I think the problem with this approach is the state of health of individuals. Smoking, drinking, drugs, obesity among other things will crush this approach financially. I personally do not want to pay for health care for a drinking, smoking, fast food, drug junkie. Just pick one if you must.
Love the rich kid can't do attitude from the establishment. American the country that can't do it yet every other first world nation has.
The strongest argument against it is corporations that want to hold medical over our heads and have control. Free us so we can work for whoever we want. Give us Freedom. Stop making us slaves to the wealthy.
We can do this. The only reason we won't be able to is because of republican and wealthy donor sabotage abusing it and sinking poison pills into any legislation.
Vote every corrupt politician in both parties and put in people who won't take donor money. This frees them to listen to voters and small businesses.
6
I am fed up with these harpie (yes, even men can be harpies) Republicans who use number tricks to scare the bejeesus out of voters. Yes, under Medicare for all, individual taxes would go up; yes, corporate taxes would rise and yes, state budgets would definitely go up. But that is only half of the equation. Individual overall spending would dramatically go down by dint of replacing enormous monthly premiums, exploding co-pays and co-insurance payments with a tax increase that overall is substantially less than the cost for private health malfeasance - er, I mean insurance - today. It really is a no-brainer. Plus, with everyone - patients and doctors - as part of the same national health plan, the canard about losing your favorite doctor goes out the window.
3
The problem with healthcare in general is that costs are way too high. The doctor's charges are too high, the hospital costs are ridiculously high, ambulances, specialists, nursing staffs, all are expecting too much and the result is unaffordable. A rural community cannot get a Health Officer without guaranteeing an annual income of $600,000 or more. Add to that the profit margins for insurance companies who don't belong in the health care market.
Add to that the cost of prescription drugs and you have an entire industry that is totally out of balance. Put the screws on fees and maybe, just maybe we will have a reasonable health care system.
9
This column doesn't prove anything, other than that individual states do not have the ability to enact a Medicare for all system for the reasons stated in the article. Trying to extrapolate those problems to a national Medicare for all health plan is a meaningless exercise and Mr. Suderman's feeble attempts to do so are evident here. Mr. Suderman, as do all of the opponents of Medicare for all, fails to acknowledge two facts: First, that Medicare is a government program that actually works, i.e., it accomplishes its stated goals and second, that our present health care system is a failure in terms of what we spend as a nation and the outcome, which ranks us at the top for the former and near the bottom for the latter. The present health insurance system sucks about $500 billion (the estimated gross revenues of the health insurance industry) out of our economy that does nothing for the health of Americans, other than enrich the CEOs and shareholders of the health insurance companies. So Mr. Suderman, please make the case that this is $500 billion well-spent.
11
This is a silly premise. It's self defeating.
5
Simple math here.
if Canada and England managed to do it, so can we.
14
National systems work. We already have a working Medicare system! Enough excuses!
13
After 70 + years of disinformation, I am not surprised that Joe/Jane 6-Pack are lukewarm about Medicare for all. The news media has not helped- especially at debates by throwing out Republican / Insurance Lobby talking points looking for a gotcha instead of an honest answer.
All insurance is a risk pool and a universal plan of over 300 million Americans would certainly have the kind of scale no private insurance company could ever hope to attain. Any Medicare for all plan needs to be Federal- not state by state- to get the kind of scale needed to spread the risk and expense.
It amazes me that the same people who claim ours is the "greatest country on earth" think we are unable to make a universal coverage plan work. Apparently, they think Americans are so stupid as to make the project an impossibility. Given that Donald Trump is in the White House, I might give them that point.
The biggest problem has been that it has been poorly explained to the public. I would love to see the NYT host a debate on health care at the 92nd Street Y and let Robert Reich take the pro side- send whomever you want to oppose.
https://youtu.be/WtGhaJjW-4Y
17
This op-ed is a complete snowjob. Not once does it mention the astronomical premiums Americans pay for health insurance and prescription drugs, the numbers of people who can't afford them, or that we pay more per capita than any other country for lower quality care.
Sorry, Reason Magazine, it's time to join the rest of the civilized world and adopt some form of single payer, and we don't have to re-invent the wheel. We should emulate countries like Switzerland, Germany and others who outrank the U.S. in quality healthcare for a lot less money.
17
I'm so tired of hearing that it won't work politically. All that means is that the profiteering big medical/pharma/hospital/insurance establishment and all their satellites don't want to give up their gravy train. Every other developed country has universal care. Every one. What they don't have is billionaires like the Sacklers who make their fortunes off medical "care" that causes more harm than good.
16
This is a ridiculous argument against single payer. Vermont would be the last place to try single payer. It's population isn't large enough to reach critical mass. The same program across the entire US would be far more likely to succeed. (Like it does in every major country on the planet.)
99
The Times will NEVER support single-payer health care; we might as well accept that. However, I could tell you stories about Canada... and horror stories from the US, for that matter. What can one state do?
5
California, too, desperately wants single payer, with the nurses unions and other favored groups drooling at the chance to jump on the government payroll and collect fat pensions and other taxpayer-funded benefits. Politicians here bloviate nonstop about their deep and sincere commitment to single payer. But even with supermajorities in the legislature and committed leftists controlling all the levers of power in the state, they can't get past the revenue issue. As blinkered as they are by their ideology, our leaders know that Californians are taxed to death already and won't accept the kind of hikes necessary to fund single payer. The middle class is fleeing the state; a big tax hike would turn that into an exodus. You can keep all your blah-blah-blah about how expensive and wasteful our current system is and how much we could save in terms of overall GDP burden by adopting single payer. To most taxpayers this is meaningless. They know when they're being lied to: "don't worry, we'll tax the rich to pay for this" and "taxes won't need to go up that much because the government can better control costs" are the biggest whoppers of all. The prospect of significantly reduced paychecks to pay for a new and very expensive entitlement will be enough to sink this measure -- or keep it from ever being seriously considered.
5
Americans are waking up to the fact we pay more for health care, get far worse outcomes, leave millions without, and play medical bankruptcy roulette. Eighteen percent of every dollar we spend buys healthcare here. Other countries pay a third less, cover everybody, and don't let 47,000 of their peers suffer and die from untreated routine ailments. Every Year.
We pay more. We get less. And all of us who have it, approve of Medicare.
And you say we can't all do it...just why is that?
I suggest you take that argument with you, get out of the road or else get trampeled.
We gonna fix this sucker, and save enough to afford universal child care, preschool and post high school programs for all our kids.
67
My only gripe against medicare for all is that is is easy to demagogue. Millions of dollars will be spent to lie and spread fear.
With our ignorant population the lie will win the day.
4
If at first you don't succeed, try again. Wasn't it an American who said that?
3
Pathetic. Your politicians have bashed their constituents over the head with the mantra that “all taxation is theft“ so many times that when they actually need to impose a tax to do some good courage evaporates and they are unable to articulate why this tax would be a good thing. Single payer plans have always been a hard sell due to the opposition of special interest groups with money. Sometimes it has been the doctors, sometimes the insurance companies but determined, courageous people have got it done as a look at Canada and Britain will show. And the battle never quite ends as there is always somebody trying to make money from someone else’s misery. And then there’s the “why should I” types who are unwilling to pay into a system that might support other people whom they regard as shirkers or malingerers. These people never think about accidents, heredity or just plain bad luck that could end up putting THEM in the poorhouse under the current system forsaken by their insurance companies and beleaguered by debt collectors. There is a better way folks, you just need to elect and stand behind people who are prepared to do the hard work to get you there.
8
Mr. Suderman make all health insurance companies non-profit and then we can pick up this discussion again.
5
I am writing this from the UK and I'd just like to mention that it is completely absurd that this opinion piece was published in a national news paper. In the United States if you can't afford Health Care you literally just die. Any discussion of health care policy must begin and end with a recognition of the barbarism of the current system.
The moral rot at the heart of American political discourse is not a product of the reactionary right alone, we see it here on the pages of the New York Times where many a pundit can expose his searing distain for human life in polite company and without consequence.
15
Feds print money. States don’t. That’s why M4A is doable.
3
To a Canadian, this just sounds bizarre. And cruel.
8
"A Sanders presidency would have to overcome a deep trust deficit born of both lingering frustrations with Obamacare ..."
I thought support for Obamacare was at an all time high. You can check out Pew Research website or even follow Fox News poll: https://www.usatoday.com/story/news/politics/onpolitics/2018/08/23/fox-news-poll-obamacare-gop-tax-cuts/1074570002/
2
What a nonsense piece. It doesn't argue that MfA won't work, it argues that MfA isn't popular. And it makes bogus arguments to boot.
6
The author is an editor at the libertarian magazine Reason, whose two largest donors are named Koch and Scaife, both prominent anti-government billionaires. I imagine the author has excellent healthcare.
9
So let’s getting something straight right now. The rest of the world has health care and these CEO’s are looking at making money
This has nothing to do with Higher taxes this is about uncontrollable salaries for shareholders and CEO’s
How in the world do we justify letting people die to support Wall Street
So don’t try to write a story about higher taxes because that is nonsense.
We are a country of haters and there names are the GOP everyone can be covered but no we want CEO to abuse sick people and populate the homeless
Bernie ,Warren are talking the truth about health care and I would expect better from the NYT families are dealing with dementia, Parkinson’s terrible nursing help
Without full coverage we all will be in the streets because stagnant salaries just aren’t going to do it for the regular people. We do love our families and want to do the best. Thank God for Bernie and Warren who care about Americans.
5
This is yet another op-ed piece by the NYT that is intended to be provocative, but the reality is, there is little substance behind it. Vermont's effort was full of holes, which the author readily admits. There is no reason to believe a more thoughtful piece of medical-care-for-all legislation could work at the national level.
5
There are a bunch of issues that never get discussed. If you're going to go to a single payer system where does that leave the "health care as a business" mess we have now? What about reembursement? Many docs can't keep the lights on at Medicare rates. Why aren't we talking about taxes on things that are causing many of our problems- alcohol, sugar, bullets, gasoline, tobacco, etc. Oh right, can't make those sacred cows mad. I could go on all day. The point is that, nothing is free, health care isn't a "business", yet docs and hospitals have to pay the bills and some of the biggest causes of our bad health are choices we make and we don't want to pay for them. Just like climate change, the numbers and basic solutions are out there, the problem is there are vested political and economic interests and PC blinders that keep us from putting the cards on the table and getting on with a solution.
3
Didn't work at the state level......one time tested.....so it won't work nationally.
How does someone intelligent like this writer complete overlook the "Medicare for All," national health plans EVERY other country has and for the most part operating very well. At half the cost.
I suggest that "Reason" isn't doing what it's name implies. Logic.
3
You're going to lover Green Mountain Care; brought to you by the folks who gave you the Department of Motor Vehicles!
1
Reason is a magazine devoted to libertarian, free market ideology . No surprise that its editor would push the idea that MfA can't work.
3
you're equating a bad execution of a decent plan with a bad plan
2
OMG! the Competitive Enterprise Institute doesn't like Medicare for All! What a surprise...
4
Peter Suderman is aware of this, but I just want to point out to the readers and whoever edited this at NYT that the Cornell Policy Review piece from 2017 that is cited was written by a first-year Masters degree student in a policy program. Even if we accept this as a reputable source, the student's overall analysis does not align with Suderman's views.
Mindless and stupid article. Medicare for all can not exist alongside a private system. It requires very high participation rates to work. There might be room for some supplemental plans as now exists with Medicare. 34 out of 36 First-World countries have proved it works at half the price we are now paying. Changing the gouging American Medical-industrial-Complex in a corptocrcy/plutocracy like the US is near impossible.
4
Blah Blah Blah
So why is America, in contrast to all the relatively prosperous countries, east and west, unable to figure out how to provide medical care to the people that live here. Really, tell me why ?
3
No, the problem is we live in a stupid, greedy and ignorant culture. Lots of people get rich from it. More, many more, get poor or stay poor because of it.
You just don't want it, period.
4
We already have a medicare system and a VA system that works. It's simply a question of priorities and ROI. We invest 3/4 of a trillion dollars on defense spending each year. The nation needs to re-calibrate because, I'm sorry the returns have been woeful. Multiple foreign wars, no clear wins anywhere in the world, policies that create fanatics (kill my relatives while they're attending a wedding/funeral/whatever) and then come and talk to me about hearts and minds? The rest of the civilized world figured this out long ago, nationalize it, fund it, legitimize it and stop the whining. Giving people healthcare will unleash tremendous productivity in this country and allow its people to put their intellect, passion and MONEY into far more useful enterprises than creating the next generation of jihadists!
2
Guy from "Reason" writes illogical analysis. Dude, we are 10 years later. Health Gougers have increased insurance rates 30%, making single payer a better option. Vermont represents 1/500 of the population of the United States -- a tiny fraction. There is big savings at scale. The reason single state programs fail is because each state has to implement all the infrastructure. With government moderating the process, that's 49 states that don't have to. Vermont is 28th in per capita income, so no help there. Also, first guy over out of the foxhole draws all the enemy fire.
I could go on. This piece is scurrilous cherry picking. What happened in Vermont 10 years ago is not predictive of what needs to happen now.
3
I am so tired of hearing how other countries do better than the US. It’s simple, they let their sickest patients die. In the US just 5% of patients consume 50% of all healthcare expenditures. In other countries the sickest 5% only consume 25% of healthcare dollars.
Also in Europe and the rest world aren’t litigation crazy like the US.
Putting all your eggs in one basket is never a good idea and besides every been to a post office. I rest my case.
4
I have one question; why do Americans pay twice as much as everyone else for healthcare?
1
What a waste of column space. As others have stated, universal single payer means ONE PAYER with the whole country in the risk pool. Incredible the lengths you go to to describe why a program that would have only covered those outside other payers (VA, Medicare, Medicaid, employer based insurance) would be too expensive and unworkable. Nice try to sway those who don't understand the Byzantine system you have in the USA...but no dice.
2
The fiscal math is indisputable: single payer does not add up. My newly released book, Enlightened Public Finance, lays out all the numbers for national health care options and the tax levels and policies they will require. There is no "tax the rich" strategy that would raise the $1.5 TRILLION ANNUALLY required for single-payer. Also see my recent article in PA Times on the Rubiks' Cube of Health Care Finance https://patimes.org/the-rubiks-cube-of-health-care-finance/ It's all there, black and white.
1
Mr. Suderman has an opinion and has no more expertise than the average reader has. Most likely he also has very good insurance and can afford the deductible.
1
Here's a list of things I haven't had taken care of because, with or without insurance I can't afford them. I have been struggling since 2013 when my "generous" employer downsized me 3 months before my 54th birthday. It was a wonderful birthday present and reward for 13 years of hard work.
Eye exams. Let that go for 4 years.
Physical/Gynecological: haven't had one in decades because of too many unexpected costs.
Allergy and asthma meds: ended them when the job ended. Can't afford the doctor, the meds, or the tests.
Dental: 1X/year
Emergency care after falling off bike, cracking helmet, and having a concussion: forget about it.
Booster of DPT: no doctor, forget about it.
Bronchitis: no doctor again. Rely upon sleep, rest, hot showers, hot tea, and OTC cough medicine.
Limited mobility in right shoulder: no checking it out. Can't afford to. Can afford to become crippled however.
I've been going from job to job and because of my age (60) it's hard to find an employer who is willing to hire me. We need to decouple the ability to receive medical care from employment status. If this is not accomplished this country is going to wind up with something worse than a wealth gap. All it will take is one epidemic and the richest dying because they have to share the air and have us work around them for them to realize that health care for all is better than dying. Epidemics don't respect economic status.
10/9/2019 6:48pm first submit
4
Medicaid, Medicare, Medicare for all. Somewhere LBJ is laughing.
So a bunch of stubborn clueless Republicans who don’t believe in evolution, or science, or climate change, or a women’s right to choose, or the necessity of clean and water, or equal rights for gay people, should determine the course of medical care for the entire county?
3
This header for this article really does not cover it contents, as the issues cited by the writer have nothing to do with Medicare for All, but all with an under-informed a not understanding public. Naturally this causes uncertainties and fear. The main thing that I learned from the article is that any such large new program, and Medicare for All most certainly belongs to this category, needs to accompanied by a very well-presented objective and effective information program. A better title for the article would have been “Why Medicare for All needs to be Accompanied with Thorough Public Education.”
2
Pretty simple solution here if America would become politically mature. Simply copy what the politically-smarter-than-us Swiss and Germans do. Cut the DOD budget to make it fit. Let’s recall that the DOD spends $500Mil per yer on just military bands. There is plenty of fat. A Citizens Committee could figure out the cuts independent of the corrupted pols.
1
I think like a thousand people failed at building airplanes before the Wright brothers finally succeeded. Good thing they didn't use this kind of logic.
1
Mr. Suderman knows, or should have learned already, why one state without national legislative power cannot implement single-payer healthcare. This is especially true of a state like Vermont at or below the national average in wealth.
Vermont ranks 52th among U.S. states and territories in GDP, just above Guam: https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_GDP
According to U.S. News Vermont is the fifth among states most dependent on the federal government. It receives $1.26 federal for every $1 paid in income taxes.
https://www.usnews.com/news/best-states/articles/2019-02-12/these-states-depend-the-most-on-the-federal-government
Yet Vermont pays nationally determined prices for healthcare, including pharmaceuticals. It cannot negotiate these prices.
Governor Shumlin was correct in attributing the difficulties to "the limitations of state-based financing, the limitations of federal law, the limitations of our tax capacity and the sensitivity of our economy..." Note the limiting factors: "state-based financing...federal law...[state] tax capacity"--in a relatively poor state.
Of course, single-payer healthcare is possible (and desirable) in the U.S., with more progressive federal tax policies, revenue-sharing, and federally mandated standards and negotiated prices. Every country in Western Europe, and Canada and Japan, has already done some version of it!
1
This column is absurd. Medicare for all or any rational single payer system will reduce cost significantly because the price paid will be set by the government, not big Pharma, medical device companies, etc. No longer will sick, vulnerable people be exploited for profit.
2
So because we had one failure we shouldn't continue to try to figure it out? It is possible because other countries have it. This is a lame excuse.
2
So in short: the USA simply is not capable of providing what is provided and taken for granted in much of the rest of the wealthy democratic world, at less than half the cost of US health care with 100% coverage because? Or: sorry folks, if you want free publicly-funded health care you'll just have to join the US armed forces, become indigent or get yourself sent to prison. No worries.
2
I always like to look up the person writing an article like this so I can see where they are coming from. Mr Suderman writes for Reason, a online thing geared for libertarians. You know, the libertarians are young white guys, doing well, with a good wage, who don't feel like they should pay taxes. So go figure on the article.
4
Very unwise article to write and publish. It will be in the archive forever and in ten, twenty, or thirty years, it will be read and laughed at as predictable nonsense. Yes, it may take time but a national single payer system has been proved workable and necessary by every other industrialized country in the world. We may be more violent, and have more buffoons as leaders (and, apparently authors), but we get sick just as often and just as seriously as all others on this planet. But is just more expensive here. That will change and this article will remain as a warning to naysayers: check where the wind is coming from before you publish!
3
Meanwhile, every other first world country, in various forms, has implemented universal healthcare, has spectacularly cheaper administrative costs per capita and generally better health outcomes overall.
The world is the “evidence” it can be done.
Lastly, something Americans might not know is the USA health care system is generally used as the “monster under the bed” in local politics in those countries, as in “don’t you dare go there.”
If no one else wants what America has, why is Suderman promoting it?
1
USA can afford health care for all; it is shameful for anyone to say otherwise. How is USA alone of the G7 unable to provide this simple act of human kindness.
Recently an article about people dying due to bad insulin batch and USA has the worst live birth rates of all the civilized and many so call second tier nations.
Today, Trump saying the Kurds did not help with Normandy is what passes for leadership.
1
Not one mention of the bloated "defense" budget. Most going to congressional district payola for over bid contracts on billion dollar planes/ships et al...which are never used, and rarely even finished. Be honest; cut that budget by 1/2 even 1/3 and schools, health care, housing homeless...all become affordable...it's not magic. It's priorities.
Also, tax the corps that make us sick from food, cigarretts, liquor, emissions, toxic skin/bedding/clothing/hair products...don't tax individuals...let the devils pay...Then they will clean up or pay up!
3
Ridiculous. You people already have single-payer health care--but it only covers seniors. It works just fine, it has just been artificially withheld from the rest of the population. But. It. Works. Fine.
If you had medicare for all, like we do here in the civilized world, whatever taxes you had to pay to support it would be offset by the extortionate amounts you would no longer have to pay for private health care.
Just to be clear (because the yammering propaganda of the anti-single-payer cohort is so loud) here in Canada the idea of paying thousands (!) or tens of thousands(!!) of dollars a year for health care is absolutely alien. Just completely nuts. It would almost be like asking someone, "How much is your family spending on oxygen this year?"
The costs you take for granted are unheard of here; or rather, we pay them too, but through taxes to the government rather than directly to private insurers. The difference is that when we actually get sick, our system is designed to provide treatment rather than to excuses to avoid paying for someone's treatment. We actually get what we're paying for. You're paying for what you get, and then some.
2
Hello, this is the rest of the developed world calling to tell you it can and does work if you have the will to put healthcare over profits.
2
Conservatives only have arguments against universal health care....there will be peace on earth before they come up with any real solutions.
2
How is it that the self-proclaimed greatest country in the world can't do what Canada can do?
2
In Aus a Medicare system was bought in about 1973-4 .1.5% tax.go to a doctor pay nothing .private health insurance available if you wish 500 dollars a month for non immediate treatment plus dental & other stuff .People just pay over here because it works
2
Well, if this is the ‘best argument’ against Medicare for All, I guess we are good then, eh?
2
Some time ago I saw this short video that Oprah did while visiting Denmark with President Obama. I think it is worth sharing with others who may have missed it.
It highlights some of the fundamental differences in mentalities, philosophies and approaches to the role of citizens & government between the American and Danish people - those differences that also explain why single payer and all the other social insurances work in Denmark but may never be possible in the US.
This 18 minute video compares the two nations' mentalities on a number of subjects quite well. Those mentalities are what differentiate, not the policies themselves, in my opinion.
https://www.youtube.com/watch?v=eKa-3lbLeyA
I have been on Medicare for many, many years. I think Americans deserve and want choices. Many a time I have had bad issues with Medicare and wished I wasn't locked into to a system with a deadening, unresponsive bureaucracy that at times was inept and unfair.
Medicare serves the needs of the elderly, but financially supports specialists. There are very few M.D.s specializing in geriatrics because Medicare pays them so little. This has been well known for decades, but no movement towards correcting this obvious problem. Treatment of my own Mother was cruelly tunnel visioned during her last 6 months. Her pain was ignored while the Heart Doctors took over. They treated her as though she was 40 with no other conditions. She was 94 with a shattered lower leg, that was not healing.
Medicare in its infinite wisdom, decided I did not need the insulin I must have at the time Obamacare was introduced. The pleas of the staff of my Representative did not good. The people at Medicare seemed to suddenly believe my insulin was an opiate, or something. Without my insulin, I would be dead within a week. The bureacracy was an unmovable stone. I learned how to navigate the new rules, but my independent pharmasist never was paid for 9 months of insulin he sold to me at cost.
When government runs the health care system, there are no checks and balances. We need a vigorous system that curbs the impulses of cost cutting clerks.
120
@Caroline P.
Good luck getting affordable private insurance if you are elderly. Insurance companies don't consider you to be a good risk. I have many friends and family members on Medicare, and they are all very happy with their coverage. I'm sorry your mother's doctors were not more responsive to her pain, but that is not the fault of Medicare. Insurance companies are in business to make a profit - they do better when they deny you coverage. We need Medicare for all.
116
@Caroline P. - I am sorry you had problems, but anecdotes, especially personal anecdotes are not data. The Commonwealth Fund had a large survey in which they questioned people on private insurance plans and another group on Medicare. They found that people had 3 times as many problems with private insurance as with Medicare both in the areas of coverage and payment.
If you want personal anecdotal info, I can tell you I had private insurance for many years. I had problem after problem. For example, they did not want to pay for the birth of my second child because my co-parent would not tell then the name of my daughter's father. I had to go to the NJ Commissioner of Insurance to resolve that one.
I have NEVER had any problem with Medicare in the 16 years I have been on it.
106
@Caroline P. - I'm on Medicare, too.
My old doctor was impossible to reach when I was sick. The wait was scary.
My old insurance company debated every payment, resulting in unexpected bills on a regular basis. The reason: the item wasn't "covered."
Surgeries I needed were considered "electives." Medications which would have made a difference were not included. And the doctors I needed were "not in your plan."
Medicare works. Even if you run into a bureaucrat. Regarding which, unlike private insurers, you can generally go over their head and get something done.
Wow, you've really got it in for the idea people might actually get health care at the expense of whatever your political ideology happens to be.
87
Good morning Times readers. A small amount of background research identifies the Reason Foundation and publication as a libertarian organization. Need I say more.
8
Brilliant.
The reality is that Medicare for All is a pipe dream. It will take the Democratic Party to a massive defeat in 2020. Trump will be president and both Houses of Congress will be in Republican hands.
Medicare for All might be good policy but it is horrible politics. And I doubt it is even good policy.
3
This is total nonsense. Medicare works, doctors are used to it, and simply expanding it to cover more people is very simple. In fact expanding it, and pushing aside the private market that it is currently forced to co-exist beside, will allow Medicare to be even better. And the counter-examples offered here have no relevance to what is being proposed by Sanders, Warren, Harris, etc..
4
Insurance access is not necessary health care access. US insurance model trims 1/3 of the citizens health-care dollar as overhead. Not a good deal for the patient/voter.
After 1980's “managed care” farce insurance companies simply now have a better path to exclude, preexisting conditions, overcharge and deny the patient care. Adding insult to injury some of the money goes to paying people to figure out how to deny claims.
Some where along the path we lost sight of fact that insurance coverage is about shared-risk.
Seems millions citizens/employer paying monthly health insurance premiums there should be sufficient cash to treat all the USA.
Using real-world figures my premium is $420 monthly If all the US population (300,000,000) paid the same $420 that produces $120 Billion monthly or $1.5 Trillion annually. Even at 80% participation that is $1.2 Trillion. We are paying enough ‘insurance‘ to provide first class comprehensive health care for all US citizens.
USA will not have good healthcare until the politicos/rich have the same healthcare as the common citizen.
Again: access to insurance is not access to health care. Currently the US healthcare most expensive worldwide and 35'th inefficacy. We got health related deep-pocket special interest groups paying our politics big bucks to maintain the status quo. See the problem? When US politicians have the same healthcare as the citizen then we all will have good healthcare. Single payer levels the field for everybody.
2
So a single payor system established by Vermont did not work and therefore single payor systems will not work. The war in Vietnam Nam did not work so wars do not work. Two 737 plans crashed therefore 737 planes do not work. Yep i get it.
4
There are other views of why single payer failed in VT. Under pressure from overcautious members of the Democrats' legislative leadership, many of whom opposed single payer from the outset, Shumlin eventually put forward the most regressive possible funding plan after holding back on a funding plan far too long. Several alternative proposals were put forward by single payer advocates, but once Shumlin and the relatively conservative leg. leadership closed ranks, there was no further public discussion of those. Those looking back on this tend to overlook that the leg. actually passed two laws mandating progress toward single payer healthcare; fortunately these are still on the books here.
1
Address healthcare costs and Medicare For All is possible. To that end, identify 6 countries with healthcare outcomes better that the US. Then average the cost for healthcare goods and services, including drugs, in those countries. Those avg. costs then becomes what MFA pays to healthcare goods and services to providers.
Make it illegal for healthcare goods and services costs to include the cost of advertising, lobbying, donations to political Pacs or political campaigns. Hold executives in these industries personally liable for fraudulent billing practices under these laws.
Everyone must participate in MFA — no carve outs. If the wealthy want to pay more for upgraded accommodations, truffle soup, etc. let them, with no tax deductions. If corporations choose to pay for extra insurance coverage for executives, let them, with no tax deductions.
Change lax white-collar criminal laws to ensure anyone who defrauds MFA is not allowed to game the legal system and then become a governor or a US Senator. Eliminate bankruptcy as a way for corporations to avoid paying fines from defrauding MFA. If corporate coffers are empty then executives, board members, and owners can pay the fines. Make the fine hurt, not just a cost of doing business.
Change is possible if politicians are not rewarded for obstruction and the false narratives about MFA being spread by those getting wealthy from a corrupt healthcare system are ended.
6
Thank you for your compelling argument against Medicare for all. I will now have to vote for Joe Biden in the primary instead of Elizabeth Warren.
One difference between a Medicare for all plan and the Vermont plan is that we already have federal Medicare and Medicaid and we know how they function. Expansion is much easier and predictable than creation.
One significant problem with the common criticism of Medicare for all is that the hand wringing over increased costs almost always fails to take into account what employers and employees are currently paying for private health insurance. The salient fact is not how much a single payer plan would cost but how much more it would cost (if anything).
Finally, completely eliminating private insurance may be desirable, but it should not be a condition of a Medicare for all plan. Most, if not all, countries with single payer systems have some form of private insurance as well, and private insurance is involved with Medicare here also, whether through the HMO type Medicare Advantage plans or as supplemental insurance.
2
How is it that our government engages in selective single-payer health insurance (for our military) when it needs volunteers to risk their health and lives to meet national emergencies, and serve only the health needs of our most politically engaged and aware class (our wealthiest, oldest, and political representatives). But for the vast majority of our other citizens, our government leaves our health and lives to chance. No profitable livestock farmer would want to insure the health and the lives of only a fraction of his animals. A superpower cannot long remain a superpower without insuring that a majority of our people are healthier than any adversary’s.
2
If this is the strongest argument against Medicare-for-All then it is also the strongest argument that we live in a dysfunctional and collapsing crony capitalist republic utterly incapable of eliminating widespread corruption. It shows we have failed as a nation to accomplish what most other nations have already accomplished on behalf of their people.
I'm an old man who has been on Medicare for some time. I also have had employer-based private insurance through my spouse's job. Several years ago I had a triple cardiac bypass. The total bill for that surgery and related expenses was approximately $76,000.
With my employer-based insurance as my primary coverage I expected it would pay for most of that $76,000 and Medicare would pick up the rest. But when the bills and payment statements arrived, I saw that my private insurer had been able to pass the entire cost on to Medicare due to “arrangements” with the hospital. So the hundreds of dollars we paid each month for our employer-based medical insurance was apparently purely profit for the insurance company!
Now if Medicare is ultimately paying all of the medical bills of seniors with private insurance, then America already is halfway to Medicare-for-All.
So let's expand Medicare to cover everyone and save by eliminating private medical insurance. Let's negotiate as a nation for better prices from medical suppliers. Let's tax corporations at rates of 50 years ago and invest more in the health and well-being of all.
8
Somehow, much of the rest of the developed countries manage to get this done. A decision to decrease the military budged by the amount needed to fund health care for US citizens would not increase taxes.
2
If this is the strongest argument against Medicare-for-All then it is also the strongest argument that we live in a dysfunctional and collapsing crony capitalist republic utterly incapable of eliminating widespread corruption. It shows we have failed as a nation to accomplish what most other nations have already accomplished on behalf of their people.
I'm an old man who has been on Medicare for some time. I also have had employer-based private insurance through my spouse's job. Several years ago I had a triple cardiac bypass. The total bill for that surgery and related expenses was approximately $76,000.
With my employer-based insurance as my primary coverage I expected it would pay for most of that $76,000 and Medicare would pick up the rest. But when the bills and payment statements arrived, I saw that my private insurer had been able to pass the entire cost on to Medicare due to “arrangements” with the hospital. So the hundreds of dollars we paid each month for our employer-based medical insurance was apparently purely profit for the insurance company!
Now if Medicare is ultimately paying all our medical bills, then America already has Medicare-for-All.
So let's save ourselves a bundle by eliminating private medical insurance and negotiating as a nation for better prices from medical suppliers. And let's tax corporations at the rates which were law 50 years ago and invest more in medical research and in the health and well-being of all.
8
"Medicare for All" is nice shorthand for single payer, and it's become a popular term for single payer's supporters to use because generally Medicare is popular and people generally understand what it is.
That said, there's a downside to using the term. A good single payer system would offer higher levels of reimbursement to health providers. It also would not have the varies copayments required by Medicare. And it would likely cover more things.
What's happening now is that we are having an argument over Medicare—its strengths and weaknesses—rather than arguing for a single payer system that should be better designed than Medicare and not merely the current Medicare program expanded to include more people.
1
Mr. Suderman claims that "instead of showing us how it would work, it showed us why it would fail" but if it showed us failure, the real question is WHY did it fail? Did it fail for the reasons given by the author, or were there other factors at work?
I don't agree with his reasoning. Americans see ourselves as a nation of "individual rights" holders, to the exclusion of communal responsibilities. Hence the appeal of states' rights, with far less sense of shared identity or shared personal investment than is found in countries where the entire country shoulders the same burdens and benefits from the same successes from end to end.
In America, we don't think our neighbors work as hard as we do, we judge those with pre-existing conditions as people who have led "bad lives"; other medieval beliefs flourish among us as well. The point is, we don't let ourselves have health care, greater educational access, improved living conditions, enhanced civil rights, more equitable wealth distribution, etc. because we judge each other and find our fellow citizens wanting...modern day puritanism...and, so the belief goes, who wants to pay for "those" people? So we bite off our individual noses to spite our communal face.
6
A huge problem with Medicare for all in the US is that here we have a Republican party devoted to reducing government assistance and efficacy which may, in the future, be in charge of the funding, eligibility, and coverage rules of any government program.
3
While consructing a government run health care is not easy it can be done. The solution is a genuine public will to support such advances by all stakeholders including physicians to receive a little less money in order to get the system up and running. And it can in general flourish more easily by smaller entities moving forward initially. It can be done!
1
So are you suggesting Medicare is a failure? The program that provides most healthcare (not complete I grant you) to seniors at a much lower overhead cost? Are you suggesting that in order to be acceptable, it has to be popular before it can be implemented. The ACA , as imperfect as it is, was unpopular when implemented. Not so much anymore. And for DECADES, DECADES Republicans have been debasing each and every Democratic health care plan with NO alternative proposal. The problem here, plain and simple, is Republicans want the free, profit based, market to rule the day. And the private sector system is viewed as being so much less onerous than the government. I just love all the red tape and paperwork and co pays and deductibles and in network and out of network and TV ads for expensive drugs and so on. I don't know what I would do without it. Oh and the improved outcomes compared to all other developed countries. Makes me so proud. Stop painting a doom and gloom picture and give us a health care system that works and that is far less difficult to navigate. And as to needing public approval before anything can be done, look at gun control. The public is OVERWHELMINGLY in favor of background checks and limits on assault weapons and that gets us exactly where Mr. Suderman?
5
I was the first to post on this article and there were a large number of questions and responses. But not one of those posts mentioned the serious problem that I wrote about regarding Medicare's role in discouraging M.D.'s from taking up Geriatrics. During the last year of life, this situation is cruel and generates enormous waste for our taxpayer dollars. This has been known for decades. Medicare is directly responsible for the low payment to Doctors who specialize in the care of the elderly. It is a scandal-----
As a former resident of Vermont, I would say characterizing it as a 'deep Blue state' is misleading. The combination of financially comfortable liberals and old New England libertarians, and the relative absence of race problems or large concentrations of visible poverty, make it seem like a liberal state at the ballot box. But at least half the population is highly averse to higher taxes and the things that that might buy -- better education and health care for all.
4
You know what? If Elizabeth Warren championed Medicare for all, it would be edgey and "out there" and it would not go over well with the public at first. But, just because she did it, and got the public used to the idea, a few years later, the same idea will seem far less radical.
If you think something is the right thing, just go for it. Politicians are too conservative and cautious about that kind of thing these days. There is such a thing as leading which means getting out in front of the people and expecting them to follow and eventually catch up.
Rather than being this super cautious politician who keeps following the polls and is always ready to decree this and that "politically impossible."
3
Universal health care for all will not work until the costs are brought down.
Costs come down when there is an adequate level of competition.
For there to be an adequate level of competition there has to be an open and free market.
MRIs cost between $2500 and $ 2700 in the USA.
MRIs in Canada cost $1000 or less.
In Mexico an MRI costs less than $500.
Get it?
1
Single payer creates a monopsony so the price is what the payer agrees to pay, just like Medicare. Get it?
4
Canada has the system that you say won't work and also pays less for an MRI? It sounds like you undercut your own argument.
Sanders & Co. loves to use Scandinavia as their model but fail to mention that there are severe shortages in doctors and many hospitals are run down with antiquated equipment.
Those who can afford it, either go to the U.S. for serious medical treatment or pay for private coverage (in those Nordic countries that still have it). Moreover, Scandinavian collective population is less than Texas's.
Is that really the model we want to emulate?
3
The failure of VT adopting a single payer system merely shows that most states lack the resources to enact it by themselves. This is where the national government needs to intervene.
3
All other health plans have failed. I don't see how following failure after failure will help repair health care.
1
The thing that always confuses me when I read these articles that tell you that something can't be done is if the American broken system of health care is so good why isn't the rest of the world clamoring to have their health care system replaced with the American model.
14
As a US citizen living in Bremen, Germany, it works and has been working for many decades. And there is less wait time than in the US.
14
The reason VT failed in this effort is because the population is small and old. Period. That is why it needs to be done nationwide like a Medicare For All plan. Then, you have enough young healthy people in the pool to balance things out. Why is it pretty much every other country on Earth has figured out a way to provide healthcare to everyone and the country that put a man on the moon can't? I have a "Cadillac" insurance plan and I'd happily trade it in for a Medicare For All. It would be worth it just to be rid of the aggravation of dealing with the insurance companies, being able to go to any doctor I choose and not have to worry if my doctors are still in my network every year. And once employers are freed from paying healthcare expenses, they can expand, hire more people, raise salaries, etc. This is a no-brainer folks.
7
The author is presenting the Libertarian view of health care insurance. This means that underneath it all, they believe that unfettered corporatism is always the best solution. This can easily be refuted.
We should never conflate unfettered corporatism with arms-length competition on a level playing field of a free market, but, more importantly, there are substantial elements of healthcare delivery which cannot even be served by a free market — emergency services and pay-it-forward investments such as chronic disease early detection, monitoring and control.
No for-profit corporation is going to invest in you today for your improved health decades in the future. In fact they may not be interested in your improved health or reduced medical cost at all, but rather growing their profits by increasing your cost, even if that means you end up less healthy or less able to pay.
The Libertarian model fails when corporations have a regional monopoly as do health care insurers in most states. It also fails in emergency and pay-it-forward situations. Finally, it also fails where government regulation is required to protect public health.
In Vermont’s case, is anyone surprised that the healthcare lobby through advertising and contributions to legislator’s campaigns was able to block passage?
7
Please explain how EVERY OTHER country in the developed world provides universal coverage.
Vermont's situation, with only 640,000 residents, is quite atypical.
8
I just retired from a blue chip company with a strong health care care plan. I'm now on a Medicare Advantage plan - my total cost for this program is $5880. My max out of pocket is $4000. I kept all my doctors.
And this cost includes my wife!
5
It’s interesting how the case against single-payer health care rests on the fear of draconian tax increases.
It is insanely hard for businesses of all sizes to provide benefits. The employer-paid premiums are, well, draconian, and getting worse by the year. The opportunity cost to businesses is high too: executives are forced to waste time scrambling to craft plans that keep employees happy and don’t bankrupt companies. Imagine what businesses could do with that time and money if they could leave the benefits-management scramble behind.
It’s also hard for employees to access benefits. Copays, deductibles, and premiums cost more every year. And sorting out how to use various healthcare savings accounts (HSAs) to defray those costs can fray the patience of anybody.
The case against single payer rests partly on distrust. Employees think their employers will take the money and run if they no longer must pay for those benefits. We all suspect somebody else will get more than their fair share of care ; I’ll be stuck with the tax bill for that hard drinking pack-a-day smoker next door.
Yes of course, single payer requires tax increases. Maybe all taxation is theft in the world of Grover Norquist and Paul Ryan. But if that’s true, the costs of the present system are also theft: they steal time and money from all of us fortunate enough to hold jobs with benefits.
Who gets hurt with single-payer? Benefits managers, insurance companies. They are the thieves.
5
So we should accept the present system that is financially untenable and produces poorer outcomes?
5
It is fallacious to compare a Medicare for All system proposed by a small state to one financed by the federal government. The main reason that no state has established universal health care is that states, inherently, are incapable of raising that much money. The federal government, on the other hand, can (and does) raise and spend almost unlimited amounts of money on whatever it wants. Not to mention that the federal government alone can create the conditions necessary for such a system to prosper -- for example, by becoming a virtual monopsony consumer of health services and forcing prices downward. If other, smaller and poorer, countries can create excellent systems of universal health care, so can we. America is not that exceptional.
4
Study Europe, not Vermont. And if you don't like the European models, look at Singapore, South Korea and Japan. Single payer or other systems predicated on the premise that all citizens participate (i.e. spread the risk across an entire population) work for a whole host of good reasons that the good journalists of the NY Times should be writing about. The reasons cited in this opinion piece point to a poorly conceived plan and roll-out not a justification for not putting a comprehensive, universal health care system in place.
7
In 2015, I had a reverse shoulder replacement. The surgeon's usual fee was $16,500. Medicare (and my supplemental insurance) paid the doctor $1,755.
Do you need any other reason as to why Medicare for all is a disaster. I WANT my physicians to be adequately compensated just like every other American worker. Prior to my surgery, I told the surgeon that I would make a contribution to the hospital for his research which I did.
If we are going to be a Capitalist nation where hard work and excellence is rewarded then single payer system cannot be successful.Should every American have health insurance? Absolutely! But we need a system that is fair to everyone, patient and doctor.
1
@Gerald In the rest of the developed world, doctors are well-off: they are not rich.
Meanwhile, the US has fewer doctors per head than the OECD average, and their outcomes in all three key indictators (life expectancy, infant mortality, maternal mortality) are the worst in the developed world.
Gerard, you've been had.
4
Mr. Suderman, your conclusion basically says, "oh well, it failed once so it'll fail again, nothing we can do." This is specious at best, dishonest at worst.
Every other developed nation on the planet has figured this out; it can't be something that will automatically "fail" just because Americans don't like certain words. Throwing the word "tax" around (which you know people don't like) while glossing over the more important, and more truthful, metric of cost is disingenuous. Who cares if the tax increases...IF the overall cost paid goes down?
But the issue of "rising" taxes is a red herring; what working, as you are, to ensure that "Medicare for All" fails does is, it keeps medical care tied to employment. While that does less for the health and freedom of the employee, it does more for the employer by maintaining their position of power over their employees - the power to hold those employee's health over their heads...the so-called "free market" at work, putting profits over people as only America capitalism has mastered.
5
Excellent outline of the results in Vermont of the Bernie led effort to move to a state based single payer system.
It really is too bad that Americans are OK with budget busting expenditures for "defense", for huge tax cuts for the wealthy, for completely unnecessary and destabilizing wars, for crony funded infrastructure building in countries where those wars are ongoing while ignoring our own infrastructure.
We are all OK with those sad items breaking out Nations financial back,
But, bringing all the war machines home, raising taxes a little on everyone, to support reasonable health care for all?
Forget it. Can't do it.
I get it.
7
This opinion assumes no one learns from mistakes. Warren is not like Trump. She will not charge ahead without considering what is likely to work.
1
This is truly bizarre (so typical for conservative policy). We have a failed health care system now. The writer examines the failures of one state's attempt to do a single payor plan and notes poor outreach, website problems and compromises in design of the law that produced fewer savings than expected, so... the solution is to not try harder, using what we learned!
In the history of the advance of technology, we advanced by trial and error, so wooden plank roads failed, but canals succeeded till railroads came along. So let's use what we learned - not give up and stay where we are, which is nowhere.
9
So instead of paying increased taxes, we will continue to pay increased premiums, increased deductibles and increased copays. Insurance companies and hospitals will continue to spend on glossy advertising instead of patient care and will continue to hound people with debt collectors for any unpaid bill. Hospital and insurance company CEOs will continue to make six figure salaries. Americans will continue to get poorer health outcomes at higher cost than in any other developed country. Oh, and that's just those of us fortunate enough to have health insurance. The uninsured will have to continue with their plan, which consists of praying no one gets sick.
5
I think your set of facts shows that costs are not an obstacle, they're an excuse. So, if the costs are not prohibitive, what are the real obstacles?
1
First off. I understand that it cost more than expected. HOWEVER, everyone was covered, instead of just some people. If I only had to pay 11k per year I would rejoice! Right now I have to work through a 6k deductible and pay premiums before my insurance pays anything! Plus I still pay co-pays. Based on this article it seems to me that Vermont was on the right track.
3
Medicare for All is a bridge too far for the United States. We cannot completely throw the current system overboard without huge disruptions that people and businesses won't tolerate. Lobbying against it will be ferocious and full of lies. People will be scared.
There is much improvement that we can achieve in our system by re-instating and improving on the ACA. One of the main faults of the original ACA can be remedied by increasing the subsidies and extending them to higher income levels.
Then we need to focus on controlling health care costs.
The current price for decent health insurance in the United States is $20,000 per year. That is what Americans are paying on average for employer provided health insurance. Employees pay about $14,000 and employers pay the rest. All of this money essentially comes out of the pocket of the worker. So we are already paying too much. Eventually people will be educated. It will take time. Meanwhile, make things better incrementally.
2
Raising my taxes for people who don't go to the gym, who smoke and/or drink and do not eat healthy and live sedentary lifestyles isn't fair to me or mine.
Raising my taxes for someone else to not have to work and spend their own money for healthcare is not fair either.
It is not my job to support you or to make your life better, that's your job.
2
@Randy L. -- Except , of course, those things that help you would be exempt.
@Randy L. You've spent your entire life paying twice as much for healthcare as you should.
Instead of raging against your fellow citizens, why aren't you angry at the heartless thieves in US healthcare?
Raising my taxes for people who don't go to the gym, who smoke and/or drink and do not eat healthy and live sedentary lifestyles isn't fair to me or mine.
Raising my taxes for someone else to not have to work and spend their own money for healthcare is not fair either.
It is not my job to support you or to make your life better, that's your job.
3
Being a physician I have dealt with insurance companies personally to get coverage for patients as well as being a utilization reviewer for 2 hospitals, dealing with denials and retroreviews. There is a way to do this.
First allow employees to keep their insurance and sign up regardless of age for Medicare as a secondary insurance . Second, allow people to sign up for Medicare and get Medigap and get Part D (prescription coverage) regardless of age if they do not like their employer insurance or have none. Third, allow people to sign up for Medicare Advantage plan( Medicare HMO run by an insurance company). You will need to keep Medicaid since it covers things like nursing homes and services for certain populations.
Thus the insurance companies stay in business and everyone has a choice . This is not a radical transition and is already being done for seniors. States can give people in the gray zone coupons to pay for Medicare advantage and lower their Medicaid population.
Sanders, Warren and Harris- wake up and read this !
5
@adonovzn
Yes! Several Dem candidates propose strengthening the ACA and as well as adopting Medicare for those who want it: Buttigieg, Bennet, Bullock, Klobuchar. Universal coverage should be the goal. In the current political climate MFA is a pipe dream. The Trump administration is still trying to dismantle the ACA, and they may succeed. Anyone with a preexisting condition is extremely vulnerable.
This is NOT an argument against Medicare for All. This is an explanation as to why it will be very difficult for anyone to implement Medicare for All, regardless of whether it is the best solution.
Two very different things.
1
Let's keep in mind that the federal government does not do many things well. There is a model for federal control of health care, and it's called the Veterans Administration. Does anyone want to argue that the VA has ever been well managed?
Let's try another federal government healthcare system, called Medicaid. Does anyone want to argue that this system is well-managed? Non-citizens in the U.S. are allowed to enroll in Medicaid when seeking medical care, so this system has some pretty big holes also.
Given the inability of the U.S. government to manage small scale programs, why on earth should anyone think a Medicare for All system will work?
1
David simply by declaring something does not make it so. Can anyone argue that war is not managed well? Let’s privatize war (more mercenaries) on the Bush model. Can anyone argue that our roads are congested and therefore not managed well? Let’s privatize roads like the model Florida is now using. Want to go anywhere, pay a toll. Disney World? I think health insurance should be modeled more closely to life insurance. More closely is the operative phrase.
Let’s keep i mind that private enterprise does not do much well. And always tends to the extreme. Monopolies are not good for America. Robber Barrons got their name for a reason. Mercenaries wound up running the Iraq war and that did not end well. A mix might be a better way if established correctly. Private enterprise was always established by public enterprise. Witness the space program.
What this column points out is that the health care challenge is systemic one. The "system" however is not just economic. It involves the expectations we have for care, the lifestyles we want to pursue, the limits of our commitment to common good, and the trade-offs we are willing or not willing to make. This is like many sound-bite policy proposals such as the Trump Tax cuts that can get spun in theory, but in the end fall prey to reality. Unfortunately and to the GOP's lasting disgrace, the Trump Tax cuts have been implemented.
This sounds like a badly managed plan:
- the fact that the lawmakers were deliberately vague about how to pay for it suggest that they didn't believe themselves that they had something that the people would accept.
- one of the basics of project management is limiting the scope. By allowing lobbies to expand the project it lost its focus. The initial proposal should be well considered and make it very hard to make changes that are not really needed.
- in this context it looks like the plan was launched too soon. More behind the screen negotiations should have been done.
- trade unions, employers and people working in the medical sector should be involved in the preparation of the proposal. In the article they are mysteriously absent.
@Wim Roffel - - I think those experienced adults - even liberals in Vermont - knew very well that trusting government with such an important job is wildly careless and outright dangerous.
Look at the health care provided by the federal government to veterans. What you see is a gigantic bureaucracy and many soldiers needlessly waiting or dead on a waiting list.
Our experience with Medicare is that the federal gov't never has had the first clue of how much a program will cost.
Trust the Founders. they gave us a list of what to have the federal gov't do.
Sure, if we keep everything as is, Medicare for all will fail. We need good enough hospitals, good enough salaries for medical workers, good enough testing. We won't need the medical insurance industry. Given all this, we'll have to accept the fact that we won't be able to get all the unnecessary testing we get done as patients, and we won't be able to have unnecessary procedures that the very elderly now often get. Doctors will have to accept the fact that many of their salaries will be lower, pharmaceutical companies will have much lower profits, hospitals will no longer look like luxury hotels with private suites, and the medical insurance field will be wiped out. Good. We either make the change now and accept the fact that our medical experiences will be different or continue as we do now and slowly lose our ability to even get the medical care we need. It all boils down to money in the U.S. even when our very lives are at stake.
4
This is a weak argument against a moral imperative—with a ridiculous headline. Medicare for all will require more financial input. Consider that an insurance policy against people going bankrupt for getting sick, or falling, or being in an accident. If the rest of the world can do it, so can we.
Congress must give up its automatic health care for life, so that legislators can feel the drawbacks in their constituents’ health care options, if those options even exist, we will have health care advocates.
Businesses fight Medicare for all because they want their employees to be dependent and desperate. Insurance companies fear losing their high salaries. This is an issue that will not go away. Please publish an apples-to-apples article, instead of a vapid argument where the state couldn’t compete because the money wasn’t there. Which is more important, some CEO’s 20 million dollar salary, or the rest of America’s peace of mind?
5
A single-payer medicare system for all has never been singular, but has involved multiple-payers to multi-providers. And that is its problem. If Vermont’s Green Mountain Care health insurance had been only for one payer to one provider service it would not have been faced with how to pay for multiple-payer increases. Each area of treatment’s cost increases can wreck a single-payer plan with enormous rises in cost. For as soon as government or private insurers increase how much they pay for health costs, providers immediately raise their out-of-pocket prices for consumer/patients. Look at dental insurance. Look at the single-payer cost rises of health care for our military, active and veterans.
Vermont ought to have started with reducing cost for one provider service such as medical treatment. It could have controlled the costs there by offering free medical education to nurses, general practitioners, and medical specialists for salaried positions providing care for a period after training. When the state had control over costs of medical care it ought to have turned to the costs of pharmaceuticals, equipment and long-term care. A single-payer one-size fits all is too much to accomplish in one swell-swoop for a nation, or nation’s military, much less for a small population-state like Vermont. There are multiple industries serving our health needs, an elephant size problem. But the way to eat an elephant, as a Zulu proverb goes, is in small bites.
With a tiny population of just over 600,000, a high percentage of older residents already on Medicare and one of the smaller economies in the United States, Vermont was the wrong place to experiment with single payer insurance, and the author is wrong to use it as proof medicare for all can't work on a national scale.
7
Libertarians just leave me shaking my head. Protecting the greed profit center at all costs? So Vermont made an attempt in 2011? There has been a lot learned since then and a majority of citizens now back a universal healthcare solution. Many businesses do now as well, once they realize they wouldn't have to go through the arduous process of changing Healthcare plans annually and cut cut back their HR departments with a cost savings. Open Medicare to all with part c & d included as a pay option. Insurers still get a piece of the action and CMS maintains control.
4
Let’s discuss the failures of capitalism and healthcare for profit un hinged. CEOs who take home hundreds of millions in salary and other compensation. Bankruptcy due to medical bills that cannot possibility be paid because the costs of the procedures given were priced to make profits and not deliver positive healthcare outcomes to the patient who is paying for them. The big squeeze for those who have employer based healthcare like me. Every year the costs shifts so that I pay more and receive less. Surprise bills from emergency room visits. Insurance companies denying coverage for items that should be covered so that every bill becomes a negotiation or out of frustration the patient just pays it (it they can). Not taking a full dose of your prescribed medicine because the costs of the prescription is way over priced. The stress caused by uncertainty of continued healthcare into the future since most healthcare in this country is employer provided. Lose your job and you are offered Cobra which is ridiculously priced and then go uninsured or buying one of the junk high deductibles plan which makes you feel good as long as you never need to use it. When I’ve talked with people in other countries which have reasonable healthcare options or plain national health this comments I get are positive to the systems those people have and the horror about the idea of having the American system of healthcare come to their countries. I want NHS in USA.
6
none of these costs seem unreasonable if you factor in what insurance normally costs. And the other problems -- political pushback from lobbyists and other hurdles -- are not with the plan itself, merely hurdles to its implementation.
If there are good arguments against Medicare-for-all -- and I'm sure there must be some -- this article certainly does not mention them.
2
What would work? Increase supply of health care: stop protecting higher-priced providers from competition by lower-priced ones. I've taken stitches out of myself by myself. I think my sister got an insurance company to pay her to have a baby at home rather than in hospital.
And reduce demand: medical savings accounts would let us keep what we don't spend, giving us an incentive not to spend unless we have to. (Insurance lets us spend other peoples' money, giving us an incentive to be ill.)
Health, health care, and health finances are individual; how can one-size-fits-all work for 300+ million Americans? Apply the 9th and 10th amendments!
Thank you for your thoughts about Vermont: population 636,200. Please now explain 32 out of 33 developed countries: population ~1,000,000,000.
Or I'll explain it: price regulation. As a fanatical free marketeer, you should know that a free market only works where the buyer and seller have equal power, notably the power to walk away. In healthcare, the seller has all the power and the buyer is worried, hurried and uninformed. That's why insulin costs around $360 a month in the US but $70 in Japan and $65 in the UK. (Except that in the UK, Japan, and every other developed country, the individual doesn't pay.)
America regulates the price of electricity distribution. If it did so with healthcare, universal coverage would be easy.
11
I will tell you what Medicare for all would do: same thing as in Canada and Great Britain for instance: delays and delays. Plus high income taxes. Not even sure you will have a doctor.
I know, I was on a waiting list for one for 10 years. Then you will be on a waiting list for years for certain tests. So what so you do: you pay out of pocket for private tests.
The US wouldn’t have enough doctors to cover all the needs for all, as care would be free, there would be more and more visits for medical needs, even the most minor ones. On top of that, the government would pay less to doctors.
Consequently, you would get a two tier system, one for the rich and one for the rest. Again less doctors for the average person. Nobody thinks the government would jail doctors that refuse to participate in public care. I know, as in Canada, some doctors work in the public system a few days a week, and in private practice the rest of the week.
4
@Danielle Davidson
"I know, I was on a waiting list for one for 10 years. "
Many medical conditions can wait or need no treatment at all. Blank criticism of long wait in Canada is unfair.
@Danielle Davidson
"I know, I was on a waiting list for one for 10 years."
You waited 10 years to get a doctor? Where? The Amazon jungle? Sorry, I find that impossible to believe.
"Then you will be on a waiting list for years for certain tests"
Survey after survey has shown that the US has worse waiting times than many of its peer countries. And around 30 million Americans have no healthcare coverage at all except the ER.
"So what so you do: you pay out of pocket for private tests."
The vast majority of Europeans (for example) don't bother with private medicine or with private health insurance, which "accounts for less than 10% of total health expenditure in every member state except France (12.8%) and Slovenia (13.1%) and for under 5% in two-thirds of member states."
http://ec.europa.eu/social/main.jsp
1
And yet, amazingly, ever other developed country in the world has managed to do this.
2
@SbW Yes, with the same results described above by Danielle Davidson. Ireland is a two tiered system. If you do not buy private health insurance, you could wait years for any surgery or procedure that is not any emergency. (Think car accident) You must look at each country to evaluate that country's medical care scheme. They are not all equivalent. By the way, to emigrate to Canada, the emigrant must not have any preexisting conditions. And if a person is over 47, that person loses points and may not have enough points to emigrate there. It would be a lesson to read all the rules, that convey points, involved in moving to Canada.
3
A few weeks ago the NYT published an article showing the budgets of three American families. I was curious to see how the budgets compared to our family budget here in Europe. We do pay more in taxes, but we have no additional health care costs (also no daycare costs and no pension payments, although we choose to pay into a private pension account as well) and in the end we have more money to spend on other things than the Utah family, although our incomes are similar. We also have no stress about unexpected health care costs and no worries about changing jobs or temporary unemployment because our health care continues no matter what.
13
@Ilona Thank you for this comparison & valuable perspective -- great antidote for this highly deceptive article attempting to protect corporate profits at the expense of a healthier society and better quality of life for everyone.
4
Enacting a single-payer system in a single state is foolhardy. A single state has to work with Medicare, Medicaid, Obamacare, the Veterans Administration, dozens of national private health insurers, and nearby state government to make it work. (For example, how do you organize a system when people live in Vermont and work in New Hampshire, New York or Massachusetts or vice versa).
The tax costs mentioned in this article do not figure in the taxes already paid for Medicare, Medicaid and Obamacare and the reduction in wages due to the high cost of employee-sponsored health insurance.
However, a single-financing system - somewhat like Obamacare or Medicare Part C - in which everyone in America receives a risk-adjusted voucher to purchase insurance in a regulated market - would work quite well. See the Netherlands, Germany, Israel and other nations for examples that work.
3
Those who support of Medicare-for-All or other single-payer health care system are right that it would be a better, more equitable system than what we currently have; however, it is impractical to create a complete single payer system without first experimenting with a prototype in the form of a public option addition to Obamacare. Democrats should commit making Obamacare stronger with addition of a public option if they win the White House and Senate in 2020 and retain the House. The public option should not be limited to people who don't have health insurance, but should allow private employers to offer the public option to their employees as an alternative to the higher copays and deductibles of private insurance. If the public option proved successful over time (as it should if well-managed), then the private health care insurance industry would atrophy as more and more people became convinced that the public option was superior to private health insurance. Instead, some in the Democratic Party are willing to risk reelecting Donald Trump and a Republican Senate because they underestimate how hard people will fight to hold onto their private health insurance. In other words, Democrats will frighten many voters away if they insist upon scraping private health care insurance in favor of a new, untested, government-run system. Besides, Trump is doing so much damage to the nation that health care may not be the single highest priority for the Democrats or the average voter.
2
So reason me this Mr. Suderman. Why is it that in every developed country in the world (including Canada our next door neighbor) single payer systems deliver health care to all citizens with better outcomes at lower cost? How does that happen? Is it magic?
9
I think one thing you are missing is that "distrust of government and lack of political support" are often the result of people mistakenly (or in the case of those with an interest in the status quo, intentionally) misrepresenting Medicare of all as "government-run health care". It should be more accurately called government-provided insurance or government-covered health care of taxpayer covered health care. The point is, it's not about doctors and nurses who work for the government dispensing health care. Rather, it's about public insurance instead of private insurance. If the idea is properly described, I imagine that distrust and lack of support goes down by a significant margin.
3
Obviously, this Op-Ed piece presents a logical and thorough assessment. But the so-called Sanders proposal doesn’t warrant it because it’s not really a proposal. Rather, it’s a campaign slogan that uses a whole lot of bogus claims designed to con well-meaning people in order to get campaign contributions and try to win votes.
1
The Vermont example really bears little relationship to how a properly structured system would work. Single payer may worker better at the state level where the more prospeous blue states are not carrying the less wealthy red states.
Also GOP gov'ts impose rules on the provision of public services which make those programs next to useless in daily practice.
The bigger economic fact is that the US spends nearly twice as much money per person as Canada does with poorer overall outcomes for most Americans.
5
Universal health care in Canada is such a failure. Just look at Canada's lower infant mortality rate and higher life expectancy. Canadians' health care is not linked to employment, so changing jobs or moving is not a crisis. And no one goes bankrupt or loses their home because of illness.
9
You are correct that “the first problem for any single-payer push would be political support.” True, as long as insurance and pharmaceutical companies pour millions (billions) into advertising and lobbying to fight any sensible approach to health care, the political waters will always be muddied.
As a 70 year old, I’ve seen the burden of paying for health care shift more and more to the middle class. When I was young, every place I worked at provided health insurance with few deductibles, no co-pays, and no employee pay-in. In the 2000s until I retired, the increased cost of insurance more than offset any raises I received, which meant my standard of living wasn’t going up no matter how hard I toiled. Meanwhile, I had fewer and fewer choices.
(Can you keep your doctor? is a bogus question when you are penned in by one or two options.)
When I was 67, I dumped my company’s insurance for Medicare with a supplemental plan. It was cheaper while covering more, and I saw how it had worked for my parents.
A recent WSJ column quoted an insurance exec as saying the odds were 10,000-1 against Medicare For All from becoming law. Sadly, it’s probably true, and Warren, Sanders and Harris know it.
But it’s time for America to aim higher. Maybe then we will get a health-care system that works for all the people.. Columns like yours just do work of anti-change insurance companies. Instead, use your platform to offer real ideas to solve the problem.
9
Those Europeans must really be geniuses.
They have single-payer systems that
1) cost little more than half of what the US spends
2) deliver far better medical outcomes
Perhaps Mr. Suderman could investigate how it works there, and why it won’t work here. Yes, its easy to criticize Vermont’s failure on this score. But its far more useful to figure out how other countries make it work.
9
the economic reality of a national health care system as opposed to the present one in the US is fairly clear: you either change it or go broke.
1
In Medicare For All" the taxpayers pay for the system. In Corporate healthcare the employers /employee pay for the system. The millions who cannot pay at all get their care in the Emergency Room --- lot more expensive, delayed care and no preventive care. Who pays for them? The insured!
MFA is cheaper because it gets rid of the "Middle Men" who skim off billions.
The experience of the rest of the Industrial democracies repudiates the naysayers. The members of Congress enjoy a system similar to Medicare For all. It would be interesting if any of them would reject this "government" healthcare.
This same drama played out when 'Medicare for the Elderly' was introduced. Half a century later it cannot be abolished by any politician. Those who say that MFA is Communist should know that Prussia (Germany)'s Chancellor von Bismarck introduced it in the late 19th Century! Since then,
in slightly different forms, it is the norm in the First World!
2
Mr Suderman rolls out the usual 'libertarian' and Randian talking points, mumbles vaguely about funding, and concludes that single payer won't work. The real reason being that in Vermont, they didn't go far enough to fund it.
Pretty much to be expected from a guy who pushes the 'free market' lie every chance he gets.
6
This failure has a number lessons to be learned. Perhaps the most important is that the cost of medical care in the US is far too high while the overall efficacy is way too low. We pay far more for far less than most other industrial countries. You can debate why this is, but until the science is done to give direction to the solution, it is far too early to begin legislation.
Far better to offer a national health care plan that competes with private insurance, the public option.
2
Another libertarian whose critique is really based on his religious faith in market economics. As far back as 1962, Kenneth Arrow explained why medical care cannot obey these simplistic models. Defenders of market-based medical financing point to well-defined procedures like Lasik whose outcomes are qucikly and easily assessed. In those few cases,p price comparisons and quality measurements are possible, and competition has reduced prices.
However, most of healthcare and medicine doesn't look anything like that. In fact, a system of "insurance" policies that annually reset is an absurd way to finance medical care since everyone (should they be so lucky) gets old and eventually dies. A truly consistent market based approach would, among other things, have to eliminate EMTALA, the provision that requires ERs to accept all comers. It would also have to deal with the inelastic demand for life -- perhaps by convincing people that their medical debts will follow them into the afterlife. The satisfaction often expressed by those holding employer provided insurance just shows how good the insurance biz's game of 3 card monte is -- the rubes love their low copays, but don't realized that the costs are utlimately coming out of their salaries. Virtually no one can possible make rational normative decisions about insurance because, unlike the insurance companies, the individual can't see prices or the big picture. The Casino always wins. Suderman's critique is shallow.
4
Insurance is "privatized socialism." In exchange for a shared burden insurance companies make profits. This should appall us, but we have been trained to sit, roll over, and take whatever food is put in our bowl. Woof.
Quote is my own.
3
Oh Well, I guess Vermont and America by inference cannot do what EVERY other developed Nation as well as many middle income Nations can do , are doing and in some cases have been doing for decades...better, cheaper and with greater coverage of all their citizens.
You would think that as the 3rd decade of the 21st century approaches that all Americans would , like many western Nations have taken for granted a Health Care System that covers all its citizens Health Care needs for a reasonable/affordable cost as well as also having other societal givens (and they are givens almost everywhere and have been for years) such as Paid Maternity Leave , Paid Sick Leave, Subsidised Child Care and a minimum 4 weeks paid leave.
Not to mention nobody ever going broke because of medical Bills as well as crazy inflated prices for prescription drugs.
All of these things are standard societal givens and have been for years in at least the top 20 Western Nations and are standard (in different degrees in many others)
The Richest Nation of them all however, is yet to be on the starting block for many of these things. And all the arguments you hear of why they cannot work be afforded or not possible are specious and frankly baloney.
But you are a Nation with almost the highest levels of inequality in the world with poverty levels higher than any developed rich nation should have and yet as the richest of all, have the most.
You CAN afford these things.
And deserve them as much as anybody.
6
Actually, I think it could work better at the national level than in a small state like VT. Now, if CA tried it and failed I'd say your argument holds water. Think about the logic of how insurance works in terms of spreading the risk around - the larger the pool, the easier it gets. This is why the ACA was a success ON AVERAGE. If the Republicans hadn't fought it tooth and nail, it'd be better.
That said, I think the best way to "try" this out is via a public option. Let people opt into the existing Medicare with funds dispersed accordingly depending on their income and current insurance.
I think healthcare also needs to be reformed but that's another issue. This is about how we pay for healthcare. What healthcare costs and should cost is a separate discussion. The two things are being mixed up here.
2
Extra costs to cover out of state workers would not be an issue for a nation-wide program. I think the burden is on the author to describe in what sense our current healthcare system could be described as “working” by first-world standards. Medical companies charge whatever they can get away with. There’s no incentive to control costs because suffering people have to pay what it takes to survive, or die.
2
Why don't we start with baby steps.
Currently our system operates on the 'cable model,' paying for 500 channels when you only watch 20. Reducing preventable disease by adding a small tax on the cause would start reducing premiums by using the tax revenue to pay for part of the treatment, and possibly over a ten year period, pay for the entire treatment. For example, the health effects of tobacco are widely known but its current taxes only cover a fraction of its health care costs.
There are other areas in which this concept could be applied and might be a good first step toward medical care reform.
1
What if we translate the healthcare code of France or Germany or Canada and be done with? If it works for them it should work for us.
2
Single payer doesn't work, says an editor from libertarian magazine Reason. His implication is that the for-profit medical-industrial complex is successful. A 2002 study published by the Institute of Medicine found that 18,000 people died each year due to lack of health insurance. A study published by the Urban Institute put the figure at 22,000 deaths in 2006. I don't know the figures post-ACA, but I imagine folks are still dying. Libertarianism is the parallel universe of doctrinaire communism -- a pie in the sky philosophy that's guilty of advocating murder.
9
Mr. Suderman should read the history of universal single payer in Canada. The first effort to provide a single payer health care system in Canada was in Alberta in 1935. Proposed by the United Farmers of Alberta it was scrapped when they lost electoral power to the Social Credit Party which killed the plan due to "financial" issues. Yet somehow Canada still managed to create universal single payer!
Perhaps Vermont is a bell weather and soon we will also have universal single payer in the USA.
7
Mr Suderman says medicare for all can't work and cites as sole evidence the fact that it failed in Vermont.
Everyone knows, however, that economies are found in scale. Vermont's population, at 630,000, is a mere 1/4 of that of Brooklyn's 2,533,000, and a precious 1/520th of the entire nation.
The Feds will wield a far bigger stick than Vermont is capable of ever even dreaming of.
6
Drug costs and procedure costs have to be brought under control before any national plan can work.
American medical care is not an integrated system and its
individualized costs are too high.
No plan is really working now.
3
I live now in a country with 2 tears of insurance. The Public options is indeed no frills in terms of luxury, and for certain tests and procedures there is a wait of a month if you want them for free.
Then there are a parallel tier of private insurance for the rich and well off, with very elegant practices. In order for the private to cover anything I must be sent by my regular practitioner and/or have an emergency. Both the state and the private insurance try to scam a little - the state by making me wait and ask an extra payment if want the test done right away the privates by requiring an emergency and denying many procedures they deem non urgent or aesthetic.
So it is an imperfect system, but it is 1000 times better than the health care situation that I did not have, as a freelancer, in NY. And there are no co-pays. I stayed for a week in a hospital for a surgery, under the state plan, where i had excellent doctors, better than many doctors in NY, and I paid under a hundred dollar when I left.
Even if Medicare for all will be adopted in the US, I am afraid that GREED will lead to various schemes to milk people of much more money than due.
I left NY after the doctors at the Metropolitan Hospital in NYC were unable to find my diagnosis and offer treatment, but sent me home with a bill of 9,000. (I Europe I was diagnosed right away). By comparison the American hospital looked and functioned like a third world hospital, priced insanely.
7
@European in NY "2 tears of insurance " is the most wonderful typo I've seen in quite a while.
1
"lawmakers were cagey about how to pay for it" - surprise!
Lawmakers are not cagey and the people are rational in the few places where single payer actually works well. Really VERY high taxes for everyone are needed to provide things like healthcare, free daycare & universities for all.
In Denmark income tax rates are around 50% for salaries from $55k and up. ALL pay 25% value added tax on most goods. Recently, the centre left won the election because they flipped their position on massive migration because of the negative impact it has had on their social insurance system for all, btw.
Denmark, like all well functioning countries supports and works with business, the economic players too. They are the ones who provide work, jobs and goods to export for their futures, while the government provides the education the workers will need for the industries - in turn and together they keep they keep the economy going for all.
The US could very easily do the same if we double and triple income tax rates for all, from working classes up. Would the citizens accept an honest and truthful proposal based on such successes?
There are no countries where it is "the rich" who pay for everyone. We have so many examples of how that idea has repeatedly failed around the world.
1
I get tired of the "Medicare for All Failed in Vermont", when it is more accurately stated that "Medicare for All Failed to be Tried in Vermont". Big difference.
4
You are pussy-footing around the real reasons Single Payer didn't work (yet) in Vermont:
* Publicly financed health care, though it would raise taxes, would eliminate the need to pay for private, for-profit health insurance. Understandably, prvcate insurors and their allies have developed massive ,well finance opposition to Single Payer (public) funding.
* 30% or more of health care expenses are wasted, because of enormouspoor cost conrols and complicated systems for cost coverage and payments to providers (careivers, hospitals and clinics, drug companies, meidcal equipment makers, etc.. A deep study the American Medical Assocation has just explained this in detail. (See PNHP, website of Physicials for A National Health Program)
* All o the opposition to Single Pasyer concentrattes on funding of Congresspersns. state legislators, and other public officials, and the media, espcially cable and TV..
4
I'll just bet that you have medical coverage. You may not love what you have. It may be just good enough, but I can almost guess with certainty that you have health care coverage that is at least enough for you and your family. I've yet to meet anybody who argues against medicare for all, that doesn't already have some form of coverage.
Regardless of how difficult it may be to get this done. It needs to happen. These cynical arguments against medicare were said about so many things before: gay marriage, the first black president, the civil rights act, and yet we've accomplished so much against the odds. The nay sayers will always exist, but that should never stop those who want change to work towards it a better system. We can have health care for all, with or without the support of the cynics.
5
Well then, it can't work! Debate over. And all Western democracies including Japan that have national single payer health care are figments of your imagination too.
Roll out a half-plan in an inept way is to prove only that inept plans will not work. Do it right, finance it right, explain it, and do not undercut it before it begins, it will work.
If I stop paying to my employer health ins premiums and instead pay those to the government, it's a net neutral. And when I eliminate the middle man insurance companies who profit, and remove more of the profit of Big Pharma and of doctors rife with their conflicts of interest, I'm well ahead.
Now your turn:
First, SCREAM "COMMUNISM!!"
7
These are not comparable situations. Changing the national health care structure is much different than creating a state based universal healthcare system. Read this new article from JAMA. https://jamanetwork.com/journals/jama/fullarticle/2752664
As a trained US physician who is currently working in New Zealand, I can say with certainty that some kind of universal health insurance is imperative. We should continue some sort of optional private health insurance component, but the only way to make this reasonable is to cut down on administrative costs and instigate price controls, and the only way to do that is with a significant single payer component,
5
Our ‘private’ healthcare system is bankrupting families and the Nation as a whole. The economic reality is that we cannot afford this immoral inefficient healthcare system.
The only practical alternative is a single payer system. Everything else leads to economic ruin.
2
Personally I find this to be one of the weakest arguments I've ever read. No political will is another way of saying Republicans are against it because theu are against state funded everything. The general public are way more for it than they were 5 years ago. Republicans need to get with the plot.
2
Comparing a tiny state's attempt at single payer vs. nationalized/ subsidized health care for all is comparing apples and oranges. If anything Vermont's example further illustrates why a Federally- run/organized system is the only viable option, while states attempting to go it alone will inevitably struggle and flail. The Federal government has infinitely more ways to amass funding than the tiny state of VT. There is more than enough money out there to cover everyone, from raising corporate taxes, taxing capital gains as income, trimming the bloated military budget, cutting foreign aid, etc. All members of congress get taxpayer- funded pensions if they've served at least 25 years- sounds socialist to me! These fat cats have no problem having their own health care subsidized by the common man, but when we ask for the same playing field, the cowards are nowhere to be found.
1
The current medical infrastructure cannot possibly support “free” medical care for 330,000,000 million people,impossible. And any politician that says that Medicare for All is feasible both practically and fiscally is lying More lying “If you like your doctor you can keep your doctor..” or “I don’t want bureaucracies making those decisions.” President Barack Obama statements during the ACA debate. In addition the unions would have a opt-out that would be immensely unfair. Seniors who paid Medicare taxes throughout their working lives would essentially be treated as “expendable”.
The best solution would be a nationwide high deductible government funded HSA made available to the uninsured or unemployed as a safety net and supported by a national sales tax or VAT of course the cost of consumer goods would double.
This is a very weasle-worded article. It suggests MFA can't work but what it documents is the challenge of passing the legislation to even try MFA.
The title should read, "Difficult to Pass is the Strongest Argument Against Medicare for All."
That argument itself will be changing within the next 6 years.
1
Vermont has a relatively small population, meaning it has a small risk pool that would obviously need full participation and higher costs per person to work. Medicare for all for the entire country is another kettle of fish. This is a specious argument. Go back to the drawing board, Mr. Suderman.
Trump and Republicans want to get rid of Medicare. Some sleight of hand, they want Medicare Advantage expanded greatly. In case you didn't know, Medicare Advantage is run by large insurance companies and that would benefit them. It's not government run. So Republicans like it. Medicare for all, eliminating current employer provided health insurance is certain to be political suicide for the Democrats if that's their final proposal. While voters like the single payer idea, many do not like giving up the insurance they have now. Too radical a change. Americans don't like radical change.
No system of universal healthcare has EVER failed. Only one state, Ukraine, has ever moved from a universal, government-backed system to a private one (with disastrous results).
Any argument to the contrary is not just wrong it is deeply immoral.
4
Lot's of talk about insurance rates but not much about health. Why's that?
2
Did the Times just publish this to make fun of it? I see how clever you are!
Moving the US to Medicare for all or single payer is not going to be easy and quick. It's likely to be complicated and painful, especially for those benefiting disproportionately from the current system (cough, drug companies, cough). But it's what needs to be done to make sure the US has affordable health care for all of its citizens.
1
How do all those European countries make it work, Mr. Suderman? I would love to see Ezekiel Emmanuel and Peter Suderman debate universal health care. Please read some of Ezekiel Emmanuel's articles on the feasibility of universal health care. He is an actual expert in the field. Short of universal health care, a strong public option would be great, like the original Obamacare.While Vermont does not have "medicare-for-all", it does have a strong public option. How about the healthcare system in Massachusetts that Mitt Pomney helped start?
2
Yes, you're right, we Americans just aren't as smart as Canadians, Brits, and Germans; so there's no way we can make universal healthcare work in the United States. We should just give up; it's sure to fail anyway. (/s, in case anybody can't tell.)
3
A writer for a "libertarian" magazine, Reason, against a program that would save Billions because insurance companies would not be siphoning the money off.
Color me shocked.
2
Mr Suderman must be affiliated with the health insurance industry as this article does not represent both sides of the debate. Medicare for all would save businesses billions of dollars by not paying their employees health insurance premiums. Why is this fact never mentioned?
1
@GolferBob: I, too, have been surprised that employers aren’t leading the cry for universal health care as it would save them lots of money since they would no longer be contributing to their employees’ health care premiums. Anecdotally my cousin, who was a high ranking executive for a railroad in the early 2000’s, told me that his railroad was losing freight traffic in northern states because small logging companies were moving their operations across the border into Canada. There they could hire employees whose health care premiums would be covered by a universal health care program.
1
I have never known one person on Medicare, no matter how right-wing, no matter how enthusiastic they were about Trump, who was willing to burn their Medicare card and drop out of the system. They want medical care for themselves, but don't care if other people have medical care.
If you Trump voters do not want everyone to have health care guaranteed, why don't you start with yourselves. You could save the U.S. a lot of money.
2
How do other countries manage to have it? Are they richer than us? Smarter? If we gave less to that five sided money pit- the Pentagon -could we have it? If the GOP stopped screaming about how it's- Socialism!!!!- would people support it? I've heard people make the argument that if we all had insurance there wouldn't be enough doctors to go round. Couldn't our government helped people become doctors and health care workers? Is it too large of a problem for all the brilliant minds in DC to figure out?
2
So, we shouldn't do the right thing because it's... difficult? Because of monied opposition? We should let rationed for profit health care which leaves thousands do die without care be the continued norm? That's quite literally the evil choice where you let people die. One plan takes care of people and saves money in the long and short term (no private health tax and deductibles), one plan lets millions go untreated and thousands to die. Let me ask my six year old right quick which one sounds like the evil plan from a cartoon...
1
This editorial is beyond foolish in its naive and unsophisticated understanding of the impact of a national single payer system.
Extrapolating from a small state example that has NO ability to negotiate prices, deal with existing companies or with any other component of the system and then has to exist in the vortex of our fragmented system is just a non starter as an argument. Saying that since I can’t make a go of it by producing automobiles in my garage, then obviously Ford Motor Company has no chance to succeed is an apt description of this editorial.
Our existing hodgepodge of a costly, fragmented system was not designed by anyone, it was the default result of NOT having a national health care strategy and plan. We can either try to get everyone covered and have a viable mechanism to rein in costs or wait for the economic catastrophe in ten to twenty years when the wave of boomer costs leads to the failure of existing insurers and hospitals.
2
Funny how every other 1st world country provides Medicare for all but not the USA.
3
And so here we are with employers proving healthcare - which is the single worst possible system.
It would be better if your local waste management district provided your healthcare - as well as picking up trash and recycling!
As long as the employer pays for the health care several things will be true:
1) employees will stay in jobs that they do not like and are not good at - just for the healthcare
2) employers will discriminate on the basis of cheaper healthcare! As we learned yesterday from the comments to a NY Times article on hiring algorithms, computers are rejecting out of hand applications that appear to show a person over the age of 40. Interviewers are trying to discern and person's age, if they are married, if they have any health problems, all because of the costs of health insurance!
3) Workers in the so-called Gig Economy have no way of getting affordable health care AT ALL! In the Vermont exchange a family of two can only get a subsidy if they make under 43,000 a year.
I do not care if this proposal causes new taxes or forces drug companies out of business or doctors make less than $300,000 a year. It is what has to be done and this article is un-American for suggesting that we should not even try.
Shame on this author and shame on all of those who make a profit on the illness of others.
2
Vermont’s tiny population and Trump / private insurers are the main hurdle for Medicare for All, not the opinion writer’s non sequiturs. Vermont is America’s 49th most populous state, with just around 600,000 residents.
1
Vermont is a small, elderly state in the Northeast where expenses are high. It was doomed. We need regional systems, maybe 5 or 6, big enough to get a varied pool of risks, but small enough to manage and be held accountable. And we need COST controls, just look at pharma and health insurance CEO salaries and start there. The rest of the developed world can figure it out so can we. Healthcare is a market failure presently.
Many thoughtful Americans are quite aware that single payer health care is not likely to be achieved in our lifetime. One might have said the same about the abolishment of slavery in the 1850, the right for women to vote in 1920, or the end of segregation in 1960. This does not mean it will not happen. Only that the painful, throbbing boil we call the American insurance industry is not quite ready to burst.
busshit. larger the pool, higher the healthy contributors. as long as we are not inclined to eliminate high profit factor, yeah it wont succeed. but this isnt trailblazing. there are models to learn from the world.
Vermont as the best test for single-payer healthcare? Frankly Mr. Suderman, your's is a poorly constructed argument. Vermont, a small state surrounded by major referral centers in other states where its citizens travel for healthcare (e.g., Dartmouth, referral centers in Boston), is not a reasonable single payer model. Vermont is not in a position to implement a single payer system without a similar system in surrounding states. Evaluate the countries of Europe, all of which have better health outcomes than the US at lower costs, many of which rely on various forms of single-payer systems.
The only reason why the U.S. does not have single-payer healthcare system is that healthcare as a right is not a U.S. priority. Americans prefer to tolerate many preventable deaths in order to preserve for-profit healthcare to benefit a few. It is this simple.
1
I don't want "Medicare for All". I want "Medicare For Anyone Who Wants To Buy In". Make it optional, make it a 'public option' for the ACA. Make it possible for employers to, with the employee's consent, transfer the money spent on employee healthcare to the employee, who can then buy in to Medicare, and keep anything extra. Make the Medicare part of that transfer not subject to income tax, only the extra. Make the choice the employee's, not the employer's. Make it "Medicare Available for Everyone", but not mandatory. And see what happens.
1
This has been my argument all along against Warren and Sanders. Even if the Dems when the WH and both branches of Congress, there aren't enough votes to get it through, and the public won't buy in when the costs become apparent. And I'm guessing some, like me, don't trust our government with their life. I would rather see baby steps than no steps at all.
I read a great case on PBS for removing the age limit of 65 from the current Medicare legislation and allowing it to function for anyone alongside private insurance. I think building and improving on what you have is generally a better idea than throwing it all out and starting over. Unintended consequences always happen. Look at the ACA.
1
Current system has failed long time ago but is being propped because there is money to be made. It can not go much further cost wise before it bankrupts all of us. America spends more money on the healtcare than any other nation. We still have millions of citizens without health insurance and millions of other citizens without adequate insurance in case of serious illness. American government pays most of the healthcare cost while private insurance collects profits from the rest.
Vermont is too small of a state population and resource wise to implement single payer system on it's own. Your argument does not prove your claim!
The way to do Medicare for All is step by step, not all in a day. Lower the age for access to Medicare by, say, 3 years. Leave the Medicare Payroll tax in place all the time. So at 62 you can get Medicare as a choice, not a requirement. You pay the Medicare payroll tax on earned money as usual. Shortage of doctors? We start offering Medical school scholarships on condition of taking Medicare patients at Medicare rates for a number of years or a percentage. Medicare is allowed to bargain drug prices which will cut PHRMA's obscene profits. Don't worry about research. Most of the research has been done by the government (the NIH) all along and you've been paying for it. PHARMA does ads - and we'd all be better off with fewer drug ads. Raise the cap on the amount of income that is subject to the Medicare Payroll tax. The cap needs updating periodically.
The idea is to add a few years worth of people at a time, so you get to correct mistakes and experiment as improvements to Medicare are added, and adjust the amount of payroll tax income without scaring people to death by outlawing private insurance. Private insurance took 21% of the money paid last time I looked, so it's not a great deal but leave it, especially the version that pays for what Medicare doesn't cover. A lot of private insurance will get dumped because Medicare is a better deal and you have the freedom of not having your healthcare tied to your job.
Buried in Mr. Suderman’s Argument is the concession that cost savings in Vermont were reduced by the subsequent decision to insure Vermont workers who lived across the border in another state; they received the benefit without having to pay the taxes that supported it. This is one reason why state plans are not a good indicator of outcomes in a national plan.
Over the past 3 years, we have heard a lot about the woes of rural America. One very real problem is lack of healthcare and poor medical infrastructure. Having lived in rural areas of countries with a national healthcare provision, I never found these ‘medical deserts’ to be a problem. When everyone is covered, doctors and other healthcare workers and facilities can flourish, because everyone can freely receive care without fear of being bankrupted. Not so in rural America, where poor and uninsured residents are significant segments of the population. In those kinds of conditions, doctors will not remain long, not because there is no need, but because there is no mechanism for paying them. A single-payer national system may help solve the terrible scourge of poor medical care in rural areas.
1
If you earned money in Vermont you would be subject to Vermont income taxes, regardless of where you lived.
So, why does single-payer work in other developed countries?
3
@Ilya Shlyakhter
The odd thing is that the most successful societies have rather high taxes. It turns out that, in the real world, regarding healthcare, government does know how to spend money better than you. Judge by results.
@gratis The government has more bargaining power. Judge by the costs. Sure, their taxes are higher, but if you add on what we are paying for health insurance and what we have to pay in deductibles before that insurance pays a dime, who is paying more?
Yes, Vermont was a practical failure on friendly turf, but this has to be seen in context.
First you are probably correct that a practical and politically viable way to finance the whole shebang is a challenging task. Technically it was a much harder task in Vermont (compared to the whole country) because of the actuarily small population base. Insurance costs are always minimized by a larger population base.
Secondly, it is important to realize that projected costs and savings are inevitably distorted by the self interest of the analyzing party. Commercial insurance companies,and pharmaceutical firms, for instance, earn so much (excess rents - in the technical economic sense) that they spew a lot of estimates that minimize potential savings. For instance somewhere between 15 and 40% of the premium dollar is lost to medical care due to administration and overhead (especially if you include the costs to each employer and provider to cope with the administrative complexities of the pseudo market in health services.) There is also real concern about whether and how much employer insurance cost savings will be passed on to employees as higher wages.
Finally, but sadly, as demonstrated by the 14 states that have refused to expand Medicaid under the ACA, American health care is infused with a strong dose of racism or discrimination, a lack of compassion, and a rejection of concern for some of our neighbors' needs and security that is both unseemly and immoral.
2
It can't be done? Don't believe it!
Many Quebecers travel to Vermont by car and it is widely acknowledged that Vermont's roads are in much better condition. Northern Vermont's winters are not radically harsher than those in Montreal, so why are "nids de poule"
(potholes) so much worse north of the border?
Peter Suderman's article delves into the minutiae of why single payer for all cannot happen in Vermont, while miraculously, north of the border, it's been a successful reality for more than sixty years.
Both problems have their complexities. Perseverance will be needed to overcome the obstacles. But Vermonters and Quebecers are living proof just across that border that these obstacles can be overcome.
If I had to choose between the two problems, I'll endure the potholes if I can keep my healthcare. It's far from perfect, but it's better than constantly negotiating with insurance companies or risking bankruptcy if a family member contracts a horrible illness without adequate coverage.
1
Most people still want a choice. A Medicare option gives everyone that choice. They can choose Medicare. They can choose a private plan. They can choose a supplement to Medicare with an HMO or a PPO. They can choose an Advantage Plan in lieu of standard Medicare. Some want their employer-based plan. Some want to keep their union-negotiated plans . Health reform does not have to be an all-or-nothing proposition. When Americans learn that Medicare-for-All will not allow them to keep an alternative plan, and when they realize that a mandatory state-run health system would by necessity raise their taxes, they will think twice. I like Pete Buttigieg's idea: Medicare for all those who choose Medicare.
@Raimundo this is not a choice. Being forced to pay extra for profit insurance is not health care for all nor is it a choice for those that can't afford it. Alternative plans are just a way for insurance companies to keep raking in the profits off our backs - and refusing us the true options and choices our health may require.
2
With regard to the cost per beneficiary for Medicare for All, it should be noted that as a current Medicare beneficiary I pay the following every month: Part B premium of $135.50 + Part D premium of $35 a month + Medicare Supplemental Insurance of $180 a month. I pay for a private dental plan $55 a month. I have no coverage for eye exams, glasses, etc. The total is $405.50 per month. I recently paid $1,000 for two medications -- half for a three month supply of a drug not covered by Medicare and half for a one month supply of drug, which was applied to my Part D deductible. Medicare is funded by a combination of dedicated taxes, general revenue taxes, and premiums. If Medicare for All is to gain any traction with the general public, specific information about what it will cost (in increased taxes and premiums) must be provided and compared with the cost of private insurance.
There are so many working models of "Medicare for All" in Europe and Asia that there's not real argument against it based on real world results.
EU spends 50% less, covers 100% of its people for 100% of the medical needs and gets better results....everyone using a version of "Medicare for All"
That a small states doomed to fail attempt to build a working health care system inside a massively dysfunctional national insurance industry run system is the only "argument" Mr. Suderman can make against the proven Medicare for All systems around the world has the opposite effect of what he intended.
5
A faulty premise yields a faulty conclusion. Anyone who knows about health policy knows that the coverage rules and financing of health care is greatly impacted by Medicare and Medicaid. And to the extent the federal rules aid, or damage, a state health policy, that policy will either rise or fall. This is what Governor Shumlin was referring to when he talked about "the limitations of federal law" Moreover, a state cannot achieve the economy of scale that a nationwide single payer plan can achieve. (the Governor's reference to "the limitations of state-based financing"). Bernie Sanders was right, if a state could do it then surely the nation could. But the fact that a small, not particularly wealthy, state did/could not do it, doesn't mean that 50 states together could not. So, nice try free market guy, but your argument is both specious and unpersuasive.
9
The author omits the obvious fact that private insurance rates are higher than Medicare rates because private insurers and pharmaceutical and health"care" conglomerates are all trying to make an enormous profit off of illness for their shareholders rather than actually providing health care. If we cut off the making a huge profit aspect of healthcare suddenly there is a lot more money that frees up from and for everyone to pay for great healthcare.
7
Coming from Canada, it's stunning to me that Americans don't acknowledge that the US already has "socialized" Medicare for all as long as you are 65+ years old. That's because the health insurance companies don't want to cover you once you reach that age and their chance of payouts increases (i.e. they can't make money on you).
And do you think the money for those under 65 that have employer-paid health insurance plans comes from heaven? Since the US per-capita health care cost is about twice what it is in most of the other prosperous industrialized countries with public health care, payouts to cover increased taxes to pay for medicare would be far less than the cost of private employer-paid health care premiums plus their immense administration costs.
6
@Dave
The VA is real socialized medicine. The government owns "the means of production" , the facilities and employs all the medical staff.
As a retiree on Medicare I'm pleased.
However I practiced primary care medicine in rural upstate New York 36 years, and medicare rates would not keep my office payroll solvent and my doors open were these rates applied across the board.
1
Mr. Suderman fails to mention the real reason for failure--there was a giant misinformation campaign by the health insurance industry. Lies can do real harm.
8
@Fred V wrong on that. The State of Vermont kept putting out higher and higher figures for the cost. People simply said no more. The public employee unions didn’t help much either. The public plan had to be the equal of their gold plated plan. They wouldn’t give an inch.
Oh great point. It didn't work once in one place. It will probably never work anywhere.
5
If this is the strongest argument against Medicare for All (one state's inability to implement it several years ago), then Mr Suderman just strongly argued for Medicare for All.
Couple other arguments for Medicare for All:
-the end of medical bankruptcy.
-the end of Americans dying because they can't afford healthcare.
13
A total 21% (combining both employer portion and employee portion premiums) of a worker's overall compensation package for healthcare is "too high"? It might be too high for government employees, but not for small business employees. I'll take it in a heartbeat.
2
@VonG Most voters don't really know how expensive our current healthcare system is, especially for small businesses. If the price tag of single-payer system is 21%, I'll call it a success.
3
Left out of Suderman's analysis is that the necessary infrastructure for Medicare for All is already in place- Medicare. Contrasting a major program built from scratch vs an expansion of an existing successful program is misleading at best. It is opposed so vigorously because it is actually achievable.
8
Wow, this must be music to the ears to for-profit insurance company execs. Thanks Mr. Suderman.
4
The inability of a small, rural state, with a risk pool spread across only 600000 people, is a poor argument against M4All indeed. Taiwan instituted a National health Insurance, de novo, in 1995 for 24 million, and 99.9% of the country were effectively covered within the decade.
Our US Medicare system of 55 years is the best argument for improved, universal Medicare for All. Almost all of the developed world utilizes either 1.a tightly regulated, progressive payroll-tax funded mostly non-profit "all-payer" system of insurance intermediaries, which return any surplus back to the premium holders, (Germany, Netherlands, France, Japan, Belgium) 2. a National Health Insurance (Canada, Taiwan, Souh Korea, US Medicare) or 3. a "socialized" system such as UK, Scandinavia, New Zealand, or our own VA system. All such systems evaluate and negotiate reasonable costs with pharmaceutical makers, coordinate social services and mental health services with primary care , and provide superior outcomes in most metrics of health at half the cost. Until we demand a nw paradigm, campaign finance reform and an end to the institutionalized corruption we see via moneyed (health) industry lobbyists, (safe harbor regulations, bigPharma CEOs appointed to run HHS, etc) we will contend with our current unaffordable, dysfunctional failed "free-market" mess.
9
i was recently informed by a NY Times article that mr. sanders found his love of single payer in canada, not in vermont.
i was intrigued to find that the "limitations of federal law" figured number 2 in gov. shumlin's regretful excuses -- right after "limitations of state based financing" in a demographically aging state with fewer people than the district of columbia. what limitations of federal law, exactly?
it's a flimsy soapbox to preach foregone failure from a single example. once upon a time, single payer was a republican idea -- because it made sense. it still does.
3
Nonsense. The obvious-to-most reason single payer healthcare is difficult to work out in a very small state like Vermont is that if we here provide generous government healthcare to all Vermonters, many sick people would move here! The cost of caring for every New Yorker, et al who cannot afford care a few miles away would soon bankrupt the system.
A national healthcare system would not have this problem (unless we think Canadians will be coming down to use our free healthcare instead of their own!)
6
The author writes for Reason...A notoriously libertarian periodical which has no interest in seeing any sort of universal health care succeed.
7
The only obstacle to Americans having good, affordable, universal health coverage is the same obstacle to Americans controlling guns—Americans' "can't-do" attitude.
6
Suderman is the features editor of Reason magazine, which is described as conservative libertarian. So we should can assume his opinion is the same.
6
Suderman strangely focuses on Sanders and makes no mention of Warren, who is best positioned to win and the only one who has the necessary combination of charisma, character, honesty, will and policy ideology, imo, to improve this nation.
But she's in trouble, in great part because she's not carrying the electorate on Medicare for all (as well as free college, and college loan forgiveness). Too unclear and too loosey-goosey in policy. She needs to tighten up in those areas and not engage in largesse that is perceived as either unfair or destabilizing. Mostly, she needs to shore up her credibility.
In a sobering analysis and good read, a local Massachusetts reporter explored in these pages recently why she's not persuading enough white non-college educated Massachusetts citizens. If she can't do it there, she can't do it in the nation as a whole.
https://www.nytimes.com/2019/09/18/opinion/elizabeth-warren-massachusetts.html
The premise here is inexcusable. Iow, it's too hard to do so, we can't do it.
The reality is that every single 1st world country does it and therefore we can do it. And, they do it at half the
Cost of what we pay in this country.
Study them and get real.
7
One way to approach single payer is to cover all under 18 Anericans and lower the eligibility age by 5 years, with a plan to review further reducing the starting age. I believe that a majority of Anericans would support covering all children and would accept an incremental rollout.
4
Medicare for All doesn’t have to mean Single Payer. And in my view it shouldn’t. This isn’t just about political support. What if Paul Ryan gets back into politics and decides he still wants to kill Medicare? Single Payer Medicare for All would make that even more catastrophic than it would be in the current system!
.
To me, Medicare for All should be a hybrid program: what I call “Limited Medicare for All with a Private Option.” We could all get basic coverage through Medicare: which could pay for things like regular doctors visits and vaccines, and provide us with means tested catastrophic coverage (designed to prevent medical bankruptcies). People who want more coverage could still buy private health insurance, (in which case their Medicare benefits are managed by the private insurer and their catastrophic coverage is reinsurance to that insurer.). But nobody would HAVE to buy private insurance.
.
The best healthcare system in the world, France’s, is such a system - and they spend half what we do for their care, while matching or beating our results. We know it can work. If only people were willing to listen to reason. But alas, I think many Americans are so sick (literally) of how they’re treated by the Health Insurers, that they’re willing to go to Single Payer just so they can kill the industry. Results be damned.
4
But that is exactly what the Medicare for all means. The problem I guess is just in definition what to consider as a 'basic coverage'?
I never have understood why Medicare pays lower rates than private insurance pays. Or are they overpaying and getting kickbacks or something besides cartel favoritism? Something doesn't seem right. And I'm sure docs are relatively overpaid here than in other countries.
Navigating healthcare through all the powerful special interests involved is just a ramification of this nation being run by greed and grift. Special interests run DC, not the public.
1
Many Americans, especially small businesses, are already overburdened with rising medical insurance costs. Such private plans are often the focal point of labor disputes with management. Moreover, while Americans are often blamed for their unhealthy lifestyle choices and lectured to shape up, most of them, especially the poor and working class, are often bombarded by fast-food marketing and live and work in environmentally hazardous places -- a situation that will only get worse with deregulation.
As many polls show, a large share of the public is unsatisfied with the current state of affairs. It's really mind-boggling how the richest nation on earth has yet to figure out how to ensure that all of its citizens have access to adequate medical care.
Other less-wealthy nations have adopted government-insured systems that have covered all of their populations at a proportionately less cost while resulting in overall better medical outcomes. While single-payer systems are far from perfect (as are democracies), they have garnered enduring public support in countries such as Canada and the United Kingdom, where conservative governments have not dared to question their existence. Surely, the U.S. -- which sent men to the Moon and back -- can adopt a single-payer plan molded to American idiosyncrasy.
Too bad Mr. Suderman does not apply his penny-pinching logic to the most expensive, inefficient and wasteful federal agency (borne out by GAO studies): the Defense??? Department.
5
Color me radical, but I think every American should receive the same level of care at the same cost as do their elected officials in Congress.
12
And, Mr. Suderman, we all know how well the current health care system in the United States is working. Let's just keep it and see what happens -- nothing but the sickening mess we now have.
6
Defeated before we even try.
The little guy always pays... and there are zillions of regressive taxes on everyday stuff -- gasoline, booze, candy, McDonalds, while private jets receive tax write-offs of various sorts and perhaps not one penny in tax is paid on that 40million dollar painting purchased at auction legally. (No federal tax at all now that the luxury tax has been eliminated by WJC.)
I guess all of those more or less single payer medical plans in Europe and Canada and Cuba are doomed to fail
Just tell me is Reason a right wing magazine. dedicated to making the rich richers?? Eh Peter?? PS. state systems are very different from federal. By the way even tho Vermont is blue I believe it is a relatively poor state with numerous people on Medicaid. And given the usual mishugenas with laws, it is not explained here exactly how taxation for the plan was implemented apparently it wasn't and one might imagine more of various sorts of clinics that would save healthcare $$ while delivering medical care.
4
From the dept. of bad math--here we go again...
"Yet by 2014, Mr. Shumlin’s own estimates found that employers would have to pay taxes equal to about 11.5 percent of payroll, while families would have to pay as much as 9.5 percent of their annual income to make the financing work.
As much as 9.5%! Imagine that. At 100K a year (well above the median), that would mean a tax bite of $9500! Why would anyone in their right mind sign on for such an astronomical boost in EVIL TAXES, when they an get away with paying $20,000...current average cost per family of four? Those crazy unhinged liberals!
But wait--it gets even worse. We'd have to forfeit our right to pay for vision care and dental out of pocket. There goes our liberty--right out the window. Who wants that? Even worse, there would be universal coverage. That means everybody! Including murdering, illegal immigrant rapists and drug dealers. I ask you--what kind of crazy system would offer health care to just anyone?
5
So the rest of the civilized world can do it, but we can't?
7
Let’s not forget Reason Magazine is a Libertarian right wing publication - something written by them that will be interesting is when they acknowledge they have been wrong.
6
Yes and I have a four year old who hates broccoli even though she's never tried it.
I'll give you that public confidence and support for any ambitious new policy is generally a prerequisite for its success. That's where visionaries come in - people of wisdom and intelligence who use logic and leadership to shape public opinion. Sanders is one of those people.
You can make arguments for profit-driven health care insurance or for a universal public health care system, but no self-respecting economist is going to agree with your assertion that the latter is somehow inherently unworkable.
The U.S. is virtually alone in the G8 for its absence of universal healthcare - an astonishing fact considering it is at or near the top in national wealth. And then there are dozens of smaller and less economically advanced countries who have made a success of it.
The problem of course is that there are many vested commercial interests in America that are violently opposed to universal health care because it would significantly impact their bottoms lines .. if not their very existence. At some point - and I think we're nearing it - a majority of Americans will insist that one's prospects for surviving a major medical crisis cannot be predicated on the size of their bank account.
Until then, those monied interests will continue to amass fortunes by squeezing huge profits from illness or the fear of illness.
2
One argument against a national universal healthcare plan like in the rest of the world does not equal the myriad reasons to reject the status quo. This article's reasoning is weak at best. The problem in Washington is a regressive tax system (the worst in the country) that the State hasn't even begun to tackle. A universal health plan was doomed from the start.
Sources like the NYT has an obligation to present the solutions and results from outside our borders instead of the doom and gloom that it typically presents.
3
Currently the cost of standard Medicare for the age 65-114 age cohort is approx. $7,200-7,500 per year. That is Part A Hospitalization ( aka catestrophic) which the over 65 and any disabled person receives for free due to years of taxes paid. Part B is the part that includes doctor visits, ect. It has 20% co pays a deductible, this is the part $136 per person per mon. Is taken out of Social Security checks some higher income people pay up to $200/ mo. More) . Then there is part D is the drug portion. Which costs $30-50. Folks purchase supplemental F-G for $50-200 per month.
This is the most expensive cohort there is. With most of the spending occurring in the final year of life, usually around 80. So just starting to open it up to the first year those 55-65 and 0-10 would enormously bring down the cohorts cost.
Also we could get rid of Medicaid with it low rates and just have Medicare. If everyone is insured there won’t be write offs for bad debt. My daughter works at a major city children’s hospial and 70% are Medicaid, if they got paid at Medicare rates they would be happy.
Having 55-65 insured on a public option stops blatant age discrimination. An ACA plan for a 60 plus year old is 12,000 to 18000. So getting them on Medicare for $7500 is your best savings! Everyone else brings your pool down. So you add 45-55 and 10-20 the next year. Followed by 35-45 and 20-30 then 30-35 and anyone who missed out.
2
After closely reading the many comments about healthcare around the world, I wonder if a country's healthcare system reflects its underlying national ethos -- the story it tells itself about itself -- more than any practical considerations.
Brazil and Japan, two countries where I've lived for many years, tend to bear this out. Brazil offers decent government-funded healthcare that helps the low-income majority manage its chronic ailments, while a thin stratum of the well-to-do supplement this with private insurance that guarantees gold-plated care in top hospitals. Net: a reinforcement of their harsh two-class social system with its hypocritical, pro-forma nods in the direction of "the people". In Japan, the system provides everyone with access to similar and generally excellent care, wide choice in doctors, and similar obligations to help pay for it regardless of wealth or status (with exceptions for those who are truly poor). Net: a reinforcement of their self-image as an egalitarian consumerist utopia.
Where does that leave the US? I'm afraid too many of us are still stuck in a mythic realm of self-reliant, gun-toting pioneers surviving on the far edge of the frontier. Need that leg amputated? Gulp down some whiskey and chop it off yourself with your double-bladed axe! We won't have the collective will to move toward universal healthcare until we rid ourselves of those self-reliance fantasies.
6
Thank you for an excellently written, thoughtful, closely reasoned post. Far superior to the muddled reasoning in the editorial itself.
1
The excessive and inflationary costs of health care, whether a public payor or private insurance arrangement, is because of pharmaceuticals and the fee for service payment system. Drug pricing can only be fixed with a substantial rewrite of patent laws. The fee for service payment system, however, can be fixed. Without ending fee for service, there will never be any hope of fixing the runaway crippling costs.
Almost all hospitals, especially those in rural states, are now vertically integrated: band aids to heart transplants. States need to go the hospitals with their public payor programs, i.e. Medicaid, and tell the hospitals that it will now pay the hospitals a flat sum per year for each of the patients in certain zip codes that the hospital serves and for which the state pays the bills. States can then turn to employers and individuals and offer this capitation option with an administrative fee of 5%.
Providers will no longer be motivated to overtreat and overcharge. Hospitals on budgets will become obsessed with preventative care rather than treatment. The savings will make it possible to provide capitated health care services for everyone who wants it. If someone wants a better system with more choices, they can go buy it privately.
Trying to provide more people with health care without ending fee for service is not simply a waste of time, it actually compounds the problem.
2
The larger the pool the more price efficient. Health care should not be employer based. Keep private insurance for those who want it but have a medicare buy-in option. Increase MediCare rates to keep providers happy. Also, Medicare Supplemental policies can still be available Let the best man win.
3
@Harris Lemberg
Actually this statement is incorrect because of fee for service. The more patients one puts into a fee for service arrangement, the worse the costs get because
you have a system that encourages over treatment. All systems, public and private are having the same problem with costs and inflation because of drug prices and fee for service. The savings from reduced administration costs by going to a public payor system is a one time event and then the underlying problem of over treatment just marches on and nothing is different.
Sure John, which explains why health costs are so much lower per person in the US than in Japan, Canada or the EU. Wait, what is that you say? The costs are far higher in the US than in countries with national healthcare systems? Oh, than it must be a deep state plot...
1
ONE: Vermont doesn't have the massive pool of people and businesses to draw from that the US has.
TWO: Every other (EVERY OTHER) advanced nation in the world has national health care, and we are are the richest of them all. If they can afford it why can't we? So we have buy a fewer multi-billion dollar aircraft carriers? I'm more than okay with that.
THREE: See number TWO.
3
"The first problem for any single-payer push would be political support"
Exactly. So end political power of the con-artists or educate them.
This argument is bizarre. It's like "The problem with fixing the opiate epidemic is so many addicted people want their fixes."
Bothsidesism (both sides are reasonable, well informed intelligent) is obviously crazy.
2
My good health care is a benefit that I received for work in lieu of pay. Many people feel this way so I am inclined to agree that the support for socialized medicine is not there yet.
The way the USA works, for the best medical outcomes under single-payer, supplemental insurance or some other payment would still be required. It would be nice to have a country where the general welfare is as important as one's own, but the United States is not that country.
The way to change is incrementation or disaster.
4
If you pay for your good health care what difference does it make if you pay to your employer or to the federal Government? Just paying to the Government ensures that the access to healthcare will be there even if you lose your job or your employer decides not to offer the health care.
2
Strange. Canada enacted single-payer healthcare several decades ago.
5
Our society is becoming, or has become, one that never fails to fail, only shows up with problems, demands something for nothing at every turn, wants individual "freedoms" and "liberties" to be at the cost of their neighbors, and offloads individual costs onto society at every opportunity.
We do excel at whining, however.
MB
4
@Michael Bain Whether it's private insurance such as the U.S. which has, by far, the costliest system in the world (with poor outcomes compared to other advanced economies) or single-payer, it all comes out of folks' pockets. Canada has single-payer and what the citizens get for their paying for the system is 1.) a cost of only a bit more than half per-capita what Americans pay, 2.) better healthcare outcomes and 3.) no one uninsured !!!
4
Why is everyone concerned about the high tax rates when your employer provided health insurance is currently about 10-20k per year? Instead of going to a for profit corporation, it’d be administered by a government accountable to the people
8
The article is predicated on the assumption that costs cannot be lowered which in turn is predicated on the assumption that physicians must be handsomely compensated. When I get my brakes fixed I am putting my life in the hands of my mechanic. When I fly I am putting my life in the hands of the pilot. When I get a checkup I am not taking nearly the same level of risk by I am forced to treat my doctor like a god. This country has been controlled by the AMA's false advertising for far too long. We need to bring our doctors back to earth. They are professionals but they are not gods. They should be compensated like every other professional. As for the insane training that we make them go through, that needs to come down as well. I don't need a brain surgeon to give me my physical. A nurse would suffice.
10
Your internist or family practitioner is not earning the vog bucks. Outsized wages go to specialists, and they control the AMA.
One state cannot enact single payer effectively and efficiently alone in a country with 49 other states who do not have it. THE IMPORTANT POINT TO REMEMBER IS THE UNITED STATES PAYS TWICE AS MUCH PER CAPITA FOR HEALTH CARE THAN ANY OTHER DEVELOPED COUNTRY IN THE WORLD AND WE HAVE SHORTER LIFESPANS
WE ARE GETTING RIPPED OFF AT THE HIGHEST LEVEL WE PAY TWICE AS MUCH PER CAPITA AS CANADA AND THEY LIVE THREE YEARS LONGER
15
A very dubious argument since the cash-strapped states have nowhere near the revenue that the Federal government has, but corporate-America is against any socialization of services, so even a pitiful argument such as this one enters the official narrative.
If our politicians ever got their priorities straight, and centered on making health care affordable for the public, they could shift the bulk of the money we spend on programs that are euphemistically referred to as "defense".
End corporate welfare, such as the subsidies for big oil, and the fed is in even a better position to ease the onerous burden of health insurance on the average citizen.
But the average citizen doesn't make health care policy. The elite, who will never feel the burden of today's health insurance costs, make policy - and the corporate-media will keep hush hush on the fact that health insurance premiums have soared over the last several years.
The only thing our current system is good for: transferring wealth upward.
12
We tried to expand Medicaid in Tennessee 15 years ago and it failed for similar reasons. To do universal healthcare properly will be phenomenally expensive. We should just be honest about this. Trying to cut corners will lead to failure. Either we as a country are willing to pay for it or we are not.
5
@J. Patrick
To be honest, we can't afford the private, mostly unregulated healthcare market. It is too expensive and most profitable for the shareholders of the industry. The industry is social Darwinism on steroids.
5
Seems like the healthcare based on the private insurance companies IS phenomenally expensive. We are paying two times more than anybody else who has single payer system .
2
@J. Patrick How does Canada do single-payer for a bit over half the per capita cost that America's draconian system costs it's people?
I wonder if Medicare for All would also help Medicare because i it would reduce the average & health age of the pool--rather than Medicare just covering seniors-- and therefore maybe Medicare would be able to pay doctors more than it does now, which according to one of my doctors is abysmally low.
4
@Clarice
It certainly would reduce Medicare costs. Medicare is expensive because it is a high-risk pool. That is why the industry does not want them, old age is a pre-condition.
2
Civil rights legislation had “no chance of passing” for years and years. Women’s suffrage was “politically impossible” for nearly as many. Major political power brokers of the time were on the wrong side of history for both of those movements. The same is true now with the mighty commercial health insurance lobby.
It doesn’t make Bernie wrong or anyone else who supports providing healthcare for all
using a system proven to work many times over in countries with much less money than the United States.
12
Just curious as to how many millionaires or billionaires live in Vermont and were going to pay their fair share of the taxes that would go toward the program...
My husband and I, retirees, are willing to spend our "fair share" of taxes toward Medicare for All.
9
The way to do this would be to level with American people as to what the actual costs are - no unreasonable assumptions like Medicare payout rate.
It'll work only if the tax increase is at or below the premiums they pay now. That should be the case for 90%+ of the population.
To everyone that's pointing out how it works in other countries, they make certain compromises as a society. We need to be upfront about those. For example, in most of those countries, medical education is heavily subsidized so physicians don't get paid as much. We'll also need government run "death panels" making cost-benefit analysis of healthcare reimbursements. We spend way too much on end-of-life care compared to other countries.
4
@GV i lived most of my life in an eu country. no dead pannels there... here, in US, you get one as soon as your insurance denies your coverage. as simple, as asking to those around you with the possibility to get back to their countries: if you had a serious disease would you be treated in US or fly back to EU?
i am still to meet and European that is not scared of the US health system.
7
Also other countries aren’t as plaintiff lawyer friendly or have no-fault malpractice courts that decrease the cost of malpractice insurance.
1
This is the "strongest argument" against?? M4A should be a shoe-in: It greatly simplifies a maddeningly complex insurance patchwork, plugs gaping holes in coverage, eliminates unnecessary anxieties about change or loss of employment, removes profit motives where they have no place, relieves Americans of the compulsion to become insurance experts in their free time, and makes it possible to improve results while saving money. It can be "sold" to a skeptical public by any skilled politician who believes in it. It can be phased in over several years to allow insurance companies to divest from the healthcare sector, and the law could require employers unburdened by health insurance costs to add their net savings to employee salaries as they phase in the payroll taxes, so employees would see the raise and the tax together. Honestly, once you take entrenched insurance interests out of the room, the whole thing is really quite simple and could be transformative to this nation.
5
Why will it work on the federal level? Because the healthcare became priority for many voters who feel the growing burden of healthcare.
6
The public is very mistaken if they think Medicare for all will bring down medical costs. While people might feel at first they are better off with a Medicare type system, it would merely shift the burden of paying the costs from the public and insurance companies to the government. Who really thinks that means the public won't wind up paying much more eventually? Does the public expect the government is going to print money to pay for all of this? I submit to you that the real driver of higher costs is the medical / hospital / pharmaceutical industry, which have a strong interest in keeping costs higher, because they become wealthy from it. Other readers cite examples of other countries where single payer systems seem successful, but the commonality among them is that the doctors, hospitals and pharma companies earn far less than in the US. Until that changes in the US, high costs will remain high and growing. In short, until doctors, hospitals and pharma companies agree to take less, nothing will change (and I would add malpractice lawyers to that pot as well).
6
But that is exactly what the single payer system will do. It will be able to dictate the prices. Why the prices of Medicare are lower than for the private insurance? Because it is huge, and if the health provider disagree the will lose a big chunk of their practice. Medicare for all will be even bigger, and therefore, have much more negotiation power than any private insurance.
7
@yulia
Don't bet on that. The lobbying efforts of those industries are highly effective and pervasive. And the government hardly has a track record of frugality in dealing with high cost. If anything, the process will become less transparent and more confusing. Don't get me wrong, I am no fan of insurance companies, but they also have no interest in claims on high health costs. I don't think they are the bogeymen in all of this.
1
Not so persuasive as the politicians fear of increasing taxes, which would required if the system will be not frugal. And the Government could be pretty efficient, after all Medicare do pay less than private insurances. Sure, insurances would love to decrease the cost, but they don't have enough power, and beside why should they if they can shift the high cost to the customers. I don't think there will be trouble with transparency, because there will be one entity to pay, and that entity will dictate the practices and prices. Right now the problem with transparency is because there are too many players with different payment schemes, and different set of rules. That will be eliminated, and definitely wi'll improve transparency.
1
It's worth pointing out that Peter Suderman works for a libertarian pro-capitalism (read: anti-government) magazine ("Reason"). Therefore, it's no mystery that he's opposing a single-payer system (albeit, by asserting that one failure among many other successes worldwide means a failure every time).
9
We lack the courage to try! Other nations provide better care at less costs. At the very least, look at the best things they do and COPY!
4
People fear big change. If we had MfA now and proposed switching to our current system, the same people would be opposed for the same reason: big change is disruptive and scary.
That's what's so great about the ACA. It was no change at all for the vast majority of people. Yet it helped the people who most needed help.
Let's build on the ACA. We can get everyone covered. Without big, scary change, and the strong opposition that comes with it.
Fear of the unknown is rational. Let's work around it if we want to make progress.
4
Unfortunately, ACA didn't help many people. It was not able to stop the growth of health costs, and now people with health insurance could not afford access to health care.
1
In New York state there is a single payer plan that has passed the NY State Assembly for the last several years and has a good chance of passing the NY State Senate this year. A Rand study has shown that it will save the average taxpayer in the state a great deal of money taking into account increased taxes but almost no medical expenses of any kind. It even provide free long term care! If it passes the legislature and Governor Cuomo signs it, New York State will provide a model of single-payer healthcare for the entire country, just as the Canadian province of Saskatchewan did for Canada. It is strongly supported by the New York State Nurses Association and several other groups.
5
@Grandpa Bob It wasn't even introduced in the state Senate this year, even after the Dems gained the majority. Why? Tax revenues taken in by the state were a lot lower than in recent years. We just don't have the money for this plan.
1
Umm...it's not a limitation as a concept because Vermont couldn't pull it off. As you state, many artificial barriers were created and existed to never let it succeed.
I'm very much for it, but perhaps it's just not in our will. It will actually mean hospitals and doctors and drug companies serve people's health instead of their own bottom line. Medicine becomes "less sexy" but actually more effective and health promoting.
Simply put, if providers had to negotiate amidst an entire nation of patients, costs would fall, service would become transparent, and risk would be spread. Other countries do it. And we could do but I think we'd rather just keep overspending, under-resulting, and draining tax dollars toward futile care anyways.
10
@Cooldude
Delusional in that we would all be under the illusion of healthcare without actual care being provided. “Sexy” has never entered my mind caring for a 89 year old patient with dementia and multiple co-morbidities each with their own complexities , complications, and medications. You have to wonder when people who have never seen a patient have all the easy answers.
Seriously, Suderman, you think that we as Americans, who regard ourselves as the most creative people on earth, cannot figure out how to do what every other large industrial nation on earth has done? That we need to remain under the chokehold our health "insurance" companies have over us? Do you have a plan to reduce the unconscionable cost of medical service in this country? If so, present your positive ideas, because even as a retiree on Medicare, I find myself unable to escape hiring a private insurance intermediary I don't trust for even a moment. Where are your ideas, not your criticisms.
10
The existing medical infrastructure and staffing (clinics, hospitals, general practitioners, specialists) cannot nearly support the flood of patients that a Medicare for all program would generate. It would take years and a gradual phase in for such a program to work.
2
Right, because good healthcare and preventive medicine makes people sick, so if medical care costs less everyone will run out and contract alife threatening illness.
All of which simply says these people couldn't get it done. Not that it can't be. The rest of the developed world has proven it can be.
6
So many pundits raise the supposedly scary point that government spending will rise, that the state budget will double or triple. That's a canard. Of course government spending will rise. The more important points are what such proposals do to healthcare spending (overall, average, median or by some other measure) and how will these proposals be funded. Senator Warren does herself no favors when she dodges the funding question.
3
I dislike that medicare for all is considered one and the same as single-payer. Do we really want the government to monopolize women's reproductive care? What do you think a future Republican government will do to women's health with that much power? It is bad enough that the government is trying to legislate out women's right to choose. I will not recount the multiple other ways women, particularly women of color, are treated unfairly by the current healthcare system, which at least is not a monopoly yet.
It makes me furious that no one is talking about this obvious risk to women, transgender, minorities, immigrants, if single-payer really goes into effect.
2
@MomOfTwo that is a great point. The decisions of what services will be offered could hinge on politics. Government funded care now has limitations (the VA, TRICARE, Medicare/Medicaid, Indian Health Service) and exclude some procedures - to include abortion unless it meets very specific criteria. How will that be handled?
1
@Mary the same way as in any other western country. separating religion from health care. most eu countries have far more progressive laws than US
How do women now manage the reproductive rights? Ones who could afford, pay for abortion from their pocket, some have access to abortion through the insurance, other don't have abortion because they could not afford. Same with birth control. The reproduction rights will be control by the government with private insurance or without it. It is completely different question.
It is possible to be for universal medical care for all, and not for medicare for all.
We need to look at the specifics of our nation, and build upon that. It should be an expansion and improvement of Obamacare. some of the European nations have health care for all citizens based on tightly controlled insurance programs-germany, switzerland. that is the way we should go. sometimes I think Sanders’ medicare for all is his way of eradicating Obama’s contribution so that he may claim credit. sounds trumpian.
no one I know on Medicare can manage without supplemental programs. doctors who leave medical school $ 250,000+ in debt cannot accept medicare fees and survive.
4
@Honeybluestar
The problem is that when one does that, all it sounds like is noise. I agree there are a lot of different plans, but Americans do not understand the differences. Dems seem to think hours of blah blah blah convinces people. The better idea is to get them to like one simple idea, and the vast majority have an understanding of Medicare.
Get the simple idea across before you inflict hours of monotone policy on people. But Dems never want to listen, only talk.
Medicare For All. Americans know what it is.
1
Why couldn't they, when majority of them definitely could, otherwise Medicare would not exist. Sure, there are system based on the private insurances, but it still will require huge changes (and, yes, overriding Obamacare) because these countries have no employer-based insurance, their insurances are not for profit and highly regulated by the Government. No matter which way you want to go, it will require huge changes.
Government spends billions of dollars to keep a military killing machine well funded. We never pass up an opportunity to invade a country. We never seem not to reject a tax cut for billionaires.
Yet, when it comes to health care, the US cries broke. Why don't we borrow more money from China to support our health care system? We've been borrowing from China for a minute.
5
What is missing from all these discussions is benchmarking against what is (and is not ) provided under other countries' single payer systems. Other countries triage health care by age - believing it is unethical for some young people not to be treated while the elderly are getting expensive, and sometimes minimally beneficial, aggressive care. Also, there is more emphasis on healthy lifestyles. We need to tackle obesity, opiate addiction, drunk and careless driving, etc.
The current system is unsustainable. And, a single payer built on the current system is unaffordable. When folks finally admit it, we will be on our way to creating a sustainable future.
2
Well, the single payer will be completely new system, that is not based on the current one.
"The Vermont plan was done in by high taxes, distrust of government and lack of political support."
In other words, the only thing that killed it was the belief that it wouldn't work.
5
Medicare will cost everyone $135 per person.
How is this a better idea?
A family of four will pay $540.
No one is asking the right questions.
1
@Tommy Obeso Jr Where are you getting these numbers?
I'm a single person. I can afford $135 per month. That's less than I'm paying right now with subsidized health care from my employer. My deductible is $5,000 so I rarely go to the doctor.
Medicare for All would mean that I would never go bankrupt if I lost my health insurance and had to pay out of pocket. So many people go bankrupt because of our current failed system.
9
@Tommy Obeso Jr How is Medicare for all a better idea? Many families of 4 are NOW paying well over $1,000 a month.
4
I live in Australia where we have a 'medicare-for-all' program called Medicare. All citizens and permanent residents are covered by this scheme which provides free doctor visits, free hospitalisation and heavily discounted medication prescriptions. It is funded by a 2% levy on all employed persons, collected by the Federal Government. This covers about 67% of the cost of the program with the remaining cost covered by Government funding.
I am in a single breadwinner family and earn $70,000 so my annual contribution to Medicare is $1,400 for total health cover.
In a four month period last year I had hospital expenses of $72,652 as a result of triple-bypass heart surgery and subsequent intensive care treatment. Medicare paid $69,801 of those costs, leaving me a total expenditure of $2,851.
If my country can manage a program like this, I find it almost amazing that the richest country in the world can't -- and that so many Americans don't want such a program.
10
@kamai America may be the richest country in the world but only because we have a lot of billionaires and multi-millionaires. The inequality is staggering. That is why we haven't been able to pass anything such as Medicare for All - because the oligarchs don't want it.
7
@kamai I'm with you; as an Australian in the US it staggers me that so any American's simply don't get that they are paying so so much more than they need to for basic health care. And it's so complicated for them - you should see the annual renewal process and choices they need to make on what level of cover they want, how much they have to pay for it, blah blah blah. It's crazy. In Australia I have medicare plus have always had private cover for electives etc. And it's still way cheaper than in the US.
The other thing in the US is if you pay well then you get to see the over servicing that goes on. But you can't get away from the insurance companies complaining about spending a dime more on treatment than they need to.
American's are really get a raw deal on this one.
Countries around the world have national healthcare.
In nearly all of those countries, per capita healthcare costs are less than half of what we pay in the USA.
Many of these countries have higher median heathcare quality than we do, according to the WHO.
Why can’t this work here? It works in Canada, Norway, the UK, Germany, France, Sweden, Japan...
Why not us???
7
Because the government is owned by corporations.
1
Articles such as this one try to undermine public support for single payer health insurance by citing the higher taxes and larger government budget that attend such systems.
These arguments are, of course, empty tautologies. If government insurance replaces private insurance, of course the size of government increases. If insurance premiums are now called taxes, of course people pay more in taxes, but less in premiums. The tax increases are irrelevant since total health care spending for the country and most of its citizens will decline because a national single payer can negotiate lower prices. It is the total cost figure, not whether the costs are called premiums or taxes that matters.
6
Norway has a national health care system, paid for by much higher taxes than Americans pay, but also co-pays. Where did Sanders ever get the nutty idea that "Medicare for All" wouldn't require major tax hikes and co-pays too?
5
He doesn't claim that it will not increase the taxes, he claims that taxes will be offset by elimination of premiums and co-pays. Obviously, health cost in Norway is still lower than in the US: 6,647$ per person vs 10,208$
1
Per capita annual healthcare costs
Norway = $5289
USA = $10,568
Source: data.oecd.org
Taxes go up. Health insurance payments, by individuals, by their employers, etc, — go away.
Over-priced hospital administrators, doctors, specialists, hospital charges, pharmaceuticals, unneccessary procedures... are BROUGHT UNDER CONTROL!
No other major, developed country is close to $10K per person per year.
2
Because in Canada there are no "co-pays" for single payer health care.
1
Two thoughts:
If 28 of the 27 industrial democracies in the world are smart enough/abel to make universal healthcare for their citizens, why isn't the US?
As long as "health care" is viewed as a profit center, Americans will pay more for less, assuming they can afford the "insurance"...
8
@HapinOregon Huh. Do you work for free? Why are doctors any different than you?
As for the "profits" of the hospitals and insurance companies, every firm has to cover its cost of capital, whether borrowed or equity. Profit is just the cost of equity capital. If a government-owned firm is not making any "profits," then it's not covering the cost of the equity it has invested in the firm and guess what? it's the taxpayers who are covering that cost. There is no free lunch.
Profit is just the cost of capital? Time for you to go to business school and learn the difference.
@Douglas
After a few visits to the dentist, it became apparent to me that my bill was always close to $1000 per hour for the time I spent in the dentist’s chair.
When I confronted the dentist’s billing clerk with this fact and asked her why in the world the dentist needed to charge so much, the dentist stormed into the billing office.
“See any dentist in this county or the one to the south! You’ll find my charges are in line with my competitors,” he loudly told me.
On my way home, I wondered if my dentist knows that price-fixing is a crime. Or that free-market capitalism involves competition. That he was confessing to conspiracy and collusion.
Douglas, the American people are swindled out of nearly $2 trillion every year by greedy over/priced doctors, hospitals, medical schools, specialists, pharmaceutical companies...
Attempts to justify this gouging have gotten very old and tired.
People who desire to be healers, to ease the human misery of disease, injury and aging — get the idea through your heads that you don’t deserve to get rich following your dream. A comfortable middle class living? — yes. Millions and millions of dollars? — no.
The greatest swindle of all time, the For Profit American Health Care System, is going out of style.
We can’t afford to be cheated out of trillions a year any more.
1
I really wish that people could work together and create a successful universal health care system in the US. I am from Taiwan, which is a small island off China. Taiwan has a fully functioning national health care system since 1995. It is heaven on earth for the ordinary people on medical expenses. You can see any doctors you want. For in-patient service, you pay extra if you want a private room but I am totally fine with roommates. In addition, dental, acupuncture, chiropractic, prescription services are all covered. Foreigners, like international students or foreign workers, are covered too. This is not a fairytale, it is real.
9
How is it the US is the only western democracy not to have figured this out? Too exceptional?
Yesterday morning I took a header down the stairs in the subway. In the last 24 hrs, I've had a same day appointment with a doctor in my regular md's practice (no waiting), had an xray at a clinic (20 minute wait) and was advised to go to the ER (took several hours, but my injury wasn't urgent.) Now I have a referral to a sports medicine clinic and advice on how to look after my busted knee. I have paid $0 out of pocket and filled out 0 forms. How can you afford not to have a universal health care system?
2
@Alice The U.S. has spent the last 70 years building empire - funding the Military Industrial Complex - while other Western democracies have spent that time bettering their citizens' lives.
Time to wake up America. It's past time to put resources into health, education and addressing the climate crisis.
7
I've read a lot of comments (most of them in fact) that defend MFA by citing the success of universal health care in developed countries. I hate to say it but this is America and a lot of countries do great things we don't do. I'm all for it but agree with the op-ed. The crux of the problem as I see it, and he speaks about, is that many DEMocrats in Congress wouldn't support MFA. Look, both B. Clinton and Obama fought for universal coverage in their first year but couldn't get it passed by Congress. Obama couldn't even get a Public Option through the Senate. Then, they both lost the first mid-terms because of their efforts. So no. I don't find the argument of these comments persuasive.
1
@Annie
You forgot to mention the Republican opposition and the power of the industry.
China with a population of 1.4 billion provides national health care, but we can't. What is our excuse?
@Annie Universal coverage is not synonymous with single payer. Many countries with universal coverage have multipayer systems, that is, public and private insurance. Germany and Switzerland have very successful multipayer, universal systems.
Sounds like a messaging problem to me. Republicans have used scare tactics to convince Americans that single-payer doesn’t work.
Dems need make a series of commercials showing real Americans sharing their own personal nightmares about what happens when private insurance companies refused to pay for their wife’s cancer treatments or doubled their co-pays or claimed the doctor they saw in the emergency room was out-of-network.
4
@Carrie
Not to forget the deliberate dis and misinformation by the industry. Single-payer works worldwide but the private system does not work not even in the big US market, that is the truth.
"Yet by 2014, Mr. Shumlin’s own estimates found that employers would have to pay taxes equal to about 11.5 percent of payroll, while families would have to pay as much as 9.5 percent of their annual income to make the financing work."
Let's make one thing clear - employers don't pay payroll taxes, workers do. If you have ever managed a headcount, you know that your department is charged for the entire cost of each worker - salary, FICA, FUI, SUI and benefits. From the employer's point of view, that's the cost you're paying to hire someone, and it doesn't matter how the money is allocated. If you have $100K available to spend, you can hire someone with a salary of $70K.
3
So paying more in payroll taxes means less in salary.
2
@Jonathan Not true. Payroll taxes are split into 2 parts -- part of it is employer based contribution that the business has to pay extra out of its own pocket for every employee.
1
@Jonathan
payroll deductions for insurance like FICA are not federal taxes, they are insurance premiums, regardless of the name of the insurer, private or government managed.
Medicare for all will have a chance of passing when the last of all of us boomers are gone.
2
Nobody seems willing to accept that US healthcare is a completely dysfunctional marketplace. It I do not think single payer can work in workin a State market. There simply has to be a unified national regulatory scheme. This is because of the outsized power of pharmaceuticals and their patents.
Healthcare can never work as a commodity free market. The big problem is that there is simply no elasticity in demand. It is very hard to shrug your shoulders and walk away from lifesaving treatment because it costs too much. All of the power is in the provider hands.
Healthcare is no longer a commodity. It is a utility. Treat it like one.
8
Medicare for All is not a national health care plan, it's an aspirational campaign slogan. It is also a campaign loser.
There is much to repair in the US healthcare system, with its skewed incentives and unsustainable profits-over patients-approach.
But rather than sit down with doctors, institutions, insurers, and patients to have a serious, open discussion about how to improve US healthcare, including moving to a system involving the government, possibly a hybrid plan typically of other countries, MFA advocates are putting a specific end before the process, effectively ruling out more viable, possibly better alternatives, and ultimately disregarding the process altogether.
That is the fatal flaw. Nothing durable gets done without broad consensus.
1
@RD Exactly. We're more likely get to universal coverage incrementally than to demolish the gains made via the ACA and try to start a completely new, totally public system.
As a Canadian, I am flummoxed by these arguments.
The universal, single payer plan in Canada:
1) Covers everyone from birth to death - the risk pool is the largest possible.
2) Payments (taxes) are collected by the already established tax system and are built into progressive tax rates.
3) Payments are automatic and are made to all doctors according to an agreed fee schedule - 99% of doctors accept these payments, and the infrastructure to handle this costs 25% less that what is current in the USA
4) Medical care is free at the point of use.
5) The cost of this universal coverage is about 1/3 lower per capita than the cost Americans are actually paying for coverage that ignores millions and has debilitating copays for millions more.
6) Not *everything* is covered. People can buy private insurance for dental, excess prescription drug costs (the single payer system pays for some), vision care and some ancillary services.
7) General levels of health outcomes are better in Canada than in the USA.
The template for doing this is out there in many countries.
I have trouble understanding what is stopping you.
17
@Jean As a Canadian, I have lived in both Canada and the United States. I have to correct your misleading picture of the Canadian health care system.
First, there is not a single system, but a collection of provincial systems, all of which are administered differently and require the beneficiary to be a resident of that province.
Second, the provincial plans collect insurance premiums from their members. The premiums vary by province.
Medical care such as lab tests can be billed. Medication can be billed, and frequently is.
There are fewer doctors available in Canada, and the wait for specialists can be very long. The range of available treatments is smaller. Access to physiotherapy and mental health care is not as good. The cost of Canadian care reflects this. You can’t compare apples with oranges.
The statistics on better health outcomes are misleading. The U.S. system is highly unequal, and not every citizen receives equal care. This is the problem with coverage that the ACA tried to address. A comparison of equally-insured patients in both countries would show a much different result.
This is not an argument for maintaining the current U.S. system, but it won’t help American voters if they’re led to believe that other countries’ systems are different from what they really are.
1
@Global Charm
Nice to hear from you.
The Canada Health Act passed in the mid 60's specified how universal health care would be administered, and it became a provincial responsibility with federal rules. At the time we had about 10 provinces and a couple of Northern Territories.
I note that you are writing from BC, my province. You failed to mention that some right wing governments collected an extra premium from some people, which in the case of BC has been reversed by the new more left gov't. You failed to mention that poor people did not have to pay this premium based on income.
Yes, we have a problem with access to specialists. We don't have enough doctors.
Having been a Canadian citizen for 70+ years, I blame the governments who have made medical school tuition so high that graduates have 6 figure student loans.
We are not perfect, but for you to say that a median income person in the USA ($59,000) has perfect access to healthcare is bizarre.
If we present to a doctor or ER in Canada with an acute problem, it is treated right away. If we present with an unusual problem we are treated right away. Free at he point of access.
What is your point?
@Jean Sorry, under #3, the cost of administration is at least 75% less.
As long as there s a Federal Tax burden, NO state will be able to enact a successful single payer system.
1
Vermont is a little and not a very powerful state. But medical insurance and pharmaceuticals are powerful industries, their lobbyists sit at the table with the legislators writing the bill. ACA gained some regulations setting minimum policy standards but the taxpayers had to reimburse the industry for any profit losses. The industry dictates the conditions just as the NRA dictates the gun laws. So much for the government for the people by the people.
Medicare Part D surrendered to the Pharma industry, the government consented to make it illegal for Medicare to negotiate subscription drug prices to get crumbs for the patients. Why see a doctor when you can't buy the medicine needed. Where is the logic if not in the profit margine.
3
The author’s magazine REASON is ideologically committed to free markets. Explain how the middle men of the private health insurance corporations who pull $100 billion in profits out of the system annually contribute to our health care. Medicaid covers 75 million Americans and reimburses at a lower rate than Medicare, so Medicare for All would improve doctor fee reimbursement. While disinformation will be the major weapon against Medicare for All, paying private taxes to corporations or public taxes to government is still money out of my pocket. The latter with Medicare for All would just be less.
11
@Dave Rathke
Is it "Christian" behavior to steal from your fellow human beings? so interesting that one is supposed to invest in the misfortunes of people all over the world doing tough jobs for little $$. No church should invest. Start your own business but do not invest/exploit.
State and national single-payer financing options are not the same. National options are numerous and include a progressive income tax and a tax on stock and bond transactions plus a wealth tax. We can also negotiate drug prices on a national scale that saves lots of money on health care costs. All the money now going for Medicaid, Medicare, and tax subsidies we pay to the private health insurance companies (for so called "Medicare Advantage" programs) is money available to help fund a national program, too. It can be done nationally.
5
What no-can-do people like Mr. Suderman are counting on is that nobody is this country realizes that Universal HC for less is successfully happening in many other countries.
There are 2 parts to this: Reducing the overhead of for-profit insurance. Medicare-for-all covers that. Second, is standardizing and reducing the costs of the actual health care. No more $15,000 emergency room visits for minimal care. Or $2,000 charges for aspirin.
Those changes need to happen to get a handle on this explosive system. Continuing to insist that nothing can be done is not going to work as more people are demanding change. Regardless, of the politics, this system can not stand as currently configured.
8
@Driven: No one goes it alone in healthcare, anywhere. If you have insurance you are paying for others who don’t and show up at the ER where they are typically much sicker and cost much more to stabilize - you pay in higher hospital charges and higher insurance premiums and out-of-pocket costs. If you have car insurance you pay into a risk-pool, so you are “subsidizing” bad drivers. The risk-pools make it possible to offer insurance, of any kind.
No one has a “right” to drive their car on a safe road- we are granted permission by state DMVs, we pay taxes for the benefit of greater good. Ditto Military, Education, Police, legal system, etc.
4
https://economix.blogs.nytimes.com/2013/09/04/obamacare-vs-romneycare-the-labor-impact/
“...Massachusetts law did, on average, increase marginal tax rates and thereby reduce the reward to working. But the impact was well under one percentage point, and for that reason it’s probably not surprising that, relative to other states that were not experiencing health reform, the Massachusetts labor market did not change noticeably after the law went into effect...
“...the impact of the Affordable Care Act on nationwide marginal tax rates: it increases national rates about 12 times as much as the Massachusetts law increased rates. Earlier this year I explained why the Massachusetts law was so different from a tax perspective: among other things, its employer penalty is an order of magnitude less...
Frankly it would only be noteworthy and worth publishing if someone from Reason wrote a piece supporting Medicare For All .
I didn’t come predetermined to be a supporter and advocate for Single Payer . I saw a clearly broken healthcare system woefully inadequate to meet our needs . I studied up , kept abreast of the subject and started hearing about how other developed countries provide care to their citizens and became exposed to the concept of a Single Payer system.
Once I saw the enormous cost savings coupled with the societal benefit , I was sold .
12
It works in other developed countries. They get better health outcomes for less money. Start with what gets the results and adapt from there. Healthcare is a human right. It is obviously feasible since countries like Cuba manage to have it (and even live longer than us). It is not a matter of if we can make it work, it is if we are willing. And the key to making it work is recognizing healthcare as a human right. Enough with the excuses.
8
@Meredith the same applies for education, other countries get much better outcomes for far less money. America is broken.
The Medicare Benefits Scheme and Pharmaceutical Benefits Scheme in Australia are funded upon a 2% to 3.5% tax on gross income. Folks paying no taxes (children, elderly, income earners under AU$18,200, inter alia) pay nothing. Nonetheless, these schemes cover ALL Australian citizens from the homeless with mental illness and substance abuse to the CEOs worth billions.
Anyone suffering a suspected heart attack, stroke, mental breakdown, or stubbed toe can excess free and timely medical care, right across the country.
These schemes aren't perfect, but they work. As a family physician, I'm oft-times heard complaining about them.....but I wouldn't trade 'em for the world. Australians have generally conceded that the benefits of such schemes outweigh the downsides by orders of magnitude.
6
A long time ago, I listened to a radio talk show that pitted an arch conservative against a known liberal on a number of subjects. As expected, they argued and disagreed about almost everything.
At the end of the show, the host asked if them is there was anything that they could agree about, and they answered "if we don't reduce the cost of medical care by a huge amount, it will bankrupt the nation".
It's too expensive.
We already have a single-payer system. It's called the VA. It only serves a slice of the population, but it is a functioning model of how a wider system might work. Has anyone done an analysis of how much it costs to provide health care for each veteran, and extrapolated that to the entire nation? At least we'd have a number.
3
Actually VA is better than single payer, it’s actual socialized medicine
1
There's a difference between failing politically and failing when actually implemented. This article is a strong reminder of the political challenges facing single payer, and the need to be realistic about what single payer would take. But it's not saying that single payer, once implemented, would fail, or even be unpopular.
7
So we learn from our failures and try again. That's because this problem is not going to go away. Just like rocket science, this one is a big problem. Failed launches are an expected part of the learning process and you don't give up. Many reasons are given in this article for failure, but I don't see any of them as proof that the problem is unsolvable.
Pick yourself up, dust yourself off and start all over again.
4
The writer overlooks a basic difference between the states and the federal government: progressive taxation. The problem on the state level is that without being able fund the system through higher taxes on the very wealthy, many people will see little financial advantage in changing to a single payer system and so are opposed or at least wary of change, especially if they think they already have good insurance themselves.
3
ObamaCare is the way forward. It's goal was to increase those covered by health insurance and it has met that goal. The most dramatic increase in coverage has occurred for those covered by expanded medicaid, state sponsored programs for those with low incomes unable to pay for expensive insurance premiums. With most Americans covered by employer sponsored medical insurance and an even larger expansion of medicaid, nearly everyone would be eligible for affordable medical insurance. The issue of medical costs also has to be addressed but that's a different problem.
2
Actually I would draw the opposite conclusion as that of the author; while I think single payer on a national level would work wonderfully, I don't think individual states can do it on there own.
The vestiges of the way the country was set up at it's beginning with the states being individual entities that joined the union, unfortunately has lead to destructive competition among the states today. The states are all in a competitive bidding war to attract companies, jobs, etc, even rich people.
If a state like Vermont tries to have universal health care, companies will leave for lower tax states, people who need health care will move in, and doctors will move across the border to places like Massachusetts with higher reimbursements.
It's has to be a federal thing, individual states cant do it.
10
It would be necessary for the Feds to grant waivers on use of Medicare/ Medicaid funds to a state so they could use that money to help fund single payer in addition to state taxes replacing private insurance and premiums. It would work. Canada did it province by province starting with Saskatchewan in 1961 and the successful models led to the federal program in 1970. Vermont never got the waivers
The Canadian system could apply State by State or as a Federal plan, but it would take years to implement & such US plans, while less expensive than the private & public systems together now are, would continue to be more expensive & less efficient than those in Canada.
Each Province over decades established an effective quasi-monopoly that (a) excludes private insurers from offering coverage for necessary basic medical services, & (b) makes delivery of the basic services covered by a Province's plan impractical except within that plan. This must appear draconian, but it provides many benefits for both service providers & the public & is accepted with different degrees of enthusiasm by most Canadians.
Our plans often don't provide direct services at peak capacity. Many authorities contract with private hospitals in nearby US States to serve overflow patients during times of highest demand. US hospitals give our authorities preferred rates & this adds to the savings, at no loss of access or quality of service, that our authorities & patients enjoy by avoiding overstaffing.
There are constitutional & cultural reasons plus the fact it has taken Canadians 6 decades to develop the Provincial plans now in force that make it highly unlikely that the US will establish such State or Federal quasi-monopolies &, insofar as public plans become sole service providers, the need to overstaff to cover peak demand arises.
These are but 2 examples of efficiencies unique to Canada.
3
Vermont's population is roughly the same as Memphis, TN.
You neglect to mention the simple question of scale. Is a single payer system feasible for a small city, and the impact of having major employers like IBM that are self-insured, and having corporations (IBM, General Dynamics, UTC Aerospace) that operate at a national level and have their health plans governed by national regulations.
Having lived in VT through that period of time, I think you're simplifying the issue to meet a particular point of view.
10
Interested folks should read what Seema Verma, who oversees Medicare, has to say:
https://www.cms.gov/blog/cms-blog-medicare-all-just-another-name-government-run-single-payer-system
Her comments parallel those in this column. There are some things only the government can do; for example, the military. But controlling medical care is not one of them.
Basic medical care should be available and affordable to all. But it can't be a free for all; there must be limits, such as deductibles and co-pays.
Almost all countries with national health programs have found that these programs don't meet all needs; they are supplemented with private medical care and medical insurance. The same is true in the US, where most Medicare recipients buy private "Medigap" supplemental insurance. "Medicare for All" is not going to mean care will be easy, and billing non-existent.
We're going to need a hybrid, and that means some complexity. Government regulation will be needed to enforce price transparency, and keep costs under control.
People will have to accept that good medical care does not always mean more medical care.
Drug costs must be brought under control; we need to stop subsidizing inexpensive drugs in other countries, often developed by American taxpayers.
We need to address the very difficult "end of life" problem, with too much care provided to many when it's time to ease off.
We need malpractice reform. The costs of defensive medicine are far greater than most realize.
6
My 1 month old daughter got a bill today for $11,500. For being born. It was the 'nursery fee' (she never stayed in the nursery and had zero complications at birth.) Happy Birth Day from the good 'ol USA!
I don't really care if Vermont was a failure; we've been dealing with a failed system for a very long time.
12
Why should other people pay more taxes to support me? I have no right to another person’s paycheck nor does anyone else.
If you can’t support yourself, then you go without. I don’t understand why that is so hard to accept.
2
It’s this thing called the social contract. Western society is essentially based on it.
9
@Chad
There is no contract. There is no requirement—but there is charity. Anything forced turns out badly.
You are more heavily taxed when the uninsured throughout the US visit the ER because they have no PCP and then default on their medical bills, than you would have been if they'd had medical coverage in the first place.
You're taxed when people fall into such ill health from not having coverage that they stop working and starting collecting benefits - that happens all the time. You're taxed when your costs go up to account for everyone else's failure to pay their astronomical bills.
It's the same old argument.. 'why should I pay school taxes if I don't have kids in school?'
The answer is that paying for decent schools is cheaper than paying for prisoners down the road. Prevention is always the smarter and more efficient buy.
You could add in that it's the decent thing to do, but even if you've chosen not to be a decent person, it's still the smarter choice.
1
The argument this article makes is based on 2014 assessments of single payer insurance popularity and cost studies from 2011. It is a fairly well-known and obvious fact that those numbers have changed significantly (to say the least) since then. Support for a single payer system has skyrocketed to ~70% since then. The need for a single payer system continues to skyrocket in less concretely measurable ways (human pain and suffering).
To me, at least, it is confusing for Suderman to invoke "initial cost estimates" from 2011 when the year is 2019. Why not provide more up to date examples of cost estimates being too detached from reality? It also seems disingenuous for him to invoke cost estimates when the American system ends up costing the taxpayer twice as much for healthcare compared to the average European socialized system. It would seem important to weigh the current actual costs that are our harsh reality and not isolate
ten year old cost estimates from their political and cultural contexts.
Suderman is right to point out the issues that face single-payer, continued public support, cost/tax concerns, and an adversarial nihilist Republican party. However, if he would look at the *2020* platforms of the candidates posturing to take this issue on, he might find that the specifics of his concerns are somewhat outdated. That being said, I would be curious to see what problems he thinks we might face in this new decade.
3
The Senate will almost certainly be Republican after the next election and therefore a single payer system has precisely zero chance of success in the next five years.
2
@Dr if Why does the Senate have to be Republican? What are your numbers?
That was then, this is now. So much has changed and so much is continuing to change. It is a new era of systemic change. If you don't believe me, think about the schoolchildren out in the streets in huge numbers agitating for action on this climate crisis. That wasn't happening even a couple years ago. Medicare for All. Green New Deal. Education for all not wars for oil and empire.
3
I'm a Vermonter and experienced the failure of the single payer proposals firsthand. Much of what's mentioned is true- the VT exchange had major technical problems and nobody is ever thrilled with the prospect of increasing taxes (even if it might mean higher incomes). But to compare a system proposed by a small, no, tiny state and conclude it can't work at the national level is downright silly. Medicare already has systems in place to price and pay for care (at much lower admin costs and lower prices). Vermont does not. Further, the state would have to make complex agreements with the state as much of the $ would have come from $ the feds were already paying (via Medicare and Medicaid).
What the author failed to mention was the very real concern that uninsured sick people would move to VT from other states. That was a very real concern and one that's moot with a federal single payer system. There's no question this would happen- you're uninsured and discover you have cancer or need a transplant. You could just pick up and move to VT and get care- this would explode costs for a single state.
3
One Federally managed affordable catastrophic plan (e.g. kicks in after $5000/person/year). The penalties for fraud will be set very high, and by statute will be able to pierce any corporate veil and hold individuals accountable.
To ensure competitive markets and consumer involvement:
No other medical insurance permitted to be sold.
No monopolistic provider businesses.
The prices of all health care goods and services shall be the same for everyone, and those prices will be required to be readily available to the pubic.
Low cost and clinics, treatment centers, and wellness programs should be encouraged for businesses, municipalities, schools, non-profits, etc.
3
This article is misleading. We call Vermont "Brave Little State".... in this case, the emphasis in on the "little". This initiative failed quite simply in response to two variables: 1) a concerted attack by the insurance industry, and 2) economy of scale with a little state going it alone.... nothing to do with the notion being unworkable.
7
Keep Medicare for all above the age of 65 as is although enhancing it as has been done by a presidential executive order last week may turn out better. Medicare for all is nonsense but Vermont's failure is a good reason not push it on the nation.
Politicians like Bernie are confusing health insurance and health care and they are not equal. As Bernie himself found out the best health insurance that he has as a senator could not prevent his heart attack because he ignored the component of personal responsibility and proactive self care. He does admit to making dumb mistakes in not doing anything about the symptoms/signs of fatigue he felt but the point is if one causes self inflicted harm then no mater how much you try and get the government to pay for health insurance if you do not get on demand optimal health care and as a person you do not comply with NIH guidelines for healthy living it is a colossal waste of health care dollars.
The Department of Health and Human services (DHHS) has the largest budget of any federal Department with a spending of 1 billion dollars a day on Medicacid among other spending by DHHS. What is the use if Americans don't get the full benefit of billions that is spent?
1
If we are all in a boat in the middle of the ocean and a problem needed to be solved. We'd have multiple solutions solving the problem. The first step in identifying a common problem in this circumstance would be to decouple employer based health insurance. Putting everyone in the same boat to readily identify a common problem.
1
This article is absurd pretzel logic.
It also uses unfair and unrelated comparisons.
But one of the biggest differences between a state and the federal government:
A state does not have a bloated military budget, of which only a small percentage in cuts could easily pay for Medicare For All.
Another difference:
A state can't charge a tiny percentage transaction tax on Wall Street, which would also generate more than enough revenue to pay for MCA.
The federal government can do these types of things, and more. It is simply a question of priorities.
Do we want to have a more fair, healthy, and equitable society, or do we want to have thousands of our citizens suffer and die every year while private health care insurers make billions of dollars in profits for themselves and their stockholders.
Shouldn't we be asking other questions.
Not "What are all the reasons we can make up why MCA won't work"?
Maybe "Is it really OK that in the richest country in the world people's homes get taken from them because they can't pay their medical bills"?
There is a recent video of a mom in tears telling the story of her diabetic son who died after he rationed his insulin because he couldn't afford to buy the next sufficient dosage.
Is that really OK with you, Mr. Peter Suderman?
Really?
10
I have paid into Medicare for forty years, supporting the seniors from my parents' and grandparents' generations. Now that I am 65 and ready to sign up for Medicare myself, I would feel very cheated if suddenly the rug is pulled out from under me and I'm forced to pay higher premiums for "Medicare for all" which would cover individuals who have not paid a cent into the system. Medicare is not cheap as is. I will have to pay premiums for Part B and Part D and for supplemental private insurance that covers the percentage that Medicare does not. It is in no way a freebie. If you are too poor to pay these premiums then the government gives you Medicaid coverage, that is a freebie that very poor seniors get. Similar to the free Obamacare policies for the poor. How much more free or universal can we get? Honestly listening to the political discourse one would think we were a country bereft of services where only the top 1% could see doctors.
5
"The Vermont plan was done in by high taxes, distrust of government and lack of political support."
This argument doesn't wash.
If universal health care was so impossible, how can other countries like Canada and Sweden do it? We should just hire people from those countries and ask them to help design it.
Distrust of government I get, and it's no wonder when government is acting so untrustworthy. Solution: Earn people's trust. Health care would be a start.
High taxes, maybe, but as Bernie says, taxes displace other costs like profits to private insurance companies, and inefficiencies of a private system. Not to mention untrustworthiness (see above) of private coverage ("Oh, we don't cover that").
Finally, lack of political support. But maybe it would get more support if the public weren't misled by articles like this.
4
When a libertarian talks about taxes, rememberer that he's usually making things up to fit his argument.
They like to talk about how taxes will go up if a single-payer health care system is implemented. And they're right -- taxes will increase.
But that ignores the significant amount of money people pay each month for health insurance. My employer pays a premium of nearly $10,000 for my insurance. (That's just for me, not my family.) I pay about $1,200 a year ($50/paycheck) for my part of that premium. On top of that, there's a deductible of $1,000 per year, plus there's a co-payment for each visit to a doctor's office.
A 5% tax to cover Medicare for All is less costly than the premiums.
Of course, the problem is that since many people have a large chunk of their insurance premiums paid for by their employer, they only see the $100/month (for one person) part of the premium they pay. They don't see the $10,000 a year the employer pays. So that tax increase does "cost more" than their subsidized premiums. America, the innumerate!
I can't imagine that any employer, especially a small employer, wants to be in the business of providing health insurance to employees. Now one hopes that when Single Payer is law, every employee will get a nice raise equivalent to the amount the employer was paying in insurance premiums ...
4
@Andy, or people will be able to quit their jobs or change jobs or start their own business. We must uncouple health insurance from employment! I can't believe more business don't support MFA.
3
The author captured and then rapidly missed why the Vermont exercise didn’t work. The model was not implemented because of politics and undercutting at every turn. The ACA works and would have worked much better if actually implemented as written. I welcome hearing the author’s proposed solution because if you are not part of the solution, you ARE part of the problem!
6
Make Medicare an option that anyone can take if they wish. Leave it at that for now. This is basically the "public option" as discussed for the past ten years.
2
The article offers some good lessons. Maybe we can't get to Medicare for all right away because people are scared. Fine. Let anybody who wants to, including companies, buy into Medicare. Private insurance will be gone in a decade.
2
@Véronique
Choice is always better than enforced solutions. If everybody in need of better insurance wants Medicare, that is ideal. But, remember, I am on Medicare. It is not free, much cheaper than any private insurance though. And much clearer in what is covered and what is not.
1
I love these arguments against Medicare for all and by implication a public option or even a phase in by age starting at 50 with absolutely no alternative even suggested. Right now Trump and Republicans are challenging the ACA in court and offer nothing else except a beautiful, great wonderful plan Trump will reveal after he is re-elected. That should be the topic of discussion not article after article of how actual policy proposals will not work. As far as paying more taxes most working class people will have higher salaries with their employers no longer providing their health care and billionaires no longer paying the same rate of federal income tax as the average worker. Also no mention of the front runner Elizabeth Warren who most concerns people like the author of this op-ed
3
U.S. states are not analogous to the U.S. federal government, because they do not have monetary sovereignty.
Other first world countries ARE analogous to the U.S. federal government--and they have universal healthcare that works!
Never forget that the weird thing is NOT having universal healthcare.
2
“Monetary sovereignty” is a euphemism for “money printing and endless debt”. Interest payments on the national debt are already projected to surpass military spending by 2025. Financing any new programs through irresponsible monetary policy is the definition of insanity.
2
I'm no expert, but I suspect it takes a national buy-in to make Medicare for All work, not a single state.
3
I was a NYS medicaid research analyst for 28 years. The one area New York & the country at large is failing dramatically is Dental Care. Dental care is vital for proper nutrition and thus general health. Why not focus on that first ?
3
@Mike Brown ,
Simply make dental care a part of the umbrella of "health care" instead of a distinct service.
There is no good reason for dental care to have its own insurance regime and cost system.
The fallacy of this argument is scale. Single payer at the state level equals a ratio of 50-1. Hardly any leverage.
If you’re a business like healthcare, and one in fifty patients are giving you grief, what do you do? You ignore them or make it very expensive, worth your while.
Single payer on a national level is completely different. The Government is the _only_ buyer. It’s their way versus the highway. The healthcare industry cannot fight that.
They are beholden to it.
2
The problem with Medicare for All is that it will be Medicaid for All.
2
“Lingering frustrations with Obamacare” might make a Vermont-style plan hard to implement across the country?
Why yes. Of course.
That has been the motivating idea behind the never-ending challenges to Obamacare: If it can be prevented from working as envisioned, a generation or two of health-care consumers will learn from its advertised-as-inevitable decline to be wary of any new system.
And here we are.
2
A tired, old, irrelevant argument. Vermont has less population than the District of Columbia. Any workable healthcare plan depends on the size of its risk pool. The Washington state public option passed; it did not fail. If "this is the strongest argument against Medicare For All," we are well on our way to getting it. The only thing "strong" about it is the boldface used for the title.
5
What an adventure it is that a rich an resourceful country as the US can't take care of is own people. look to Europe, we do it here.
5
How about expanding Medicare to everyone 25 years old and younger? Those are cheap to cover, with big upsides long term.
3
"But while some polls show majority public support for single-payer, that support declines substantially when faced with trade-offs like the elimination of most private coverage or higher taxes..."
But was is NOT mentioned is that the media fails consistently to tell the truth about these two "problems", instead simply parroting them as gospel from opponents of MFA. In fact, while taxes MAY go up a LITTLE for SOME people in the upper middle and upper classes, even these people would see a net savings when the cost for current premiums, co-pays, and deductibles are eliminated from their budget. As for eliminating all private insurance, that has not yet been finalized - some versions of MFA include a "private option", and some allow for private supplemental coverage. In any case, most Americans will quickly opt for MFA and forget all about their "beloved" private insurance once they see their savings and improved coverage.
Now, on the matter of outreach and voter education, this does have to be greatly improved, but again, the media need to stop regurgitating false and misleading information.
The healthcare and political landscape are vastly different than 10 or even 5 years ago. When Sanders ran on MFA in 2016 it was widely questioned, but now all major Dems are touting some form of it. The time has come to get rid of the for-profit, vulture healthcare system we now have and move to one that actually cares about people more than profits.
3
Amazing how these Conservative and Libertarian types can continue to write about the impossibility of instituting some form of universal coverage in the US. This despite universal coverage plans in the rest of the industrialized world. And, despite the fact that all of these other countries provide universal care at substantially less cost than the patchwork system of health coverage that prior to Obamacare covered only about 80% of the US population.
It is as if Mr. Suderman is looking up into the sky at an airplane and lamenting the fact the humans will never be able to fly.
4
Americans will never want the tax burden of those other industrialized nations you mention. This is as much cultural as anything else. We tend to believe we can spend our own money better than the government, and we do not nationalize industry in this country. I don’t trust our government to run healthcare effectively and efficiently because they’ve never done anything efficiently.
1
@Justin
Anyone who has spent more than an hour of their life trying to wrap their head around tax policy in the US will realize that treating ‘taxation’ as some monolithic entity that affects all parties involved equally is idiotic. If you’re going to argue that Americans all (or even a majority) feel the same way about taxes, you shouldn’t. What taxes, from whom and for what? Otherwise your argument doesn’t get past the point of sloganeering. No one likes to pay taxes, true, but most of us still end up paying them because no one in Washington is in our corner.
I get so sick of people talking about taxes in this country as though everyone was paying the same rate. The truth is far more complicated than most people have time to unpack and cynical types seize on this fact constantly, talking to every worker in this country as though s/he was making as much as a Koch or a Trump.
I appreciate Bernie Sanders and his campaign because he hasn’t given up ideals for the sake of political expediency and I expect if the Democratic Party could do that, people might feel more passionate about them at the polls.
Two thoughts: This was 9 years ago... costs have risen more than 30% since then. All of this focus on health insurance- which is what single-payer is about- ignores the real culprit: The ever-escalating irrational COST of healthcare itself. The 'industry' has proven that it can't/won't address this; perhaps the government will have to impose some sort of price controls or inflation-indexed formulas. This is not something I would normally favor, but when the market can't solve such a massive problem, something else will have to be done. This will eventually bankrupt the country as its now bankrupting so many Americans.
OR... if you want to see real, honest capitalism at work- eliminate insurance completely and set up clinics for the neediest. If healthcare providers, hospital chains, drug companies, etc were forced to charge 'what the market will bear,' imagine how upset they'd be if they thought they could only charge what average Americans can/will pay? The current system is just a massive transfer of wealth from our citizens to private healthcare companies. Most of us with 'private' insurance don't even consider it insurance. The deductibles are so high, many will never meet them- and have to allow $5-6K or more of their annual pay for healthcare.
4
Some medical treatments are either unnecessary or have little or no benefit to the patients. Yet, as reported by NY Times on several occasions, the (Traditional) Medicare still pays for them.
On the other hand, Medicare Advantage plans have more say in what to pay and what not to. The medical results of these Advantage plans are in general not any worse or better than the Traditional Medicare; at least that’s what some researches found.
So whether “Medicare for All” will or will not work really depends on what kind of Medicare plans are offered. If you let Medicare pay every and any treatment, then it’s not going to work.
2
it is fundamentally disingenuous to compare a state's ability to fund single payer to that of the Federal government given the latter's ability to deficit spend
3
Vermont was never a good location for this experiment. It's a tiny state. Vermont simply lacks the state government infrastructure to pull off such an effort. Despite its reputation, Vermont is also a deeply conservative state. Not in the current political vernacular, but in the "change is really hard here" vernacular. Finally, Vermont is a relatively poor state; a small poor state has limited room to maneuver, and limited opportunity to overcome mistakes. There are many places that could better serve as the initial state experiment, California is the most likely contender, but I could imagine Colorado, Virginia (after Republicans are consigned to the dustbin of history there), my own Minnesota, or maybe Illinois serving as better labs.
All that to say, don't read too much into Vermont's failure. You've seen one state try, and one state fail. It was never the best state to try, hopefully it won't be the last.
3
My mother went through serious medical issues this summer, which put me at the center of Canada's single payer health care system for the first time. Everything I experienced- hospitals, operating arenas, nurses, cleanliness, timeliness--was first-rate. I had no complaints, and I am a complainer. So much better than the American experience. And her seven weeks in the hospital plus brain surgery was all free-- sorry, $45 every year for the card plus $11/day for parking...
6
@roger Everytime I am given the argument of choice of provider, control by patients and so... i make this very little remark. ask any canadian, aus, EU working in US whether they will stay or will go back to their countries if facing a serious disease. As an inmigrant to the states, with a job job and insurance, but also somebody who grew with a national health care if I fell seriously sick, i would be in the next plane home.
Again, the tale related to Vermont is one opinion, one person opining!
Any such momentous must:
Be well planned,
Openly designed,
Openly discussed,
Properly financed from Day One,
Many politicos and CEOs thrive on this chaotic situation,
Good planning will require voluminous effort to design a realistic actuarial cable ...
I could go on as both a medical consumer and a medical patient and as a human being ...
Needless to say, UNTIL the PEOPLE force Politicos and Insurance Industry to get with it the current chaotic mish-mash shall continue ...
1
Here's what I know about a single-payer system. I lived in Montréal for 14 years, went to the doctor annually, had normal blood tests done regularly, went to the doctor for other concerns, too, had other tests done, too. I never saw a bill. I never paid for anything out of pocket. I moved to Louisiana a year ago and have very good private insurance. I've already paid $100 in co-pays and other nonsense. I can afford it. Either we want everyone to have access to health care, or we don't. For me, it's the latter because I know that a single-payer system can and does work, and people are healthier because of it.
2
This article points out political obstacles to enacting single payer—but not actual obstacles. The fact is we already pay more than $10,000 per capita for health care in the US. The money is all there and paid already. It's just that now, most of it is deducted from people's pay checks and forwarded to an insurance company. Under single payer, it would be deducted from people's pay check and forwarded to the government. Same money, just goes to a different place once deducted.
The advantage with the single payer system, though, is costs can be shifted so people making less money pay less and people (and corporations) with more money pay more.
There is no actual reason why we can't implement single payer.* There is only a political problem—and unfortunately there are a lot of people (including the author, I suspect) who want to exacerbate the political problem because they are opposed to government programs in general and hope that the political problem is enough to kill single payer—even though single payer would benefit hundreds of millions of Americans.
________
*The only actual challenge is how we transition out of the private industry without creating too much disruption to the insurance industry itself and for the people who work or invest in it. This is a real challenge, but it's just a short-term transition issue, not a long-term obstacle.
3
One key is to make it worthwhile for businesses who underwrite healthcare to stop doing so. If the taxes they pay under Medicare for All are less than what they are paying in premiums and admin costs now, this will add momentum. On the international front, it will make us more competitive.
Another issue no one wants to talk about is cost control. It has to be done.
Finally we have to look at realistic projections of what will happen if we do nothing. I have not seen a plan that looks at all three factors.
1
Vermont is a very small state. The article cites the problem we had with the original website, which is a lot of the reason the plan didn't work. We have a lot of unhealthy people. All the advantages of a Medicare for All system are not taken into consideration -- such as people being able to move from one job to another, small businesses being able to grow without having health care absorb all their profits, and most of all, the medical industry looking into ways to keep people healthier through real health, such as good diet, exercise, and a real understanding of healthy living.
2
Please state what you believe to be true, Mr. Suderman:
1) we need insurance companies to deny care to save costs
2) co-pays and deductibles - in essence, a kind of denial of care or restriction of it - are essential in any system
3) administrative costs can hardly be any lower than with private insurance
It's hard to believe we need administrators telling us our care is being limited because they know best. It is also hard to believe that it is desirable to seek less care due to the incentive of lower user costs. This cannot be good for outcomes, as it causes a dangerous diagnosis of health care problems for the incentive of saving expenses. With costs an issue, we need to look at every possible savings, and it would seem that administrative costs should be on the table.
3
No, the strongest argument against Medicare for All is that it's isolated from the real world. It's a dream inside a vacuum. If Democrats regain control in 2020, there are hundreds of things they need to shore up, instead of launching a Good Ship Lollipop. Bring the insurance companies and pharma to heel, within a context of first and foremost stabilizing things from the destruction of the past term.
1
I am an expat currently living in Melbourne, Australia. Australia has Medicare for All. I have had multiple health issues, pituitary tumor, parathyroid tumor, both removed in hospital. Total cost $16.95 plus parking for my family & friends to visit.
This article ignores that most of the rest of western world already has transitioned to a Medicare for All type system, successfully. All of them spend far less, (around half), on their healthcare systems. And they all cover all their citizens.
So the argument presented here is moot. The example is the rest of the western world successful implementation of universal health care.
2
Medicare for all COULD work, IF it were done correctly. However, no one is asking for a more granular explanation of what Medicare for all would look like, so arguing about it is arguing with an amorphous undefined blob. Also, "done correctly" means different things to different stakeholders, so it is almost to define what this means. Keeping it undefined and blob like helps to gain support for it, since one can claim (without needing to be specific) that each constituent would be protected. So what is Medicare for all mean? Not a whole lot.
I lived in a small European nation that had a national health care system. I was covered by it. I never saw a piece of paper when I received medical care there except a doctor's prescription. Here every transaction generates pages and pages of paperwork. It was far more efficient than our system, cheaper to provide and it provided a better quality of care. It covered every citizen and even people such as myself who was there with a work visa. It didn't depend on my employment; I couldn't lose it if I had pre-existing conditions; there isn't a problem for anyone who loses employment, changes employment or retires. You just get healthcare. It was great. Wish we could have a system like that here.
7
This "argument" missing SO many significant issue sand data points. What about the change in public opinion between 2014 and now after the public got used to the ACA? What about the fact that VT is a very small state with a small population that has trouble due to its size and location attracting younger workers? What about MA's system which does seem to work reasonably well despite its slightly larger but small population? What about the costs of delayed healthcare by the uninsured? What about health care systems in countries like Japan that work? So many questions. So few facts underpinning the "theory" of this opinion's very thin conclusion.
1
The biggest, single obstacle to "Medicare for All" has nothing to do with its cost. It is the medical provider's lobby, big pharma lobby, and libertarians.
8
So your argument is, American exceptionalism cannot achieve what 32 other developed economies have acheived?
Universal single payer health care is beyond our means, even though we are the richest, most technologically advanced nation on this planet. The one true Super power cannot provide basic universal Healthcare to all of its citizens?
I reject that argument. I am sorry, but you are wrong sir.
10
So your argument is, American exceptional ism cannot achieve what 32 other developed economies have acheived? Universal single payer health care is beyond our means, even though we are the richest, most technologically advanced nation on this planet. The one true Super power cannot provide basic universal Healthcare to all of its citizens?
I reject that argument. You are wrong sir.
3
Of course if corporations and the ultra wealthy paid their taxes as they should, more money would be available to float such a plan, and that is the rub. As things stand, the best thing the we Dems could do is to offer a public option which in time would become attractive enough for a buy in by the greater portion of the people.
But Medicare already exists.
That's the difference.
3
44 million Americans have no medical insurance. That stark fact should mandate a universal insurance program to benefit the uninsured. Automatically enroll every American and massively decrease the burden of providing health care for the uninsured. If not Medicare then build brick and mortar affordable insurance centers throughout every state with advisors committed to enrolling the uninsured in affordable care plans. Massachusetts has successfully boosted enrollment with online and walk in physical MassHealth centers.
interr
1
The aim of extending Medicare to all ages is not to decrease spending on healthcare but to make sure all have adequate health care.
We have a lot of government programs that do not save the government money.
The bloated defense budget is a prime example.
We pay for K-12 education, police and fire departments with government programs.
We do this because we believe these provide an important need.
I believe health care is also an important need.
Conservatives oppose extending Medicare because doing so will increase their taxes to help pay for care of OTHER people.
1
The US is the only Western industrialized nation without universal healthcare. Mr. Suderman's proposal is not a first. When Mitt romney was governor of Massachusetts a similar plan was developed which became very popular with the citizens.
1
Every debate/complaint/proposal avoids the central fault of America’s health care and insurance non-system: cost. More exactly, the unregulated greed-grab by health care’s corporate drivers. Even when proposals like Medicare-for-all indirectly are about cost, there’s unrealistic cost-saving claims because no one will utter the word “regulate,” which is what Medicare does by, somewhat, setting cost (eg, profit) limits.
1
National health care systems work in every other advanced economy. What they have done to help lower costs is wring out excessive profits for health care providers. In the 1950’s we could have started a national plan but chose to let private markets into the system. Once the horse is out of the barn it may be difficult to get it back it.
6
This year I had to plunge down the rabbit hole of out of network providers and in paying directly for services and getting reimbursed by my insurance provider, what I've learned is that my 'Cadillac' insurance plan bases their payments off the Medicare rate sheet plus 20%. Why not cut out the middleman and pay directly for Medicare?
Once you add up my office copays and yearly deductibles, I'm not sure I'm actually getting any benefit for the premiums I pay each year just a lot of paperwork and hassle.
I'd rather give the doctor 30% than pass it through the insurance company and benefit manager,
2
Vermont is a tiny state with a population roughly equal to that of Nashville, TN. So, there's little ability to negotiate with hospitals, doctors, drug companies, etc. Administrative costs would still have to deal with insurance from tourists and Vermonters who seek care in neighboring states.
2
There’s just flawed logic in this opinion. It states taxes would have to be raised to support single payer with no mention of the savings: lower or no premiums, no deductibles, perhaps lower overall health care costs because the profit incentive is absent, no catastrophic health conditions leading to bankruptcy, perhaps savings on prescription drugs. And, as already noted, one small state cannot compare to a national model. We already have Medicare, a proven model. Just expand it and give people a choice for a public option. As Warren points out, how many people actually like their current insurance based health care?
"Medicare for all", "single payer system": buzz phrases with little meaning; and yes, the devil is in the details. I pay premiums for my health insurance and my employer does too. Even for normal Medicare there are payments during our working life-time by ourselves and by our employers. There are even payments by us after retirement. Nothing is "single payer"! Now if we could treat insurance companies like public utilities and guarantee them a profit of 10% and not more, and if we do not allow exclusions or higher rates for pre-conditions, because health, good or bad is not a "pre"-condition, even private health insurance for all might work.
There is one thing that could get many voters on board with a single payer plan, me included: a hard cap on maximum out-of-pocket costs. If OOP costs were capped and providers were not allowed to pursue patients for more, it would guarantee that a medical crisis would not turn into medical bankruptcy. Not having to choose between losing my life and losing my home would get my vote, even if I ended up paying more in taxes than I do now.
2
@Nikki Your comment seems to encapsulate the confusion that many Americans have about single payer plans. In a single payer plan there are no out-of-pocket costs and providers cannot pursue the patients for payment. It is a SINGLE PAYER plan. The providers have to go to the payer to get paid.
(My statement that there are no out-of-pocket costs is a bit of an idealization. One of the big complaints about the cost of healthcare in Canada is the usurious rates that we have to pay to park at the hospital.)
1
@Alan White in spain in addition to parking, the complains are for the 3euros you pay to get cable tv in your room when hospitalized!! :)
my sister visites me this summer. her kid had a ear infecction and got antibiotics from the doctor through her travel insurance. it was over 120 dollars for an antibiotic that is barely 5 euros in spain. she got refunded but was in shock.
People seem to not understand the difference between Medicare for All and what countries like Canada, Germany and England have. They have state run healthcare without private doctors, hospitals, etc. I’m not saying it good or bad, but many people need to realize they aren’t taking the profit out of healthcare by going to a Medicare for All model.
Germany doesn’t have a state run system. It does require everyone to have insurance but there are many options including private insurance. However, charges by doctors and hospitals are capped. No patient has to fight over which treatments are covered or not; basically all medical necessary treatments ordered by a doctor are covered. Sometimes, small co-payments are required but they are about 10-20 Euros per visit.
@Bk2
Are you trying to say the state is making a profit out of healthcare for all? That is simply untrue. Not sure what you mean by healthcare without private doctors. I have a GP. If they are unavailable and it’s not an emergency I can go to a walk in clinic and see another doctor or wait for an appointment with my GP.
In Canada hospitals are public charities they not directly run by either the federal nor provincial levels of government. If you are trying to imply the government is directly connected to my healthcare you are simply wrong.
They do run public health programs like the one that put huge visual health warnings, instead of brand labeling on cigarette packs. This was so successful it was taken up in other countries. But the government has no day to day involvement in people’s health choices.
1
@Julie Tea I’m saying that there will still be profit motive in healthcare because all Medicare for All does is change the payer from insurance companies to the IS government. It doesn’t make anything more efficient and could actually cost more in overall costs.
Oh me oh my, it can't happen here, let's not tax the rich, they provide jobs and their money they save trickles down on us so we can pay their taxes, etc. Let me know when you write some coverage of Senator Sanders that is not negative. The closest you've come so far is to feign sorrow that Bernie suffered a heart attack which should convince him to get out of the race.
3
How much are American families now paying yearly in insurance premiums, co-pays and out-of-pocket expenses? That amount, which is probably in the trillions, would go to offset any increase in taxes. One externality never considered by economists is the societial good that comes from ensuring healthcare as a fundamental right. Are we really OK with people losing their homes to bankruptcy because of medical bills. We can find the extra money if necessary by reducing the military budget. Peace.
5
Nice straw man, Mr. Suderman. It turns out that it is a lot easier to create a national one-payer system than a state system:
1) What do you do about your own workers who work out of state? You can't tax their employers.
2) What do you do about out of state workers who work in your state? Your taxing your own residents to support health care for them.
3) How do you avoid a race to the bottom? Firms can locate across the state border to avoid any taxes put on them.
An example Mr. Suderman might have paid attention to is Hawaii where none of the above issues arise and has had employer mandated health care since 1974. This isn't a one-payer system, but along with Massachusetts, Hawaii has the lowest uninsured rates in the nation.
With all due respect to the medicare for all crowd, the goal should be Universal Affordable Coverage, there are many ways to get there.
3
I think one of the most cruel things that history will comment on is the pro-lifers fighting tooth and nail to NOT help people live longer and healthier lives. Up really is down.
3
I am so glad to see so many comments pointing out the fallacy of the logic in this article.
Essentially the writer says: it didn't work in one state in the USA, so it can't work for the whole country. This is so flawed logic, it hurts me to summarize it. I feel like I have been told 2 + 2 = 5, and that's the way it is, like it or not.
As everybody around here pointed out, a single payer has been working quite well in a lot of countries. Now use this logic instead and you see that it's quite feasible.
Reasons not to do it:
1. a few rich people will no longer be able to get richer.
2. we would have to reduce spending on military, weapons of mass destruction, wars, and all that nonsense. Last time I looked we were spending approximately 35% of the federal budget on that. So many billions of dollars that I can't even imagine it wasted on useless pursuits.
3. can't think of any, but please, feel free to add to this list
5
A libertarian says, with minimal facts, to support his analysis: 1) it won't work because we haven't done it yet, and 2) (implicitly) all those countries with national health insurance must be wrong.
8
A single payer system is the logical conclusion for anybody that doesn't have as its first concern obscene profit-taking in the crazy-quilt private-insurance bureaucracy layer of the system.
3
Actually, the moral is that a single-payer system needs to be done at the national level, not at the state level. The reason for this is simple: states are constitutionally prohibited from running a deficit. So whenever there is a recession (which is exactly when people need help with health care the most), this is precisely when states are least able to afford it. This is not just theoretical. California had a very generous "Medi-cal" program back in the 80's which they had to cut back on as soon as there was a recession.
3
Bernie's so-called "Medicare for All" is not Medicare for All. It goes way beyond Medicare, and way beyond the universal coverage of any other country. Medicare, like all the other single-payer systems in the world, pays about 80% of all medical care, with the remaining 20% paid by supplemental insurance and/or the patient individually. Medicare has premiums, co-pays and deductibles. Bernie's plan doesn't. It would pay for virtually all healthcare costs for everyone, and it would prohibit all supplemental insurance. Medicare pays much less for medical services than does private insurance. Single payer proposals that are based on providers accepting Medicare rates would be met with strong resistance from providers, and of course, would be met with even more resistance from the health insurance lobby. Most Americans are covered by private insurance, and most of them are at least satisfied with their coverage. (Most of the satisfied probably have not had a serious medical event yet, but that is another story.) Even with the public option removed, it was almost a miracle that the ACA passed, and Republicans are still trying to get rid of it. It will be an uphill battle to fix the ACA and add a public option, but it is a realistic goal for 2020. Bernie's plan would never pass Congress in the foreseeable future. If we add the public option and tweak the ACA, we can move toward a universal system.
4
The only reason the GOP is against universal healthcare is because it works. It works so well that once people have it they'll never give it up. But having it would mean billionaires might have to pay more than 0% of their income in taxes. So, like giving up checks from the NRA even though their position on gun laws promotes mass-murders, it's a non-starter.
It's a non-starter as long as people keep voting for people who's main priority is to keep them in needless physical and mental distress, and 1000% more likely to be shot to death by a military-grade assault weapon, because those things make the GOP a ton of money.
3
Here is another reminder as to why Medicare for All in the US is a virtual non starter - the lack of any road map that explains to us how we migrate to Medicare for All from where we are at now. Such a plan is absent from even Elizabeth Warren's critically acclaimed tool box.
Proponents know that once any such plan is put out there, there will be a significant pushback from the voters. This is one instance where the means may be more important than the end.
Works well in the UK? Maybe - but US 2020 is not UK 1945.
3
You don't have to invent this system. Australia has had medicare for all for over 45 years. Canada has had it since the mid 1980s. It works. The Australian system allows those who want private health insurance to pay it. High income earners without insurance pay a higher medicare levy in their taxes (this is what my wife and I choose to do because we have lived in the US, experienced your health service and want to support public health to avoid being like you). If you get sick you get looked after, with modest means-tested co-payments for those who can afford it but major treatments are free. When my wife had our kids, the only cost to us for the delivery and 2-3 days in hospital was a voluntary contribution for nappies/diapers. Pharmaceutical drugs are also largely paid for by the system, and the government invests in preventative medicine programs. Our health care costs are much less per capita than the US and the health system treats us as people and not profit-making units. If you get sick you get cared for and it doesn't ruin your and your family's life. Our life expectancy is 4th highest in the world, the US is ranked 31.
8
I followed Vermont because of its push for single payer. There are several factors not mentioned.
First, the economy of scale was much harder in Vermont (pop. 626,000). A national (pop. 327,000,000) plan would be much more affordable.
Second, Vermont's failure to create a health insurance exchange was because it had to negotiate the complexities of the ACA and dependence on the myriad of private insurance plans. A single payer exchange would be so much simpler.
Third, Shumlin got less than 50% of the reelection vote and needed the state legislature to reaffirm him. Among their demands was to abandon single payer.
Fourth, if you polled Vermonters today, I think the need for health reform has only grown making the mandate stronger.
The current non-system is a disaster. A true single payer, national health insurance system would quickly become the most popular social program in America.
5
Every large country in the world has a variance of single payer - except America, with lower costs and everyone covered. So you single out a try in Vermont?
If the truth gets out - not insurance company propaganda - the public will welcome Medicare For All.
5
The question here is why would Sanders and Warren attempt to take a program that failed in a deep blue state and make it National policy?
There are not many good answers.
Especially given that they are calling for the end of Obamacare, when many were hoping the Democrats would enact the Public Option, to engender competition.
It's a given fail, this Medicare for All, but some have chosen to put it out as an election gift, to put it nicely.
2
The biggest stumbling block mentioned is the added cost of out of state workers, but this wouldn't apply to a national plan.
2
The money wasted on redundant military expenditures, subsidies for profitable business, and tax cuts for the wealthy could easily finance better health care for all.
4
The top level truth remains: Every developed country in the world provides health care which is at least as good as ours to all of its citizens for about half the per-person cost of our slap-dash jury-rigged system. We're Not Doing It Right.
9
Very good article. A single-payer approach, while it may have appealing clarity and simplicity, simply won’t work. For one thing, its costs, estimated at 30 trillion dollars over ten years, will require increased taxes, and not just on the rich. For another, it will require people to give up their private insurance And lastly, do we really think the federal government is capable of administering a system so potentially vast?
A better approach, one used in Germany and other countries, is health care for all provided by a mix of government and closely regulated private insurance companies. People pick the approach that works fir them.
2
If you read the other letters-Australia, Canada, most of Europe-National Health insurance WORKS.
For all those talking about it can’t work because of taxes or this or that or the other thing, what it means is the US can’t make it work. The question is why not? Please stop saying single pay doesn’t work or can’t work. Quite simply it can and does everywhere else in the world.The question is why the US can’t, as other writers have commented, as one of the biggest most successful countries in the world. Single User works. Quite simply it can and does everywhere else in the world. By the way Canadian doctors seem to be happy with how much they make.
They certainly aren’t moving down to the US by the score....
2
@Mark Siegel
Only Germans earning over a certain income can opt for private and only ten per cent of those choose to. Stop making it sound like Germany has too equally important systems. It simply not true.
1
Peter Suderman has presented an important criticism of single-payer based on a close examination of Vermont's plan. I'd like to add to the discussion a couple of points.
I think it disingenuous for Suderman to cite the lack of public support as a cause of Vermont's plan problems while trying to reduce public support for single payer.
A better way might be to say that the rulers should wait until single-payer gains more popular support before trying it.
My second point is rarely raised, if ever. Consider that some people might not want to do business with the government. After the Khashoggi killing, some did now want to have any business with MBS or the Saudi government, while others were willing, even eager, to do so.
The U.S. government has killed many innocents and some might not wish to rely on an such an aggressive bloodthirsty organization for their family's health. I suppose it depends on your moral tolerance for evil. Maybe first replacing the U.S. government with an ethically legitimate organization can address this concern.
5
Medicare works pretty well as it stands and covers a large portion of American citizens. I see no insurmountable reason it is not scalable over an extended lead-in period. Overall costs would not be any different than the are now. Whether total health care costs are paid by taxes collected by the government or insurance premuims collected from employees and employers, the total expenditure will be the same, albeit rising over time due to reasons that have little to do with who pays what.
While I don’t think eliminating private insurance is necessary, a good quality government funded level of guaranteed care would make us healthier st the same cost. That sounds like a step in the right direction. Once there, perhaps we can sort out how to lower total costs just the rest of the developed world has.
1
OK, then: A public option; or, Medicare For All Who Want It.
2
You can't have private insurance and universal healthcare. What will happen is the private insurances will take all of the healthy people and the public option will be stuck with all the sick. It would then undoubtedly fail then all of our honest politicians will go look, we told you it doesn't work!
This is all logistics. According to the National Priorities Project the US spends 32 million dollars every hour 24/7/365 and has since 2001 on corporate wars for profit. More than that is the fact that 90% of good health is the product of diet and exercise, no smoking, no drinking, proper weight. People should be able to get the health care they need.
1
it's unfortunate there's not a country in the entire world has a single payer health care plan that works.
if only there was an example of one.....
6
Single payer doesn’t work, say politicians in only place that doesn’t have it.
13
If the rich in the US paid their full taxes you would have plenty of money to switch up your medical system to a broader one. Once it’s up and running the sheer numbers being served will bring down overall costs.
The level of anxiety lowering alone would improve general health and well-being in your nation. As it stands now the majority in the US are one ectopic pregnancy, one hard to treat cancer, or one late developing genetic disorder from financial ruin.
Things are not perfect in Canada. We don’t have dental care nor an overall prescription drug plan. We place far too many barriers in the way of immigrants getting their Canadian qualifications to practice medicine in a timely manner. The lack of useful supportive housing for the mentally ill is shameful.
Not having worry about anything other than your health when headed off to emergency is truly priceless.
5
After reading many of the comments about this anti national health plan presentation it was VERY CLEAR that this Opinion should have been published on the same day as a well argued presentation showing the evidence of how limited Suderman's presentation was. My own experience is that it doesn't become so drastically clear how weak our system is until you experience a well developed national health care plan in another country. The medical social Darwinism of the US health industry then becomes painfully clear!
4
The fact that it does in fact work is demonstrated by every other developed country. Maybe y'all should start from that simple evidence based conclusion.
6
This is not an argument against Medicare for All.
Not even a little bit.
It is an argument as to why the American system is ill-equipped to implement it politically.
3
@EC A transformational national change in health insurance is a political process, not a technical exercise. The US is definitely ill-equipped politically to implement Medicare for All nationally, just as Australia is unable to implement humane immigration laws.
@MVonKorff
I think you are referring to asylum seeking laws.
Legal immigration in Australia is quite robust. 30% off the pop. being born overseas. Same number is 14% in the US. But yes, assylum seeking provisions could be better.
1
Vermont is a small state with little economic leverage to use to pressure the medical care industry. Its failure highlights why a state by state approach is not viable. We need a strong national solution that can regulate the medical care industry and set sane price controls.
3
I'm confused. Did the Vermont plan ever get implemented or did it die on the vine in the planning stage? A single-payer plan can't "fail" or be "put to the test" until it's actually a real thing that people can use. Seeing as how this state plan was being hatched at the same time the national Affordable Care Act was being debated and rolled out, I can understand that Vermonters weren't overwhelmingly supporting it. The ACA was confusing enough. Secondly, how did the Vermont plan deal with private insurance and specifically, employer-subsidized group plans? The author of this piece doesn't tell us much that applies to the Sanders Medicare for All proposal. It just sounds like an insurance lobby hit job. Now, NYT, give Sanders and Medicare for All advocates equal space. I dare you.
1
For-profit health care has always been a flawed concept. When choosing between profit and health care a corporation or business will always choose profit. Single payer health care would eliminate layers of corporate bureaucracies fighting each other to refuse payments, promoting new plans and finding new revenue streams. Besides, todays health care system is just overwhelmingly confusing and complicated for the average consumer as they try to figure out the "best" plan or option, all of which present slight differences that can only be relevant if you have a pre existing condition or can foretell the future..
2
I am an American citizen who has lived and worked in Canada [becoming a Canadian citizen in the early 90s, while retaining my American citizenship], where I have enjoyed the security of the Canadian version of Medicare for all.
This extended experience of the day-to-day benefits of a genuinely single-payer health insurance system, with easy access to both family doctors and specialists, has insulated me against the sort of specious arguments advanced in this editorial.
I can only ask: When will Americans awake to the realities of modern health insurance delivery?
4
The strongest argument against government-controlled health care is that "governmental leaders" like Pence and Trump exist ....and are ideologically supported by approximately 50% of our population.
Whenever folks think of government-controlled health-care, they think of it in tandem with big-hearted, generous, liberal folk like Sanders or Warren: Sure, it may cost a lot, we think, but who cares because we will get the health care and medications that we need when we need them. Sanders and Warren and their ilk will make sure of it!
But take a moment to think about what would happen to women's health care access/coverage/payment - as one example among many - when a Pence type of person came in to power. Same goes for access/coverage/payment of medicines and procedures used by the transgender community.
When government unilaterally controls something, it can do what it wants - for good or for evil.
3
Is a specific case of an attempt at single payer relevant 10 years later?
The political climate has certainly changed since 2010 when the ACA was enacted. We've had a chance to see what can be reformed when you keep it in the private sector.
I would assert (its pretty obvious actually) that single payer, whatever the specific form, has moved from fringe to mainstream since 2010.
3
I disagree with the author. The failure of state attempts to implement single payer is exactly the reason IN FAVOR of Medicare for All. In the US, profit-based healthcare has run up prices wayyyyyyy beyond what is reasonable. The ONLY way to fix that is to put the full force of the federal government behind negotiating prices for every drug and every procedure. No single state has the power to affect prices in the way that the federal government has.
3
I'm all for MfA, but if it takes a transition period in the form of initially requiring employers to allow workers a Medicare option instead of their "tried and true" private insurance, in order to get everyone covered, then don't let the perfect be the enemy of the good.
As a Medicare recipient of 7 years standing, I can truthfully say the overall experience with traditional Medicare does not take a back seat to any employer-provided coverage I ever received. There would still be room for private insurance in the form of Medigap insurance (which would undoubtedly have to be kept under tight scrutiny to curtail gouging the insured). And, none of it is "free," despite the campaign sloganeering, pro or con. Those of pre-(Social Security)retirement age would have to pay a premium for their insurance in addition to their Medicare tax (which, let's face it, is a pittance and is going to have to be adjusted upward). Still, the cost for Medicare will probably be significantly less the the private offerings.
If nothing is done, the entire health care system of America will implode. Government control of drug and medical device costs is inevitable. The longer it is delayed, the harder and more costly the transition becomes. When Medicare is allowed to negotiate these items, their cost will come down. It is, plain and simple, economy of scale. The drug and device makers can't afford to lose such a huge customer base, so prices are held down.
3
Medicare for All advocates ignore the political realities of implementing a transformational change in one-fifth of the US economy. Their idealism may help bring about much needed change in US health insurance if it is tempered by commonsense, but in the short term their naivete will be political suicide for the Democratic party if Medicare for All is the proposed health care policy of the 2020 Democratic candidate for President. Public option ("Medicare for All Who Want It") is the way to go. That alone will be a heavy lift. The argument that because other countries have single payer (under VERY different circumstances than the US) the only reason we cannot achieve it is because of greedy insurance companies is so simplistic and naïve that it cannot be taken seriously. Good intentions and high ideals are not sufficient. If Medicare for All is attempted and fails, which is most likely, we will have Republican control of all branches of government for a generation or longer. Pass single payer and make it work in a large deep blue state like California before you foist ill-informed pie-in-the-sky policy proposals onto a nation that will turn on progressives if and when MfA implementation fails.
Assuming physician compensation at Medicare rates is a huge mistake that will lead to disaster. There is already a shortage of physicians in many specialties and a critical one in family practice. Lowering compensation to physicians in the face of such existing shortages at the same time that demand for their services will dramatically increase once everyone has healthcare coverage is...unwise.
2
@Jim
How about if we give them free medical school, and pay for their malpractice insurance? It'll work just fine.
Articles with this spin always ignore the fact that many other first and second world nations successfully do what people like Mr. Suderman say we can't. It didn't work in Vermont, hence it's impossible.
The medical community has had decades to manufacture a system where medical care providers can grow fat off the suffering of their fellows. It won't be unwound overnight. Note: by "medical care providers" I mean hospitals, drug companies, and insurance companies - the fattest parts of the pig.
Capitalism may indeed result in a cheaper yet more technically sophisticated smart phone, but if we compare America's health care system to, say, most of Europe, we have to conclude that unbridled corporate greed does not produce a good result in healthcare.
9
As a Vermonter, I not only lived through this, I was charged with leading the implementation of the state based Health Exchange at VTs largest health insurer. Lots to say but I just make 3 points:
1- governor shumlin was a political opportunist. He did not “believe” in a single payout solution. It was a political weapon he used for elections.
2- The Shumlin administration was ideologically blind to the realities of the costs and implementation challenges and never genuinely engaged in solutions
3- During all of this, Shumlin’s team only hired and listened to academics and never once engaged the health care industry or business community for input or opinions.
We knew it was dead long before Shumlin and his team did.
4
You’re cherry-picking arguments. How does Vermont in any way resemble the United States economically? It doesn’t really, but this was a convenient example to argue against anything but free market health care and also show some disdain for Bernie Sanders at the same time.
5
The real benefit of Medicare for All is that it gives the government the power to push down prices. Europe delivers the same services for 40% less on average, and they do it with government price-setting.
No single state can pass a Medicare for All law, as medical providers will simply move to other states. The SCOTUS covered this ground when Social Security was attacked by conservatives (Helvering v. Davis), saying it had to be national or there would be a "race to the bottom" as businesses moved to states with less generous pension arrangements.
What should be done? Lower the Medicare eligibility age to 55, excluding those who are employed and have a qualified healthcare option available through work. Steadily lower that age limit and give the government increasing power to set prices. Make more eligible for ACA subsidies to cover the 30 million uninsured. CBO estimated the ACA was a deficit reducer, as tax hikes on the rich paid for the subsidies.
If more revenue is needed, economists Saez and Zucman estimate we can get $750 billion/year from just the top 1%. For scale, our budget deficit was forecast to be $600 billion this year just prior to Trump's inauguration; he's blown it up to close to $1 trillion (but I digress).
3
But, wait, doesn't Medicare work now for the folks who receive it? And wouldn't it work for everyone else? And what about the care your veterans and federal government people receive?
Americans pay twice as much as the rest of the developed world and get lesser outcomes. There are a number of successful models to choose from around the world that vary from government provided health care to 100% private care that operates within a single payer system.
Sitting on my side of the border, I can only surmise that the greatest obstacle to Medicare for all Americans is self-interest on the part of the huge medical industries in the US that can charge exorbitant prices simply because they can. You can only have a decent health system for all when it is centred on the folks who receive it, not on the folks that deliver it.
6
Clearly, this is a conservative explanation of why a single-payer system would not work. However, Medicare For All with a choice would only require an increase in payroll tax to support this system. As a payroll tax one would deduct the costs of insurance premiums either private of employer sponsored and the absence of high insurance deductibles.
Most Canadians do not remember that our single payer system was phased-in over decades. It began only with hospitals and diagnostic services in the mid-1950s. Physician services were not fully included in all provinces until 1972. Many of the benefits of a single payer system can be achieved in a sector by sector approach. In Canada hospitals are not financed on a fee for service basis, but are instead given global budgets with various formula based adjustments according to variables such as volume and nature of its services. Also, there are no for-profit hospitals. All hospitals are not-for-profit run by independent boards. They are not government run. In the US I would start a single payer system by reforming the way hospitals are financed and organized.
3
Vermont, or any other single state, would suffer from an adverse selection issue in that people who really need expensive health care would have a reason to move there. That's not an issue with national borders involved.
That said, a more gradual transition to some sort of Medicare for All is a better way to go, than imposing it all at once, hoping for everything to work right on the first try.
2
The establishment and the insurance industry are on a full court press to save the greedy, worse than useless, cost-increasing private insurance companies and their obscene profits. No, single payer will not work at the state level. It is a national issue. Every other advanced country in the world has some form of single payer and every one of them has better health care at one half or less than our costs. Those are the test cases, not a single state with no medical infrastructure. Medicare at the federal level already exists. It is 10 times as efficient in delivering health care as the private insurance companies and members love it. This article is just another example of how far the 1% are willing to go to mislead the public.
Oh, and by the way the statement that medicare for all would eliminate all private insurance is a blatant misrepresentation. Sanders' Plan would prohibit any private insurance that duplicates medicare for all coverage. If the 1% want to continue their extra gold plate coverage for private hospital rooms with room service and private nurses, they can.
2
Mr. Suderman provides good arguments, never mind they are based on older data."Medicare for all" would significantly increase health insurance costs for the state and federal payers and most likely reduce cayments for health care providers. Medicare payments to providers are now lower than private insurance payments. Therefore providers do not like them. Several major fallacies in most respondents to the author's arguments compare other developed countries to the US. For example west-European or the Japanese. But they do not take into consideration significant differences between the US and those other political systems and economies. Japan, all west European countries are - roughly - "socialistic" - a hugely unpopular term in the USA. So those other countries have - again roughly - free and public education from pre-K through your doctoral degree. And also "free" health care insurance. Also taxes are far higher than in the USA. So comparing the USA to "other civilized countries" is simply a crudity. Most USA citizens even criticize the rather mild socialism of FDR which gave us Social Security, and, later, Medicare. In those other countries social security and health care and education insurance were always legislated at the same time under quite broad political-philosophical programs that stand significantly further left than does the USA. So such comparisons are simply weak and based on lack of knowledge and experience.
@Friend of NYT
How about some education for us since it works so well in most other developed countries?
And why, Mr. Suderman, does universal healthcare work so well in other advanced countries at often half the cost of their GDP compared to the US system?
Germany, for example, was the first country in the world which started universal health insurance in baby steps, first for blue collar workers under a new law in the mid 1880s by that darn socialist Chancellor Otto von Bismarck. That was followed up in a couple of years by accident insurance and social security for the same workers.
Bismarck didn't create these laws because of the goodness of his heart, but because those working the hardest, ruining their health in the process and being underpaid started getting restless.
Other nations started to follow suit soon. For ages health insurance costs in Germany have been split evenly between an employee and the employer, each paying a little over 7% of their gross income for life long free healthcare.
Those under a certain income of about $70 K are automatically insured, while those making more per annum can either chose to be privately insured, or chose a mix of public and private insurance.
And, by the way, not one single person in other OECD countries has to chose between either putting food on their table and clothing their family, or paying for medicines they urgently need, nor do their citizens go bankrupt when a family member becomes seriously ill.
6
The reality is that the version of Medicare for All proposed by Sanders and other Progressives doesn't exist in the real world - for a reason. Even in other countries that offer single payer, private coverage is still allowed (and commonly used to get faster care and more treatment options - see the UK for example). Furthermore, literally every country with Single Payer still mandates cost sharing between the government and the patient - that is copays or deductible.
Furthermore, no country with single payer has 10 million illegal residents who pay no taxes and are still provided free healthcare. And our number of illegal immigrants would only go up further increasing the cost. Medicare for all as its being discussed is nothing more than an irresponsible boondoggle. Prop up Obamacare and allow the rest of us to keep our private coverage if that's what we want.
1
As a physician for > 30 years, I dont think Medicare for all should be the first step. The better way to do this is to have a public option so that anyone can join and be covered under Medicare. Let the public option compete with the private sector health insurance. This way there would be choice. Maybe both set of payers would become more efficient and cost effective.
Additionally let Medicare negotiate prescription prices under Part D, an ability Medicare was denies during Part D passage in Congress
These are the necessary first steps in providing insurance coverage and lowering the costs of health care
3
By not going to some type of universal health care we are condemning millions to shorter, disease filled lives. There is no other way of putting it and nothing more to say.
3
What is happening in America is fraud and manipulation of the system. People who never worked and are eligible for Medicaid get all kinds of benefits without much limitation. Even if you work whole your life, if you retire before 65, you won't have any medical converge. Even if you are eligible for Medicare after 65, the benefits you are eligible for are limited compared to Medicaid. So, old people are forced to manipulate the system to be eligible for Medicaid. They are forced to transfer their wealth to others before their death. People who work whole their life and paid tax should not be forced to transfer their wealth just to get Medicaid. It is possible to provide universal health care though private insurance system if we collect health insurance premium through a central agency from individuals and business, and transfer money for Medicaid program to that agency and pay premium for private policy from that agency. It is a single payer system for paying premium for coverage provided through private insurers. The cost will be much lower in every respect.
3
If the goal is to eliminate private health insurance then single payer is extremely easy to implement. So Green Mountain Care (GMC) simply begins the program by getting state agencies and universities to hand over their health care spending to GMC. Step 2 is for GMC to prove than can run the health insurance spending better and more cheaply than the private health insurance company that came before them. Step 3 is more employers will hand over their health care spending because GMC proved they can run the system better than the private sector. After a few years everyone will be covered by GMC.
The strongest argument? Some people in the US are so blinded by their ideological bias that they just can't see alternatives to their made-up reality. The fact that there are single-payer systems in many advanced democracies in Europe and notably in Canada and that these have existed for decades, outperforming the US system in terms of GDP costs and efficiency does not matter it seems, since they tried something in Vermont and it failed ergo it would fail nationally. No wonder the US is such an unequal and backward democracy! I count my blessings everyday that I was not born in a country where I either have to go bankrupt or be insured by someone else (to a point) if I got sick. Healthcare is not a privilege but a right!
5
Single payer won't work unless it's a national system. If most major democracies in the world can do it you have to ask yourself: What's wrong with America?
3
Vermont's biggest problem with its attempt at universal healthcare is its small population, and older demographic. Also, Vermont's tax base is small, wages are low, and state and local taxes are fairly high already.
4
The question is whether higher income taxes would amount to more or less than the cost of insurance premiums under ACA. A lot of individuals have seen premiums soar under that plan. Insurance companies will not allow themselves to be cut out of the picture, and have powerful lobbies to make sure of that. Also, Hospital lobbies don't like the smaller reimbursements under Medicare, although some studies show they could function just as well will the lower reimbursements. Finally, politicians and lobbies against single payer could go on propaganda sprees, scaring voters with tales of "death panels" and such. Obamacare is basically a regressive tax on the middle class, which is the only kind of plan that can pass Congress. Likely, the ACA will just be expanded so everyone is covered, since dismantling and going back to the "drawing board" would be politically controversial and maybe not doable.
1
@Mark Browning
You name realistic problems, but if we stop letting money dominate our Health, we could solve all of them.
Political and institutional barriers, as the Cornell report states as the main reasons for failure, should not be a reason to abandon trying to implement a federal system. We could try for a public option like in the UK or how Medicare is administered - that is a public baseline option with supplemental insurance provided by private insurance.
The thing we do not want to do is implement Trump's recent executive order. It would move more people who can afford it to Medicare Advantage, increasing costs for everyone else. It would ultimately bankrupt the Medicare system, which is what the Republicans want to do.
The lack of political support or distrust of government while it affects the feasibility of medicare for all says nothing about its desirability. Second, while the saving turned out to be lower than anticipated, it was a saving, so that does not count against putting the program into effect.
With respect to the amount that people would pay, 9.5% of their income, the sum would have to be compared with the actual cost that is being paid in order to see whether it is a plus, a minus or neutral. And yes, payments to providers, particularly medicines, would have to be lower. While all these are questions to be resolved and signify a considerable change in the present system, the question remains: should we do something to make health care available to all people and prevent economic disaster for many of them.
1
If so, this is a VERY WEAK argument. Small state, under extreme siege by the establishment? Really?
Medicare works fine for our elder population - it will work fine for more people. End.
3
@Multimodalmama
I have full healthcare paid by my employer. I am not giving it up for Medicare that I will have to pay for. Sorry, this article is dead on.
How do you know you've been propagandized?
Other countries have universal healthcare (and free college, paid vacations, paid maternity leave and many other social goods).
You've been convinced (and articles like this are one reason why) we can't have the same in the richest and most powerful nation on earth.
Of course we can.
6
@Scott
Yes, we can however, when I first traveled to Ireland I could not understand for the life of me why worker's pay was taxed at 40%. Now I know why.
2
@Real Food i pay a lot of taxes in Mass, and I dont get national health care, public school starting at 2.5 years, free university, 6 months of full paid maternity leave, subsidiazed daycare, ...
1
Yet nations who have universal healthcare, spend much less on healthcare than the US, yet have better health outcomes in regards to measures such as life expectancy and infant mortality.
6
Remember death panels? They didn't exist. But that didn't prevent Republicans from deliberately misconstruing a provision that would permit paying doctors to discuss end-of-life issues with their patients, transforming it into a license to kill.
The arguments in favor of universal healthcare are very strong. But the final package must be conceptually simple enough to be easily understood. Otherwise, Republicans will nitpick it to death.
We need to aim for universal healthcare, provided at the lowest cost compatible with high quality. Compromising with people whose sole objective is to destroy the entire project makes no sense. If Republicans have a better idea, let them present their own program. They shouldn't be permitted to mangle the Democratic offering.
There is at least one respect In which universal medical care would clearly benefit even those who already have excellent insurance. Today, diseases are easily spread around the planet, and antibiotics are losing their efficacy. It should be obvious that anyone whose symptoms might indicate that they are infectious ought to be able to go to an ER or Urgent Care clinic for diagnosis and treatment, without being deterred by fear of bankruptcy or being arrested by ICE. As is the case with herd immunity, where my vaccination may protect you from disease, having at least basic medical care available to all helps to protect everyone.
2
One could way forward is "Obamacare with a public option". That's essentially what they have in Switzerland, Holland, & Germany.
When a public option was proposed in 2009, the objection was that the public plan would be more popular and would crowd out the private plans. So let's find out.
2
Very few ever compare M4A with the how much the current system really costs. Include all the time spent haggling with bureaucrats. The staff that doctors must have to fill out paperwork. The societal costs of tying people to unfulfilling jobs just to keep their insurance is a waste. Small business should be clamoring for this so they can be on a more equal footing with the big corporations.
1
We don't have to guess what taxes are needed to support a single payer system. All we must do is look to Canada.
Their National tax system is similar to ours, except there is no deduction for mortgage interest. It is their Province level tax system that pays for their health system. And these taxes are much higher than those levied by any US state. Interestingly, they bite lower earners much harder than our system does. And, it is interesting that paying for health "insurance" through taxation takes the $24,000 a year that a wealthy person might pay to insure a family in this country and makes the cost totally open ended. Single payer health care, financed through taxation, is a significant form of wealth redistribution.
For those interested in seeing what you might pay, here is a tax calculator. Plug in a theoretical income, select a Canadian province, and solve for your tax bill. It is eye opening.
https://www.ey.com/ca/en/services/tax/tax-calculators-2019-personal-tax
4
Talk about cherry-picking: "It didn't work in Vermont, so it can't work."
Yet it works in Canada, the UK, Germany, France, Japan, etc. -- in every industrialized democracy and in some nations that *aren't* part of the G20.
If the interstate highway system didn't exist but today's leaders proposed it, then citizens' ignorance coupled with a strong misinformation campaign by opposed interests would kill it. Likewise if Medicare were proposed today -- yet the program has universal support.
It should be (but isn't) as simple as leaders saying: "This is great for society as a whole, and the people who tell you otherwise are lying to you so they can keep profiting from your needs. By the way, it will save you money either immediately or in a couple of years; we might have a hinky year or two as we deal with some unforeseen problems, but we'll figure it out -- and soon you'll wonder why we didn't do this 50 years ago."
4
So, what are you proposing Mr. Suderman?
268
@Shea This is always the way. "It won't work! It won't work!" But never a more palatable, econimically and politically feasible alternative proposal. What's certain is that the existing for-profit model is gravely flawed.
59
@JSK Hi from Canada, where "Medicare for All" costs less and delivers better health outcomes than whatever you have at present.
I'm sure that residents of:
Germany
France
Sweden
Ireland
Norway
Spain
Cuba
and so would agree with me, so I wonder what exactly it is which holds you back from using a repeatedly proven template to fix your healthcare system?
119
@JSK - There was a "national consensus" back in the late '40s when Harry Truman proposed a national health care system. It was a popular idea until the American Medical Association decided that the change would not be good for them and decided to spend millions with the original political spin company to convince Americans that providing national health care would turn the U.S. into a commie nation. At least, a good case is made for that in the article, The Lie Factory, at the New Yorker. From the article: "Whitaker and Baxter’s campaign against Harry Truman’s national-health-insurance proposal cost the A.M.A. nearly five million dollars, and it took more than three years. But they turned the President’s sensible, popular, and urgently needed legislative reform into a bogeyman so scary that, even today, millions of Americans are still scared."
Why you and so many others think that this country, alone out of all developed nations, is so lacking in ideas, innovation, and capability that we cannot create a workable "Medicare for All" type national health care system is a question that boggles the mind.
40
Directly below this comment box is an essential corrective to Bernie Sanders Medicare for All banner. Read every word of Mor California - every word.
Mor, Swedish for mother, states exactly what I have stated repeatedliy here: No Democratic Party hopeful has displayed a full understanding of the way Universal Health care functions in the countries Mor names or to speak from the country I know well, Sweden. Mor speaks for me, word by word.
I have given n = 1 of my own 23 years of Swedish UHC so I need not repeat. Instead I will use plain blunt English.
The USA is not a 21st Century country. Yes it can have Nobel Prize winners in Medicine or you name it, but US health care is not Public Health Care for everyone.
As a Warren supporter it pains me to admit that she, who has a plan for everything, clearly has not learned enough about UHC in the countries all of us ExPats will report from.
One question needs to be asked, one for which I, who once concerned Vermont as a place to move back to now raise.
Give us full SES data for the tiny population of VT. Many people there tell me that it is headed for becoming the retirement home for the rich. To the extent that may be true, it is not the place to learn about UHC.
Time for me to go back to the high-level coverage of the war on Syrian Kurds, coverage on Swedish public TV and Dagens Nyheter where I expect in a few hours to see superior reporting by Nathan Schachar.
Only-NeverInSweden.blogspot.com
Citizen US SE
4
I'm surprised France, The Netherlands, Sweden, Finland and Denmark (and others) haven't drowned in red ink yet. Why does single-payer work for them but not for us? Oh yeah, they don't have GOP donors.
10
I lived in Vermont during those years and was a practicing physician.
There was never any way that state could ever pull off single payer, they just don’t have the revenue or enough people in their tax base. That was not a tough calculation to make.
While I largely disagree with the author and think it is not a fair model to use in dooming a universal federal single payer system , it does show quite well the naïveté and unpreparedness of those involved— like Mr. Sanders. Regrettably, that is a fair model of how he will likely perform in the White House.
3
The numbers thrown out--9.5 percent of personal income, 11.5 percent of payroll--are, roughly, what I and my employer are paying now for insurance that's unusable due to high copays and deductibles. And the data quoted is five years old. The cost of insurance has increased significantly since then.
Medicare for all? Bring it on. Even with the dismal figures quoted, it would pencil out for me.
660
@August West
The reason it won't work is that the knives are out for single payer and the candidates who support it. For the past two months my wife and I have received on average one mailing a week telling us that such ideas will ruin our health and bankrupt the nation.
24
@Srinivu ,
And from whom did those letters originate? Were they sent by persons or organizations with a vested interest in the status quo?
17
@August West
The one thing I would add to your comment is that while Medicare For All is not the cheapest plan out there, I do think if we factor in the idea, which I think most American accept now, that we need to get to universal coverage, then I think Medicare For All looks much better.
If we are going to cover all Americans, which I think is what most Americans want, then Medicare For All looks very cost competitive.
My point is, I see many cost comparisons between MFA and other insurance proposals that don't cover everyone. If you compare apples to apples (everyone covered) MFA is really not that expensive.
18
It's very simple.
I teach risk management. One bit of the basic tenets of the discipline is that, in any given risk pool, all other things being equal, the greater the number of people in the pool, the lower the cost for every individual member of the pool.
Therefore, the way to provide everyone medical insurance at the lowest possible cost is to put everyone into the same risk pool.
In other words, Medicare for all.
The only way this doesn't make sense is if you believe it should not be a national priority to provide everyone with medical insurance.
768
@John That may or not be. And it's also entirely besides the point. If a plan has no chance of passing, and carries the risk of scaring voters into the GOP camp, there is only a downside to obsessing over it.
9
@John First of all, cost savings are not the only goal. Quality of care is a goal. Second, it's the lowest cost for everyone only if everyone contributes to the pool. The proposed plans that include no deductibles or copays and cover illegal immigrants would likely raise the cost for the middle class above their current costs particularly for millennials like me who need relatively little healthcare and are still suffering the effects of graduating into the Great Recession. Medicare for All is an absolute non-starter.
12
@John This is overly simplistic and is related to the 'preventive care saves money' trope, which is also untrue. If you provide coverage to more people, costs inevitably go up, because those people seek medical care they were not seeking when uninsured. They go to the doctor and get treated for their multiple chronic conditions (diabetes), they get their knee replacement, etc. They are seen by doctors multiple times a year instead of none. This is not speculation, it's been proved empirically in multiple settings including the imposition of the ACA.
The idea that more coverage will result in lower costs is pure fantasy that has a place only in the speeches of politicians.
That's not to say we shouldn't have universal coverage (we should), just that we shouldn't pretend it's going to reduce costs. It will increase them dramatically, cause severe economic stresses, and also reduce quality of care when existing systems are strained beyond capacity. Eventually, this combination of high costs and unsatisfying health care experiences and outcomes will produce the political will to finally constrain the entrenched interests (drug companies, monopolistic hospitals) who are responsible for the excess costs in the U.S. relative to other developed nations. That will be a fairly unpleasant transition. But it's coming sooner or later, so I say bring it on.
21
A small state plan versus a national plan? Give me the national plan. I'm sick to death of every single career move I make being made based on ever-increasingly expensive medical benefits, instead of mental health and genuine desire. The only way to fix this is by decoupling healthcare from employment and making sure everyone's covered from birth to death, and covered well.
880
@Abigail
We could decouple health insurance from employment by modifying the ACA. Mandate that all health insurance purchases made over the health care exchange so employers no longer offer plans they negotiate with insurance carriers. This would allow you to buy your own insurance decoupled from work. Employers could still off to subsidize some or all of your insurance costs, just as they do now. This would stabilize the insurance pools in the exchange quite a bit and would force the companies to offer competitive rates if they want to attract business. Yes, the transition is a bit messy since everyone getting insurance form work would not have to spend a bit of time finding a new policy, but it's entirely feasible. We should go one step further and remove the tax free subsidy employers pay as well as the ability to buy the employer share of insurance premiums with pretax money. This is one of the things that pushed us into the ugly system we have now and the increased tax revenues could be used to offer more assistance to people struggling to pay for health insurance.
18
@Bratface and watch as it gets undermined AGAIN by copays, by overcharging employers with female employees, etc.
NOT AGAIN!
10
@Abigail Insurance schemes work most fairly--and best--when the covered population/risk pool is largest. That isn't the case in a small state.
10
Yes! Heads up, all you Canadians who imagine that Canada will ever be able to adopt a single-payer system, an absolute impossibility in the near... Oh, wait... I've just learned there have been some developments since 1966.
491
Not only does Canada have Medicare for all, (with each province having their own plan), but my private work insurance covers my dental, chiropractic, physiotherapy, orthotics, massage, etc. which are not covered by Medicare. With ten times more people in the U.S. it should be possible to have something similar, if the will is there. Canadians still complain that some benefits are better in Ontario than in the Maritime provinces, but the good news is that we all have benefits.
52
@Jack true, but we live under the horrible yoke of socialism.
if only the system worked as well as well as Venezuela's which, as we all know, is typically socialist.
and that's the only example.
2
There are some truths that all Americans will have to accept with Medicare For All which, let's be realistic, should be acknowledged. First, there will (and should) be higher taxes from every American to pay for it. This is the funding which the ACA's individual mandate was intended to provide and, as a matter of equity, everyone should pay something for health care. Only illogical fools can really believe anything is truly free. Second, the quality of healthcare WILL suffer under this program for the average American. Because we will not have the same choice in providers, hospitals, etc. Why? Because there will always be a fee-for-service option that high-in-demand medical providers and hospitals will gravitate to - which favors the highly wealthy in this country. Those providers simply will not have enough incentive to accept Medicare. Basically, Medicare for All will be like a mediocre HMO. The sad truth is that the ACA does a better job at both improving the quality of health care, providing choice, and maintaining affordability. It is hostage to cutthroat whims of politics, hopefully this will change.
@Brenda
You're making up all these objections. I'm in Medicare and it's great. Affordable and most of the best doctors.
1
The author works for Reason magazine, a right-wing organ whose largest funders are David Koch and Sarah Scaife. So this is just the usual right-wing propaganda insisting that what works for the entire rest of the civilized world could not possibly work here.
10
Many NY Times readers are left-leaning and will fight to the end if you tell them they cannot have Medicare for all. What they fail - or perhaps don’t want - to understand is that the US is NOT like other countries. We have much higher rates of obesity, gun violence, drug abuse, etc than any other wealthy countries. The US leads developed nations in diabetes prevalence and drug overdose deaths.These factors impact longevity and health and a large reason why we have worse metrics. In addition, Americans will be unlikely to tolerate waiting weeks or even months for a CT or MRI scan or surgery as is often the case in countries with socialized medicine.
3
@woods39
A friend of mine in Ireland whose daughter was in the hospital was in need of an MRI. My friend had to pick up her daughter and drive her to the big hospital in order to get an MRI. The local hospital had no "scan". I was stunned.
2
Why were you stunned? MRI machines are very expensive. Nor every hospital needs to have one of everything. The salient points are that she got the MRI and didn't go broke in the process.
5
@woods39
Left-leaning-- not at all, I stand up straight!
Glass half-full, half empty. If people are dead they no longer participate in the health system and PS the dollars spent on their care go to WORKERS, who spend that $$ and pay taxes except that currently too much goes to lawyers and the CEOs and shareholders in insurance companies - predatory capitalism.
health care reform has consistently been derailed by a failure of both parties to understand the true nature of the health care market. the debate is based on the premise that the markets for health care are characterized by free market capitalist principles. this is absolutely not the case. instead the markets are based on 4 interlocking govt sanctioned monopolies. Doctors enjoy a govt protected monopoly to practice medicine, and a govt protected monopoly to decide who can obtain a medical license.Doctors also enjoy a govt protected monopoly on access to prescription medicine, and pharmacists a govt protected monopoly to dispense it. Insurance companies enjoy a government protected monopoly to sell insurance. US Pharmaceutical companies enjoy a govt protected monopoly to sell drugs in the US. to say that these govt granted monopolies exist is not advocating that they be removed. however it is essential to recognize them for what they are if the two main purposes of health care reform, cost containment and guaranteed access, are to be achieved. usually when govt provides an industry a protected monopoly as in the case of utilities it creates a commission to control prices and ensure quality of service.going to a single payer system would not solve these problems. the entire range of costs; doctor salaries, medical school fees, pharmaceutical costs, shared pharmaceutical development costs, supplemental insurance costs will all have to be taken into consideration.
1
Individual states possess neither the financial resources nor the authority over the health care market that the federal government possesses.
Tell the people of Canada, Australia, Denmark or Taiwan (among others) that a universal Medicare system (Canada actually calls its system "Medicare") can't work. All of the developed nations that utilize single payer health care not only have lower costs; they also have better outcomes including longer life expectancy and lower infant mortality than the U.S.
But if individual states attempt to mandate a single-payer system, they can't regulate the practices of out of state care providers or insurance providers. And of course, those companies can simply choose not to do business in a single state, especially in the least-populated state in the union.
The federal government has much more power. Where are the care providers to go if they are subjected to national rules?
The only thing the Vermont experience proves is that states can't do this on their own.
2
I was a finance executive for two not-for-profits in Vermont during this period.
The reasons for the failure to rollout Vermont single payer were economic, that any business person would recognize, that do NOT translate to infeasibility of national single payer.
The two reasons both result from Vermont being a small state.
1. The insured population of Vermont is small and inherently difficult to serve by an insurance model at all (that requires large numbers in a statistical population). In Vermont in particular, the average age is higher than national thereby increasing insurers' claims.
2. The fixed costs of setting up a reliable, robust infrastructure to serve a few hundred thousand insured, could not be economically justified (costing state taxpayers).
At a larger statecscale (say California or new York, or regional compact - new England), these objective factors would not have been relevant.
Sadly, the author's bias against single payer, motivated his picking a strawman.
11
I say just get government completely out of healthcare and that includes any tax breaks given to any corporation. Corporations will quickly stop employer plans. Let people deal with these oligopolies one on one.
This way only the 1% can afford healthcare and we get rid of 99% of our healthcare infrastructure.
Who needs healthcare anyway?
1
Medicare for all? How about health insurance for all, meaning competition between the insurance companies and the government.
I have yet to hear Sanders or Warren or anyone else advocating Medicare for All to explain why they are afraid to allow competition into the market and let the best plan win. They talk around it and complain about private insurance companies. There is much to complain about. But they have no real competition and control the market. Might I remind everyone that is exactly the position Medicare for All leaves us all. Government is not an efficient machine. Why are they suddenly the best path to universal health care?
True competition drives our economy and allows people to make choices on their own. We don't need someone else dictating what health insurance will be. Let the consumer decide. There will be a mass exodus to Medicare if the private sector cannot compete. The reverse is also true.
It amazes me to hear complaints when corporations merge because lack of competition will drive prices up. Why isn't Medicare for All looked at the same way?
The single payer advocates are not being forthright and honest.
Why?
@ArtM Healthcare is not a commodity where free market/perfect competition can be applied. Here from a simple google search are the requirements for perfect competition.
The following characteristics are essential for the existence of Perfect Competition:
Large Number of Buyers and Sellers: ...
Homogeneity of the Product: ...
Free Entry and Exit of Firms: ...
Perfect Knowledge of the Market: ...
Perfect Mobility of the Factors of Production and Goods: ...
Absence of Price Control:
1
@ArtM
All studies show that Medicare has a lower expense ratio than any insurance company, because it does have pay any CEO's tens of millions of dollars in salary and bonus.
If the GOP would allow it, it could also force lower drug prices instantly, like other countries do.
@Mari
I disagree. Each one of your definitions applies to healthcare providers and the American public.
Perfect Competition? I'm just looking for competition. Nothing is perfect, including a simple google search.
Single payer could work, but there are many issues to be worked out.
1. Grand social programs enacted in a vacuum fail. You cannot do something so expensive without mandating that able-bodied people work. And really mandate it. With great rights come great responsibilities. Too many people off the books, too many people on disability who don't need it, etc....
2. Medicare is incredibly wasteful. Fortunes are spent on care during the final stages of life trying to put off the inevitable another day. No other country does this. Not fun to talk about, but we must if this were to work.
3. Americans don't tolerate being told "no" to anything in medicine. No to a knee replacement when you are grossly overweight and will cost much more to the program... they say no to that in England. American's won't tolerate being told that the MRI is of no value... they just want it.
4. Will Americans change the tort system that drives costs and unnecessary tests to enrich lawyers? That is necessary for this to work, and the lawyers will fight it.
5. Will we stop illegals from getting a foothold here, so non-taxpayers don't eat up precious healthcare dollars?
6. How much are we paying MDs? Medicaid rates now are less than minimum wage. Medicare is barely break even.
All in all it is possible.... if Americans want to change. But you cannot have the level and amount of care we have now for everyone without breaking the bank. It is not all good care at all, but it is what we are used to.........
7
@Ny Surgeon
What are you are describing as problems is what exists now!
With MfA, they would be greatly reduced. I understand your fear as a surgeon, but you're completely wrong.
Single payer failed in Vermont because the insurance industry lobbied to water down the bill and spent millions in advertising to scare the people of Vermont.
Shame on them.
9
The author’s conclusion’s absurd really. So, just because the attempted single payer system failed in Vermont, it can’t succeed nationally’s truly irrational and extremely narrow minded. Nor, would a successful single payer system in Vermont lead to a success nationwide. The reasoning’s fatally flawed in my opinion
3
this guy's grasping at straws. but he's right in showing how the politicians are weak kneed in stating the cost realistically. Sure it will cost, but will pay off in the long run. And big time once the drug manus and insurance plans are reigned in.
2
Who pays for the senators and representatives' healthcare?
3
@Gangulee Members of Congress and their staff members are required by law to purchase their health insurance through the exchanges offered by the Affordable Care Act. However, the federal government subsidizes approximately 72 percent of the premium cost.
Let 20 blindfolded people feel the different small parts of an animal and they will all miss what the animal really is. Everything I read, this article included fail to propose a comprehensive proposal. Yes, doctors and some hospitals will be paid less. The best models suggest that docs should be paid salaries at non profit institutions. Guess what, the best ones already do so ( Mayo and Cleveland Clinic.) Remove the insurance companies profit model and see what that saves. P.S. They are also ripping us all off in the Medicare Advantage carve out. You can look it up. If everyone was required to pay for their routine care and screenings, we could easily pay for all the catastrophic care at a percentage of income roughly half of our costs, via a federal tax. No more deductibles, no more co-pays, etc. No more bankruptcies. This isn't "socialism", it is "Canadian." I married a woman born in Canada. They aren't any smarter than we are. Just more sensible and decent.
8
This article is written to promote disfavor for single payer by saying it didn't work for some place at a time in the past.
How many other movements, policies and proposed laws weren't successful in their initial attempts.
Peter Suderman would be well advised to understand the vast failings of the current health insurance system in this country, realize the benefits of universe healthcare for everyone and write a piece encouraging more people to understand how much better off they would be without health insurance companies that are more interested in limiting care so they can maximize profits.
6
Funny how every other country seems to be able to have a single payer system at half the cost, with better outcomes, everyone covered and no deductibles or co-pays. For profit and only profit health care will never work, never.
12
@MDM
True, but those other countries pay for it, and a fair amount more. While I think that's worthwhile (you pay, and you receive when you need it), Americans by and large are not used to such higher taxes. They already think taxes are too high and "what do I get for my taxes," as if they receive zero benefit from infrastructure, education, etc. On top of that, the income disparity has exacerbated that way of thinking for far too many.
We have a long way to go to convince many, many people that single payer is the way to go.
You really cannot compare the finances of Vermont, a not-wealthy state, with the resources of the federal government, which can tax financial transactions on Wall Street and pays $800 billion for the US military. This essay is absurd.
8
@Anne : That's a fantastic point -- thank you!
1
Another hit piece, in the decades long incredibly successful effort by corporate America, and our corporate owned government, aided by their corporate owned mainstream media, together artfully managing the perception of hundreds of millions of Americans, constantly manipulating the numbers, bringing out biased study after biased study, scaring the wits out of the masses, lying all the way to the corrupt banks they also own.
There are several truthful studies which have been done, but most get little to no exposure in mainstream media, and people are simply too busy trying to make ends meet, to spend time searching for the truth.
All of Europe, Canada, Russia, and dozens of other nations, including Turkey, in today's news, provide universal healthcare for their citizens, and in Turkey's case, they also cover the healthcare of approximately 3 million refugees. This universal healthcare is funded through corporate taxation along with employee taxation, and is far far less expensive than any private option, and no one lives in fear of not being able to secure healthcare, or be bankrupted by some serious medical condition.
The following report on Medicare for All costs is entirely accurate -
"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
15
So there are people who failed at it, therefore it is impossible.
That is the "Party of NO" thinking out loud!
11
READERS TAKE NOTE: "Reason Foundation advances a free society by developing, applying, and promoting libertarian principles, including individual liberty, free markets, and the rule of law." This is taken from Reason's website, the advocacy group the author works for. It's the opening line of "About". Plain and simple propaganda still pushing the "free market" agenda, which is how we got here in the first place.
17
People ask how we are going to pay for Medicare for all.
We already are paying for it. We just aren’t getting it.
We spend around $10,000 per capita on healthcare. The other first world countries spend $4,500 to $5,500 per capita.
They get universal healthcare. We have parts of the US with infant mortality rates of a second world country.
All the money we spend with private insurance would be redirected to Medicare for all.
And we would save money.
12
@Independent
I'm in.
"All the money we spend with private insurance would be redirected to Medicare for all."
So, how do we get the private insurance industry (and their lobby) to just roll over?
Seriously, though, that issue needs to be part of the solution. I don't think supplemental insurance plans would make up for the difference for that industry. I'm not advocating for or against them - but to be honest, that voice will be heard also.
1
Sorry I don't buy this argument, to trash something that is universally beneficial and sound for our fellow countryman.
If we want to make it work, we can. We have the resources.
Tragic that the author and far too many others, will go to whatever lengths necessary to say universal healthcare, true universal healthcare can't work. It can if we want it too. Sickening that a profit system is what so many in this country want to see govern our lives, and the care of our bodies and health.
8
It failed not because it is a bad idea or infaisable, but because conservatives say it is socialism.
5
Too many Americans resent paying any fees for medical care until they need it.
3
Meh - I don't buy the argument that Americans are too incompetent to do what Germany, Sweden, Japan, France, Australia, Canada, Belgium, South Korea and other OECD countries have done.
If you look at per capita spending on healthcare, the US matches or exceeds all but a two or three countries in public spending alone. In other words, US taxpayers are already fully paying for a decent single payer system. We just aren't getting our money's worth.
On top of that, American private spending equals our public spending. If done as efficiently as, say, Germany, the savings on healthcare spending would be about $1 trillion. That is why Mercedes and VW can be more competitive than Ford or GM. They don't have huge healthcare bills to pay for their employees.
Finally, forget about the myth that a public system precludes private supplemental insurance, if you want it.
We don't need to reinvent the wheel. We can look and best practices in other countries, and also learn from their mistakes.
5
This is an exceptionally mendacious article -- I wouldn't be surprised if Mr. Suderman does hack-work for the insurance or pharmaceutical industries. The Vermont effort was an experiment, and its failures/successes have been well-reviewed in medical and political magazines. Mr. Suderman cherry-picks the negatives while ignoring the positives. His greatest deception is asserting "it will never work" when nation-wide-single-payer in many varieties (as well as regulated insurance systems like Obamacare) successfully pay medical bills every day in countries all over the world.
It's one thing to say "this will never succeed" and another to say "we cannot make this succeed". The former is false by virtue of the successes elsewhere. The later is true for now, perhaps, but that can change as the US pays more and more for less health and declining longevity. Every medical bankruptcy is a another argument for nation-wide health insurance of one sort or another.
7
I support single-payer in concept.
The challenge with your argument is that, for the most part, other countries had a clear(er) field upon which to implement such a system and not a network of firmly entrenched plans and other players willing to sabotage changes.
And Western European countries have a much stronger sense of social solidarity generating support for single-payer.
Think optimistically but don’t minimize the practical and scaling-up difficulties of MfA in our current world.
3
It is not the matter of costs of Medicare For All. The saving are obvious. After it was implemented Americans would be shocked how much they were conned by insurers and for profit hospitals.
And there is the threat, too much money against the reform, and too easy to demagogue the reform. Half of Americans would be screaming that they want the con to continue.
8
In my view the liberal position should be "quality healthcare for everyone".
Saying that the program should be called "Medicare" or should even be a single payer program is something else that should be left for accountants and business experts not politicians. I suspect that a successful transition will eventually end in a single payer system, but the word TRANSITION is a big one and it may take a decade or more before we end up there. Changing how a huge fraction of the gross national product gets distributed will take time.
2
Isn't this the same opinion page that just printed a piece showing that $200 billion is wasted every year on paperwork because of insurance form dupllicaiton? And if we had a much more equitable tax system in which the higher brackets, especially the upper 10% and 1% paid their fair share would provide a much needed supply of cash for medical care much more would be covered. Also we need a national, federally funded system, not a piecemeal state by state system.
6
Without even looking at the legislation, let me guess, it was a compromise where conditions were set by the Republican side to introduce free market ideas into it.
In other words, they injected the “ideas” they espouse when wanting to sound like they have ideas or principles. And it ruined it just like ACHA.
8
Single payer is the ultimate goal---the dream---but the current reality in the U.S. makes a quick leap into that future an untenable one. Even with broad popular support and a clear understanding among voters that while, yes, taxes will rise even as their overall household balance sheet is better off due to lower premiums and out-of-pocket expenses, it's impossible to disentangle overnight (or in a single term) a for-profit health care payment and provider apparatus that employs millions of people and through which HUNDREDS of billions of dollars flow each year.
It's so easy to shout "Medicare for all! Single payer now!" but fervor and the righteousness of the goal are not a pathway to get there. The Vermont experiment needs to be taken seriously, not dismissed because "Well, other countries can do it so why can't we?!" Those other countries set up their systems a generation or two ago before health insurance of any kind was the norm (i.e. you paid your doctor or you didn't go). They were building payer systems where not much existed whereas the U.S. has a MASSIVE, lucrative and complex payer system already in place that must be reckoned with realistically.
3
A single state system will always run into funding shortfalls as states do not collect as much revenue as the federal government. It is only with the federal tax base that universal health care will work. It is too bad our federal tax dollars go overwhelmingly towards military expenditures.
17
Actually states have the power to raise taxes to pay for this program. From what I’ve read, Single Payer is supposed to save money and not cost more. If it costs more, then why change to it? As far as the Federal budget goes, most of the money is spent for Social Security, Medicare, Medicaid, Human Services, and Education. If we spent zero dollars on the military, we would still run a deficit each year. Please tell us where you would make the needed cuts in Social Security or Medicaid so that all liberals can rally around the idea.
1
Republicans and Libertarians love to tell us a single payer doesn't and won't work and yet most of the countries in the industrialized world show us it can. I'm tired of these lame excuses for not enacting a national health plan, these same arguments we have heard repeatedly and they are just designed to protect the private insurance companies, medical equipment companies and big pharma. So stop telling us that it wont work Mr. Suderman, we look all over the world and see that it can.
34
Yet every other major industrialized country on earth has chosen to provide their citizens with some form of national or single payer system. We must be so much smarter than all of them. After all, how else could we have the advantage of thousands of families going bankrupt each year due to their catastrophic medical bills.
17
Well, Medicare works. TriCare works for 9.5 million people and counting. Why wouldn't these programs work for the rest of us? I've never heard any senior or military veteran/spouse complain about his/her health insurance.
Let it be optional. Fools who want to pay the markup on private insurance can have at it. The rest of us can be covered, for a reasonable premium, and not be shackled to jobs we hate or (I know of several such cases) spouses we aren't crazy about any longer, just to keep health insurance.
9
Single payer will work for the US just as it works well for most other modern countries who already have it and have much lower health care costs and much healthier citizens.
Why does Suderman fail to see this? His analysis starts with an erroneous conclusion and then he picks an unrepresentative case which he mis analyzes to support his faulty premise.
Bad logic. Bad analysis. Failure to look at all the data.
You are wrong Mr Suderman.
Single payer done correctly is just what the US needs.
14
It is disingenuous, truly deceptive to compare a small state’s attempt to have a single payer system to that of a wealthy nation’s.
Medicare is not perfect, but close. As a recipient, I wish it for all.
8
This is quite a leap. Because single payer failed in Vermont, it cannot work anywhere, ever? Many first world nations seemed to have done it. Also, this is a diversion. What the Right come out and say is: Only people who can afford health care should have access. When you oppose expanding coverage, your only resort is to create a straw man to shoot down. If single payer won't work, what are the GOP plans to ensure that our citizens won't die due to lack of coverage?
9
Any time you see an "argument" from an editor of Reason, skip the lying words they type and comprehend their true agenda: Reason is run by anarcho-libertarians who believe the government should be replaced by powerful corporations and billionaires, who will rule vast fiefdoms as they please. This, to them, is the only ethical form of society.
Yes, they are that radical.
15
A first start failed. So what? But if you have 49 other stakeholders, and a dedicated team assembled, success has a greater likelihood.
Thomas Edison would have never invented a light bulb with a failure oriented attitude.
It’s not like a Moon mission where you get one shot to get it right.
Did the rest of Western Democracy fail? No.
Sheesh!
3
The biggest challenge with implementing single-payer in the US is that we are going at it way too late. Other countries have enacted their single-payer systems decades ago, when healthcare costs were just 5%-7% of GDP and the transition to single-payer was still manageable. But healthcare costs in the US have now grown to 18% of GDP (while other countries have kept their costs under 12% thanks to better management, like single-payer systems).
At this point, it may be that the best we can do is start with a public option, and do a slow transition to single-payer over 5-10 years.
3
When it comes to endless wars, money is no object.
Conversely, Medicare For All is cost-prohibitive to our bought and paid for politicians.
9
By all means add a public option to the health care now offered by private insurance companies. If asked to choose between paying $1,000 more a year in payroll taxes to fund expanded Medicare or paying $14,000 a year in insurance premiums for a family of four, even the most devout Trumpie will opt for the public option. Same goes for employers who provide company-paid or company-shared health insurance for their employees. It's a no-brainer, which is why health care providers are fighting tooth and nail to prevent it.
3
Americans are not fit mentally to be healthy
That is the greatest obstacle,it resides inside our brain like many things.
Food and shows are our national disease.That is what the cost is all about
On top of that the institution to manage health ,the state will cost for lack of competition
Bear it
The bottom line is this:
1. Take away Insurers portion of expense, at least 10%, and take away deadbeats who don’t pay at ER now, and you have already 15-20% of savings, enough to offset the lower Medicare rates.
2. Add to that a small 2-3% tax on everyone, including young Americans, and a portion of higher taxes for the rich, and you may decrease the premiums or eliminate them.
3. Include preventive medicine practices and further savings will certainly show up 3-5 years down the road.
We can’t do that in a single state because federal regulations will need to be enacted.
2
I feel sorry for Americans. I truly do. As an expat living in Italy, I have posted many times here regarding the scam known as the U.S. health care system. You're all being fleeced by a system that's designed to pick your pocket rather than serve your needs. Even here in dysfunctional Italy, the health care system functions quite well and everyone can see a doctor without worrying about being shaken down by the doctors, hospitals, insurance companies and the myriad 3rd party vultures ready to collect on your bills. Why is it that European countries can offer health coverage at 1/2 the cost to their GDP's with outcomes that are arguably just as good or better than the States? I'll leave it up to you all to do some research and change your system, but I guarantee you this: if you keep listening to the "experts" about why a nationalized/single-payer/socialized system won't work, you're not listening to the right people.
41
Medicare For All could not get away with the relatively low reimbursement rates of existing Medicare. If the Federal government tried to exercise monopsony to control costs, providers would simply refuse to participate in Medicare and charge the market rate to those who could afford it. The rich would get medical care and everyone else would suffer. If laws were passed to force providers to accept Medicare payments, those laws would create a black market in medicine.
2
We are evidently doomed to pay half again as much for our health care as other countries do. When our businesses pay for health care for some of us (their employees), we want them to do so by buying policies from health insurance companies rather than (as in other countries) by paying taxes or by raising our wages so we can pay the taxes. If businesses stopped buying health care for their employees (as some have), the money they saved would go for dividends, stock buybacks, or perhaps investment in the business.
Do businesses that do not offer health coverage to their employees pay higher wages than similar businesses that do? Since health insurance costs thousands of dollars per employee, there should be a significant difference in wages and salaries. But there isnt. In a full-employment economy, businesses that did not provide health insurance would find it difficult to recruit or keep workers. So such businesses prefer an economy that booms enough to give them investment opportunities but not so much that their employees can easily find jobs with competitors that do offer health coverage.
The bottom line is that we do not mind paying through the nose for our health care as long as the money goes into the private sector in complex and devious ways, but we hate paying for health care directly and obviously through taxes (except for Medicare). We seem to be confused, and billions are spent on advertising to keep us that way.
7
Why can't the USA implement a modern health-care-for-all program like the rest of the Western world? Every one of those countries had to start somewhere. Every one of those countries had obstacles to overcome. They still did it.
Why can't Americans get their heads around it?
23
@LauraF
They don't want higher taxes and don't want to give up their present plans if they are any good.
2
@LauraF
Did you read the article? Paying for it is not as easy as you pretend.
2
@LauraF
Because money, that's why. Specifically the billions of dollars in profits that the for-profit health insurers and big pharma make by picking everyone's pockets and not providing them healthcare.
3
The experience of one state is hardly relevant. The tax base of Vermont is significantly smaller than the tax base of the United States as a whole.
Further, a single state's employers would be disadvantaged compared to competitors from other states that would not have to pay for employee health care.
Nor—contrary to the author's claim—do all the savings come from paying Medicare rates. They also come from eliminating marketing budgets, lobbying budgets, shareholder returns, hundred-million dollar executive compensation packages, corporate jets, and the need for every single medical practice to hire a full-time billing specialist to handle insurance companies.
Also, contrary to the author's assertion, Sanders does make it clear how Medicare for All would be financed. But does it even matter? There was no financing mechanism for a trillion-dollar tax cut for the rich. The military budget isn't paid for by taxes, it's part of the deficit.
Why suddenly get all sticky about how a social program is to be paid for but nothing else? I think we all know the answer to that!
10
This is a bad analogy. States can't do it because of Interstate Insurance, the inability to tax or print money at the rate the federal government can.
6
As the humorist Art Buchwald once said , " The only thing keeping Canada's health care system alive is that we are between Mexico and them ." The only thing keeping Medicare alive is the presence of a private health care system paid for by insurance companies. Unless " Medicare -for -All " pays hospitals , doctors and other providers at private insurance rates , the argument supporting it is based on a false premise .
2
@PFS Jr. Even if medicare for all paid providers at the exact same rate as private insurers do under today's system, the savings gained by operating under a larger economy of scale and the elimination of massive insurance company profits would still leave huge savings to the country as a whole.
3
We've all heard the arguments against Medicare for All for many many years. Same old tune every single time. "Vermont couldn't do it!" "Somebody's gonna get something for free!" "Why should we give free medical care to brown immigrants?"
It's gotten really boring at this point.
Can you offer something other than "No, we can't!"?
If you don't like Medicare, don't enroll in it. It's not mandatory. Go ahead and pay for your health care needs from your own pocket.
But just because you don't like Medicare it doesn't mean others wouldn't like it either.
27
If congress would return to their roots as an august, deliberative body they might save us. Instead, I see a collection of tarted-up street-walkers without an ounce of morals.
7
It will take us a decade or more to transition to something resembling Medicare for All.
No amount of hectoring American surgeons and other key stakeholders within our current system will get them to suddenly begin thinking and acting like Europeans or Canadians. It's just not going to happen; there's too much money involved, and few people gladly embrace a significant cut in their income.
This is going to be a process. That's the reality. The Federal Government will likely need to take a strong hand in training (and setting the financial expectations for) the next generation of medical professionals for this to work.
If we can at least reduce the role of the for-profit insurance industry to that of a bit player, and remove any bar to the Federal government both negotiating with pharmaceutical companies and producing its own generics where and when appropriate, we will have had a gigantic impact.
7
“Like Mr. Shumlin, Mr. Sanders is a devout single-payer supporter”.
But Governor Shumlin is different; he was actually able to say: “I have learned about the limitations...” and admit that his plan cannot be implemented.
Senator Sanders is cut from a different cloth; he will never admit he is wrong or that he needs to learn, and he will not change the subject. Millennials apparently take that as a sign of “authenticity”; those more old-fashioned see it as simply fanaticism.
6
Medicare for all veterans (as an option in addition to VA) today. Bring the rest of us in as this step proves successful. That's politically possible, and will build support and confidence for the system.
4
Arguing that politics will be the strongest reason for Medicare for All to not be enacted is fair. It will be extremely difficult to pass, that's true. But just because Vermont had difficulty doesn't mean a national plan would fail. Medicare has been working reasonably well since it was enacted more than 50 years ago. Surely if it were expanded it could still work just as similar plans work in every other developed country in the world.
We need a leader who genuinely believes in universal healthcare and can get the public to buy into it. With public support it will be able to get through Congress.
12
Mr. Suderman's argument is misleading. The US already HAS a medicare system in place while Vermont did not. Medicare is fabulous; ask any senior. The one flaw is that some practices do not take medicare patients, for example, the Mayo Clinic. This should be fixed by legislation. Doctors are licensed by the state and should be required to accept government insurance.
Medicare can be easily extended to all by gradually lowering the eligibility age so the system does not become swamped during the transition. Taxes, both individual and corporate would rise, but not as much as individual and corporate contributions to private insurance as private insurance profits are eliminated and fees are negotiated by the government.
Unlike Bernie, I have no problem with private supplemental insurance as this IS a feature of current medicare. Perhaps in the future, this would not be needed.
Medicare works! Extending it makes sense. Additionally, people in the US are quite mobile; they change jobs and they often move to different states. Such moves currently place a HUGE burden on those who must re-establish their medical plans.
Comparing a state, that doesn't have Medicare, to the Federal Government that does, is misleading.
24
"... One reason the plan lacked strong support was lawmakers were cagey about how to pay for it. …"
Healthcare as percent of GDP:
USA: 17%
every EU country: 10-12%
The question " how to pay for it." needs to be replaced by "what to do with the massive 5% of GDP savings"
The drag on the US economy that is the 5% GDP of the extreme overhead to compensate the C-suite, shareholders and the massive private bureaucracies needed to manage the byzantine array of policies, policy options, who has a pre-condition, who to cap, who to apply rescission to, etc.... would finally be eliminated. Just imagine this 5% of GDP could do if it instead was targeted to education, infrastructure, and scientific research.
12
@oldBassGuy
Or just letting people keep 5% more of their own money, which would increase consumer spending and grow the economy.
6
@oldBassGuy
Indeed. And imagine the entrepreneurial genius that would be unlocked if people could quit their jobs to start their own businesses without losing their health insurance!
Medicare for All is just political foolishness at this point.
But a Medicare option in the insurance exchanges would be a tremendous step forward. Allow individuals and employers to buy into Medicare, at cost, as an alternative to private health insurance. And meanwhile, give Medicare all the power it needs to negotiate prices with drug companies just as it negotiates with doctors and hospitals over rates.
The Medicare payment framework is already built and it is probably the least dysfunctional part of the American health care system. Doctors and hospitals may not love Medicare reimbursement rates but they can break even.
Medicare might be cheaper than private insurance, or private insurance might be cheaper. If private insurers think they can be more efficient than Medicare, this would be a chance to prove it
9
So, then people not qualifying for Medicaid can wait until they are sick to buy into Medicare?
It is absurd to think that a state and a country should be considered similar enough to make the argument that Mr. Suderman is making.
At least it should be absurd. States can't control their borders while nations can. Do Democrats really want to control the border is up for debate.
Most every other rich democracy in the world has a healthcare system is more socialized than the system in the US. Most countries have similar results as the US with far lower costs. Anyone working with "Reason" should want a system that produces similar results at a lower cost.
Put another way, IF it were possible, we could duplicate the UK system of healthcare and we could balance the budget AND even cut taxes with the money saved in the healthcare system. Why shouldn't a conservative or libertarian want to look into a system with the potential to reduce taxes AND balance the budget?
But, again, my main point is that Vermont has no control over its borders and little control over its taxes since multistate entities can shift taxable income quite easily if the incentive is big enough.
In other words, Mr. Suderman creates his own strawman and then thinks it is a great accomplishment to knock down the strawman he created.
6
@Tom Wilson
This is a valid point comparing state to federal government is a bad analogy. Especially when it comes to funding.
"In other words, Mr. Suderman creates his own strawman and then thinks it is a great accomplishment to knock down the strawman he created."
Republicans do this all the time.
3
Mr. Suderman writes: "But if it couldn’t work in Vermont, with a determined governor, an accommodating legislature and progressive voters, Mr. Sanders will have a tough time explaining why it will somehow succeed on a vastly larger scale."
Maybe I'm missing something, but I think "it" -- Medicare -- has succeeded on a vastly larger scale, covering virtually all of the elderly in this country, as well as those with permanent disabilities and end-stage renal disease (leaving the younger and mostly healthier parts of the population to the for-profit insurance companies).
Mr. Suderman also notes that savings from single-payer assume payments to providers at Medicare's rates, rather than the generally higher rates paid by private insurers. This argument implies that patients get some value, presumably greater choice, from the higher payments. Although it is true that some providers do not accept Medicare, it is also true that private insurance uses networks to limit choice, in many cases canceling any benefit of higher payments to providers. The elimination of networks resulting from adoption of single-payer would itself be a huge boon in terms of continuity of care, time savings for patients and providers, and simplification of the system.
Single-payer seems to be the only way that our system will ever be able to control costs.
I find it interesting that Mr. Suderman's strongest argument against Medicare for all is all but devoid of any actual defense of for-profit insurance.
17
At the outset of my business career over thirty years ago, I paid nothing towards my premium and complained about a $15/$25 primary/specialized co-payment. My annual out of pocket was inconsequential. Today, my family premium offset payroll deduction is a little over $10,000 per year and my other out of pockets costs run in the thousands. Dental has become another nightmare bill. The question to ask is why have costs gone up so much for the vast majority of medical coverage. Doctors made house call as late as the late sixties in my neighborhood in Queens, Dentists were not expected to be rich (my father and grandfather were DDS, not rich). Rampant capitalism and excessive greed are the reason for these seismic shifts in costs. Half of the electorate want change the other half think this is the only way. Better alternatives and options are always possible.
12
Pure sophistry. As any Economics 101 student knows, implementation and cost efficiency are matters of scale. The Medical-Industrial Complex fears price controls and dwindling profits so its apologists cherry-pick statistics to scare people. The real contention is with Medicare because it does not coincide with a free market economy. If you think about it however, neither do the unregulated trusts of Big Pharma and Private Insurance.
Pointing to the failure of a healthcare insurance program in Vermont is as specious an argument as criticizing West Virginians for not eating enough fresh seafood.
23
A lot could be done if Republicans would get out of the way but they won't. Their job us to block any proposal that doesn't steer money to their patrons.
9
Congratulations on the necropsy of a plan that failed five years ago.
So...WHAT’S YOUR PLAN?
Status quo? Tough noogies?
“As the Cornell Policy Review noted in a 2017 post-mortem, the mix of higher-than-expected costs and administrative problems “fostered an atmosphere of uncertainty and distrust in the state government, turning a politically steep climb into a politically insurmountable one.”
Vermont had to set up a whole new administration. Since Medicare’s administration is already well established, and functioning well, even to cranky old folks, that isn’t a problem, is it, Mr. Suderman?
My issue with Sanders’ version of Medicare for All is that well, it isn’t really medicare. I have taken care of three elderly relatives, and am fast approaching medicare age myself. Medicare has premiums, mostly unseen by the elderly because the premium is deducted from social security before the recipient gets their check. Medicare pays 80% of usual and customary charges, not everything, as Bernie’s plan does. And that leaves a yuge niche for private insurers to sell medigap policies. United Health Care has made a great business out of doing that for AARP members, so it wouldn’t abolish private insurers, either.
I would buy into Medicare as is, and buy a Medigap policy.
6
If people don't get medical care they don't add to the "Medical Loss Ratio," an insurance term I find repulsive. Of course, we will spend more money as a nation if we take care of people's medical bills. Presumably we will have a healthier population, too, which will decrease costs in the long term (but not in the 24 hour news cycle which seems to matter more.)
I hold that good health, not having as many preventable deaths, ability to find out what is wrong and treat it sooner, having less pain, treating depression, avoiding bankruptcy due to medical costs, and not lying awake at night wondering what will happen because of some medical condition has some value. Maybe that value doesn't show up in the board room, but it sure shows up in the living rooms across this country.
3
It can't be done state by state. One of the important (if not the most important) factors that makes Medicare for All (and, indeed, all universal government run programs) so efficient is that everyone is treated the same. You cannot do that in a state program. What do you do about the money people have paid into Medicare and those actually on Medicare? On Medicaid? TriCare, Indian Healthcare?, etc. The only thing they could think of in Vermont was to leave them out. Then an even bigger problem came up. What do you do about people who work for multi-state corporations? Would these be covered by the Vermont plan or by the plan the corporation has for all of its employees? Again they were left out. If you have a national plan all these problems never even come up.
Here is the bottom line on costs:
Canada has a system similar to M4A. In 2017, Canada spent $4,753 in PPP dollars per person for health care. We spent $9,892. That amounts to a savings of $1.8 TRILLION or 51% each and every year.
18
@Len Charlap
Was the $4,753 in Canadian $ or US$?
@Allan - It was in PPP dollars which are US dollars adjusted for the cost of living in each country. The figures are from the OECD.