth. The message is just: believe!
A house is a very WYSIWYG thing in most cases. You can tell what is going to happen easily if you change the windows or blow it up and start over.
Wildly complex human systems are rarely like this, other than identifying some obvious flaws such as creating an open invitation for fraud.
The safest path forward is mixing a public and private system, because it is the most flexible and able to react to technological and cultural changes. Once a system is fully public, it is very hard to change it to keep pace with a world of private actors - compare FedEx to USPS or Megabus to Amtrak.
So while the safety net of a public system is beneficial and desirable, maintaining a private system that can inform the public one by staying at the cutting edge of technology, fraud prevention and learning from price signals and other data also has tremendous value.
So while such a hybrid system seems less idealogically pure to almost anyone, it could still be theoretically optimal once we consider that we live in a dynamic world with many independent actors with different and sometimes competing interests.
3
@Alan
FedEx is not charged with delivering a first class letter any place in the US for 55 cents. You also won't see FedEx or UPS clamoring to carry the junk mail (you know, the stuff that loads our landfills with paper and ink) at money losing rates, just another subsidy to businesses. The USPS is what it is, but certainly can not be compared apples to apples with FedEx or UPS. That said, I agree, for the most part, with the healthcare analysis.
3
As an architect I like the house analogy a lot. But there’s another aspect to it I’ll point out. Not only must we ask whether the existing healthcare system is a tear-down. We must also ask: what healthcare system can we build (or rebuild) that cannot be sabotaged by the Republicans?
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Single Payer scares me, and should scare you. Imagine we get it passed. Imagine then that Paul Ryan’s kids graduate college and he gets back into politics: running for and winning the Presidency. He and a sympathetic Senate send the whole Single Payer system into turmoil by drastically cutting spending on Medicare. Hospitals go out of business; doctors and nurses, and their patients are left in the lurch, people die.
.
If we use the analogy of a house, then we the people are the homeowner. Congress and the Senate are the Architects, and the President is the Contractor. Whether our healthcare-house is a Tear Down or Add On, we need to make sure it’s designed right and cannot be ruined by an unscrupulous Contractor.
7
You’re absolutely right. America needs to take a look at healthcare in Germany, Austria, Switzerland and the Netherlands, where most people who have a job have private health insurance (from insurance companies that are very tightly regulated). The elderly and those without a job are covered by public health insurance.
I don’t think the British or Scandinavian model of single payer public health insurance is right for America, exactly because of what you’re saying.
5
@ZAW You make a valid point. Even though it's difficult to imagine the next rendition of the republican party being worse than the current, it is possible, especially if there were a healthcare tear down. The only potential brake on Ryan-like tear down of a new healthcare system could be that if we are all in the same plan, there could be widespread opposition. After all, everyone would lose. However, with so much money at stake, it's hard to believe the insurance sharks would not be involved in any of these decisions.
1
@Alex T. I live in the Netherlands. Everyone buys their insurance from private ins and pay 98 EU/month 350EU deductable. It has nothing to do with working vs non-working. Those in need are subsidized based on income and family size. My ins covers cost of assisted living and long term care for my lifetime. There is no medical bankruptcy, Dr's are empowered to make decisions based on pt and greater societal needs (Antibiotics are not given out like candy, people are not released from hospital care who can not climb the stairs in their homes, everyone has a house GP within 10 minutes of their home, Dr.s make house calls.) I get to live in a country where mental health is treated as a health care problem, there is no homelessness and gunshots are unheard of because the country prioritized personal liberty to live over crazy people wanting assault weapons. Gunshot victims cost health insurance a fortune to treat as well as long term care for disabilities from wounds. If you want to own a gun you have to apply and prove your stability and proficiency to have a weapon. A beautiful new hospital was just completed in the town where I live.
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If we would look carefully at the working health care plans in every other industrialized country in the world I'm sure we would find examples that would work in the US. Probably would have to adopt some features from several different plans but at least we don't have to invent the wheel all over again. I recall watching a report on a health care plan adopted in Switzerland. A local businessman and community leader said he was opposed to the plan initially but once in place and he actually had to live with it, he became a big fan.
6
I totally agree! But that would require recognition and acknowledgement that we might be able to learn something from other countries. A hard sell for some, particularly the Party of No.
4
@WhiskeyJack
Every single other country country has some limits on what they cover. 20 to 40% of procedures & treatments in the US are useless but add to the costs of our systems. Many should be barred. Many new drugs that pass FDA are safe but not really a significant improvement except in cost. They should be barred — until the cost is below the older drug. And so on.
Books have been written on this. If we don't actualize this info we will still top the charts on costs & languish at the bottom in quality.
This old house is a gettin' creaky, this old house is getting old, this old house leaves too many of us out in the cold. But are we ready to pay for our dream house? Perhaps we should bite the bullet and at least double our taxes to pay the tab? Perhaps we should cut our bloated defense budget to help pay for a new system? Perhaps getting rid of insurance companies and their employees is worth it? Will the quality of our medical care remain as high as it is today? How much will the 80% who have insurance and good health care be willing to sacrifice so that everybody can have a modicum of insurance and health care. Is the view worth the climb?
1
You went wrong when you called it a healthcare system. System: "a set of principles or procedures according to which something is done; an organized scheme or method". No. We don't have a system at all let alone the bizzare housing metaphor. Medicare for all who want it while employer based insurance is phased out is the only way to proceed.
8
Democratic candidates who support universal healthcare or medicare for all or for all who want it, in any form of construction to use the metaphor in this article, must be honest about how we will pay for it, and honesty IS the best policy because in this case, eliminating the at least 30% overhead, profits and huge executive salaries of insurance companies, pharmaceutical companies, and for-profit hospitals will enable a shift to reasonable tax increases for those who can afford to pay them while the system can subsidize the poorest, resulting in a net decrease in overall costs for most everyone, including those who still have employer insurance, much of which is rife with deceit and hidden costs. Those who tout "medicare for all" seem to conveniently forget about the 20% gap in medicare coverage, for which the poorest people and most elderly people have no funds to pay, or to pay for medigap insurance and thus can be bankrupted by their first major illness or injury so how can that work? Universal healthcare is and must be doable and politicians must be honest and transparent about the costs and benefits. It's not that hard to explain.
10
I want a system that can't be chipped away by a future administration. It needs to be enshrined into law the way Social Security and Medicare now are. We've seen what an incremental approach looks like with the ACA and it just doesn't work with a constantly changing Congress. We need Medicare for All. I have excellent private insurance and I have no worries switching to a system that covers everyone for everything.
36
I would support the proposal of Medicare option for all. Mayor Pete proposed easing into it by expanding Medicare to those 55 and older and then a few years later to those 45 and older to ease into the system to allow time to work out the bugs. In the meantime, private insurance can start figuring out how to offer alternative plans and adjusting to the changes. They could be supplemental plans that offer coverage of things not covered (like cosmetic surgery) or that would have what is now concierge providers. My guess would be that employers are going to go with the government plan, as it is less expensive for them. Then individuals can buy the supplemental plans. Another thing to remember is dental and vision coverage - would this be in the Medicare for all plans or as a supplemental?
4
I am a true believer in Medicare for All that covers Americans for all their healthcare and dental needs from cradle to grave. Yes, we would have to pay a little more in taxes to cover it, but those extra taxes wouldn't be nearly as high as monthly premiums, deductibles and co-pays. There would be no arguments with insurance companies about what they will pay and won't pay. You wouldn't have to contend with networks that dictate where you can go and where you can't. There would be no surprise bills because you wound up with an out-of-network doctor in an emergency.
When my bother had a wound in his leg that wouldn't heal he was advised to go to a wound care center for treatments. He lived on eastern Long Island and the insurance company made him go to a wound care center in White Plains. He had to go every day all summer, and anyone familiar with the New York area knows what a drive that entailed. Because of all the driving his wound go worse. In the meantime, there was an excellent wound care center 20 minutes from is house.
I know people who live in New York part of the year and in Florida part of the year and they must have two different insurance plans.
I wish the candidates would show some examples of the costs for some real people. They should show how much a person or family has to pay in premiums, deductibles and co-pays per year and compare those costs with the extra taxes they would pay. It would be a very rare case where the taxes would be more
22
@Carole A. Dunn Agree with you 100% Carole. The first paragraph says it all.
4
Omission: The Pelosi and Biden plans also, like the current plan, will continue to have deductibles and copays that prevent people from getting the care they need and out-of-pockets expenses for operations, cancer treatments, etc., which bankrupt them when they're most vulnerable.
14
The private health insurance market is fragmented and as a result has very little negotiating power with providers. If they consolidate however they'll have too much negotiating power with patients.
The government should allow them to consolidate under the condition they accept more regulation and allow patients to sit on their board of directors (they way German workers sit on their employers board of directors).
In other words a simple trade; Health insurers can consolidate in exchange for letting their own costumers becoming organized!
1
The cost of health care must be brought down. How many tests are ordered by doctors and are they necessary? Hospital costs are unreal. The specialists make much more money than the GPs. The obesity crisis will add much cost in terms of diseases, heart problems and joint replacements. Americans must assume more responsibility for their health. Between defense spending and health care where will the money come from? Sanders and Warren are modern day Robin Hoods, the rich will pay for it, not the working class. Canada, Norway and Sweden have universal care and they pay high taxes to support it. There is no tooth fairy. I do believe that health care is a right but we must have an efficient system and be willing to pay for it. The Federal budget of 2018 demonstrated that neither party has fiscal reponsiblity.
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@JAB "Responsibility for our health"? What would you do about people who have lived responsibly as regards their health but nevertheless develop cancer, or heart disease, or lung problems, or serious joint problems, or have accidents? You don't have to be obese, or a smoker, to have any number of health problems. And please don't forget that guidance on diet etc. changes every few years!
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Re: the current system: "But even if architecturally incoherent and a bit leaky, it still works."
No, our current system does not work. It doesn't work well for the underinsured, and it doesn't work at all for the uninsured. Too many people are standing outside the house, wondering how they can get inside. And people who are inside are paying far too much.
We can get to Medicare for All gradually, by lowering the opt-in age in five year increments. (Medicare is an opt-in program - no one is required to sign up for it). At the same time, we can improve Medicare by having Medicare Part A cover all hospital costs, not just 80%. Get rid of the private prescription drug plans that require elderly people to comparison shop a bewildering array of plans. Instead, simply have Medicare cover all FDA-approved drugs. Add a vision plan, then coverage for hearing aids.
Eventually, we will be at Medicare for All without tearing down the house.
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While I agree that the healthcare system is as corrupted and convoluted and inefficient, etc. as it gets, it seems absurd that nobody in this debate is talking about the root cause of the problem: America's health crises. Look, the insurance model was not designed to handle so many people with chronic conditions. Heart disease, cancer, diabetes, and pain are out of control in this country. We need to reframe the debate to emphasize overhauling the farm bill and transitioning the agriculture system to a regenerative one. This includes eliminating agrochemicals over a period of time, and replacing them with innovative intercropped, perennial, intensively grazed, and agroforestry systems. We need to add back recess, PE, and mandatory sport. We need to change our land use laws so that suburbs and sprawl are no longer developed, and our urban centers are more walkable and cycleable. All of these solutions benefit the planet and human health and in fact, happiness. We also face a mental health crises, after all, which is not aided by processed food, a sedentary lifestyle, toxic chemicals in one's environment, and the impending doom of the ecosystems we know, love, and depend on. Plus, medicare for all is never going to pass if a certain Republican insists that people over here will have to pay for the treatment of ill people over there, which is in fact true. Healthcare should not be at the center of this primary, climate should, and Democrats have to make this a winnable issue.
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First of all insurance companies are the problem always have been the problem and will always be the problem. Now add to that our wayward DEA which adds a lot cost then of course that comes along with our phony war on "drugs" with it's trillion dollar price tag. Then last but not least the real bad guys the real drug dealers are allowed to bribe our politicians into stupidity and that shoots all of the prices sky high.
Then as others have pointed out there the bizarre bureaucratic levels which prevent patients from ever complaining or report fraud and wastes a tremendous amount of time and gets nothing done.
8
Our medical system is broken.
How is it possible that if you need say, knee surgery:
- It will be $60,000 if you don't have insurance
- With insurance maybe they'll be an 80% discount so you and your insurer collectively only pay $12,000.
- If you are on Medicare which is cost plus the total might be $2,000.
Same patient, same doctors, same facilities, same procedure but prices that range from 1 to 30x?
And unlike most markets where price are known upfront, most patients have no idea what a procedure costs and hospitals do not publish their chargemaster.
In the case of an emergency, it might not be prudent to drive for miles looking for an alternative. And finally the demand for wellness is inelastic. If your leg is broken, you are not considering how much it costs to get fixed, you just want it fixed.
34 of the 35 OECD countries have national healthcare. Germany has had national healthcare since 1883. In 2015, Germany's per capita healthcare cost was $5,267 compared to the US $9,451. Additionally all Germans are covered, and do not experience a half million medical bankruptcy per year.
Medicare for all is the way forward. If you want to go slow, lower the eligibility age by 15 years (ie, 65, 50, 35, 20, 5, all) and within six years well be rid of this for profit monstrosity that results in 25,000 avoidable medical deaths per year.
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National health plans and Medicare for All are NOT synonyms. I cannot for the life of me see what is so tricky about this.
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@Cee
By what you refer to as 25k "avoidable medical deaths per year" I think refers to the estimate of deaths among those who don't have access to any medical care.
The number of Americans who are killed each year from preventable medical errors exceeds 200,000.
Don't believe me? Google it. Any cite I give you would suspect.
Tear it down, it's rotten to the core. My daughter died this summer, a victim of the system. She had a treatable autoimmune disease but although she was eligible for Medicaid she couldn't keep up with the red tape documentation and kept losing coverage. She missed her meds for a few months before being reinstated and that led to her decline and death. With automatic universal coverage she'd still be alive. Why is this so hard? Cost? How much does it cost for the bureaucracy that denied her coverage supposedly prevent "cheating"?
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@DH. I'm so very sorry about your daughter. I had a friend who had breast cancer and no insurance. She had a good prognosis and paid for treatment from her savings. When her savings ran out she applied for Medicaid. In the meantime her treatments stopped, and Medicaid took so long to decide whether to cover her or not, her good prognosis went out the window and she died. These things don't happen in a civilized country. We are not a civilized country.
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Our health care system is like something from a dark comedy. There's waste and overcharging at every step of the process, as documented exquisitely by the Times' own Elisabeth Rosenthal. Whether it be hospitals that aim for the luxury hotel experience, the immense amount of paperwork and bureaucracy caused by having different prices for different insurers, or pharmaceutical companies charging as much as they want because they can, it's not a fixer upper.
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The only political actor in the current national debate who has actually passed a major health insurance bill into law is Nancy Pelosi. If health insurance changes were easy to pass, I suspect the large majority of Democrats would be for some variant of single payer. Health insurance changes are brutally difficult to pass, particularly when they require a super majority in the Senate. If even one or two Democratic Senators don't support the bill, it will be defeated. Moreover, there will be a ferocious public relations campaign opposing changes that will scare the daylights out of many people who have private health insurance. And, all Republicans, Fox News and the rest of the right wing media will blanket the airwaves with lies. The advantage of the public option is that it preserves choice--"Medicare for All Who Want It". It is harder to mount a campaign against giving people a choice than it is against forcing people to give up private health insurance for a government program. I have not seen much evidence that the people arguing for Medicare for All will be able to flip enough Senate seats to pass single payer. The Democrats winning seats formerly held by Republicans generally favor public option over Medicare for All. The argument that "other countries do it, so we can too" does not extend to passing legislation through the US Senate. Don't tell me how great single payer is--I know--tell me how the legislation will be passed. Talk is cheap.
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Americans pay a very low share of their healthcare costs out of pocket, with only the French being lower. The costs mostly come through in insurance premiums and taxes.
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@Will If 1 out of 4 people DIE or suffer huge catastrophic medical or financial consequences in the existing system, then by your logic, since 75% do reasonably well, tnen the system is working. NO!
The existing system is outrageously expensive, ineeficient, leaves 25% or more of the population behind and is uncivilized and drags our country down.
To use the analogy of the article, the house we are stuck living in is not some historical gem that should be carefully restored, but a horrid asbestos and lead infested dump that should be declared unfit for human habitation, condemned, and demolished without delay.
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When one wants to change the surroundings of the abode, one needs to establish ones needs and they in phases one could improve on the house. If space is available start the construction of the new house as an appendage and when the new section is complete have the old one demolished. Well enough of this analogy.
We do not in reality have a Healthcare system, we do have a Health insurance system, trying to figure out who would pay the premium and what benefits are included in its policy.
In most developed countries people are provided an identification number and it is used where ever the person goes for treatment with hardly any co-pay, billing or lawyers and collection services etc. The only records that are maintained are EMR and is accessible by every Physician, Pharmacy, or any other provider. My experience is from Austria.
If we do want a health care system we would have to design one which is patient centric and is geared for patient care and not geared to maximize the profits of the insurance companies.
Why it would be difficult to achieve is the fact that it would eliminate/reduce the emoluments of collection agencies, lawyers, and Executives of the Insurance industry and hence the US lawmakers would not be able to get money/campaign contributions from them
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Very important is to recognize that we don't have a health system in this country, we have health chaos that by its very
nature drives up health costs. I lived in Denmark and was covered by their health system. Doctors there are well paid but their offices don't need staffs of people to figure out how to code treatments and submit bills to different insurance companies.
Hospitals don't need extensive accounting, insurance or collection departments saving their system millions of dollars every month.
Drug companies are not allowed to advertise to the public as this cost, in the U.S. runs into millions of dollars a month which is passed on to us in higher costs for medication.
Everyone pays into the healthcare system and your monthly premium is based on your annual income so that the more you make, the more you pay each month for healthcare.
There is private insurance for supplement if you want it, but
the executives in these companies don't get million dollar bonuses each year. All those rich bonuses that are given
to healthcare insurance execs are paid by us in high premium costs.
What we need is a true healthcare system which also deals with preventative steps such as eating correctly, not smoking, exercising more, getting enough sleep, etc.
We do none of these things.
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All are to be considered. However, A really cost of all medical care. BIG problem is the lack of any control over this. Surgeries, imaging, lab tests , drug costs all are up for grabs. No analysis of what they should cost and everyone gets to charge what they can. Regardless of the system if we do not act to control costs the medical care will continue to increase in price.
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America's healthcare system works exceptionally well for the wealthy but not so well for the rest. Note that the wealthy are the political donor class. These facts limit what is politically feasible.
I have heard that about half of all Americans are in a government health plan: Medicare, Medicaid, and Veterans Administration. Many others receive a government subsidy under Obamacare. Each of these plans is significantly different. Where is the study that compares features, effectiveness, and patient satisfaction?
Democrats agree that healthcare is a human right while Republicans believe it is a consumer good that is available to those that are able and desire to pay for it. This divergence is responsible for a system that is both enormously expensive and results in lower life expectancy compared with other advanced economies.
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Great article and illustrations. Glad to hear someone point out what I see as a fatal flaw in the Bernie/Warren-backed vision of Medicare for all, which is its outsize generosity.
I'm all for a single payer system, akin (as Bernie says) to the NHS in the UK or Australia's or Canada's Medicare systems. But a system like those makes decisions all the time about cost-vs-benefit: if drug A costs 10$/month and works about the same as drug B which costs 100$/month, then the NHS tells most people try drug A first, and drug B is reserved for a minority of patients who have a reason not to use drug A.
Bernie's plan says everything is covered, even if the best evidence suggests that there's something that works just as well at a tenth the price. I know its an incredibly fraught conversation after the "death panel" mendacities of ~2009, but I'm disappointed that neither Warren nor Sanders have broached this point. If we don't demand our health care system offers better value, we will continue to pay 18% of our GDP annually, whether it comes through our wallets, our paychecks, or our taxes.
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@Local Do you think that insurers don't control what drugs you use? Have you never been told by your pharmacist that the medication your doctor just prescribed isn't covered? Have you and your doctor never appealed the decision to no avail, and in the meantime you are getting worse?
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Lost in debates about health care is management. Health care is nothing like a house. It's much more like an army. Right now Medicare works, with 4 or 5 bureaucratic levels. It outsources all management to insurance companies, who have 3 levels or so. 7 or 8 levels is a military division. Medicare for All, Sanders style, replaces insurance companies with federal worker. Either way, 3 or 4 more bureaucratic levels as we ramp from 60 million to 325. 3 or 4 layers is nothing, right? Actually, it's huge. Largest institution in the world, US military, has 10. Not much evidence you can run anything with more. So Medicare for all, Sanders style, is an army from another planet.
The reason an extra administrative layer is a big deal is they're exponential.
There's probably only one way to do this. We've got to divide the country into five equal parts, 65 million each, pacific, prairie, midwest, southeast, northeast. Each gets some Medicare money, and each region, not state, can raise taxes for health care. Each region gets to setup and run it's own health care system. Yes, there will be wild disparities between regions. But right now, the wealthier coasts pay for the hinterland. These areas are opposed to government health care. So this is what the country wants. The important thing is not to let it be state by state run. That's unfair to many states, and doesn't fit what a reasonable health care system can do.
3
@Brian. That sounds just as crazy as the system we have now. What happens when a person gets sick in another region of the country? Are they covered? What about the sane people in the southeast who never vote for the nut jobs that run the state governments, but have to suffer with insufficient healthcare? We are either one country or we are not.
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The fault in the analysis is not realizing that the primary components of the system are PEOPLE and NOT money. As such, they're not immutable things like furniture or a wall.
Let's be real about what's changing: we're changing a bunch of ill thought out jumble of rules that were never really thought out into a rationale set of rules. Once it's clear what they are, people will ADAPT.
The point isn’t to plan the whole journey. It's to put into place a new framework onto which a new system will be built. No one can plan out such a large complex system from the start. It requires adaptation.
What other change does that sound like? The American Constitution. Is it perfect? No. Is it better than what came before? Yes.
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Did Biden really say if you like your healthcare now you can keep it? Where have we heard that before? Big mistake!
3
Or a two speed system:
all new entrants get the new house;
you can make a one time change to the new house (can't go back, unless you decline all taxpayer support for any medical (and employers can't tax deduct premiums for people who change their minds));
keep your old arrangement.
Eventually every one in the old plans age out, and there is only the new house.
The key point is that there is one and only one opportunity to change from old to new, with no opportunity to go back.
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No matter which candidate’s plan is most appealing to you, anything (or nothing) is still ultimately up to Congress - and no matter how much presidential strong arming is involved, Congress will pretty much always be much more conservative, resistant to change, and subject to influence. Therefore, to have any hope of getting anything at all, we must demand the most radical possible changes, knowing in the scheme of things all the benefits of change will be whittled down to almost nothing at all. Ad astra per aspira.
13
Using this analogy, the problem underlying every approach is we rely too much on the builders who wildly inflate the cost of everything — the powerful, corporate hospital systems. Its cost, years of lowering our expectations that we have any power over this, that really inhibits change.
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This analogy is not adequate. It is not about "fixing up the house" versus "tearing it down and rebuilding". It also ignores aspects to "fixing up a house" versus "tearing it down and rebuilding".
First, it is about how the house is part of the community. How it gets water [money], energy - electricity and gas [pharmaceuticals and technology],police [patient and insurer billing and payment], fire protection [insurance], telephone-cable-internet [information technology] and environmental services - garbage collection and, landscaping [public health] services.
Second, house teardowns rarely destroy the foundation.
The American health system has an excellent foundation of physicians, nurses, therapists, technicians and other caregivers. It also has an extensive network of hospitals, solo and group practices, community health centers, skilled nursing facilities and a variety of other institutions.
What needs to change?
Water: The pipes under the foundation need to relined and the pipes in the house need to be replaced.
Energy: Price regulation.
Police: Transparent laws and better training.
Fire: Government-overseen fire services, possibly using non-profit volunteer fire departments.
Telephone-cable-internet: Standardization, better hardware and software and more bandwidth.
Environmental: Low-water use landscaping, termite control, toxic waste cleanup.
That is needed - then we can repair the house.
11
You do a good job showing this debate is not about health or care. It is about MONEY.
18
Add to the metaphor that there was never any plan for the existing house. It was created from World War II wage controls (employer provided health insurance), a “war on poverty” (Medicare and Medicaid), a plan to “buy” votes from the elderly (Part D drug coverage), and a Rube Goldberg compromise (Obamacare).
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@John Graybeard
Never forget that a small number of people are doing really, really well under the current system, and won't just lie down and die. Gird up for the fight!
1
Medicare for All should just be Medicare-Part-A-for-All. Part A is the coverage for hospitalization, which is what can get expensive. Medicare Part B is doctor's visits, which can remain private insurance, or self-pay - if you're not going to the doctor much, why even have insurance for doctors' office visits?
A lot of the high cost of medical care is with hospitalizations, including out-patient surgeries. So move all of that to a single-payer so we can better control costs by limiting what Part-A will pay. Costs will come down; the providers have no choice at that point.
This plan will leave intact your relationship with your normal doctors since they are not part of this plan. But it will also prevent you from going broke from catastrophic medical events.
12
@Scott Werden
"...if you're not going to the doctor much, why even have insurance for doctors' office visits?"
Apparently you don't understand how insurance works.
The reason everyone must be insured -- the young and healthy as well as the sick and old -- is because it is the healthy who pay for the sick. Think of automobile insurance. Those who aren't involved in accidents and don't file claims are still paying premiums and are effectively footing the bill for those who are having accidents.
The Obama Administration never succeeded in getting millions of Americans to understand why the individual mandate was absolutely necessary if people wanted pre-existing conditions to be covered. The administration may have been partly at fault but the real problem was a severe problem that plagues every aspect of life in America today -- ignorance.
With health insurance, no one knows what tomorrow will bring. Some with poor diets and lack of exercise may live into their nineties without significant health problems, while some health conscious young people may face terminal cancer or a chronic illness whose treatment may cost a quarter of a million dollars a year. Life is not fair. The foolish often prosper; the wise often suffer.
Universal health insurance and care gives everyone a chance.
PS You also seem to be oblivious to the cost of many medications today.
14
Medicare Part A covered in patient hospital stays, but only the facility charge. All physicians treating you still Bill part B for their professional services. Part B also pays for our patient facility charges -including those for our patient surgery- not part A. And it’s all expensive.
3
Ms Sanger-Katz claims that Senator Sanders' Medicare for all plan "would require everyone to have the same type of insurance, with no easy workarounds for patients who aren’t satisfied."
Please tell us, Ms Sanger-Katz, what in the world would cause dissatisfaction with a plan that covers everyone from birth to death, that eliminates often unaffordable copays, and that would cost, based on the experience of universal healthcare systems around the world, half what it costs us now, and without "hidden costs" or devastating expenses for those with serious illness or injuries? Please tell us specifically what you envision could possibly cause "dissatisfaction" in that system? And please tell us in what country with universal healthcare are people clamoring for American-style for-profit healthcare.
Ms Sanger-Katz rolls out the threadbare falsehood that "most people would have to pay more in taxes." The truth is that the American people would pay vastly less for healthcare, eliminating "premiums" to rapacious for-profit insurance companies, and substituting far lower "taxes" for healthcare to the federal government.
Indeed, it is because of that confusion between premiums and taxes that the government of Taiwan, which implemented European-style universal healthcare in the 1990's, collects "premiums" that are specifically destined for healthcare, and does not, as in Britain, lump healthcare premiums in with total taxes.
The Sanders/Warren plan is cheaper and better. Period.
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@Sean
I strongly favor universal health care, but if the system is underfunded you can expect long waits for some types of care, hence dissatisfaction.
I do not favor Medicare-for-All unless the current Medicare system is improved -- significantly. To get adequate coverage on "original" Medicare, you need supplementary coverage. With Medicare's current 80/20 coverage that 20% could easily spell financial ruin.
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@Sean If you want to see how universal health care doesn't work, go to Russia or Brazil. Those countries have twice and three times the populations of European nations, respectively. In both countries people, if they can, avoid the public option and pay for private care. It's easy to see that happening in the US, if the program is badly designed. Have you read the Sanders plan? It's not even designed at all.
3
@Sean. When I was in India they were just starting to talk about a plan for universal healthcare. They said they hadn't decided just what would be the best plan, but were adamant that it wouldn't be like America's.
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Yes, everyone likes their health insurance until they have to use it for a serious illness, a chronic medical condition that requires ongoing care and tests and medication, or an accident where they wind up in a hospital that is out of network. Then they learn exactly how frustrating, fragmented, and broken our wealth care system is. Why are these things never discussed when the article concerns our "health care" system? Why is the main point always missed: we should be able to, regardless of our economic and employment status, receive medical care when and where we need it without having to do a wallet biopsy.
Diabetics who require insulin, require regular visits to an endocrinologist, and reliable ways to track their blood sugar should not have to worry about whether or not their insurance company will cover these expenses. People in need of medication for mental illness and talk therapy should not have to worry that the insurance company will disallow the psychiatrist's fee because the patient is seeing a therapist and vice versa.
America does not have a health care system. It's a wealth care system that doesn't work for patients, families, or providers. It works quite well for the health insurance companies whose profits are based on how much care they can deny us. It works very well for the pharmaceutical industry. But not for us.
There are more than enough examples of better systems out there. All we need to do is look.
9/19/2019 11:31 first submit
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Who are they, who love their health care so much. I have been a nurse for 35 years, have a big family and a wide circle of friends.
I don’t know who these people are.
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@hen3ry
I don’t know any American who likes their health insurance. The only American I heard who likes their health insurance in the last 20 years is my mother who has been on Medicare since 1995.
Anyone who has been out of the country for any amount of time knows the American system is an absolute disaster. The care is a crap shoot and the expense is beyond ridiculous.
When I got off the plan in Spain a couple of years ago, everyone I saw, no mater rich or poor, was covered by heath insurance - despite 20% unemployment. I was, of course, jealous of their everything. Beautiful country, art, architecture, climate, people, just everything.
1
@Betsy Groth APRN
I agree.
Besides how can you love something you can’t rely on. I know I have a hard time loving a friend I can’t rely on, so why would I love such a health “ insurance” policy?
1
What passes for our health care "system" needs to be burned to the ground. It makes no sense to try to fix this mess. Unfortunately, it doesn't appear that many millions of Americans have any sense at all.
14
We have to address COST. No one else in the world has hospitals with marble lobbies, valet parking, piano players. The entire cost structure must come down from doctors' and nurses' salaries, to the cost of drugs, to these fancy hospitals that look like 5-star hotels. If you want fancy then pay for it but like our colleges, we need to look at what the purpose is - to heal the sick and to teach.
18
@Sarah99 - I never saw a piano player.....however, the receptionist did look rather like a glamorous model, and they had free wi-fi and designer chairs.
1
@Sarah99 You're onto something. Both hospitals and universities have gone on capital spending binges. Americans love size, SUVs, big houses, and they don't question bigger and fancier college dorms, hospital rooms, etc. Those are major cost drivers. US hospitals cost far more than other country's. The amount dwarfs the profits of medical insurers, by the way. But comments here will almost only talk about insurance companies, as if they alone were the cost driver. In fact, the difference in MD income between the US and other countries is more than insurance co. profits. We see the villains we want to see, and ignore the rest.
4
@Brian There are definitely cost concerns in our system, but this is 100% false:
"In fact, the difference in MD income between the US and other countries is more than insurance co. profits."
Doctors actually make more in some countries like the Netherlands, often have better hours, and don't have to pay $300k for an education.
The biggest wastes in our system are insurance company profit *and overhead* (meaning all the wasted time hospitals and doctors spend trying to get them to pay), pharmaceutical costs (which are overprescribed and are 10x the cost in other countries), and large private hospital profits.
9
No national plan should require the involvement of private healthcare insurers … haven’t we learned anything? This doesn’t mean that private insurance should be abolished; if people want it & want to pay for it. Private insurance co-exists alongside the national plans of most developed nations. The national plan should be so good & affordable that people (and employers) will choose to enroll in it. And, we already spend twice as much PER CAPITA as Canada & the UK (and for poorer healthcare results) so are already spending enough. Last, there should be NET savings for those who switch — insurance premiums, deductibles & co-pays which exceed the cost of tax increases will disappear. Democrats need to improve their messaging & distance themselves from the abolish private insurance idea, it’s a political loser.
“No more Trumpery!”
7
I have no choice but to repeat myself. My 23 years benefiting from Swedish Universal Health Care and of course occasionally benefiting from Medicare when in the USA and a long life of private health care in the USA before that leads to only one conclusion.
My 23 years of SE UHC are the best 23 of my 87. I offer the latest anecdotal example. On July 24 I had a gastroscopy, lay there, watched the whole thing, doctor explaining everything perfectly. She takes 5 tissue samples, talks with me afterwards.
A few days later I can go into 1177.se, log in using something called Bank ID, and read her detailed medical report, accessible to me and with data available to medical researchers. Eight weeks later I see the pathologist's report there in my Journal, and I get a personal letter from her.
All this cost me zero since after 85 all medical care is free. But even before 85 the cost would have been minor. No paper work, no monthly bills, nothing.
I do not see the name Warren in the column to the left. If Elizabeth Warren wants my view she can ask me. What I write applies for all three in this dual citizen family.
I was not here when this Swedish house was built. I have always wondered how did they build it?
Only-NeverOnlyNeverInSweden.blogspot.com
Citizen US SE
38
@Larry Lundgren Sweden has 10 million people. If it had 300 million do you really believe it would work the same way? By the way, in Sweden each region taxes its citizens and runs the system. Highly decentralized. Only can work in a very homogeneous place.
2
Excellent article; terrific illustrations!
2
it is clear that to make an affordable system which covers all would take a complete tear down. This is because insurance billing and insurance company profits consume a large portion of the money spent in the US system. In Italy, the fact that all are covered by a government system makes everything much more efficient with no waste. One can buy additional insurance policies to have on top of the state coverage, but everyone is covered under the government plan. There are co-payments which are in three tiers according to income. Pharmaceuticals are far more reasonably priced than the USA, and the most necessary ones are free, or with a small co-payment. A modern anticoagulant which would cost over $450 a month in the US, costs $98 for an outsider to the system such as ourselves, and would be either free or cost under $20 a month for an Italian. University education is also tuition free. Veterinarians are reasonable in cost because they dont pay fir expensive educations. Trade schools are tuition free. The healthcare and education systems are pretty much the same all over Europe with small variations, thus basic rights are guaranteed, and the playing field is leveled considerably for all social classes. The USA claims its horrendously expensive medical system is superior. The costs are greater by far but it is bankrupting even Americans with insurance. And many people are dying without medical care, The statistical results of the American system are also inferior.
24
Buckminister Fuller's quote comes to mind, "You never change things by fighting the existing reality. To change something, build a new model that make the existing model obsolete." I think that includes both our current Tower of Babel ripoff built on employer provide health care insurance as well as government run Medicaid and Medicare which relies on cost shifting ponzi schemes.
The pervasive misunderstanding that there are no premiums, need for medigap coverage and out of pocket expenses for Medicare patients is dangerous.
16
It's not healthcare that's the problem, it's people not having enough money that's the problem.
How many ways are we going to reframe the same question? Rent is too expensive. College is too expensive. Healthcare is too expensive. No one has any savings. The minimum wage isn't high enough.
None of these problems have to do with the actual industries themselves. Food is cheaper than it has ever been. Health technology is more advanced than it has ever been. Construction is more efficient than it has ever been. Students have more educational resources than ever before.
We can shuffle the deck all day long, but until the effects of inequality are less perceivable, no one is going to actually be happy with the results.
11
I do like the your metaphor but it should be extended. There are the rooms in the old house, with no roofs, and severe exposure to the elements - the 30 million uninsured, Then there are rooms with some protective overhead, less exposure to the elements but still not a very safe place to live in - the 50 million uninsured. Then there are rooms which occupy most of the house, where the rent is increasing along with the cost of repairs, and this is uncomfortable for many along with the reality that they face the possibility of being moved to the rooms with very little or no protective overhead. Then there are rooms luxuriously furnished, with owners with absolutely no concerns, because they have the wealth to maintain the furnishings in a luxurious state.
Biden's change to the house would lower the rents of some people with none or little protective overhead,
Sanders solution would be to build a similar house to one north of where he lives in Vermont, with some minor cracks but a real dream house where 90% of the residents of the house are quite content and the cost of the house is only 1/2 of the leaky and bizarrely constructed house in the US
5
Just today NPR had a story about a young man who was charged $12,460 for a 45-minute visit to an emergency care center in CO to be treated for dehydration. Ultimately, he was held responsible for $2593 after all the insurance co fighting and "price negotiations." Face it: the U.S. system is a scam, plain and simple. Everyone knows it, but you continue to allow yourselves to be treated like slaves.
I live in Italy, a country hardly known for its efficiency; however, when you need to see a doctor and, in particular, when you need emergency care, you receive the best care in the world. Cost? In total 1/2 what it costs in the States. Recently, one of my American colleagues was admitted to the hospital for an unexpected surgery. Cost? About $200. Why? Because Italians (Europeans) consider health care a right rather than a consumer purchase. Everyone pays into a nationalized system that, for the most part, works well.
In the end, you Americans won't change because you're all seduced by the notion that you can have "the best care." Unfortunately, you have the most expensive care with outcomes that aren't the best.
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@mrfreeze6
We do have the luck to have a man running for president who considers healthcare a human right. However, many Americans consider him to be too “grouchy” or too “ socialist” to be our president. These notions are foisted on us by a media and DNC who don’t want to give up the corporate status quo.
1
I've been in Medi-Cal, California's Medicare, and at best it's dysfunctional, at worst it's corrupt. They make it impossible to leave the system. It took me two years of phone calls and visits to the DPSS office just to terminate my account. It renewed automatically each year even though it's not supposed to. There are thousands of people with employer insurance who have inactive Medi-Cal accounts and California taxpayers pay Medi-Cal for each person enrolled. Something very fishy is going on. We should not build upon an already corrupt system. Tear it down and don't trust the government to rebuild it.
3
@NYandNJ I'm confused--you speak of "California's Medicare". Medicare is a program at the federal level; could you be speaking of Medicaid? I can't believe that "thousands of people with employer insurance" are eligible for Medicare?
2
@NYandNJ Medi-Cal is not Medicare. It is CA's version of Medicaid.
5
A muddle of pathetic half measures.
The radical left plan, "Medicare for all", is the best of the lot and still a weak tea approach that leaves people scrambling to afford care.
Being America we choose to frame healthcare as a violently adversarial process. The controlling assumption is that patients are scamming the system to get things they shouldn't have because they are laggards and cheaters.
Your ticket to care comes after you run a gauntlet of people whose job is to prevent you from getting too much.
While this appeals to most, it maintains a cruel, bureaucracy, a huge expense that limits the amount of actual care available.
Another form of single payer, far better and more humane, relies on doctors to determine patient care and if its medically needed its provided, no hoops, no penalties, no questions asked.
Ontario has such a system and it works. It just plain works; all the time, everywhere, for everybody. What ought please to the fat and happy "no free lunch" crowd, there is a minimal price to pay in the form of increased taxes, but far better care than we have now costs far less than we pay now.
Again, being America, this looks too much like offering actual help. Likely never happen.
All the same, its a shame Medicare for All has become the de facto rallying cry when it is a sad mongrel of a system masquerading as some sort of answer.
Where is a candidate with the wisdom and the courage finally to offer to care well and easily for everyone?
10
@oogada I love your comment especially paragraph 2. Reminds me of when I mistakenly typed in the wrong bank account number when paying a bill online. When I tried to correct it and asked to have the late fee removed the answer was, “how do I know you didn’t put in the wrong number on purpose to get away with paying late.”
1
Short term fixer-upper, long term teardown.
5
The experts who write the Upshot column would do their readers and the U.S. public a wonderful service, if they would draft a plan for getting from our current profit driven, nonsystem to one which provided essential disease care for all.
It would of course be cleverly (and nonpartisanly) drafted to be immediately acceptable to all (except those who are profiteers in the current nonsystem).
They could bring to bear their knowledge of other national programs around the world, an informed understanding of patiens’ Psychology and a practical sense of how to do the changes with acceptable levels of disruption.
Since they don’t represent any of the “stakeholders”, their impartiality would encourage all to consider their proposal openmindedly.
Thank you Upshoters, in advance.
Stephen Rinsler, MD
10
Here are the simple reforms you really need:
1. Networks are out. Every doctor and hospital must agree to take all insurance, Medicare, and Medicaid, or none.
2. Medicare/Medicaid set standard prices. Insurance must pay at least 50% more.
3. There will be no annual deductibles, but co-pays with a cap of up to $2000 are allowed.
If everything still costs too much, then further reforms can be considered.
3
@JonathanThe $2000 cap would be maximum and minimum. Simple wise use of health care is the answer .
1
The question to be answered is this: where is the tipping point?
At what point does it become more expensive to try and shore up and salvage the existing home than it does to simply tear it down and start over? Especially when you consider that the new house will be up to date and energy-efficient (unlike the old house with its substandard wiring and many cold breezes around window and door frames).
10
Why not a combination of plans. Build the new house and allow people to move in as they wish. At the same, fix up the existing house incrementally over time. If at some point, one of the houses (hopefully the old one) becomes virtually vacant, it can be torn down and everyone will live in the new house, which will be even better from what has been learned in the effort.
As for paying for health care, the US spends far more that any other country in the world. Through intelligent cost shifting, we can easily afford a greatly improved health care system that will actually cost considerably less than the current system.
4
@James Ward
From what I understand, this is precisely what Pete Buttiegg is proposing.
6
@James Ward
But the costs are so high precisely because of the drag on prices of the fleets of secretaries required for insurance billing and the profits of the insurance companies. The paharmaceutical companies command in the USA which is why pharmaceuticals often cost 5 to 10 times as much in the USA.
5
I’m Canadian and a firm believer in a single payer system. I believe it would work even more efficiently in the US with its greater population. That said, I understand that many US voters are uneasy about this (despite the success and popularity of Medicare).
So, to persuade the American electorate, a candidate has to concede an ongoing private option until public opinion catches up. Do the views of ACA now reflect the hysterical fears of 2010? The death panels never materialized.
American workers have been “chained to their looms” since Reagan began undermining the hard-fought right of collective bargaining. The fear of the loss of health care is another cudgel used by employers to limit worker mobility.
110
@Adam Clarke Yes! I would love us to have a good single-payer system as in Canada and elsewhere. I also know that political reality is we will not get there in a single structural change as Sanders and Warren advocate. I'm old enough to remember how the insurance industry fought "HillaryCare." It will be worse this time around since the teardown anology would basically put them out of business. We need to be strategically smart about getting to the ultimate goal -- which means for *now* some version of what the author calls the Biden plan (though I prefer Mayor Pete's Medicare for All Who Want It). I hope Warren, if she is the nominee, can make space for this in the general campaign. Sanders, I think, is too stubborn. I hope she is not.
3
"The death panels never materialized."
They'd already did: the private insurance cartel overcharges and intimidates people to death on a whim.
1
This metaphor was helpful. We are going to need a lot of educational “explaining” by news sources in order to have a fair and effective social debate on where to go.
This means not repeating things that are deceptive. 160 million people, for example, do not love their existing private plans. They just don’t. Also, on financing, it is deceptive to say that taxes would have to be raised under a Medicare-for-All plan without adding that premiums and deductibles would be wiped out to compensate. Nowhere did I even see the word “premiums” mentioned, while it is the primary way that employers/employees and individuals currently pay for health care. It is net costs that are are important and net payments.
Medicare allows for supplemental insurance over and above the minimum services. Medicare-for-All should too. There are your “choices.”
Finally, let’s not necessarily choose our Democratic nominee based on their health care preference alone. I’m sure that whichever Democratic president is elected, they will sign whatever scheme gets through Congress and is put on their desk.
25
@SRP - You're right. Anyone saying "your taxes would go up" is being deceptive if they don't also mention that your premiums, co-pays, and deductibles will be massively reduced or ideally, would go away. The average family health insurance plan costs $28,000, counting premiums and deductibles but omitting co-pays. For a lot less than $28,000 in additional taxes, we could have a single payer system that covers everyone as well as or better than most private plans.
For those with employer insurance, I wonder how many people know how much their employer pays for their share. The average employer spends $12,000 a year per employee - and takes that money right off the top of what the employee would otherwise be paid. And then of course most employees still pay a hefty amount in premiums and deductibles out of their own pockets.
20
@SRP
As long as the private medical industry in the US is left intact, the costs of the sytem will be far higher than any european system or the Canadian system. Doctors make a fortune in the US because they have expensive educations. Here they are educated at government expense, thus their salaries sre reasonable. Thus the veterinarians are affordable here, and are not committing suicide as they are in the USA because they are trapped by college debt. The difference in the cost of vet medicine between the US and Italy is head-spinning. The quality in Italy is superior.
8
@MegWright you are correct but every coin has two sides. It is also deceptive not explaining the out of pocket expenses most patients have with Medicare. There is a misleading myth that everything is covered completely when you have Medicare and that is simply NOT the case.
5
isn't the fundamental question: what kind of health care system do we want twenty years from now? will a "fixer upper" still be viable then? would a completely new system really be cost prohibitive?
the candidates seem to be arguing about the next four years. that's fine; there are short term needs that should be addressed immediately. but i question the judgment that we can tinker our way into the future. it certainly won't work for climate change, and i doubt the health care system is a much simpler problem.
it is illuminating to realize that we tolerate the delays and inconveniences of new roads or airports, but changing a digital bureaucracy of administration and logistics, well, that's just too much to ask.
tear it down, and start soon. inflation guarantees that the costs will only go up the longer we procrastinate.
24
@drollere
The costs aren’t only for inflation, the US is also being suckered by the greed of the pharmaceutical companies which command our politicians to work against the well-being of the American people, and command our medical system to use therapies which are super costly and venefit them, not us.
6
@drollere, the thing the politicians never talk about is that the path on which healthcare prices are rising in the U.S. are UNSUSTAINABLE. If it's ALREADY straining the economy now, in 20 years, it will crater it.
What they don't talk about is that there's just as big a risk in staying where we are.
6
An interesting way of looking at it, thank you for the article.
My concern thus far has been when democrats get a little disingenuous about their plans. So far this has not included Bernie, but it does include Warren, who won't admit the substantial tax increases on virtually everyone that will be necessary for her plan; and it includes Biden, who claims everyone can "automatically opt-in" while neglecting to mention that this assumes you have the means to do so.
Otherwise, I think the debate has been good and healthy. Initially it seemed Warren and Sanders had the upper hand but the other side certainly sowed some doubts in the last debate.
5
@Tim tax increases offset by cutting premiums, co-pays and deductibles. Net outlay less than current system, with better outcomes, and no longer tied to an employer.
9
@Tim,
All of the democratic candidates’ plans are based on the DROP in payments to PRIVATE insurance companies and providers being greater than increase in taxes.
The problem is that the debate moderators (and the newspapers?) seem to want to emphasize the rise in taxes (bad news is better for the media?) and ignore the DROP IN TOTAL COST..
Not the medias’ shining hour, so far.
9
@Stephen Rinsler Also not the finest hour for candidates and the DNC to not keep emphasizing that. Of course, that would highlight that insurance company execs would be "downsized"!
1
We are the only country in the world that forces patients to agree to pay all medical charges without telling them the costs up front
We are the only country where medical estimates do not have to be honored.
The real bill can be totally different and patients have little recourse- other than bankruptcy
We are the only country where everyone is charged a different price and there is no way to compare prices. Sometimes I wonder if it would be cheaper if I didn’t have insurance. Who knows?
Our medical costs are like a spin on the roulette wheel- do you feel lucky today?
133
It is a system designed by Ebineezer Scrooge himself. Bernie wants to bring everyone a goose dinner. Biden wants to bring a takeout turkey sandwich. The GOP is secure in the notion that if they can just keep things as they are now, prices and profits will continue to go up, and can therefore be monetized in the short term by selling financial instruments nobody understands. God bless us, one and all.
25
@Pottree
Make that half a turkey sandwich and I agree with you 100%.
1
First of all, I have yet to meet anyone who has anything good to say about their private health insurance. Billing systems are confusing if not downright misleading - perhaps designed first and foremost to dodge paying taxes. As for the old house analogy, I have had a lifelong 'this old house project" myself and if I had to do it again I would tear down the old house and build a new one. Remodeling is three times the work and time involved while our health insurance system is likely beyond repair and should be torn down and rebuilt. Indeed, we already have a foundation built through Medicare. Let's get to work!
68
@LH There are companies that exist to teach hospitals and practices how to upcode to make as much money as possible. We need a national system with uniform pricing. Some mix of private/public like Germany and the Netherlands has. For profit medicine is a failure and always will be when the entire aim is to NOT insure those who need it most.
88
Here's the problem with your image; the house sits in a neighborhood. All the other houses-- all of them-- provide shelter for all their residents; nobody is homeless on those lots, as many many are on ours.
Further, those houses keep out the heat and the cold and the rain and snow, far better than ours, which delivers very inconsistent shelter, even for those living inside, who sometimes find when the elevator door opens when they most need, there's only an open shaft.
Briefly: American health care costs more, delivers no coverage for some and poor results overall for all of us. And contains a structural flaw called "medical bankruptcy"
Other nations devote 13% of national income or so to health care for all their people and don't impoverish any. We pay 19% of GDP, leave millions uncovered and play lotto with poverty.
Get it straight.
Fixing our healthcare does not cost more. IT SAVES 6% of GDP
168
@Four Oaks Compared to the medical systems of other nations , our medical system is so expensive because
1 ) we have a lot more tests due (in part ) to our litigious ways. 2) we have more workers per patient. 3) our medical workers ( doctors, nurses, administrators etc. ) are paid a lot more. To reduce our medical costs we should 1) reform our legal system to reduce malpractice suits. 2 ) convince our patients to expect less in service and convenience . 3) convince medical workers to take a cut in salary . Good luck
12
@Four Oaks Well it does save money but one thing we have to acknowledge is that it slices off a sizeable part of the economy. What will replace that? I'm sure there are answers but we must acknowledge the question.
5
@MS Hence National Health. Standardized costs. Standardized payment structure. Standardized the legal system. No one should get $100M for malpractice.
19
It is neither.
We should gradually go over (and it could take yrs.) to a similar plan then just about all our peer countries have.
One can argue over the details but what we have now is de facto criminal where at any given time up to 50 million Americans are under or not insured and suffer pain and bankruptcy while billionaire big HMO/Phrama execs. make trillion of dollars while our health care stats are the worst and costliest among our peer countries.
42
Interesting attempt at explaining a complex subject. To continue let me say that Medicare for all would rebuild the house with much better rooms than any in the current house ( better benefits to include all drugs, all dental care, and all current benefits included in the best employer sponsored plan). In addition to the new house occupants could go to any doctor, any hospital, or any other medical provider of choice. Best of all the total cost of the new house will be less than we are spending on the old house now and future increases in housing expenses will be less. To top it off, 95% 0f the occupants of the house will pay less for housing than they do now ( google University of Massachusetts at Amherst professor Gerald Friedman's extensive financial analysis of the Medicare for All plan)!
20
@Nick Anton-Thank you for you're reply. Again all of our peer countries have figured it out. We can too. Details are important and it will take time and there are legit arguments on what system is better but anything is better than our Middle Ages de facto criminal system, anything.
9