It's shear fantasy that Medicare for All would be anything like Medicare Today. Medicare today covers hospital, some physician and drugs for services the elderly need, for which you are charge a premium. No pediatrician or obstetricians. At least you get to pick your doctor. For what medicare doesn't cover you need to buy supplemental insurance and surprise that doesn't even cover everything.
5
The constant drumbeat of NY Times editorial section against progressive action is simply unrelenting.
35
Ironic someone so opposed to national health-ie single payer - medicine in France, the UK, Scandanavia, Australia, Canada, New Zealand to name a few - so tidily omits the amount of US healthcare $$ go to CEOs and inflated drug prices.
https://www.axios.com/the-sky-high-pay-of-health-care-ceos-1513303956-d5b874a8-b4a0-4e74-9087-353a2ef1ba83.html
Until this is rectified, nothing is going to change.
30
This is nonsense on stilts.
I live in Denmark, where we have a single payer tax financed health care system free at the point of delivery.
We only pay half of what you pay in the US pr person, and we have roughly the same GDP p.c as the US.
In spite of that we have everyone covered, and we almost 3 years longer than you.
We don't have waiting time for critical illness.
My brother and two of my friends has og have had cancer. They have had no waiting time at all, and they has all had the full treatment.
We have a yearly cap on prescription drugs. The cap is in steps. 0-140 USD you pay full price, 141 - 230 USD you get 50% discount, 231 -495 USD 75%, 495 onwards 85% . You can never pay more than 580 USD in any given year.
You have an electronic medicine card , where you can follow your prescriptions to control if you get your rebate.
You can choose your family doctor once a year - in september - and you can go to ant specialist and any public hospital you want without any kind of preapproval.
We have had that system since 1970 - before that we had, what the Germans call Krankenkassen - and I have never had to worry about a doctors bill or a hospital bill.
It does wonders for your life - and your sleep at night.
An average family doctor earn 75.000 -100.000 USD a year, and as the education is free, they has no study debt.
The system has a very low overhead, and that makes it cheaper.
Your system is both cruel and stupid.
60
You say, "Dr. Atlas is a senior fellow at the Hoover Institution and author of" blahblah-ladidah. Fine. But we need more clarity on this person's background. Not to be mean or anything, I would be asking for detail even if the author was pro-Medicare for All, and here's why - there is a vast ocean of "data" out there and people have limited time and resources, and not all people are very neutral either, so they cherry-pick the "data" that suits their thesis and present it as if they arrived at the thesis from the data. This is a wicked game played by people on all sorts of issues, and is unfortunately common in the Social Sciences, particularly in Economics where political agendas seem more important than mathematical rigor.
In Dr. Atlas' case, he is a senior fellow at the Hoover Institution, which is a famously Conservative institution. He talks about the Trump Administrations interventions in the healthcare system in great detail (compared to actual journalistic reports in the NYT or WaPo or elsewhere that I have seen). Is he consulting for the Trump Administration, who else?
Finally, why is there no "One Dataset" when it comes to healthcare spending in America? This issue has been "debated" since 2008 and how come there is no one source of data on Medicare spending (by state, age, disease, LTcare, etc), Medicaid spending, Private Insurance spending+profits (profits are okay for business, folks), Pharma spending, NIH funding, ROI of each? Why NOT? Corruption??? Bias???
16
Fact: on average, western countries other than the US (like Great Britain, Denmark, Sweden, Germany, France) pay about fifty cents for each dollar that Americans pay for health care. That includes all those scary-high socialist taxes Europeans have to pay. Fact: according to WHO, both infant mortality rates and longevity rates are far better in those countries, on average, than in the US. This infers that medical outcomes are better in those countries, on average, than in the US. So how can medical care abroad be both cheaper and better than in the US? That is the question that Atlas obfuscates and avoids. The purpose of his opinion piece was to justify why we should pay double for inferior care. He failed. Atlas criticizes single-payer, but offers no superior alternative. Put up or shut up, Mr. Atlas. Atlas has impressive credentials, according to his LinkedIn page. Too bad he squandered his reputation as an apparent shill for the AMA or the insurance industry.
15
Weird, it's like doctors will make less with m4a and are against it.
11
Concur with analysis that Medicare for all would lead to many of the undesirable outcomes cited. Completely disagree with his overtly politically biased views on Obama’s ACA. A more accurate analysis of ACA Pros/Cons can be found in this analysis:
https://www.thebalance.com/obamacare-pros-and-cons-3306059
3
The Hoover Institution, another 'fine' conservative think tank brought to us by the Koch conglomerate.
15
It is pure fantasy to believe that the access and quality Americans enjoy today would hold if private insurance were abolished.
These kind of blank statements are probably caused by an excessive misuse of medical marihuana.
1
I'm surprised and very disappointed that the NYT made the decision to published this ridiculous laundry list of Rightwing lies about the dangers of a National Health Care system that works FOR its citizens in every. other. first world country. A system that a vast majority in their respective countries is perfectly happy with.
Every. one. of Mr. Atlas' assertions has been completely debunked for at least 20 years, if not longer. I'm sick and tired of hearing the same claptrap against low cost or free healthcare for Americans from the Republican party.
Shame on the Times.
27
Enjoy? Medieval.
2
I’m a staunch advocate of the repugnant-can’t three-part health plan. Every real patriot should support this plan!
1. Get sick.
2. Send in all your money.
3. Die quickly.
4
Of course ..... it is impossible to have .....Medicare for all ....
look at Europe ...they don’t have it - it is just an urban myth ....
Tired of reading New York Times articles supporting the establishment ....
10
Green is Red! Insurance employees work for Free! Ignorance is Genius! Insurance investors donate their capital and expect no profits! Fredom is Slavery! None of the billions US Medical Insurance absorbs could help the poor or uninsured! Lies are Truth!
Ok, when do I get my check?
10
Americans should get the option to have the same Healthcare Plan as our so-called representatives in the Senate, House, Supreme Court and Executive Branch. After all, we pay their salaries and benefits, including pension. Are they better than us or are we all equal? My answer, equal and it is the right thing to do so stop talking about Medicare for All is good or bad: we should have the same benefits are our elected and appointed officials ( and let's have the Supreme Court elected too by the people).
5
Sorry, the dangers to whom? For-profit hospitals? Pharmaceutical companies?
8
"When I feed the poor, they call me a saint. When I ask why the poor are hungry, they call me a communist." - Mother Theresa
Same for health insurance. If people want everyone to have truly affordable health insurance - not the half measures that keep insurance industry profits intact, we are called communists.
Capitalism is when corporations get hand-outs, even when they are highly profitable; communism is when the people get health care services, even when living in poverty.
I do not recognize this country any more. It is brutal, mean, hoarding of resources and indifferent to human needs. I am a boomer. I remember when we could do great things. Once the USA stood for something other than the greed of the corporate class.
When did killing our citizens through malicious neglect become a virtue? Why have we ceased to be ashamed of that?
20
The fellow from the Hoover Institution has misrepresented the facts. Why am I not surprised?
See other comments for the facts - I'm not going to re-list them.
6
What bothers me most about this article is the many assertions made with no backup or facts. For example,
"And it’s not just because single-payer systems restrict access to the newest drugs for...."
Where is the data to back up this assertion? And why would any health care provider "restrict" access to any new drug? Because health care providers outside the US like to kill people?
"Or that single-payer systems have shown to have worse outcomes than the ...."
Study after study points out the US system has some of the worst outcomes. But the author throws out yet another assertion to be accepted on faith.
"Or that tens of thousands of additional citizens died because of wait times."
So we should believe that everyone is dying in Canada and Europe waiting for health care? But how come surveys show the people in these countries generally view their health care systems favorably?
I agree with others that this article is utter nonsense.
19
Glad The Times published this much-needed antidote to all the self-serving, feel-good anti-American drivel from Canada, Germany and Denmark. My children and grandchildren all live in America. They have Obamacare. Their hospital, dental and drug costs are all covered, as well as all their visits to their doctors and specialist. I live in Canada, and pay more, through taxes, than they pay, and receive far worse care. When I needed a knee replacement I had to wait for two, very painful, years. Now that I'm 80+, my drug costs are covered after the first $100. Canadian health care does not provide dental care. Please don't be deceived. Canada does not have a kinder, gentler healthcare system. It may be good for their national self-image that they think so; but it's not true.
4
Every point in the opening paragraph about the Canadian medical system is incorrect.
In Canada, you can see any doctor you want, as often as you want for anything you want. Care is NOT rationed to save money. Access to effective drugs is NOT limited. Our system has BETTER outcomes for cancer, heart disease, stroke, diabetes and high blood pressure. Wait times for non emergency procedures has NOT resulted in the deaths of tens of thousands of people.
When lives are at stake the immorality of writing these falsehoods is shameful.
13
What an in-credible piece of propaganda. Not a word about the massive administrative costs that would be saved by no longer needing to jump through the for-profit insurance companies' hoops. Not a word about the money that would be saved by no longer forcing uninsured individuals to seek health care in the most expensive way possible: through the ER. Not a word about the money the economy saves by keeping folks from declaring bankruptcy over their inability to pay for medical treatment. Not a word about how much money could be saved by regulating the obscene profits made by Big Pharma. I'm sorry, but if all the writer is going to do is extol a system that values profits more than people, then the writer has no credibility whatsoever.
9
Both Britain and Canada (countries you use as an example) have greater life expectancy than USA. How do you explain that, then?
https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
5
The fact that this article was published with no mention of coronavirus is absolutely absurd.
Coronavirus tests are $3,000. But no, please lecture me on how single-payer is the system that restricts access.
5
Check out the mortality figures for the Corona virus, all the countries with mortality rates below 2% all have robust public health care systems. It is unbelievable that anyone would write this article today. How about an article in favor of black slavery, radiation is good for you, global warming is a myth, taking the vote away from women or that piracy leads to stronger ships?
4
Well, one thing seems to be obvious. Not too many readers were hoodwinked by this snake oil salesman. Thanks, Bernie!
9
The not-functioning US health-care system is a danger to the whole world.
Obviously, the Trump administration is making things worse by not taking the corona virus seriously. But even with a Democratic president there would be millions of people with no healthcare and no sick leave out there, not getting a health check and going to work with a fever and a cough.
It's genuinely fascinating that the uninformed Dr. Atlas has written this opinion piece at the outset of a global pandemic. It is like the medical equivalent of the Titanic. In his imagination, the US health-care system is the best in the world, and unsinkable, even though it is more expensive and has worse outcomes than any other in the western world. Actually Cuba has better general outcomes, though I certainly won't recommend Cuba as a role model.
The US system has great outcomes for very rich white people. (If you are rich, but black, it doesn't https://www.theguardian.com/sport/2018/feb/20/serena-williams-childbirth-health-daughter-tennis).
But so do most other healthcare systems.
It's true that a restructuring of the US healthcare system will be painful and difficult. In my opinion, it would be best to do this gradually and over several years. But imagining that it is already great is ridiculous.
8
The main danger is the rich doing anything to keep being superior by being expensive health care.
1
Dr. Atlas begins by throwing at us unsourced opinions about the deplorable state of "single-payer systems like those in Britain and Canada," and then proceeds to drown us in an arbitrary deluge of numbers and stats for which we would need a week of research to ascertain their connectability.
Example: ". . . Medicare funds, will be depleted in 2026." This is a carbon copy of the scaredy-cat screeching of a few years back that Social Security is about to run out of cash. 'The sky is falling, the sky is falling!' screams Chicken Little.
Gimme a break. Just admit that Medicare for All would be harmful to the wallets of high-priced specialists and medico-elitists who want to keep the game in their court by any means possible.
7
Sure, public healthcare only works on every single other developed nation other than ours. So sick of moderates.
2
You think the average American has assess to quality care?
Sure they do but at what cost.
My sister stopped riding her bike because if she crashed the medical bills that her medical insurance does not pay would bankrupt her.
My friend just told me today her sister was just diagnosed with breast cancer, she is looking at the option of no treatment so she does not burden her family with medical bills her medical insurance will not pay.
Remember with those numerous Medicare Advantage plans if you are hospitalized they will often deny payments.
8
Dr. Atlas,
Much of your column discusses the potential consequences of lower payments to health care providers and institutions by Medicare vs private insurance. Payment level is a crucial issue that affects the quality and number of health care institutions and providers. However, payment level and payment system (single payor or private insurers) are completely different issues, which your article incorrectly conflates with the most sensational possible language.
A single payor system is intended to eliminate the costly inefficiencies for providers and patients of dealing with multiple different insurers. I believe there is abundant evidence that single-payor systems have much lower administrative costs than private insurers. Your article doesn't address that at all.
Your article would be a much better contribution to the national discussion if you presented the pros and cons of single-payor vs. private insurance, the potential difficulties in implementing a single-payor system, the consequences of payment rates that are too low, and the improvements that could be made based on the experiences of other countries that implemented single-payor systems. Instead you present highly inflammatory statements, such as "tens of thousands of additional citizens died" without any citations.
The intent of your column appears to be scaring people away from Medicare for All with sensational claims, rather than informing them of the potential difficulties and problems. Shame on you.
9
Have any of you looked at the Australian system? It's not perfect but no one is going bankrupt to pay medical bills. No one is going without medical care. Most things are free or subsidized - including prescription medicines. I have public and private health insurance which covers dental and every conceivable situation including ambulance transport. Yes we pay higher taxes but at least some of the money goes to health care...I thank God every day that I don't live in the USA.
7
Well, hey: If Medicare broadened its pool, and the payments that support it, to include a younger and thus healthier population, it would spend less per person.
And the nation's total healthcare bill wouldn't need at least one person per medical office who does nothing but deal with insurance companies. Nor would the insurance companies, who could continue selling supplemental coverage, need the army of coverage-deniers they have now.
And nobody would go bankrupt over health costs, or need to sue somebody just to get medical care after an accident.
Just saying.
4
" . . . . while private insurance often pays over 140 percent of the cost of care, Medicare and Medicaid pay an estimated 60 percent of what private insurance pays for inpatient services, and an estimated 60 percent to 80 percent for physician services. Most hospitals, skilled nursing facilities and in-home health care providers already lose money per Medicare patient."
Well for God's sake, can't you see what's wrong with this system? An eight year old could explain why this is unfair and unsustainable, before she even got to the part about the unnecessary administrative costs and profit margins. Geez.
5
USA has 4 healthcare systems, Medicare, Medicaid, VA and Private. The government pays for the first 3, which pays for the sickest individuals in the country. The Private insurance companies pay for many sick individuals; but the sickest people who have the highest burden of illness, are the old, the poor and those who have served our country in the military. If you add up the cost, the government pays by far the majority of the healthcare costs in our country. Let us not forget the "private insurance is also paid for partly by the government through the tax deductions given to those who buy private insurance. Oh I forgot the uninsured bills that come out of the pocket of government and those with private insurance. I will guess, when you add it all up the government pays 2/3rd to 3/4 of Americas healthcare bill.
How to make it cheaper? Use taxes to pay for everyone's healthcare. Those that can't afford it get medicaid, already in place. The military gets the VA already in place.The majority get medicare, already in place. Those who do not want government healthcare buy their own private healthcare and get a credit from the government for the healthcare taxes they paid. We could call it Obamacare credits in the reverse. The wealthy and uber wealthy can go on line to buy the private heath plan that works best for them. At least the wealthy can use their accountants, lawyers, concierge doctors and other hangers to help decide which private plan works best for them
7
"The average Medicare beneficiary can choose between 28 plans offered by 7 firms." Will the average beneficiary live long enough to read, compare and understand these plans? Will anyone?
3
Does anyone remember Herbert Hoover's attitude towards the anticipated great depression?
No problem!
The "Hoover Institution" is a great name,only if one ignores the Great Depression and "Hoover-villes".
4
In a way, it's encouraging to see pieces like this. It means the CEOs, private equity vultures, hedge fund managers, collection agency owners, and others who receive lavish wealth care from our medical-industrial complex are scared. Each news story about diabetics dying because they can't afford insulin, families going bankrupt from medical bills, people getting seriously ill from skipping medication for which they can't afford the copay, and people getting jailed for medical debt increases the recognition that our health care system is fatally broken and cannot continue the way it is.
If the Covid-19 pandemic turns out as bad as some fear, millions of Americans will be left with enormous medical bills after hospitalization. So many people facing life-long debt, bankruptcy, or even jail may finally force our elected officials to confront a problem that, until now, generous campaign donations have convinced them to ignore.
Paying shills from conservative think tanks to write opinion pieces meant to promote fear of the alternatives to our failed system seems an act of desperation. The greedy executives and investors surely know they can no longer defend or justify the failings of their medical-industrial complex. We have every right to demand a health care system that serves the American people, just as the citizens of every other civilized country enjoy as a basic right. The vultures who have been literally bleeding us dry with their greed should be afraid. We shouldn't.
14
Mogens' right vs Location01: it works the other way around. it is precisely thanks to their extended single-payer systems that overall obesity rates are lower in W-Europe and that life expectancies keep rising there. In UK were generous financial support to the NHS has been jeopardized, life expectancy is stagnating for the first time in decades. Big figures may hide key issues such as medical innovation and access to highest quality care - available but to the few - but they come with a potent message: while spending less (per capita or in proportion to GDP) than the US, European or Japanese health care systems deliver more in collective terms, as measured by life expectancy and morbidity rates. That is a "danger" I can live with.
6
Since Medicare/Medicaid prices are set by regional averages, I find it hard to believe that the poor hospitals and insurers are losing *that* much money on government-funded patients. Provider fraud isn't mentioned as a cost driver; annually, providers are busted for upcoding or providing unnecessary services, costing 15% of our budgets for Medicare/Medicaid. Nor does he mention that uncovered patients who don't qualify for Medicaid are charged whatever the hospital sees fit, even if they're driven into bankruptcy. Nor does he cite studies and statistics to back up his sweeping assertions about the failures of single payer systems and the deaths they cause; nor does he compare those numbers with the needless uninsured patient deaths here in the US due to people avoiding treatment because they can't afford the costs.
Really, this slanted opinion is a waste of everyone's time. Get me Elizabeth Rosenthal from Kaiser Foundation, and let her go head to head with this gentleman. Then we can actually become informed, rather than listen to contextless pronouncements colored by the author's politics.
Finally, the gentleman never proposed that the government has a right to bargain and control costs, which it currently doesn't assert Nor did he give any answer to a simple question: Why covering our populace isn't the morally right thing to do. What he's saying without saying it is that only those who can afford it deserve care. I'm tired of these voices in this debate.
10
This is fear mongering at its best. I will tell you about private insurance providing access and quality care. It resulted in my bankruptcy, loosing my home and the inability to get coverage at any cost until the ACA came along due to pre-existing conditions. The one experience that I had outside the US health care system was in Paris, treatment and one day stay in the hospital there and I was presented with a bill for $14. Dr. Atlas obviously "has his" and does not want his 1% lifestyle threatened.
16
The author makes a number of “ factual assertions” regarding single payer systems and health outcomes that need references- otherwise to quote Oscar Wilde- “let ignorance be no bar to opinion” . If left to stand without references this opinion piece simply becomes another “factual” reference in support of the private payer agenda. Seldom mentioned in private vs. universal coverage is the freedom from the worry of “how can we afford to pay for Mom’s cancer? When I engage Americans on the subject of healthcare coverage and make this point, the reality of their “burden of worry” hits home. As this current crisis runs its course, I for one am safer knowing all Canadians - rich or poor- citizens or the newly arrived- have equal access to care. The crisis also reminds me that we are all at risk- and only by working together can we make a difference.
8
I can only say that I wasted around 12 hours on the phone trying to convince my medical insurance company (not going to mention names) that the dermatologist that THEY recommended to do Mohs surgery on my squamous cell cancer was actually in their plan. My regular surgeon wasn't in their plan, so I went with their suggestion and was happy with the outcome. But when it came to paying the bill, they refused, saying the surgeon was out of network. Several times my call was disconnected. Each time I called back I would get a different story, and no record seemed to have been kept of my earlier calls. Finally, I threatened to get my lawyer involved and I told whoever was on the phone this time that THIS WAS THE REASON I WAS VOTING FOR Bernie Sanders. That seemed to do the trick and about 6 or so weeks later the approximately $900 charge was finally covered.
10
The US healthcare system is nothing short of a legal institutionalized extortion racket.
It's insane that so many people resist the idea of medicare for all and insist on keeping their incredibly expensive private insurance plans, which may or may not cover a portion of the health care costs provided by certain in-network doctors and hospitals. Too bad if an out-of-network doctor happens to treat you at your in-network hospital.
Fear mongering and disinformation is what keeps the current system afloat. Having experienced the American and Canadian systems, I hope that Americans can see through the propaganda and eventually enjoy the health, financial, and workplace freedoms that come with a single payer system.
12
Access would be limited? Really? How about access now for the millions who have no healthcare insurance? Don’t care about them? Beyond that in our system it often takes a year to get an appointment with a dermatologist for a skin cancer check up. Much worse in Florida. People fear change, but what we have is not working for many people and not working at all for some. The uninsured access will improve 100%.
7
Be wary of any article about US healthcare that tosses around the terms "choice" and "access". They sound like good things, but they are almost meaningless.
For most of us, we have the "choice" of whatever insurance plan our employer provides, or nothing.
Within that plan, I have my "choice", to only those providers that will accept my insurance, or I am penalized, or have to pay out of pocket.
If I am in need of care, I then have the "choice" to select a service for which I have absolutely no idea what it will cost, and no provider that is willing to tell me ahead of time what the typically charge.
I then have my "choice" to pay some deductible/copay to go to a provider who will produce a health outcome for me that is likely worse than it would have been if most other advance nations, including Canada and the UK.
If I need to go to an emergency room, I have a choice to be hit over the head with outside provider surprise bills.
These all sound like not great choices. But hey, there's a lot of doctors, so that's something, I think. Something something wait times?
Providers make more money in this country than in any other country, by a wide margin, and for worse outcomes. That's what we need to fix.
7
"single-payer systems like those in Britain and Canada hold down costs by limiting the availability of doctors and treatments, even for the most serious life-threatening diseases."
I have a friend in the US who has MS. She had a doctor who she trusted and a treatment that seemed to be helping. Then her doctor stopped dealing with the insurance company who provided her funding.
She found then that the new insurance provider was disinclined to provide the drugs that she had found efficacious. Whether they didn't like the costs or were committed to promoting the products of some other pharmaceutical company, I don't know. I do know that the drugs were still available and still safe.
It's a story I've heard elsewhere about US healthcare. If your employer provides your healthcare, then they negotiate with the insurance company about the terms and conditions of your healthcare. They can cut you off from your doctor, or decide that they have moral objections to your having any contraceptives at all.
In the US it's not the patients who call the shots - unless you are wealthy - it's the insurance companies. And they are not in it for your health, but theirs.
10
What this article by Mr. Atlas made clear was the complexity of the medical care system produced by private insurance. First of all, the only thing any insurance scheme provides is money. With that truth in mind, make obtaining money through the most efficient and simplest method possible. That is, obtain money from the highest number of people in the United States to fit the bill for medical care for all, through taxation from all. The result would eliminate profit to numerous private insurance companies through the centralization of the money system. With that solved, the management of decentralized care remains the single focus of the overall problem. Once the money dilemma has been simplified and reduced through the elimination of a single expensive function unrelated to the care and curing of the sick among us, seek the solution to medical care from the medical professionals.
2
Although the current reimbursement rates for Medicare are too low, I think most of the proponents of Medicare for All recognize that and will include an upward adjustment to balance out the difference between the private insurance reimbursement rates and the Medicare rates. Not a complete replacement but not as drastic a cut as the author is warning. Also, I don't think private insurance will completely disappear -- after all I have a Medicare supplement policy, aka a "medigap" policy that is a private plan to supplement the Medicare reimbursement. This article of doomsday warnings about Medicare for All is oversimplifying and fear-mongering. If Dems succeed in the election the first thing is to establish the facts and propose specific plans to partially replace the private healthcare industry with Medicare for All, and better regulate the supplemental private insurance that will remain. Having health insurance be tied to your employment is simply unacceptable -- I cannot believe we have accepted this ridiculous system for so long. A sign of corruption for sure.
3
I may not have any insight in the Canadian or the British healthcare systems but I do know something about the Scandinavian and other European systems with a spouse that is university professor of the caring sciences.
Granted, there are a number of serious challenges from aging populations and rising costs in most of our countries but we manage to provide care to virtually all of our citizens and most of our immigrants too. Sure, the success rate is not at 100% but we do not exclude patients because of lack of insurance. Some people may choose to have supplementary insurance to ensure faster treatment at private hospitals but it is not necessary for survival. And when it comes to not offering the most expensive new treatments - doesn't private insurance in the US have cost caps and systematically reject expenses?
And generally we spend less for our public healthcare than you do. More healthcare for less money, possibly because there are still leeches bleeding the healthcare in the US.
7
Lots of arguments pro and con. Try PHASING IN better Medicare coverage by reducing the eligibility age year by year. This is especially important for people 50-65 who have been laid off due to age (yes, we know that is illegal but rampant) or who have worn out bodies due to decades of exploitive physical work and cannot work any more.
2
@John Mardinly
You have just stated Sanders' plan to be phased in over four years starting with people near retirement age gradually reaching down to younger people.
1
I'm curious why this article fails to address the actual pricing crisis in healthcare. That is, healthcare in the US costs per capita about twice as much as under the most expensive European system. Where does all that money go that we pump into insurance giants, hospitals and pharmaceutical companies? Why can Medicare not negotiate drug pricing, as is the case for our peer nations? Are Medicare Advantage plans assessed to measure if their "extras" provide participants actual value? Articles such as this one are dedicated to reciting what's not possible, what will be "lost" if we don't continue on as we are. But most carefully avoid citing much concrete data about the cost structures of US healthcare. We spend vastly more than our peer nations with national healthcare systems. Where does all that extra money go? Because it's not being spent to ensure our health outcomes are as good as those of other wealthy countries.
5
We spend the most on healthcare than any nation in the world, and yet we're 43rd among the world's nations in longevity. If we measured "healthspan" instead of "lifespan," my guess is that the US would make an even worse showing.
Childbirth death rates are shameful, and comparison by race infinitely more shameful yet.
The CDC itself has conjectured that overmedication is likely one significant cause of our shorter, sadder lives. 1/3 of Americans over 45 are on statin drugs, for example, yet these drugs have yet to be proven of benefit for primary prevention (for those who have not already had a cardiovascular event). StatinStories.com.
How much damage does overmedication cause? We have no compulsory system for reporting the adverse effects of medications: doctors aren't required. Patients could (but of course rarely do) self-report to the FDA. So we don't know how much damage.
Generic drug companies can't be sued for either faulty drug design or for not being current on their warning labels. (Supreme Court decisions of 2011 and 2013.) Hard to believe, unless you've been a victim and found yourself with no recourse.
The top 10% wealthiest Americans live an average of 13 more years than the bottom 10%. As someone in the top 10%, my life is also diminished by this fact.
We need to start by facing up to how we're really doing now. Our healthcare system produces profit for the few, not health for the many. I find that sickening.
7
"It is pure fantasy to believe that the access and quality Americans enjoy today would hold if private insurance were abolished.“
Actually, in my experience, it is pure fantasy to believe that "access and quality" are part of the American healthcare system at all.
8
We ration health care by cost, and millions of us cannot afford it. The market does it in this country while governments do it in other countries. Rationing by the market is so natural to us that it is invisible; people with good insurance get their lives extended, often whether they want it or not, while people without insurance scrounge and have shorter lives.
Our health care system is governed by a sort of invisible hand, so that everyone's competition to make money results in the whole system becoming larger compared to the rest of the economy; it does not take a group of secret conspirators to make this happen, although such a group may well exist.
If we had Medicare for all, corporations would be able to stop spending for health insurance. What they spend should be subtracted from the estimates of what Medicare for all would cost, but it isnt, in order to make the price estimate as large and scary as possible. Our deductibles and copayments and the cost of keeping track of them (and of much of our medical billing) should also be subtracted from the estimates of what Medicare for all would cost. So the cost figures are just more voodoo economics.
Billing and not being sure what is covered make dealing with health more time-consuming and stressful than in other countries. This should be factored into the cost of our system, but defenders of our system dont.
5
Dr. Atlas, you do not address the issues of how to insure those who do *not* have employer based insurance, who are *under-insured*, who *cannot* afford deductibles and/or co-pays, or *not* covered by Medicare. You do *not* address the impact of closing rural hospitals. How will transparency solve the obscene cost of drugs, or save the lives of insulin dependent diabetics for whom a $5 bottle of insulin (actual manufacturing cost for a product that has been on the market for 25 years, is *not* undergoing new research, and is *not* advertised) now costs nearly $600? How do seniors barely getting by on Social Security afford a Health Savings account? Dr. Atlas, removing the “cloak of mystery” may increase competitiveness yet it will never solve the issues that plague so many Americans. Write another opinion piece when you have solved these problems.
8
@Location01 How can you claim that the fact that Danes are overall healthy has nothing to do with healthcare? That's exactly what you get in a system with effective preventative care. Child obesity can be battled because all children regularly see a doctor. Weight loss programs can be partially covered as treatment (saving the system money in the long run). Do you actually think that Americans are genetically fat?
9
As a Canadian septuagenarian I wholeheartedly disagree with the assessment of Canadian health care for seniors. I do not have any supplemental insurance, I choose my Dr. And my Dr is free to refer to any specialist of his choosing as need arise. Due to unexpected health issues I have been referred to 4 specialists in the past year and have had extensive testing, all done in timely manner. Medications have either been covered 100% or incurred a small co-pay contribution on my part. Other than travel expense this has all been covered by the Government.
My neighbour has had two knee replacements and ear surgery that restored hearing function over the past two years and says she was very happy with the treatment. Many of neighbours are seniors and I have yet to hear any complaints about Canadian Health Care. Overall Canadians are healthier than Americans and have a longer life expectancy and lower infant mortality than the US and much of this is attributed to greater accessibility to quality health care. And overall we pay less. Many Americans have strong opinions about foreign health care that simply are not supported by facts and personal experience.
20
Our healthcare system is being looted and we our being told the theft is in our best interests.
The author leaves out transparency on the insurance side. The smoke and mirrors occurs, in large part, within the contracts the insurance companies and providers agree upon.
I was excited to read the article thinking it would be an educated and nuanced view, but within the first two paragraphs it became obvious this was not to be the case.
8
There is no such thing as a "value-seeking patient" when you are bleeding profusely and need stitches, or your child breaks their arm and needs immediate attention. I've called multiple hospitals and healthcare centers to get a quote on stitches and no one has been able to give me an answer, not even a ball park figure. Choice is an allusion and health care is a right not a commodity!
13
The US healthcare system costs so much because it is profit-driven, and has figured out how to protect its profits by burying its customers with layers of bureaucracy, inefficiencies and confusion. For years my husband and I had to buy our insurance at "market prices," and saw our yearly premium costs rise several times more than the rate of inflation.
After awhile, we went without because we couldn't afford to pay a cost that was equal to many people's mortgage payments! Once, when friends asked which plan we had, my husband quipped that we had Bush care, which meant we had nothing at all. It was only when the ACA was enacted that we could finally get re-insured. People who have access to decent, reasonably-priced insurance don't know how fortunate they are.
6
The writer needs to come clean on where his salary is paid. What is his relationship with the Big Pharma? Why does every single nation have a single payer system. Virtually every economically advanced nation in the world has universal health care. His article does not compute.
9
It really all comes down to creating value for shareholders, in any of the medical-industrial complex divisions. The pharm industry recently cut research and development funds and raised drug prices. Again, the greed of the unregulated medical market seems to the bring out the worst of those at the top of the chain.
We have the worst health-care system, economically speaking, in the developed world. Our mortality rate is 37th in world statistics, our people can be bankrupted with one major illness, and now, insurance companies are controlling doctors, and their time spent with patients, and the tests they require. It's scary to get a bad illness in the USA.
6
Be interested in knowing where you got your data from. As a Canadian I just picked my wife up from the hospital where she underwent elective surgery. Yes she waited 6 months but once in, the system was efficient and professional. Can't understand why anyone would want a private system where the quality, or availability, of care is dependent on your wallet. Also my understanding is that administration costs way more in the U.S than in Canada's socailized system.
10
@Harold Not only that, but outcomes, like life expectancy in Canada are actually a lot better than in the US. Costs are significantly lower and, frankly, I’d suggest access to emergency procedures here is also significantly simpler. I have no idea where the author gets his data and I also wonder about his funding.
11
This accurately portrays the true consequences of ‘Medicare for all’. We in Canada have it and incur its’ costs. We enjoy worse access to non-emergency healthcare then do you, we have a higher shortage of providers then do you, and we wait far longer for non-emergency tests & procedures then do you. These ‘costs’ are real as are the benefits-universal coverage and less spending on healthcare per-capita.
2
Dr. Atlas's op-ed deserves what seems like an unprecedented torrent of negative comments. I concur with other readers in recognizing that his opinions are based on ideology and not supported by evidence. That's not the way physicians are trained to diagnose and prescribe. To earn the trust and respect of others, and maintain our own self-respect, we should only offer professional opinions that are evidence-based. For the Times to provide a forum for Atlas's ill-informed opinion raises questions of journalistic responsibility that I hope the editors will take to heart.
9
I don't think I seen so many untruths (politely) in the first part of an article for some time. I think Dr Atlas has the weight of vested interests to bear.
8
The NYT has the same goal as the Democratic dictatorship, destroy at all cost the only presidential candidate who is not controlled by the super wealthy Democratic donors and their caretakers in both parties leadership.
Day in, day out they have their right wing journalists write negative articles about Bernie Sanders, about the horrors of Healthcare for all and or medicare, about false claiming that most democratic house and senate members are against it.
It doesn’t stop, it is a relentless attack on the majority of voters who do support healthcare for all, free education for lower income people, a form of rent control and cheaper medications and not to forget break up the big banks and Wall street and that is where they the main problems is, newspapers depend on both and don’t want anything to endanger that.
It feels as if we are already living in a Russia style autocracy, where the media is already controlled by the corporate ownership of both parties. There is no more hiding, it is out in the open. Corporate America controls and runs the country by means of course he help of Roberts Supreme Court.
A look at the Stockmarket today proves that even more.
The outcome for 2020 is already determined as voting for Trump or for Biden will have an equal outcome for the corporate power in the country.
Liberal and progressive democrats are now crossing over to the dark side showing their cowardice for all to see.
Even they hunger for GREED and power.
Democracy is dead again.
3
I’m taken aback that a profiteer of the current healthcare system is clutching his cherry desk and declaring all public health scientists that study this are wrong, it’s doomed, everyone involved will die etc.etc.
I am not an expert. I have read experts.
Experts don’t declare that cancer is worse treated in Canada and the UK when there are abundant studies comparing everything about US and Canada/UK experiences and they all find we pay more (double) in the US for lousier outcomes.
The NYTimes does a public disservice allowing misinformation like this to be promulgated by a self declared authority.
7
He is from Hoover Institute and you expect a reasonable scholarly review? Lets face it folks these guys are the anti anything but corporate capitalism, anti climate changing, anti taxes, anti regulations and anti almost anything not Repub doctrine.
Its the oxymoron that they call them a "think tank", kind of like FOX saying they are a "news" station.
Also, his math is way wrong. What have private insurance given us? Lots of paper work, lots of fine print.,lots of surprise bills,3X the costs of care that most countries have and they have given themselves millions in profits.
7
This is frightening and laughable. Atlas is just a shill for insurance industry propaganda/GOP fear mongering designed to keep people's hands off their profits. Profits made by commodifying healthcare which promotes and achieves "health" - a basic international human right. I live in Canada Mr. Atlas. I have 4 children, 2 of whom have had multiple cardiac and neurological life saving surgeries, worth millions, delivered by the finest this planet has to offer at world class hospitals. Their care is ongoing. No wait times, no premiums, no limits in choice, no deductibles, no "co-pays", no one talking to me about or asking me for money, EVER, while I was dealing with the anguish of trauma and disease in my kids. Same for my father's quintuple by-pass, my mother's knee surgery, mental health support, not to mention my lumpectomy, my hernia surgery, my c-sections and the rest of it. And that sweet relief is what I happily pay my taxes for. And I WANT to live in a society where I know the poorest among us get the same care. If I lived in the US I would be bankrupt. Not to mention your millions of uninsured who will surely make dealing with COVID19 far more dangerous for everyone, with no doctors to see, no ability to pay a medical "bill" and too poor to stay home. Then there are your border ghettos my god. So pontificate about your own backyard if you must, but don't you dare throw your agitprop around about Canada, under the guise of concern for seniors.
11
Here's a thought experiment:
If you choose to stay on your private insurance, you must stay on that insurance for 10 years ... before you're permitted to switch to Medicare for All.
Any takers?
5
@JPG
Yes
Stanford has gone the way of the University of Chicago in Economics ... it exists purely to serve the purposes and delusions of the billionaire class status quo. It has invaded and taken over my neighboring little town of Palo Alto which used to be a quiet friendly mostly working class town, but is now a vicious outpost of class warfare where the local online paper has turned into a censored totalitarian rag that exists only to prop up real estate prices and defend the market system at all costs. So much so that that it's Town Square section must be censored and purged by right-wing ideologues. ALMOST anything that comes out of the Hoover Institution is totalitarian right-wing propaganda.
4
I have lived in three countries with access to universal health care from my employment. I think the writer of this article is not only misinformed, but did not disclose a connection to the private health insurance industry. When the FDA allows a new drug onto the market, it is rife with problems from side effects, including death. Maybe it's better to wait for safety trials to be complete. How many people in this country die because they cannot afford or do not have access to the US health care system. Diagnostic and lab tests are higher than the actual costs because of how they have to bill insurance companies. In 2017 alone, United Healthcare (my carrier at the time) brought home to its shareholders over $200 BILLION with a "B" dollars (https://www.modernhealthcare.com/article/20180116/NEWS/180119932/unitedhealth-revenue-cracks-200-billion-mark) This is criminal in my view -- walking on the bones of humanity for all those people whose treatments were refused by UHC. While Mr. Atlas promotes Mr. Trump's health care plan, I have read it and found it to be shameful, deceitful and disreputable. My favorite quote from Buckminster Fuller is: "Don't waste your energy trying to change an existing system, build a new system that makes the existing one obsolete." An example is the smart phones that changed the telecom industry. It was a better product. We need to build a system that doesn't include insurance, pharmaceutical and other profiteers. Shame on you Mr. Atlas!
5
My goodness, where to begin. I have worked in the Canadian Health Care system for 25 years and I have received excellent healthcare for many years. It is a fact that single payer is the best way to cover many people. period. The biggest threat to our single payer system is the greed of the private Health Care. It really is about a different way of thinking, not just about yourself but about your neighbour etc. We have an excellent system with some waiting lists to be sure but I look South and can't believe my American friends can't have the same. Or course you can, your private system is twice the cost. Most of the article is rubbish.
9
Many Sanders supporters hear "Medicare for All" and what they hear is "Medicare for free.....for me."
@Travelers Or how about "My taxes providing health care for myself and my neighbors, rather than the military industrial complex."
1
@Marie We know a lot of Sanders supporters. They want to "do their own thing" and have somebody else pay for it.
If you are a Sanders supporter, then here is a proposal for you: Every Sanders supporter agrees to purchase health insurance for one other person in the country. Not a single person then would go without insurance, and the people who want to "do their own thing" would be subsidized by those who want to.
Sanders' proposal will actually cost people who work hard for a living in higher taxes, and they will get nothing from that. Like this article says, they will be hit hard.
p.s. "military industrial complex" is so 1960s. Please come up with something new.
This is a re-run of propaganda (there's no other term) used against public health systems for the past 25 years. It's entirely false, esp. the claim that "treatments" are on a quota system -- in all other countries of the world that have a public system -- and masses of people die waiting.
We're so rich, of course that the poor can huddle in the courtyards of our private hospitals and catch some of the glow of treatment going on inside. Corona virus? That'll be $ 1500 for a test. This article is scandalous.
4
The US healthcare system consistently ranks as the most expensive in the world and it consistently turns in the worst performance among developed nations - behind UK, France, Germany, Canada, Norway, etc, etc. We pay about double everybody else for an inferior product. Wow, I would really hate to lose private insurance that achieves that kind of result. The biggest danger of Medicare for All is to the insurance companies and their toadies.
5
I know functioning medical care for citizens (like that in Canada) is fantasy if one works at the Hoover Institution.
Didn't Milton Friedman have an office there after he retired from teaching "economics" at the University of Chicago?
3
I’m so tired of this. When Democrats loose big in November precisely because they fail to embrace things like Medicare for all and free college and trade school maybe the NYT crowd will finally get it. If you’re a blue collar person, why vote democrat? They don’t care about your health, your wages, or your kids. At least the republicans share your cultural values.
It's at this moment in time where it doesn't take much common sense to realize we'd be better off with some sort of national health insurance. It's a moment when even the most ignorant should realize that we're all in this together.
Where the author live, in a vacuum where news does not exist?
2
I can't afford healthcare, what access do I have?
2
Private insurance in the USA is you vs.the Actuary, along with marketers to set prices. The insurance company negotiates secret prices with hospitals. You still get out of network surprise bills from people you have no control over. If you don't have insurance, you pay an insane top line for services, and a trip to bankruptcy court is likely.
You cannot possibly shop for normal operations or procedures...they literally cannot quote you a price.
Drugs and hospitals advertise for profitable patients.
The way you get this insurance is be able to work a full time job as a threshold. Old people, children, the unemployed, all get fobbed off on the public to pay for. Private insurance gets off scot-free, and there is that third beach house for the CEO.
Oh, and insurers beat up on Doctors and medical providers as badly as the patients. Private health insurance is a parasite that feeds from two hosts.
Fair, right ?
3
This one sided article aggravates me no end. Mr. Atlas, you mention our high quality healthcare, innovative treatments and choice will go away if he push for M4A. But who gets these choices today?
According to KFF and the Commonwealthfund, more than 28 Million people do not have healthcare insurance and even those in private healthcare are underinsured, making them vulnerable.
https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
https://www.commonwealthfund.org/press-release/2019/underinsured-rate-rose-2014-2018-greatest-growth-among-people-employer-health
So who is right?
Most every advanced country offers all its residents universal healthcare and some even allow them to purchase private insurance on top of that. Why don't you propose that model? why should some of us be left out in the cold while those that can afford all the latest in healthcare get it.
3
"Dr. Atlas is a senior fellow at Stanford Univeristy's Hoover Institute..." That's all we really had to read to know what the content of the article would be. He is on the wrong side of humanity and history.
3
When the medical bills for Covid-19 care begin to hit, it's going to be a wake-up call for the population at large and a duck-and-cover call for the predators and their tut-tutting spokespeople.
Tyson's Law states: "everybody has a plan until they get punched in the mouth." Get back to us in a couple months.
2
Surprise! Our current medical insurance companies "hold down costs by limiting the availability of doctors and treatments" too.
Stopped reading at second sentence because of nonsense.
2
It must be easy to view for profit insurance companies in such a positive light from the ivory towers of Palo Alto.
It's not so easy when you expand from the narrow focus of this article to include many other truths inherent to the corrupt for profit healthcare industry.
Truths conveniently left out of this article:
Billions of dollars are diverted from patients and caregivers alike to investors, CEOs, and administrators every year.
Profit motive corrupts healthcare delivery systems. As a clinical social worker (not an isolated academic), I have first hand experience with for profit hospitals' policies to violate EMTALA law with impunity and refuse patients funded by Medicaid and Medicare. I say we take that choice away from them.
The current system stifles economic freedom and growth by forcing individuals to go without insurance if they leave their W2 job to start a business or go to school.
Our healthcare outcomes aren't that great (unless maybe you're a tenured professor at Stanford). More mothers go without prenatal care and die in childbirth here than in Cuba. Also, the for profit healthcare industry created the opioid crisis. 50 to 80 thousand dead annualy for more than a decade. Great outcomes you say? What a joke. Not to mention the suicide epidemic or medical debt causing foreclosures and homelessness everywhere, because shareholders always come first when somebody is too sick to work and loses coverage.
Sure, great system.
5
This man appears to be living in a world I am not familiar with. Either that or he is utterly clueless and using ... facts? to try and scare us. None of this article has the sound of truth in it.
2
What is Dr. Atlas a doctor of anyway, how to spin the truth in favor of insurance company corporate liars? I’m sure he’s bought and paid for by not only the insurance companies, but big pharma, billionaire hospital owners, millionaire doctors, and the rest of the medical/industrial complex that wants to keep our money flowing in their direction, and keep Americans unhealthy. What a shill!
1
Studies show the opposite of this opinion piece. Bidens plan is more expensive than Sanders.
Let me say it again. Bidens plan is more expensive.
See: The Lancet, Annals of Internal Medicine, PLOS Medicine, Federal Reserve survey and Journal of General Internal Medicine.
For real world examples see other nations prices compared to ours.
Between red scare and now this disingenuous piece it’s obvious the times is set on destroying progressives.
2
Serious fellow at the Hoover Institute. Don't have to read further than that.
1
Hoover Institute’s GOP advocacy makes perfect sense....
1
Diversity of Opinion? fine. Outright lying and obvious misinformation? Not fine.
Dr. Atlas perpetrates the outrageous disinformation that Medicare for All is the current Medicare extended to everyone. That is a Lie. Medicare for All recipients to not need auxiliary insurance because Everything is covered under Medicare for All. They are very different.
It is difficult to avoid excoriating the Times for publishing this grossly dishonest misinformation. Stanford's Hoover Institution is a faux academic Koch machine product. Discredited Libertarian "theory" that should be brought back into the open and publicly flayed by simple fact and truth.
5
I urge you to read
https://www.citizen.org/news/the-case-for-medicare-for-all/
Public Citizen has been around for ages, they stand up for "We the People". They fight corporations taking advantage of consumers.
Tell me more about this terrible Medicare for All!
1
See today's other NYT opinion piece, "With CoronaVirus, "Healthcare for Some", is a National Disaster".
1
Scott W Atlas of the Hoover Institute believes that the US has the best health care system in the world for care and access, which is a funny thing to say when 67 million people have no insurance and another 130 million are under-insured. He might want to read the piece in the Times today by the woman who had to make three ER appointments to get tested for Coronavirus. The Times should put a side-effects warning next to industry propaganda pieces like this.
2
What viewpoint would you expect from a fellow at the Hoover Institution, which leans conservative...?
1
If this ain't right wing propaganda, there ain't no such thing.
"Hoover Institution, " indeed. Mr. Atlas - who pays your salary? The same people who own Fox news? Or is it Vladimir Putin?
And all those countries that have health care that covers everyone and cost half per capita what America pays - that is nothing but liberal lies?
2
Shame on the Times for publishing this fraudulent propaganda. Readers of the print edition will not see the reader responses here and may come away believing this right-wing drivel. I lived in Canada for more than 40 years and still have family and friends covered by the Canadian system. Every word of this column is fraudulent. Again, shame on the Times.
5
Why is the Times helping spreading lies by a member of a right wing think thank hidden in plain sight at Stanford?
Who donates and sponsors the Hoover Institute?
Why is that not revealed?
Jim Bennet we expect more from N editor.
5
mr. atlas, who bought you?
1
The Hoover Institute is a conservative think tank in part funded by the Koch Brothers. Anything from the conservative think tanks ie the American Enterprise Institute, CATO and so forth will reflect the party line.
Conservatives want to loot the health care system. Look at what they do for allegedly "non profit hospital chains".
The are part of the "Medical Industrial Complex". Their goal is profit extraction not the health of Americans.
Look what happens when they get their snouts in the trough. Oink Oink Oink
Vietnam Vet
Vietnam Vet
2
Oooohh, noooooo! Medicare for all would bankr-, uh, throw senior citizens to the wolv-, uh, increase wit times becau-, uh, be a very bad thing by disencentivizing doctors, and nurses, and pharmacists (not to even mention hospitals, nursing home, and the pharma near monopoly) into a tizzy at the thought of losing money. Oh, dear, oh, dear.....
1
I wonder why would the NY Times allow someone to write an opinion piece which is full of misinformation and lies.
What purpose does it serve other than to distort the truth?
1
Did you know, sir, that Canadians can read every word of this, and know instantly that you are either mistaken or dishonest? What provokes an insane comment like this, "It is pure fantasy to believe that the access and quality Americans enjoy today would be maintained if private insurance — used by more than 217 million Americans — were abolished and everyone used Medicare for All." Did you none of us in the civilized world would notice?
4
I'm Canadian. this article is utter nonsense.
4
"Dr. Atlas" is a shill for the present system. Nuff said.
Where does one start? I'm stunned the Times would publish this given how many factual errors it contains. Unbelievable.
2
lol
Specious nonsense. This article sounds like it was written by an HMO.
2
Wow! I’m really astonished that the NYT would even publish this drivel.
2
Honestly, this piece is enough to give blivets a bad name. It really is a 40 pound load in a 2 pound bag.
Oh, quit your Hoovering!
The world is full of theories and proposals. But sometimes, you have to shut that all out and just look at results. The Republicans controlled Congress and the White House from 2017 - 2019. They still control the White House and Senate. They haven't passed a single bill or executive order that improves the health care system or makes it more affordable. More people are un-insured than in 2016. Medical costs are higher. Now we have a health emergency, and the response so far has been a nightmare. But by all means, keep suing to overturn the ACA. I don't know that Medicare for All is the only right answer. But I expect progress instead of regress.
2
If your house catches fire, you will get professional help to put it out, at no cost to you beyond the taxes you are already paying.
Ditto if you need the police.
Ditto if you send your children to public school.
Ditto if our country is attacked and needs defending.
But somehow healthcare for all is "socialist" and impossible to accomplish (even when many nations around us have done so)?
Utter nonsense.
222
@John
Medicare for all can be well and easily defended with facts.
Establishment media is just that, media to echo the Establishment's values and biases.
If media had been factually presenting medicare for all. more citizens would be supporting it, than the 70 percent of Americans that support medicare for all, now. https://thehill.com/hilltv/what-americas-thinking/412545-70-percent-of-americans-support-medicare-for-all-health-care
Polling for medicare for all, like all polling, reflects how the question is asked.
below from the respected Lancet study.
" Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations."
https://www.sciencedirect.com/science/article/pii/S0140673619330193
The Establishment and its media, the NYT included, have been working ferociously to kill the possibility of medicare for all, as well as the possibility of a Sanders presidency.
We will persist!
President Sanders 2020!
Medicare for All!
A Future To Believe In!
No to clueless Joe Biden and the status quo.
10
@John Most Contrary to what Bernie and his followers seem to claim, most first world nations, e.g. the Netherlands, Germany, France, Switzerland, Belgium, Spain, Japan and so forth do not have a "medicare for all." In twenty five European countries, universal healthcare entails a government-regulated network of private insurance companies. These countries have compulsory insurance which covers around 95% of its citizens; the other 5% (the indigent, poor and illegal aliens) get their healthcare paid through a government subsidized pool. Their insurance policies are about 25% of the cost of insurance in the US and that's not even counting the additional high deductibles in the US. Doctors in these countries own their own practices hence are not civil servants. Yes there can be long wait times for elective surgeries, sometimes 6 months for a knee replacement. A palatable downside that few complain about.
Ask many a Brit about how much they love their National Health System. They claim to love it only when they compare themselves with Americans. However when they compare the NHS with the many EU systems, they hate it unless they have a supplemental insurance for private care. And ask a British doctor if he/she is happy being a civil servant.
Let's improve the Affordable Care Act passed during the Obama/Biden Administration and get a majority in both Houses and dump Trump.
My vote goes to the pragmatist who played a significant role in getting the ACA passed.
9
@John
The Right third of the country have decided that logic, math, science, and facts are mythical beasts from a land called Reason, They don't believe in Reason.
From the Declaration of Independence, to the creation of the Union, to the end of slavery, to making everyone born here or naturalized an equal citizen under the law, to giving black men the vote, to giving women the women vote, etc. super-majorities have ratified the principle that it is self evident that political equality is a necessary part of Constitutional democracy.
The Right thinks they should be able to beat up those they disagree with. They cheer their president who points at someone and says "someone should beat that guy up."
Equal people don't beat reach other up for political reasons. That's called terrorism.
The Right opposes political equality for all people. Bullies oppose Reason.
Those that reject reason cannot be "reasonable people with whom we happen to disagree." They don't care about your opinions, and pocket your concessions without giving anything in return. They reject the framework for compromise, and just manipulate the system in every way they can imagine.
Their president mocks, contradicts, threatens to violate, and violates the Constitution on TV so the Right cheers.
Meanwhile the Democratic Centrists call the Left extreme for wanting to give all Americans healthcare and college, and always want to compromise with those attacking the Constitution, instead of the Left.
4
There's no need to publish apologists for the healthcare industry in a respected newspaper. This account is absurd on its face. I suppose Mr. Atlas has never had his private insurance refuse to pay for surgery, or forced him to take a different medication than his doctor prescribed because it's cheaper for them. (And no, I do not mean generic versions of the same medicine, I mean different medicine with a different chemical structure.)
I have. I do not love my private insurance, and do not have the wherewithal of choosing another. But I guess Mr. Atlas is fortunate enough to have good insurance, and blind to those who aren't.
The Danger of the Status Quo is millions of people being inadequately treated and / or completely untreated for their illnesses. I'd say pointless human suffering and premature death due to our current profit-driven system is far more threatening than any of the potential issues Mr. Atlas lists here, none of which are unsolvable.
5
There is a lot of complaining here about health insurance companies, and how they deny claims and otherwise cheat patients in order to create enormous profits. Here’s an idea – why don’t those of you who are complaining start a health insurance company that doesn’t do all the things you’re complaining about? If your complaints are valid, you won’t need a public option, you could have a very successful private health insurance company.
@Dennis
Huh? That's the defense of insurance? "You try it."
Non-catastrophic health insurance creates a dysfunctional market for healthcare. The consumer is intermediated to death (literally) from the provider in ways that completely disrupt the market It is ridiculously complicated, devoid of transparency, full of bizarre incentives, and lacking the usual competition on service, price, and results.
It is broken.
Pointing out how hard it is to run an insurance operation misses the point.
@Sara C First, yes, my defense of health insurers aginst those who complain about the way health insurance companies are run is that they start their own health insurance companies and do it better. That's how the rest of our markets work and it can work here - if the criticisms are valid.
Second, I have no idea what your suggestion is for improving the market for healthcare. Are you advocating a public option or medicare for all? If you think the market for healthcare is dysfunctional now, wait until you completely erase the price axis from the demand side of supply and demand.
This article offers no data just false statements. Americans have the lowest life expectancies among advanced democracies along with the highest infant mortality rate while paying far more than anyone else. And it is a myth that the US is more diverse thus explaining the results. Canada is far more diverse offers longer lives and fewer dead babies.
Now maybe it is not the health care system per se. It could be that a very flawed democracy is dangerous to one's health. In which case, there could be a developmental sequence - the more democracy to national health care for all to better outcomes.
4
I would tend to believe some of the things this person is saying except if you read them all a pattern emerges which is in stark contrast with what I hear from my 90 year old parents and other family in Canada. They have no complaints. NO COMPLAINTS. There I said it. When you go to a doctor you show your medical card. No forms. Nothing. What?
2
Maybe if we could get everyone to acknowledge the fact that the medical system we have right now, costs aside, is not great. It is actually pretty awful.
You see if we could get past the propaganda of how wonderful it is and accept the fact of how awful it is the change will be much easier to get cooperation with.
2
Access and quality? As in the lowest numbers in the industrialized world? One can only hope the dismal current state will not survive Medicare for All.
1
Not sure what metric does Dr Atlas use to conclude that "single-payer systems have worse outcomes than the United States system". Check, for example, the web site: https://www.worldlifeexpectancy.com/cause-of-death/low-birth-weight/by-country/, select in the drop down menu the cause-of-death (low-birth-weight in this example) and you will see that the U.S. is consistently worse than those of, e.g., Canada and the U.K. and frequently worse that even third world countries.
5
I'm very suspicious that Dr Atlas is playing games here. I've never read that US outcomes are that much better than Europe, for example. And indeed, when I google 'age adjusted mortality rates US france" I see that the US is a little better than the EU average for cancer mortality (190 vs 203 deaths per 100K residents per year), although we do worse than developed country averages for circulatory system mortality.
While these number are age adjusted, there may be other factors that determine these differences beyond the quality of health care.
And the author is confusing way different systems. Single payer systems are not the same as heavily subsidized systems, which are not the same as the British system, where doctors are actually government employees.
And there is no reference for the claim that tens of thousands of people died because of wait time for non-emergency treatment. I'd sure like to see the details on that claim. And in this country, how many people died because they initially had treatable cancer, but couldn't afford to get treated until they could afford health insurance?
This is a terrible article, more propaganda than informative. Medicare for all may or may not be the right solution, but there are many paths to far more affordable health care than we have today.
10
Uh, the Hoover Institution - despite being at relatively open-minded across all stripes Stanford University - is, while nominally non-partisan, generally pretty conservative in at least publicly expressed views (IMO). I'm not intending to use that word "conservative" here in the context of "today's screeching partisan battles". But rather just to say that "laissez-faire" (i.e. leave things alone and let "the open markets happen naturally") was a big part of President Hoover's absolute - and in hindsight, cringeworthy - "capitalism sensibilities". And so at least some of that basic sensibility is arguably to be expected in public Hoover Institution writings. I know nothing of Mr. Atlas' personal politics, but would guess - as a non-conservative in any sense in much of anything - that most of the numbers cited here are "real and honest", rather than intentionally or overwhelmingly "anti-anything".
Regardless, I personally think the most reasonable "immediate" answer to start fixing (yes, fixing is what I meant to say) US healthcare is to establish (call it what you will, but essentially kinda like Pete Buttigieg and others have pushed) processes/incentives to begin offering a "public way" alongside the various "private ways" - and let them compete as equally as possible for awhile. In any case, forcing either of the "my way or the highway" extreme "right" or "left" absolutes is a forever losing battle IMO.
1
The access and quality of health care that many Americans enjoy today is also a fantasy of those who support the health insurance/medical industry; the access and quality that upper middle class and wealthy Americans enjoy and have access to, is more accurate. I refuse to believe that a country that is as wealthy as America and that has an enormous pool of intellectuals who can invent, design and sell some of the most advanced technologies and services in the world as well as create weapons of mass destruction cannot design a healthcare program that addresses the needs of all Americans. It's obvious that what we're up against is not the inability to create it but rather an industry that controls the messaging and our political systems at the detriment of a large portion of the economically disadvantaged in this great country, plain and simple...
6
I agree that access to quality healthcare today is already restricted to those with money and connections. Today, even if you have health insurance, often you cannot afford care and treatment. Note the high and increasing number of bankruptcies and collection activities due to medical bills, many of which are absurdly high just because medical establishment can get away with it. This article does not offer facts, it provides propaganda.
1
The economics presented here ignore the fact that the healthcare marketplace is dysfunctional thanks to private insurance of non-catastrophic healthcare.
So one cannot declare that if all rates went to a lower Medicaid payment scheme, doctors and hospitals would lose money.
The easiest way to see how it is a totally broken market is to conduct a thought experiment.
Imagine if groceries had to be purchased using your home insurance. The simple act of buying bananas would start with trying to determine if the store was "in network." Then, are the bananas generic or specialty? What is your banana co-pay? How many times have you purchased bananas this year? Is the price usual, customary, and reasonable? What discounts has the Fruit Benefit Manager negotiated for bananas? Does the banana grower have a rebate program? And are you eligible?
And so on.
Private insurance has broken the healthcare market. Getting rid of can't hurt.
11
The American consumer pays more than anyone else on the planet to get access to healthcare and medication but our life expectancy is lower than 34 nations that spend less including Canada and Britain. Our profit driven system isn’t producing the best medical outcomes despite what we’ve been told. We are simply being ripped off. Other developed nations have found various ways to provide universal coverage while controlling costs. It is doable.
6
Why is it one or the other - Why not both? Actually I don't believe people love their insurance. They like their doctor - but they don't like their insurance. And are actually doing it now. Seniors can opt for Medicare Advantage Plans - that's private insurance that competes in the same marketplace as Medicare. Seems to be working OK for some folks.
Buy no need to abolish private insurance. Just let Americans buy into Medicare as another choice. Get a new job with insurance benefits - you get to select the company offered program - or Medicare. Private insurance can sell Medicare Supplements. They can sell Cadillac options.
But I'm not sure over time who would want to go with the Private Insurance companies. Loose your job - if you had the company plan - Too Bad! New doctors - new expenses - new rules If you had Medicare - good for you and your family - no changes. Just keep on getting the care you are used to.
My Medicare plan is way better and less expensive that the lousy High Deductible Plan I was forced to buy by my old employer. I had no choice in that program.
But now on Medicare - I have the same doctor. My out of pocket expenses are lower. I get the same care. I have a supplement plan that I selected. I can travel anywhere - no networks.
So Lets let people choose. That's the American way right?
4
I don't get it. The ACA was set up similar to what is practice in Germany and Switzerland -
The government is responsible for
1. Enforcing a universal mandate with penalties if need be
2. Setting up the list of covered conditions
3. Setting up the premium structures (hint: employer pays a percentage, worker pays a percentage on a sliding scale based on wages)
The private insurance sector (not for profit or mutualized for profit sharing) administers the paperwork and handles the patients. In both cases, one of the administering companies takes care of the "public option".
Hospitals are not for profit.
It works - lived that way for decades in peace and comfort.
The ACA was set up to honor the private insurance sector (albeit with some changes) and I've always thought this public/private way of providing universal access to health care would be the closest to the US economic model.
Why won't anyone mention this approach? Is it because it might actually work well and some are interested in seeing it fail?
It's a fantasy that health care is like any other service in our economy and that the 'market' will deliver the best service at the least cost, and that all people have to do is 'shop around'. Try telling that to the patient who attempts to find out how much a test or procedure is beforehand or the patient that has to wait months to see a specialist in their network.
Every year people with insurance find their premiums, co-pays and deductibles going up and a point will come where a critical mass will say ENOUGH !
We must hope that it's only a matter of time before the U.S. moves to some version of a single-payer system where health care $$ can be spent on actually delivering care and remove the profit potential in charging more for less.
6
Maybe the problem with Healthcare as with so many other things in our lives is the need to profit. Is there not anything that transcends greed. If we put a price on everything, does anything have value?
6
The facts are that health outcomes in countries like Canada that have universal care are better overall than the U.S., as is life expectancy and satisfaction with their health systems. By trying to focus on some subsets of information, this article is designed to bias opinions against MforA and government systems. But Hoover Institute is basically a right-wing, minimal-government, "free market" think tank.
It is not really part of Stanford proper. I dealt with one of their staff Henry I. Miller for years on agriculture technology issues, and my experience is that his information and perspectives are very slanted. Some accurate info engulfed in inaccuracies or out of context information that did not provide a full or accurate picture. This is a favorite tactic of these "think tanks", i.e. using bits of scholarly sounding info to impress readers, while presenting biased info. Read their opinions, but always check against other sources. I would never accept what they say without more research.
4
I don't like Bernie's "Medicare for All" plan, but this article is full of misinformation. The first problem with Bernie's plan is that it would expand the public system to include coverage that no country in the world provides. The main problem is that it will never become law, and it gives the Republicans a lot of ammunition to help reelect Trump.
Bernie's public plan covers nearly 100% of all healthcare costs for everyone. Other countries with universal care pay about 80%+/- of all healthcare costs publicly, with the remainder paid by the patient and/or a supplemental insurance policy. Some commenters will write that that isn't true, but one has to only use the Google machine to see that it is. Canada's public system pays more like 70% or all healthcare costs, for instance. See https://international.commonwealthfund.org/countries/canada/
England:
https://international.commonwealthfund.org/countries/england/
France:
https://international.commonwealthfund.org/countries/france/
5
I'm not going to bother reading the article because the subtitle says it all. Obviously Scot W. Atlas can afford and has very good health insurance and believes that everyone else in America does too. Sorry, but that is just a ridiculous premise. A public option now with universal healthcare down the road is the needed solution. With the coronavirus now threatening the American population and bankruptcy as a foregone conclusion for millions if they need treatment, what might someone like Mr. Atlas offer these potential victims. "Tough luck, kid. You should have made more money"? Sorry, but not good enough.
7
Wow, the absurdity of the scare tactics first paragraph alone meant I could not get past it. It was so over the top as to be comical. C'mon, established health care industry, you gotta scare people away with tactics far more subtle than this one!
How many people die due to no access to health care, Doc?
Why do citizens of every other first-world industrialized nation with single-payer live longer with better health care outcomes than the US?
12
An outrageous article that offers no solutions for the millions upon millions of underinsured and uninsured Americans other than the same old tired bootstrap dogma. Nationalizing the healthcare industry is the only way to ensure that all Americans are able to receive access to care, and not only those that can afford the absurdly overinflated cost of medical care in the U.S.
6
This article is so misleading and not unexpected since the author is a senior fellow at a very conservative think tank. How about these statistics.....about 45,000 Americans die each year from either lack of health insurance.....a shameful statistic for a nation that spends 18% of its GDP on healthcare (almost double what most 1st world nations pay). What we have in the USA is "overcare"...where there is a huge incentive to treat because we have a profit driven healthcare industry.
6
With insurance may copay on insulin that Mexico was $300 last week. You are not scaring me.
1
...so says a millionaire doctor and ivory tower-dwelling senior fellow at ultra conservative Hoover Institution for whom healthcare frustration and catastrophic economic financial woes are things he has only read about or heard about from his maid and gardener.
Dr. Atlas, things are not going well for those of us in the real world where every trip to the mailbox produces held breath and crossed fingers.
8
What we really need is a catastrophic pandemic like COVID-19 to cull out the weak, the infirm, the poor, and the elderly like a forest fire clearing the way for healthy, new growth. That’s the only way we’re ever going to go about lowering the high cost of healthcare. Disgusting!
2
No rebuttal of the Lancet study? Just ignore it and pretend it doesn't exist. I agree with most of the comments here. This article is pretty weak sauce.
1
Shame on you NYT. With your motto being “the truth is worth it,” how could you publish a piece that is so untruthful. Everything from long wait times for life-threatening conditions in other single-payer countries to their worse outcomes can be proven false in minutes with searches of reputable sites like WHO. Further, declaring that private carriers of Medigap coverage would be eliminated without pointing out that they would no longer be required due to elimination of deductibles and copays is a blatant scare tactic. Really, don’t you feel some obligation to fact check, or is that only for opinions you disagree with?
7
I'm a Canadian senior and have never experienced any sort of restriction on treatment or access to doctors. Also, I have never heard anyone in Canada express the desire to implement the U.S. form of healthcare here. We know when we have gotten it right.
12
Mr. Atlas, what are you talking about?
I'm on Medicare and love it. Access and quality are top-notch, exactly the opposite of your argument.
Medicare for All is eminently do-able, if priorities were straight.
1. Medicare for all would bring economies of scale.
2. Keep private insurance for supplemental only.
3. Slash the military-industrial complex. Let weapons manufacturers re-tool for something productive. Build infrastructure and high-speed trains instead.
(The navy just ordered $22 billion in attack submarines. Attack submarines, really)?
4. Reverse the obscene tax cuts for the wealthy. Adopt steeply progressive rates in the high margins. Anyone with a few billion dollars can still be very, very rich.
5. Raise the FICA payroll salary cap to one million dollars at a minimum.
6. Buy out the shareholders of Anthem, United Health, etc. etc. at a fair price. Offer Medicare jobs to their rank-and-file.
There is PLENTY of money. It's only a matter of will.
7
One of the many problems with our system is that the wrong doctors receive the high pay. Surgeons while necessary are over paid unless they're salaried and working at a teaching or university hospital. The doctors on the front lines pediatrics, family docs, psychiatry, neurosurgeons are the ones either leaving the field and becoming sales reps for drug companies or medical device manufacturers. There was a recent article where internal medicine and psychiatrists were relocating to Canada because they can earn $90k more per year there. Then you have Venture Capital firms hiring off docs from hospitals and setting up shop in white collar neighborhoods thus taking the cream of the crop patients away from the hospitals. This leaves the hospitals with ever larger pools of welfare patients and smaller profits. I have kids, I've had to have broken arms fixed and I've waited 12 hours to have a doc set my kids arm... Quality of care? My friends father, recently retired from 30 years in the Marines, a marathon runner, went in to get a knee replacement, He died of an an infection. Another friend, mother retired professor from an Ivy League school in NY, again fit as a fiddle, regular tennis player. Doctor told her she needed some minor heart procedure, it was an out patient thing, she bled out in the recovery room. So, I question your idea of our exceptional healthcare system. Yes there are great doctors out there but it's a flip of a coin whether you get a good one or a bad one.
3
The many disingenuous half-truths and outright distortions in this article it qualifies as a work of fiction, not a credibly informed opinion.
The recently published Yale University study which extensively reviewed Sen. Sander's Medicare For All legislation, the PPACA and other national health care regimes debunk the author's underlying points; first continuing grossly overspending on Healthcare is essential for Americans and second, comprehensive national health care regimes in comparable nations providing near-universal access to citizens at much lower percentages of domestic GDP are inefficient and substandard.
The simple fact is despite gross overspending on health care for decades the U.S. ranks at best less than average to substandard at worse on just about every metric of national healthcare efficacy and access.
3
As soon as the whole coronavirus thing is over with, I recommend that the article's author travel a little and see how it actually works in other countries. He is under the misunderstanding that having a public option somehow forbids private insurance. That is not a thing that happens in real life.
3
He is saying Medicare for all could cost $32 trillion over 10 years. The Gross Domestic Product, GDP, of the United States is roughly $22 trillion per year, which means $220 trillion over that decade.
So, Medicare For All works out to about 14% of GDP.
But the main thing is that over time efficiencies will lower than even more, and technology and the increasing healthiness of Americans will lower it even more than that.
The coronavirus debacle we now have shows exactly why we are all in this together and that the only way forward to solve these kinds of risks is united as a people together.
A question conveniently omitted by Dr. Atlas: Where is the access and comprehensiveness for people with pre-existing conditions and for the people too poor to pay that high monthly premium?
THESE PEOPLE EXIST, but this doctor of classroom and think tank has the gall to promote:
Out of sight, out of mind.
Republicans have been pushing-back and blowing-up the insurance-based Obamacare that expanded healthcare. When Trump signed the Republican Congress' tax cut that removed the tax incentive to carry insurance, the insurance pools lost their young payers. Dr. Atlas was mute on that folly because:
Republican healthcare plan -- is to have no plan.
The insurance industry provides -- what it provides.
In a nutshell, Dr. Atlas appeals to people's fears in order to perpetuate a system that benefits the insurance industry. The trend that only those wage earners with corporate plans get affordable rates will continue. The numbers of those with junk plans will grow; and how long until corporations dilute the plans of the currently lucky-enough? The minute Obamacare is destroyed.
Dr. Atlas paints an illusion of a static state for current benefit plans. Corporations already favor a low average age workforce by discriminating against older workers through hiring and culling techniques. When freed of Obamacare requirements, corporate basic coverage will be reduced and workers will have to pay for now optional benefits.
Dr. Scott W. Atlas is one-sided because he is a shill.
2
What access and quality?
I pay $1,356/month for private health insurance through the ACA and waited 4 months to see a specialist. The specialists, when the appointment arrived, spent 10 minutes with me and told me I was fine and should go home. The entire experience cost me $400 in co-pays and gas to travel to see said specialist. Yet my symptoms persist.
The idea that our private health care system is a shining beacon of medical professionalism and speed is a fiction.
10
Dr. Atlas, Medicare for the young and mid-life will cost considerably less than medicare for the old, as the need and demand for heroic (and catastrophically expensive) treatments is statistically much lower among younger populations.
Your opinions are based on flawed inferences. (Ask me about current private insurance costs -- I make around $50K, insurance premiums for me and one child run almost a third of my annual salary, and out-of-pocket deductibles brought healthcare costs past half of my income this year -- and it's only March!)
1
The Times' 1619 Project has a whole article showing how lacking health insurance kills Americans. I'm sensitive to the needs and anxieties of seniors. But we'll almost never hear from those who died because of our broken system.
Access, quality, and choice are great values. But medical debt causes two-thirds of bankruptcies in the US. While we get access to the latest drugs and treatments, they come at an astronomical cost to the consumer.
Plus, would we need all these hi-tech drugs/treatments if we had decent preventative care through universal health insurance?
Assume that cancer survival rates in single-payer systems is worse than in ours. I'd want to know the incidence of cancer in those populations. Cancer survival rate is one thing. But what if single payer can help reduce the number of people who even *get* cancer to begin with?
Surviving cancer is one thing. But preventing it? Now you're thinking with portals. As it is, Americans get sick, go bankrupt, and only get health insurance (Medicaid) when they've been drained of everything they have.
Finally, in a country that vaunts entrepreneurship and "job creators", we basically ensure that the workforce is chained to a job via health insurance. We all know someone who stays at a job because they need the health insurance. These are people who could be entrepreneurs and job creators. But alas, they can't afford health insurance!
It's un-American!
1
A narrow perspective. Germany has a universal multi-payer health care system that's paid for by a combination of statutory health insurance and private health insurance. Canada and Britain aren't the only models, although, as a Canadian who's received excellent health care throughout my entire life, it's a solid model. In point of fact every western country in the entire world provides health care, yet the United States isn't rich enough? It's rich enough if the military-industrial complex's budget is employed to help those who actually live in the country, as opposed to helping millionaires become billionaires and billionaires to become trillionaires.
5
The fantasy is to believe health insurance equals access to healthcare. The only access in my relationship with my insurance is their access to my wallet. I can't afford the deductibles, co-pays and co-insurance, so they collect money and I get nothing in return. And if it gets so bad I just have to risk complete financial ruin to address a health issue, there's always someone sitting in an office or cubicle somewhere waiting to tell my doctor the treatment they prescribe is unnecessary and likely not going to be covered.
2
It's sheer fantasy to believe that every American alive today enjoys a quick, efficient and effective health care system.
To claim we can't provide the same level of effective, efficient health care without a material degradation of services or effectiveness is ideological propaganda based on ideologically driven wishful speculation, not reality.
There is decades of real world data and experience readily available from other modern Western countries that clearly shows universal, quality healthcare provided to all doesn't result in overtaxation, reduction in availability or effectiveness of services, or increased costs
5
Citations please. In countries with socialized medicine, people are healthier, happier with their care, and receive more care—almost without exception. Bernie Sanders's plan would save money over time and result in tens of thousands of fewer deaths and bankruptcies every year. And of course, cost far less for the average American.
It must be getting harder to convince Americans that socialized medicine is scary now that they have so much access to information and have seen firsthand that Europeans don't hate their healthcare. In fact, they recoil when they hear about our system.
The author should be ashamed of writing this article, because they are either either woefully uninformed or being willfully deceptive. Neither reflects well.
8
Mr Atlas, what fantasy version of US healthcare are you living in? You do realize that millions of Americans do not have access, choice and quality of healthcare now? They delay care until their symptoms are serious enough for them to go to the emergency room. There they rack up costs which are passed onto the rest of us in the most expensive and inefficient way possible. The piper has to be paid somehow and refusing to expand access to health care does not mean that we save money. The NHS in the UK controls cost of care by evaluating treatments based on evidence based studies by NICE, the government run National Institute for Health and Care Excellence. Costs in the US are heavily influenced by pharmaceutical companies, hospital chains and insurance companies, all driven by profit. The USA pays more for worse healthcare outcomes than every other developed country. And "larger, liberalized health savings accounts" are a fantasy for people living paycheck to paycheck.
5
Gee, do you suppose we could cut a percentage of our defense spending to help fund this proposal that somehow every other major country in the world views as a basic right?
Or should we just put it on the credit card, like we do for all other vital government activities?
5
It appears there is a typo in the first sentence, which reads, "It is pure fantasy to believe that the access and quality Americans enjoy today would hold if private insurance were abolished."
I believe it should read, "It is pure fantasy to believe that the access and quality SOME Americans enjoy today would hold if private insurance were abolished."
Mr. Atlas, I suggest walking in the shoes of the millions Americans who don't have access to quality health care.
Yes, all of he points you make are good reasons our health care system is broke. Trying to tweak it won't get us where we need to go. It is going to mean some radical changes for many profiting off of the system.
Tell me how every other industrial country provides single payer health care at lower costs and many with much better outcomes than the United States?
6
"Nationwide, 3,148 private insurance plans now participate in Medicare Advantage, an increase of 15 percent over 2019 and the largest number of plans in the history of the program."
The author thereby parrots the fiction of the health insurance industry that an increase in the number of duplicative, administratively onerous private insurance plans is a good thing. This plays on the American consumer's desire for choice. In fact we want choice in our doctor, not choice of endless insurance plans. The bait-and-switch here is that the increasing array of private insurance plans stay profitable by restricting choice of doctor through ever-narrowing provider networks.
5
So true! These plans restrict to inferior doctors and hospitals who accept lower fees. The government also pays more to these plans than it does for the average Medicare patient. The plans provide extras like glasses or hearing aid but can still make enormous profits because they pay less to the providers who often are inferior!
We were traveling in the US and I and then my wife came down with the same respiratory ailment. I was treated in the US, total cost including meds ( all prices USD approx) US:~$400; my wife in Canada ~$75.
We were actually just outside of East Glacier Montana when my wife fell ill; the motel manager said Cardston Canada was the nearest. In fact her US health insurance was happy to for her and her kids to go to Canada since it was cheaper!
Another data point: I was in Norway for a similar level of care, cost ~$20. I saw a general practitioner in Norway, they only took cash (which I did not have on me); they were happy to treat me and wait till I went to a nearby ATM to get some Norwegian currency.
2
We already restrict availability of care by ability to pay or having insurance.
There will always be rationing in any health system, but the Canadian system decides access based upon severity of illness, not how much cash is in your wallet or how good your insurance is.
This is the typical conservative view, that the lives of those with more money are worth more than those with less.
7
What a LOAD! Nations all over the world have both single-payer systems and health care systems that deliver outcomes significantly superior to ours in every objective measure by which the quality of health care can be assessed. Pick your measure: life expectancy, infant mortality, person-days lost to work, whatever -- DOZENS of single-payer countries lead the U.S. in ALL of them at SUBSTANTIALLY lower cost when measured as percentage of GDP.
And many of those nations enjoy the same level of medical advancement, discovery and innovation as we do.
Private health insurance has never cured a disease, healed a wound, set a broken bone, delivered a baby, or eased anyone's pain. All that they do is place roadblocks when seeking care, greatly complicate paying for that care, and take a HUGE cut right off the top of every dollar we spend on health care, without adding anything whatsoever of value to our health care.
But, in their defense, I suppose they do employ a lot of clerks trained to deny valid claims and armies of lobbyists to write articles like this.
4
Agreed, Mogens. In Australia, where I live, we pay a fraction of what Americans pay, who can afford good care, and we are all covered under one of the best systems in the world. Our life expectancy is longer than Americans, life-threatening illnesses are fully covered by the national system, and you can opt to pay for extras with private insurance, if you so wish. There are also no wait times for serious illness only for elective surgeries (like cosmetic surgery) and even there, you can usually have the surgery quickly. Like Denmark, lack of dental care in the public system is the major weakness. No one goes bankrupt because of illness here either. Australia's system is ranked one of the best in the world on many metrics.
4
@Professor Your response is interesting. So, why is it that you pay only a fraction of what we Americans pay? I'm not asking sarcastically. I just am curious how you can have great health care at a reasonable price, when we seem to be unable to do so.
1
@Mark M
Because Mark M; the Aussies and we Canucks, along with other advanced western nations pay our taxes for not for profit health care rather than for profit health insurance. Nationalize your system and prioritize severity rather than individual financial resources.
In concept, I would totally support single-payer healthcare for all, but I don't think it's viable in the United States. In Cuba and former communist China, healthcare is (was) free to all and low-cost, but it comes with strict rules and regulations, many times at the cost of personal freedom. There are mandatory checkups, treatments, and military-style exercises; disease prevention is strictly enforced to keep the cost low. Americans are a people who love freedom and wouldn't tolerate any limitation to their free choice, including perceived "free choices." Given that many chronic conditions such as obesity, cardiovascular and lung diseases are consequences of certain lifestyles, which are mostly people's "free choice," it would be impossible to have an efficient system here, and "MediCare for all" will go bankrupt in no time.
2
@Phat Katt Why are you only looking at China and Cuba?? How about the dozens of European nations as well as Canada and Australia?? Plus, not all illnesses and injuries are do to "certain lifestyles". Just sayin...
@Phat Katt
Impossible in America, but running for decades in every other developed country. Is that your claim?
Oh, and they pay half as much, get better outcomes and cover everyone, cradle to grave, no questions asked.
1
The biggest danger of Medicare For All is NOT HAVING IT.
2
Any discussion of single-payer schemes needs to include using gatekeepers; strong gatekeepers.
In another piece, the writer talks about going to multiple facilities only to be told, repeatedly, that she did not have coronavirus. How many people have done similar? That is misuse of the system and needs to be stopped.
The gatekeepers would have to somehow manage the disparate ways people get information about access to healthcare and what they are eligible for.
Like it or not, you won't get to see a specialist unless the GP refers you and the gatekeepers will be watching the physician referral rate also. You will likely have to have permission to go to the ER, unless you're a bloody mess or not breathing.
This will definitely change the way people access healthcare. Many will be furious they couldn't go to the hospital ER repeatedly only to discover they are NOT the high-priority patient they consider themselves to be.
3
Rushing to a specialist is not always a good idea as they are likely to see things from the viewpoint of their own particular area of expertise, whereas a broader view may provide a more accurate diagnosis. Overuse of specialists is expensive and is no guarantee of better outcomes. Personally, I have had the best results with nurse practitioners, probably because they usually take more time to listen to symptoms, lifestyle choices, etc. so they can get a full picture of what is going on. Obviously, sometimes one needs a specialist, but I suspect that in the U.S. many people overuse specialists.
Everyone wondering what a single payer health system costs should go to any of the income tax calculators available for Canada. You enter your income and a theoretical province of residence (health system is paid for by the provincial taxes) and look at what you would pay.
You will see a couple of interesting things: everyone pays, even those who don't earn much, and those who earn a lot pay much more than what they would pay in this country for income taxes + health insurance.
2
@Kurfco
Show me the data. If earn $50,000 or less in Canada you pay no health insurance and your taxes do not exceed 15%. If you earn 1 million dollar your taxes will approach 40-43% but still in most provinces you do not pay health insurance. The administrative cost of health and medical care are less in Canada than USA.
2
@Kurfco
The US government (meaning the taxpayer) spends $4,460 per head per year on healthcare, despite only covering one third of Americans (those on Medicare, Medicaid and the various military set-ups).
This is more than the governments of Canada, Australia, Germany, the UK, NZ, France, Spain, Italy, Japan, etc, etc, etc spend per head per year to cover ALL their citizens. And unlike Americans, people there don’t then spend as much again to get private health insurance.
Whatever the reason for higher taxes in the rest of the developed world it's nothing to do with paying for universal healthcare -- which is a massive money-saver.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg
1
I get it you don't care about anyone under 65 and their lack of healthcare?? when are we going to take care of infants,children and young adults? if they are not healthy who is going to work to support the 65 an older crowd?Hello!
4
Here are some benefits of Medicare for All, for the middle class. You can work for any employer, with or without a union, and change jobs whenever you want to or need to. When you lose your job you keep your health insurance. You can retire early. You can start your own business. You can stay home to care for your babies and raise you own children or care for elderly parents. You can go back to college in mid-life to change occupations and increase your income. You don't ever have to worry about going bankrupt if the worst happens. When you get sick, all you have to worry about is getting well.
9
What’s scary?
1. Experts (not Trump) keep reinforcing that ours, here in the USA, is the world’s best healthcare system. Yet, so many of us are ready to let these bozos ruin it;
2. That so few of us, a tiny minority of NYT readers for sure, have no reservations about placing healthcare in full control of the government. This says that far too many Americans prefer a nanny state to a free one. Have our civics classes and college curriculum drifted so far toward socialism?
No, Sweden is not a reference point. Nor Cuba, now in fashion on the left. Of course, we can always do better, and should never stop trying. But that we attack the core principles that has made our nation strong and better over time is the most threatening element of today’s political discourse.
1
@Alberto Abrizzi We're just talking about insurance, not the end of civilization as we know it.
2
As soon as I saw the title of the article, I rushed over here: I was sure to find these huge "trumpian" lies that make us laugh less in France than too often cry about the end of the great old America.
In France, as in many countries in Europe, medical care is not a problem of money. In France where I live, the health system is universal: each payslip mentions a share for the compulsory social insurance collected by a state body whose operating costs are +- 3% of the contributions.
The cost of health care in the United States is hard for us to imagine. And even more difficult to understand how the citizens of a democratic country do not vote against the people who perpetuate this scandalous (and deadly) racket.
Translated with www.DeepL.com/Translator (free version)
4
Oh boy, another MD and academic who has medical benefits and friends in high places.
I work in this system and the money makers- (MD specialists, medical school systems, Congress, insurance CEOs, Big Pharm, Device manufacturers, lobbyists, Wall Street, etc) are terrified of losing their salaries and bonuses if Medicare is expanded.
Who isn’t afraid of Medicare For All?The rest of us-Pediatricians, Family Practice, nurses, nurses aides, RTs, techs, clerks, EMTs and Paramedics, public health staff, and every American making under $290,000 a year without employee paid benefits.
The system is BROKEN.
Solution? Quit asking for solutions from the ones making money off the current system. Ask the VOTERS.
11
This opinion, coming straight from Trump’s playbook, seeks to scare seniors into selling out the rest of the population which so desperately needs universal healthcare. It starts with usual lies about how awful healthcare is in Canada and Europe. But outside Trump’s fact-free world, the data doesn’t lie. Health outcomes and life expectancy are worse in the US. We need to catch up with the rest of the civilized world.
7
A simple question: why medicare for all works in all western civilized democracies, and why not for USA. The go-on question: if it does not work in USA, is it a civilized western democracy? That is a question arising more and more often in discussion at international meetings. In particular, the GOP policy is totally unethical; how these people can call themselves Christians - their policy is as far from Bible teaching of equality as possible.
8
According to the author's own numbers, the country as a whole would save 30% to 40% on medicare for all. If no savings were found, then cost of medical care would go down by $18 trillion over a decade. The government taxes may go up by $32 trillion, but the amount spent by everyone else would go down by $50 trillion using the author's own numbers.
Mentioning how much government spending would go up without once mentioning how much private citizens and employers would save makes this article oratory, and not an honest presentation of the facts.
10
In America, we have free firemen, free cops and free soldiers, but no free doctors. Why? Because that would be socialism. We're the only developed country on the planet that doesn't have some form of universal healthcare. From the 1950s to 1987, I enjoyed free healthcare in England, France, Belgium, Germany, Denmark, Italy, Greece and Jordan, without hearing the word money mentioned once. Then in 1987, when I moved to the US I heard about very little else but money. Which is ironic, given that universal healthcare was invented in the US in 1912 by Teddy Roosevelt and subsequently promoted in vain by FDR, Harry Truman, JFK, Richard Nixon, Hilary Clinton and Barack Obama, and where Medicare for Americans over 65 is the wonder of the world. In other words, universal healthcare is as American as apple pie, but you can’t have a bite of it until you collect your pension.
11
Well, no, they’re not free, we pay for them. It just happens that they are less expensive then health care. I agree that Everyone has to have free health care available but I have concerns about some of the things the author brings up. I was recently in severe back pain, was able to get an MRI the same day. Was diagnosed with an issue that required surgery and was scheduled within a month.
I realize that it may be a false narrative that I may have to wait months for the same treatment in many of the countries that have “free”medical care but these potential problems should be discussed. Personally I am in favor of ACA as long as everyone can get all of the health care,that they need, free, should their level of income call for that. I’ve researched “New York state,of health “ in New York, where that seems to be the case
1
Oh, wait, another right-winger Ayn Rand apologist for Darwinian social health policy. Like we haven't heard this one before.
I ask: where was this great free-market innovation in the days before Medicare and Medicaid? How'd the free market resolve all our healthcare woes and increase competition and drive down prices?
Let's just admit what most economists know: healthcare is not a commodity so let's stop treating it like it is.
7
Markets haven’t driven down prices because we haven’t applied free market principles to healthcare, not because it’s failed. Less government, more competition, more consumer information and choice.
Solving access is a different issue, which is only easier with strong market-based underpinnings.
1
@Alberto Abrizzi : Newslfash Mr. Abrizzi: health insurance only came into fashion as a employer-provided benefit in absence of regulations in WWII, which is de facto free-market. A simple Wikipedia read would've told you this.
If the market did not meet the need of medical care coverage back then, when it was a "free market" devoid of "evil gubermint", it would've figured out a way to provide the best market provided solution. it didn't and thus here we are. The free market is not a an omniscient god that fixes everything. It just rewards GREED.
Please stop parroting Laissez-faire/Ayn Rand passes-for-economics-for-sociopaths-"economic policy."
2
I don't enjoy any access or quality. When I had private insurance in 2007, I was unable to find a qualified surgeon on my panel (Oxford) and had to delay my surgery to change insurers, risking my life. I was paying more than $600 a month for a plan that didn't have health care when I needed it. The best plan I've ever been on has been Medicaid which paid for everything. Right now I'm uninsured and doing health sharing because Obamacare was too iffy with the rules about income, as my income fluctuates. Private insurance doesn't work. Of course, we would need other reforms. Healthcare is too expensive, because medical school is too expensive and because hospitals have too many administrators who are paid too much. Many people are overprescribed and few receive advice on healthy eating and lifestyles. Medicare for all won't be a panacea but it would solve my problems.
4
Almost every other modern industrialized nation has medical care for all, but somehow it's impossible in America. Nonsense. If they did it, so can we. Eliminate the for-profit model of current healthcare and insurance, and along with it a whole lot of middlemen who do nothing but push paper, and you would see costs drop. Also put some money into helping train doctors and other health professionals without forcing them into crushing debt. In other words, think big and take a whole system approach and we can solve this problem like other nations have.
We were first to go to the moon because we chose to do the difficult thing. If we can do that but can't even provide health care for all our people we should just pack it in and admit we're a failed state.
8
We all need to get real. Not being able to afford health care or insurance for healthcare is just as much a barrier -- more even -- than restricted access to certain procedures on national health insurance.
And those awesome ultra-necessary private insurance companies who are keeping Americans in the peak of health have been decreasing the numbers of conditions and treatments they will cover so.... they are doing the same thing you accuse single payer systems of doing, only more secretly and cynically. I imagine single payer will cover more of what works and private insurance has proven that it will cover only what costs them the least.
No-one is saying that people cannot go buy whatever they want on the open market; we're saying that with a single payer system available, more people will get more care and enjoy healthier lives. Isn't that the point?
7
I and my wife had been planning to go the US in May but have cancelled not because we will have greater exposure to Corona but because we cannot get insurance for medical treatment should we catch the virus; and that could saddle us with enormous medical bills.
By contrast, should we catch the virus in Australia, with its government funded health scheme, it will cost us nothing
5
And the reason the healthcare trust funds are being depleted? Healthy people are not enrolled in them. If more folks were eligible at an age when they are not afflicted with the illnesses of old age, the trust funds would also be healthier. Dr.Atlas contradicts himself. He cant have it both ways.
5
Dr. Atlas, did you really say cost would prevent it from working? Don't you know the current system costs about double what most wealthy European countries spend per person? Don't you know the US spends by far the largest portion of GDP on healthcare? Did you know that private Medicare plans (from private insurers) have tried and tried and never succeeded to provide the same care at even the same cost per person as traditional Medicare? (Medicare Advantage always costs more per covered life).
Did you say single-payer systems hold down costs by limiting the availability of doctors and treatments? It is the private insurers that limit the availability of doctors through their limited networks of participating providers. It's private insurers that limit treatments with complicated preauthorization and bureaucratic obstacles. With transitional Medicare you can see almost and doctor, go to any hospital, and get treatment as fast or faster than those with private insurance!
The multitude of complex private insurance plans is why every provider needs a huge staff dedicated to billing. If you reduced that wasteful overhead the cost of care would be less. The AMA made the same flawed arguments you put forth to fight the introduction of Medicare in the 1960s. Medicare turned out to be one of the biggest financial boosts to physician & hospital incomes in the history of medicine. and it still great for seniors. It's be even better for everyone.
8
Excellent point: "Beyond that, Medicare for All will radically change health care for today’s seniors because access to America’s hospitals and doctors for those on Medicare depends on higher payments from private insurance. According to a report by the Centers for Medicare and Medicaid Services, while private insurance often pays over 140 percent of the cost of care, Medicare and Medicaid pay an estimated 60 percent of what private insurance pays for inpatient services, and an estimated 60 to 80 percent for physician services. "
But if you change that to "Medical Care for All" and just start with two things: a single processor for claims and a single negotiator for drugs, it stands to reason that you will help the private plans by lowering their costs without changing payments doctors/hospitals even as drugs cost less.
As for the Danish miracle: read this https://www.thelocal.dk/20191126/confusing-and-no-communication-or-dignified-and-kind-denmarks-health-system-garners-mixed-reviews
2
It is pure fantasy to believe that the system we have today is not going to fail massively and lead to thousands of deaths this year. It is pure fantasy to believe that with or without private insurance that our system is not going to break down. See what your insurance gets you when the ER is full, there are no tests, no masks, no meds, we have no public nursing and schools are shut and people have no paycheck.
5
"Or that single-payer systems have shown to have worse outcomes than the United States system for many common diseases like cancer, high blood pressure, stroke, heart disease and diabetes. Or that tens of thousands of additional citizens died because of wait times for nonemergency treatment."
Right, yet somehow Canadians live an average of three years longer than Americans. Funny how those two sentences have zero citatons supporting them. It's almost as if the author recognizes he's being disingenuous.
12
The Commonwealth Fund is a good source of independent articles comparing healthcare systems and outcomes around the world. The U.S. healthcare system doesn’t rank well.
1
The guaranteed health care offered by all the other industrialized nations is SO BAD that...Americans are in last place in the ranking of health and life expectancy.
HUH!
I hope you got paid really well for this construction of half-truths, lies, and misinformation Mr. Atlas.
9
Why even bother arguing with the writer.
Just look at the numbers!
Life expectancy, birth mortality and so on.
US has great healthcare for some, but absolutely not for all as you can see by comparing.
7
What access? What quality? I have never experienced either in the U.S.A. in my entire life.
I see long waits to get looked at, insanely high bills, and incompetence everywhere.
Maybe you have access and quality if you're rich. I have neither.
8
The author fails to explain the obvious: why countries with socialized medicine do just fine, even better than the US
9
Enjoyment of access and quality today?
What do those words mean for those who are not covered at all?
What do those words mean when someone's co-pay is tens of thousands of dollars?
Or when they are straight-out denied?
What is the national average wait time (do the math) when so many people will NEVER be able to pay for their gall bladder operation?
The American wealth-care system is garbage, a crime against its own people.
5
From Haaretz today (truncated)
If anyone needed additional proof that a public system is the best way to deliver health care to Israelis, they could find it in the global spread of the novel coronavirus. The contrast between the dysfunction of the American health system and the relatively rapid response of Israel’s public system is striking.
The United States, which has many of the world’s best epidemiologists and physicians, was unable to identify, prevent and halt the epidemic. It only woke up after communities were infected by people they cannot trace.
The notion that people suspected of being infected with corona would have to pay for testing and treatment out of their own pockets is virtually inconceivable to Israelis, but that’s the reality in the health care is seen as a basic right, not a consumer good, and the government is considered responsible for the health of its citizens.
As a result of the fundamental belief in universal health care – which is expressed in the 1995 National Health Insurance Law, one of the most socially conscious pieces of legislation on the books – the number of people in Israel who are uninsured or have fallen through the cracks in the system, is negligible. They are the same people who in some other countries would be lost in the shuffle during an epidemic.
In the United States, tens of millions of people simply don’t have access to decent medical care, including testing for the coronavirus. In the case of such a highly infectious.....
2
As a middle aged and class, over educated woman (MPH), my only honest response to this is—as the kids are saying nowadays—OK, Boomer.
2
What do you think all the people who don’t have insurance and catch coronavirus are going to do? They are going to spread it to you, that’s what. To protect everyone, we need to cover everyone. Period.
Healthcare is a human right.
3
The Hoover Institute is a right-wing think tank funded by large industry. If the author didn't write this he would get fired. Most of the facts in it are incorrect.
The truth is that the population of developed countries who have "Medicare for all" live longer and have better healthcare than we have in the United States. The drug companies and the hospital companies can't let that fact be widely disseminated so they hire these hacks to spread fear and hate. It can cost up to $5000 to get an MRI in the United States. Everywhere else you can get one for $500 that is just as good. The difference goes into the pockets of the people that own the machine. We pay more for drugs in the United States than any other country. The drugs are the same. The difference is we allow campaign contributions so that the drug companies can pay off the politicians.
You will not get rid of this problem until you get money out of politics. As long as the politicians are on the take, they will continue this ridiculous system. That's how they get paid. http://www.opensecrets.org/ is an organization which shows you how much money your politicians are getting from each source. Look up your local United States representative and state Sen. and see how much money they're getting from hospital corporations and drug companies. Then you'll have an idea of why you can't get reasonable medical care.
Join makeitfair.us. We are an organization dedicated to getting money out of politics.
1
It's hard to believe that the author is an actual physician. I guess the Hippocratic Oath only extends as far as the bottom line.
2
Are you sure this guy's at Stanford? He sounds more like Trump University material.
8
We live in the 47th best country in health care outcomes. We pay twice as much as other countries for incredibly bad results. Time to get precise, detailed information from experts in other countries doing health care better. NYT - pay attention to nearly every response to this article. Don't waste ink or pixels on idiotic opeds like this one! If you support universal coverage but not Medicare for All, produce articles with actual information, not this garbage! If you favor partial instead of universal coverage, then explain why millions of people should be left out of the system. Then choose another line of business.
7
The author wrote:
"Or that single-payer systems have shown to have worse outcomes than the United States system for many common diseases like cancer, high blood pressure, stroke, heart disease and diabetes. Or that tens of thousands of additional citizens died because of wait times for nonemergency treatment."
Where is the data to support these damning statements?? Editorial boards (not just the NYT) need to start insisting that an author provide citations to credible sources to support the factual elements of their arguments.
We now live in the "Age of Disinformation." How is the reader supposed to know whether any of the statements put forth in this piece are true?
Do better, NYT.
6
We currently ration health care in the US. Already.
People of limited means - as in the non-millionaires among us - already cannot afford the treatments and drugs they want - even need - for many major illnesses and conditions.
So freaking out and squealing again about "socialist" medical plans and what they'll do to the US is really weak. Limp.
And doing away with "over-regulation" in order to allow private companies actually does and has done what again? Sent costs every higher.
So that is why most of us are really, truly, clearly and easily skeptical of your POV.
And who was it so so memorably noted that we're already rationing care during a Hoover Institution discussion long, long ago about health care? Why, the wife of a former director - I knew them both and was in the room at the discussion - who was an economist herself. She knew.
You should, too.
Why does the NYT print opinions that all full of outright lies? Opinion pieces should be vetted for being factual when they start quoting statistics or at least for the basic truth. Mr. Hoover is making statements that are outright false. Would the times print a opinion piece that claimed as fact that the earth is flat?
3
One would think the Coronavirus would shame this guy into not writing this stuff
2
More nonsense from the right...
2
Open Letter to the Times Editor:
This is shameful. Hiring a Hoover Institute member to write an article on Medicare for all is like your decision to employ Sydney Ember, the daughter-in-law of a senior Bain Capital to cover the Sanders campaign.
Retract this piece.
Enough already.
4
Hey Scott has got a hunch.
1
I guess this guy working for the "Hoover" Institution probably says it all. Praising Trump's plan to let insurance companies make more money. Yep, this guy is a moron.
1
Dear NY times,
It's a fantasy except for the fact that it works well in other rich country. What next, flat earth advocacy?
Please add a button for hiding pure propaganda, willfully ignorant articles like this or, better yet, impose some minimal standards on what you publish.
Chris
3
Scott Atlas needs a reality check.
This piece is rubbish. It is nothing but a compendium of tired and discredited right-wing lies.
The most obvious example is "access to America’s hospitals and doctors for those on Medicare depends on higher payments from private insurance". This is like the contractor who says he doesn't have time to stop and sharpen his dull and slow saw because he has to cut a big pile of wood before sundown.
US health care costs are out of control because private insurer profits are at record highs. The price of services provided by major health care providers is astronomical because private insurers are willing to pay for them. Those insurers are willing to pay for them because insurers get a piece of the resulting action. It's a classic you-scratch-my-back-I'll-scratch-yours kickback scheme legalized as a result of billions of dollars of health insurance industry lobbying.
It's what happens in EVERY industry built on spending OPM -- Other People's Money.
The estimated $32T cost of Medicare for All pales next to projected spending on current programs and insurance. The health insurance industry is a parasite sucking tens of billions of dollars every year out of your pocket and mine.
Industry apologists like Mr. Atlas benefit enormously from this plundering, and so it's no surprise that they write distorted pieces like this.
The wealthiest society in human history is well able to provide access to quality health care to every American. We allow the wealthy to choose not to do.
4
"Here’s another truth — abolishing private insurance would impact today’s seniors on Medicare, because more than 70 percent of Medicare beneficiaries use private insurance to supplement or replace traditional Medicare."
Here the author contradicts himself in one sentence, saying that a system that allows (and encourages) for private insurance would eliminate private insurance.
Maybe you are right, Mr. Atlas, in saying our outcomes are superior to nations with healthcare for all. I doubt it but maybe. But what about the vast swaths of American citizens who are shut out of the private insurance market? There are millions of people who have no health insurance and no way of accessing it (small businesses with fewer than 50 employees are exempt from even having to offer it). What about these people? Therein lies the error in your message. Healthcare for all will always be better than healthcare for the privileged only.
3
I’ve often read that healthcare is a number one voter concern but I doubted it. I must say the comments and concerns voiced here seem to prove me wrong.
3
As a Canadian all I can say is the writer is seriously deluded. While our Canadian medical system may have its minor ups and downs, no one uses it as a political tool, no one goes without treatment, and no one goes bankrupt. Some other commentator mention authors probable gold plated medical plan. And most of our doctors seem enough with the pay scale they receive here, even though it’s not as much as they could make in the US. The answer is plain and simple, Those that are heavily against a Medicare for all are soley concerned with profit for the select.
10
The fact that Scott W. Atlas is a fellow at the Hoover Institution says it all. Of course fellows there would not want to do anything that might hurt profits for any insurance company.
7
"It is pure fantasy to believe that the access and quality Americans enjoy today would hold if private insurance were abolished."
Oh, so funny. What would the millions of uninsured say about that statement?
4
Yes, Medicare for All or socialized delivery of medical services is the worst possible system - except for all the others. Have you tried contacting your private insurance company lately?
4
"It is pure fantasy to believe that the access and quality Americans enjoy today would hold if private insurance were abolished."
Which Americans? Wealthy ones like you? Or the poor and working class ones who have poor access and quality?
Because that's what it's really about. It's about what the well-off fear losing. Not everyone.
4
Only someone who can afford today's health care would leave out "affordability" as one of things Americans most value. The rich just don't get it.
4
As long as insurance companies exist they will dictate the rules. They should be abolished the drug companies should be nationalized.
1
I have gold plated health insurance through my employer and I hate it. Give me a public option and I would dump it.
4
Private, price gouging, stock price driven insurance, drug and medical supply companies are going to somehow lower prices for smart consumers. You should live so long. So, if you pay a lot it will be your own fault for not being smart. You’re not a patient you’re a consumer.
Read this article carefully. The aim of this Trump loving expert from a right wing think tank is to frighten people about the coming insolvency and demise of Medicare. I’m surprised he didn’t call the elderly greedy geezers. So much better to pretend concern and to sound reasonable.
5
Thus is just ridiculous. You know, we could probably compensate providers better with all the money that our current system wastes on administration. And, better regulation of the monopolies created by pharmaceutical patents might free up funds for real care.
I am glad that some get gold plated treatment for cancer and other diseases. But the fact is that if you don’t have access, then you don’t get this fine treatment.
It is time to face up to the fact that economically, healthcare is no longer a commodity. It is now a utility. And that is going to require market regulation.
2
Great to read this 'opinion' piece!
Dr. Atlas, senior fellow at Stanford University's Hoover Institution (some lobby group for vacuum cleaners?), is happy to support 'private insurance'.
You know, the girls and guys who say that they do not cover the cost of broken windows in your house because you did not lower your blinds. The same girls and boys that do not cover your cost for your damaged blinds because you are only insured for window damage.
3
You know what is a long wait for healthcare? Forever - for 27 million people. We may find that to be a bit of a bug in our system as we try to manage the current pandemic.
3
When you offer people terrible healthcare plans at low cost, sure, the price goes down because they don't cover anything!!!
2
@Jim Dennis
You know, if anyone was proposing that, you would have a good point.
Americans without insurance do not currently enjoy "Access and quality" healthcare now! So in the words of our president 'What do we have to lose.'
3
From Mr. Atlas' professional biography:
"Dr. Atlas also advises entrepreneurs and companies in the life sciences, medical technology, and health information technology sectors."
Huh, I wonder why he might not like M4A
3
The Times should retract this article. This is not a joke.
This article is a great example of Chomsky's idea of manufacturing consent.
2
@Nima
Indeed. After working for 40+ years, Chomsky's points are finally getting through to people.
Yes. A pretty bad one at that.
Tell it to the Kiwis.
3
Bernie campaign:
Please use this piece to make your case for Medicare For All.
And the biases of the Times.
Two birds, one stone.
3
Why is the New York Times publishing a column by the guy who made the bogus claim that Obamacare was dangerous because it would "kill innovation." His books advocate high-deductible insurance and HSAs as the answer. This would be a disaster for Americans who live paycheck to paycheck. But Dr. Atlas doesn't mind: He thinks it's wrong for healthy people to subsidize insurance for less-well people. In other words, he denies the value of insurance itself.
6
Tell us, Scott Atlas, how much money you are making off the current health system.
3
This is arrant nonsense. Look at America's health statistics. If our health system was such a star, why are we an also-ran in almost every category, including and especially life expectancy. Every nation worth its salt has universal health care. And if Richie Rich wants to spend more he is pretty much free to do so,
3
Lets subject this conservative author's regurgitated talking points to some real world data. These are the healthcare rankings of 11 developed countries: 1) UK 2) Australia 3) Netherlands 4) New Zealand 5) Norway 6) Switzerland 7) Sweden 8) Germany 9)Canada 10) France 11) US. It almost likes conservative talking points and narratives run counter to reality. Who knew?
4
Remember on Seinfeld George telling Jerry, “it’s not a lie if you believe it”. I am an a doctor. Medicare is my best payor. Private insurance does not pay me more. In fact most times I get less.
Stop spreading urban legend lies.
3
This is such nonsense! Complete mischaracterization of the Canadian system.
In Canada they have a healthcare system. In the US we have a healthcare industry. You have to have money to get healthcare.
Now watch how the Covid-19 plays out in the US where people with no health insurance can't afford to get medical treatment or even a test to see if they have it. It's going to spread like wildfire as a result.
Show me one country with single payer healthcare who says, "we really like the US system, we should emulate that."
We have the most expensive healthcare in the world with some of the worst outcomes compared to countries with socialized medicine.
You can do better NYT.
5
As with our newspapers, sometimes, I wonder why a newspaper with a high standard like the NYT (?!), would print articles like this, texts with verifiable nonsense, to put it mildly. I remember that some of our newspapers, some 10 years ago, thought that they should give climate deniers every opportunity to publish their 'wicked' thoughts. Keep to the truth please and don't bend it!
3
Whenever I see an article that references The Fraser Institute, as this one does in the "Canada" link, I know I'm reading some serious right wing propaganda. The Fraser Institute is about as non-progressive a "research" institute as you can imagine. If a topic can be skewed to favour runaway capitalism, the Fraser Institute will tackle it. It is a notorious enemy of public funded medicare in Canada, and should be ignored. Shame on the Times for supporting such one-sided reporting.
5
I wonder where this comes from:
Or that single-payer systems have shown to have worse outcomes than the United States system for many common diseases like cancer, high blood pressure, stroke, heart disease and diabetes.
a simple google search seems to put the lie to it
https://www.healthsystemtracker.org/chart-collection/mortality-rates-u-s-compare-countries/#item-start
1
Naturally, Scott W. Atlas, a paid flunky of the plutocracy at Stanford University's ideological organ the "Hoover Institution" thinks medicare for all is dangerous. Medicare for the elderly works very well. Medicare for everybody else would work just as well.
The Times is just an instrument in the hands of the plutocracy. its columnists--Douthat, Brooks, Friedman are all paid Republicans--and its op ed'ers like Atlas--are mere tools of the plutocracy.
We need a newspaper in the NY that doesn't serve just the top fractals of the income and wealth hierarchies.
1
Those fancy crazy expensive cancer treatments are useless if you happen to be one of the un or under insured.
1
A cowboy in Wyoming and a cowboy in Saskatoon both break their leg on the same day. What’s the difference in care or lack of care that they experience? In this case I’d be proud to be a Canadian cowboy with a broken leg. You know he’ll get the care he or she needs.
1
The mistake the author makes is the assumption that all Americans have access to health care. In states that turned down the Medicaid expansion under the ACA millions do not. Our infant and maternal mortality rates put us in a category with Albania. What he tries to say that the quality of care available to the richest Americans with great health insurance may decline. But having experienced both the French and the Swedish health care systems, I would disagree. my family had excellent care when living in both of these countries.
1
Dr. Atlas As a dual citizen of Canada and the United States I was dumbfounded by this article. Where to begin?
1 - Limited access to care-- this is complete nonsense and there are no facts that back this up. The real facts are that life expectancy in Western countries is greater than in the US. Clearly these serious ailments are handled properly. Part of the cause of American's shorter life expectancy certainly has to do with the fact that many millions don't have any insurance therefor are unable to afford preventative care.
2 - Wait times and costs are the cause of many deaths in Canada and the UK . Again total nonsense. It is true that certain ailments for example a knee replacement may be scheduled 2 or 3 months out but this is because these ailments are studied and the proof is there is no need for urgency in these cases. Serious cases such as cancer and heart conditions are treated immediately and effectively. Cost of Rx drugs and their availability causes additional deaths. This notion is laughable have you read any of the studies on the costs of drugs and their availability in these countries vs the American model?
3 - Total cost.The last I checked all the Western countries have figured this out and their cost per patient is about half of the US and everyone's covered.
Dr. Atlas I hear your a great doctor please stick to treating patients and do some research on some of the incorrect assumptions you've made in this article.
5
Much of this article is nonsense.
In Denmark, where I live, we roughly pay half of what you pay per capita, but we live almost 3 years longer.
There is no waiting time for life threathning illnesses, and other waiting times are rather short.
Cancer treatment are a focus point, and as I have a brother and two friends with cancer, I can see that it is rather efficient.
It is free to be educated as doctors and nurses, so they are not saddled with a large student debt. Actually every student get a grant of around 900 USD a month.
There are a cap om your yearly drug expences of around 500 USD. The rest is covered by the state.
It is a single payer system with a very low overhead.
We have no rules about preecisting conditions or caps on treatment, and there are no copays for treatments.
The only real flaw is that dental care are not included after you are 18 years - but we are working on it.
Your system is inhumane as well as stupid.
385
@Mogens you are trying to compare something absolutely incomparable. Denmark is an incredibly healthy country which has nothing to do with healthcare. You have some of the lowest obesity and diabetes rates in the world. The US is the largest country with the highest obesity rates. The danish are nothing physically like us. I’ve been to your country. Everyone is tall and thin. We are fat. With that, we spend trillions on the obesity related illnesses. A large percentage of Americans have chronic illnesses directly linked to this. These are lifestyle and cultural choices. Your county values exercise and has healthier food choices. We cannot afford an nihs system if we do not tackle this. Japan is highly successful also because they are not as sick as us. Your tax rate is also so much higher than ours. The average American pays ZERO federal taxes only local state taxes. You also have a large VAT tax. Your food costs are way beyond ours. Stop trying to compare a country (a lovely one btw I loved Denmark) with the us your population is the size of BROOKLYN! Lol! 5 million people we have 330,000,000 people spread across an area so large we gave states without doctors within 3 hours of populations. If your poor here you do have free healthcare. It’s called Medicare educate yourself. Your system will not have the same results here. If you want to convince 60 percent of our country to diet and cut sugar out of their diets exercise, etc so our metrics are the same then let’s talk.
28
@Mogens Also, please be wary of Medicare Advantage. Advantage plans are cheaper but you lose guaranteed acceptance into regular Medicare if you suffer a serious injury or illness. As your momma taught you, if it seems too good to be true, it is.
11
@Location01 Actually, it's Medicaid, not Medicare. Many, but by no means all, states expanded Medicaid coverage to cover low income adults but it you make $1 more than the maximum allowed, you have to apply on the Marketplace. And, I really can't believe you are making excuses such as Americans' rising obesity, life style choices that result in poor health comes, and obsession with low taxes. These are choices made on the individual and policy level, and we can make better choices. By your logic we should never have been expected to wear safety belts because Americans don't like to be restrained from flying threw window shields. We can and should do better today, and the example set by other countries is an excellent place to start.
10
The only way for private health insurance to ever work properly in America is by requiring all insurers to sell just ONE national standard health plan to all Americans wherever they live as members of one national health risk pool of 330,000,000+ people. If we can't have that then we need Medicare For All as written by Bernie Sanders.
1
Much of this article is nonsense.
In Denmark, where I live, we roughly pay half of what you pay per capita, but we live almost 3 years longer.
There is no waiting time for life threathning illnesses, and other waiting times are rather short.
Cancer treatment are a focus point, and as I have a brother and two friends with cancer, I can see that it is rather efficient.
It is free to be educated as doctors and nurses, so they are not saddled with a large student debt. Actually every student get a grant of around 900 USD a month.
There are a cap om your yearly drug expences of around 500 USD. The rest is covered by the state.
It is a single payer system with a very low overhead.
We have no rules about preecisting conditions or caps on treatment, and there are no copays for treatments.
The only real flaw is that dental care are not included after you are 18 years - but we are working on it.
Your system is inhumane as well as stupid.
80
Bless you.
But we are living in the land of stupid that even the Democrats are voting for a certified idiot called Biden.
3
@Mogens I completely agree with you. I live in France where we have a very similar system to the Danish one. We can see as many doctors as we want, there are no long waiting times for MRI, Cat-Scans or other treatments (a couple weeks at most) and all hospital expenses are completely covered.
I happen to spend 3 months every year in the US and from what I know, the health system here is a nightmare. Not only can you get sick, you are always under a threat of bancrupcy if your insurance finds a way not to cover your expenses. In fact the insurance companies have an incentive not to pay: their goal is to make money not cure you! If you are rich and sick, they will suck you dry. If you are poor and sick, they will let you die.
4
Reasons this opinion piece is rubbish:
1) Mr. Atlas is associated with the Hoover Institute at Stanford, which is a neoconservative libertarian group that dogmatically believes market forces are magical and beneficial. Furthermore, this group's work is often used as a rubber stamp to legitimize broken status quos, as this piece amply demonstrates in its defense of a private healthcare system that bankrupts Americans and prevents entrepreneurship.
2) This opinion piece is strident in naming the sins of universal healthcare schemes, but fails to compare those sins to those present in the American healthcare system. It is absolutely dishonest to claim that the British system rations care without also noting that the American system also rations care in the form of deductibles, co-insurance, and lifetime caps. This piece is full of similar cherry-picked evidence.
3) Drug pricing efforts will not save American healthcare. Drugs are <20% of healthcare spend. Focusing on drug prices is like blaming automobile consumers for climate change: blame the highly visible end user and obscure the responsibility of the broken system producing harms.
3
It is a pure fantasy to accept that the Canadian, the Dutch, the Belgian health systems are failures.
I have worked for global corporations that stationed me in those countries; later I worked for an organization headquartered in Brussels with major offices in London, Amsterdam, and Frankfort. Our New York office usually had a half-dozen Europeans on two-year assignment.
The Europeans were delighted with their healthcare systems. While they loved spending time in NYC, they insisted that our US division provide the same benefits -- healthcare, sick days, and vacation -- that they had had at home.
Our Canadian colleagues were reluctant to accept a full-time transfer from Toronto to New York or Chicago.
One year, my boss and I compared total compensation of our US teams and our Canadian teams. That year, company HQ had decided to measure "cost per head" against revenue. Boss and I were startled to discover that salary in New York was the same as Toronto, as was the cost of space, but that the Canadian employees cost almost nothing in healthcare and retirement. Our US company maintained good benefits, of the sort won by union contracts that we shared, as a computer and networking division "exempt" from union membership.
Our company paid a penalty for operating in the US. a penalty that put us at a disadvantage in the dot com boom.
3
As a Canadian, I can tell you that this piece fundamentally misunderstands both the contours of the Canadian medical system, and the inadequacies of the American system that is reliant on private insurance. But worse, I think this piece is disingenuous because the most absurd claims are also the ones with zero citations behind them or are misleading in their presentation. For example, the piece seems to suggest that patients in single-payer systems fare worse than patients than the United States, never mentioning the fact that life-expectancy in every single single-payer industrialized nation is years higher than that of the United States.
But let's just address the ridiculous rationing argument. Rationing occurs in both systems, and in the single-payer system, it's actually a good thing. Rationing occurs just as much in systems that rely on private insurers. Why do you think you generally have to clear your medical treatment in advance? It's to allow the insurer the opportunity to deny treatment. The only difference is that insurance companies use PROFIT as their main objective. Publicly funded systems ration medical care as well, but it's on the basis of proven medical efficacy, or lack thereof, for the treatment. And that's a good thing, unnecessary medical treatments are NOT risk-free and it's wasteful to have 15 experts capable of operating 24/7 when 2 can do the job just as effectively. This is econ 101 folks.
12
Google the author of this piece, Scott W. Atlas.
He also opposes Obamacare, and he opposed Obama.
He's a traditional conservative advocate for conservative healthcare reforms, like buying insurance across state lines (meaning the state with the least health insurance regulations would be home to the most health insurance agencies, a race to the bottom) and tort reform (meaning it would be harder to sue if you got substandard care or were injured due to the actions of doctors, other hospital staff, or your insurance company).
13
Speaking as a physician, I know that much of U.S. health care is waste, especially in the last few months of life when "everything possible" is done, by providers who have everything to gain by so doing. I would happily accept longer wait times in exchange for knowing that everybody has good insurance. I don't want the best to be the enemy of the good.
6
Dr. Atlas, what planet are you living on? In our mid-sized suburb of atlanta, it is a 6 to 8 week wait to get in to see a specialist. I'll bet any of the universal health care nations compare very favorably to that.
Medicare Advantage is a Republican plan that confines you to a local healthcare network - and that, just like an HMO, means you will have limited choices in terms of your healthcare. With mainline Medicare, I can walk into any hospital in the nation and expect to be cared for and have my plan pay the bill. It's the ultimate in free choice for healthcare.
And I challenge you to find anyone who works in a regular job who is happy with their private insurance. Employer plans get more and more anemic in coverage, and more and more expensive in premiums every year. Copays, Coinsurances, and high premiums nickle-and-dime participants in private plans relentlessly,
Employer-provided health insurance makes companies unprofitable, and uncompetitive with companies abroad in nations where tax-funded universal healthcare is available.
6
This was a potentially interesting take on the issue that unfortunately rapidly descended into a litany of tired trump administration/“conservative” talking points.
The author provides no support for his assertion that “single-payer systems have shown to have worse outcomes than the United States system for many common diseases like cancer, high blood pressure, stroke, heart disease and diabetes”.
A February 2019 publication of a study by the nonpartisan Peterson-Kaiser Family Foundation found that US mortality rates were generally higher than those for the OECD for most diseases except cancer, and for some cancers (e.g., childhood leukemia) OECD countries also had superior survival rates to those in the US.
I do not doubt, and have seen studies documenting, that there are waiting list issues in systems like those of Canada and the UK. However, I know of no evidence such issues are pervasive across these systems, and one recent review found US waiting times for some services (e.g.,PCP visits) to be longer than in the EU.
Having blithely dismissed universal coverage options, the author then proceeds to sing the praises of “free market” solutions like Medicare Advantage programs, ignoring the fact there are concerns about such programs inappropriately denying care.
Seems like a conclusion looking for an argument.
3
The argument about the health care systems reminds me of what I heard years ago about getting any job done. You can have it done cheap, you can have it done quick or you can have it done well. you only get to chose two of the options. So far in the US medical care is quick and done well. To promise all three is to lie about the out come.
My for profit insurance just denied my claim for a mammogram at a radiologist I have been seeing for 20 years. Out of network suddenly. I’m a breast cancer survivor. Oh, another for profit insurance wouldn’t pay for my chemo. Said it was a “specialty drug”
8
The US system rations by income. Don't pretend it doesn't.
13
@TonyC That is the bumper sticker right there.
1
My expensive for profit insurance almost killed me. An insurance wonk denied my claim for chemo therapy saying it was a “specialty drug “ which they don’t cover.
Millions of Americans can’t afford insurance and millions more can’t afford their high deductibles. Millions can’t afford to fill their prescriptions. I couldn’t until my doctor sent my prescription to Canada where I got the drug I needed for 1/4 the cost (still expensive).
I have received 4 GoFundMe requests so far this year. Medical bills. I had to spend down retirement savings, others go bankrupt or start GoFundMe and beg. Only in the USA.
We need Medicare for All. Too many Americans suffer with expensive for profit health care.
10
Articles like this one actually threaten to make me embarrassed to be a Stanford grad. Such narrow-mindedness is mind-boggling. Dr. Atlas is one of those who believe government should be for the rich and the rich only... and everyone else can suffer. The problem is that if my neighbors don't have good health insurance and don't go to the doctor's (or ER ) when sick, they could make me and my family sick, too. Our massive mess of a private insurance system is destroying health in America... and I'm really tired of the Scott Atlases of the world trying to stop the progress we need.
11
This column has only one purpose: making sure that medical providers continue to receive exorbitant compensation.
Let’s play transparency and publish net earnings of surgeons, board members of hospitals etc... on medical bills. Something is telling me that that sort of transparency would no be acceptable.
The point of Medicare for all is to limit for profit medical providers from abusing their position in society and allow access to all regardless of income. This is a proven way to improve life of millions of citizens, as demonstrated by the fact that many countries with a single payer system have higher life expectancy than the US.
7
When I was a little boy I wondered of my father what I should do when I grew up. He replied "You should become a Doctor so you can get rich". All the other boy's fathers said the same thing. By the time my daughter was of that same inquiring age, we were living in Canada in a small city which had a Regional Health Center and a large hospital. Thus, many of her classmates parents were Doctors or other health care providers. They were telling their children "You should become a doctor so you will be somebody in your community".
11
Great article. But Sanders supporters will say this is just another example of the mainstream media’s all out assault on progressives policies. I disagree but I’m almost certain that’s what they would say.
1
@Oliver
Or maybe some of us actually live in the other developed countries. Do I believe Mr Atlas or my own lying eyes?
7
Exactly! My family and I moved to Spain in 2005. Everybody, including my father in law, was covered by the public health system. On the day that he arrived to Spain he had a heart attack - he was rushed to the hospital and received the best care that one can dream to receive. Upon arrival to the hospital the nurse asked me to confirm his address ... not to send the bill but rather, to ensure that the ambulance would waste no time finding our home if he needed it again. We lived there for five years - I worked for an American health insurance company and never felt the need to buy a private policy from my company, for any member of my family.
Let’s get real - healthcare should be a human right. Period.
3
@Oliver the next time you catch a virus, you can thank Mr. Atlas and yourself for making it too expensive for many people who are sick to get the health care they need (and, generally the same republicans for preventing them from having sick leave so they can stay home). They get sick.. and make you sick. Just thank yourself.
First of all, the writer is not accurate in his assessment of the Canadian Healthcare System. My now-deceased Parents-In-Law were Canadian and were VERY WELL TREATED by the Healthcare System north of the border. My Mother-In-Law had Parkinson's Disease and she had excellent treatment right up to the end, with Housekeepers, Nurses Aids and even Nurses making home visits, not to mention Physician Care and Hospice Care in a beautiful facility. Years ago, my Father-In-Law had colon cancer and received immediate care, including surgery and chemotherapy that added years to his life. In 2011, he suffered a stroke and received the finest hospital care money could buy. In fact, he recovered completely from the stroke, but we had to place him in a nursing home because of his congestive heart failure. The Government-Run nursing home was BEAUTIFUL and well staffed with nurses and doctors on call. It was there that he died with dignity. People in Canada have to wait for ELECTIVE care, and while they are waiting, other forms of therapy are applied (PT, OT, palliation of pain, etc.)If a person is in need of immediate help, they get it.
According to a study by the Harvard Medical School, 45000 people in the US DIE EVERY YEAR because THEY DON'T HAVE ANY FORM OF INSURANCE. The writer seems to think that these deaths are not worth being concerned about as long as most people continue to have private insurance. What about them? That cavalier attitude is worrisome.
12
@Elizabeth Moore I lived and worked as a nurse in Canada. I and others from all over the world provided excellent health care to our community. I also received excellent health care with no worries. I now have an "excellent" private policy that does not allow this level of excellence. I would love to live as Canadians live now.
3
This article is frightening - because of the MISINFORMATION put forth by Dr. Atlas. "It’s not just because single-payer systems like those in Britain and Canada hold down costs by limiting the availability of doctors and treatments, even for the most serious life-threatening diseases like cancer, brain tumors and heart disease." I live in Canada and my husband of 74 was diagnosed with metastasized prostate cancer 5 years ago, At no point has there been any hesitation OR delay in his treatment. The same is true for my friends/relatives (some young and some older) who unfortunately have had to face similar circumstances. And, to top it all off, none of us, over our lifetime, have incurred financial burdens or lost our homes because of "medical costs".
I can't believe that a senior fellow at Stanford University would be so ill informed. If the Canadian system is so challenged, then why do we have a longer life expectancy and lower infant and mother mortality rate than the USA, as well as considerably lower medical costs per capita.
17
We already have socialized medicine in the US. The vast majority will get some form of care when they need it whether or not they can pay for it. The real issue is whether we can do it more efficiently so that it doesn't cost the country 18% of GDP as opposed to 10-12% of GDP for those countries not falling on their demagogic swords.
We must also face the fact that despite any shortcomings in delivery of services found in other countries, they all tend to have longer life expectancy and lower infant mortality than the US. They must be doing something right to achieve this while spending 2/3rds of what is spent in the US. The wait times may be long but then I have had to wait four months to get into a new primary care provider when my old one moved on.
This is not to say that M4A is the answer. If, when it comes to the details, it falls victim to the crony capitalism that dominates most legislative endeavor, it will not succeed. The nation's $3.5 Tr healthcare bill must be reduced.
4
Medicare for all should be endorsed by conservatives as a massive cost savings, not attacked with straw man arguments that it will limit choice. As a nation we waste something over $500bn per year paying administrators who do not provide any care. Meanwhile many lack access to medical care except by going to an emergency room, and many others are bankrupted by absurd costs. Surely the prospect of providing a more efficient, universal solution is a conservative issue. Embrace it. Stop fighting to preserve a status quo that allows the massive ripoff continues.
9
Dr. Atlas starts off disengenuous and doesn't improve.
Conflating the Canadian and UK health systems together under "single payer" may be technically correct but so would be describing Venus and Earth as orbiting the sun.
Each Canadian province structures its health coverage and reimbursement system slightly differently. Providers are reimbursed by provincial governments, so it might be more accurate to describe it as a set of single payer coverage systems.
The National Health Service in the UK is operated by the government; NHS providers are government employees.
Both countries also allow supplemental private insurance. In Britain, doctors don't need to join the NHS, though most do.
Like many arguments against Medicare For All, Dr. Atlas's downplay or dismiss the considerable role private insurers currently play within Medicare. Beneficiaries can buy MediGap policies to supplement coverage, opt for Medicare Advantage plans (part C) over traditional Medicare (parts A, B). Medicare pharmacy plans (part D) are all based on, and run through, private insurers.
More than half the U.S. population already gets its health coverage/care through the federal government, via Medicare, Medicaid, the armed forces, CHAMPUS, the veterans hospital system, federal civil service coverage, the Indian Health Service, and a few more odd pockets of the system.
Some of these resemble the way Canada provides coverage, some how the NHS provides care.
6
@grennan And for years there has been an effort to bring these systems into the private sector b/c there is so much money to be made off of sick people. We have to stop this for all our sakes. Thank you for your comments.
3
I'm going to guess the real danger Mr. Atlas is concerned about is Medicare for All's impact on the stock prices in his investment portfolio?
"It is difficult to get a man to understand something, when his salary depends upon his not understanding it"
10
Maybe Dr. Atlas could have devoted a paragraph to his “Six Point Plan” instead of flogging his straw man.
Progressives should be pushing for universal health coverage by attacking all the government spending that shores up the current system and leaves out so many.
Those corporate health plans that candidates are so fond of are very expensive to the taxpayers. The premiums are tax deductible regardless of the cost of the plan. Only those lucky enough to be in such a plan get that benefit.
The current Medicare system subsidizes the elderly using the current wage earners, many of whom can get an affordable policy. Socialized medicine only for some.
The Medicaid system pays for poor people so the medical system can avoid trying to get money from people who have none. Maybe we should eliminate that and let the system fail.
Obamacare was rigged to bailout the insurance industry from their unworkable model, and to force people to buy their bad product.
Eliminate all these special pleaders and universal coverage will have a lot more supporters. There is already socialized medicine, but it’s for the healthcare industry, not patients.
15
Does my doctor really need to drive a Maserati because he enhances my life so much more than, say, an electrical engineer who designs smartphones, and earns a fraction of what the doctor does? No. We need a new health care system , and for some, the gravy train is about to crash off the track. Even non-profit hospitals make profits. The greed of these elites may be their undoing. But only if you and I are willing to take up pitchforks. Asking them to relinquish privilege they themselves did not create, won't work. After all, they work hard for those excessive rewards. As if the rest of us don't work hard for the leavings.
21
@Michel B I would like to say here that a Maserati does not disqualify a physician because he does not enhance your life. Physicians are educated in their profession beyond most other professions. They pay a pretty penny for it too. Each physician enhances patients' lives at different times in different ways. Frankly, I would be so happy to have my life enhanced by a well educated, competent doctor at the emergency down the road.
Of course, not -for- profit hospitals make a profit and always have. However, there are rules for how not- for- profit hospitals are allowed to spend their profits.
Once for-profit-systems became prevalent in our country our health care became depleted in too many ways. It is the institutions that are making huge profits. Doctors, like everyone is are paid employees. And physicians are not necessarily paid what they are worth.
Yes, we all work hard and many of us do not make wages we need and deserve. Things have to change but blaming doctors or any other health care workers in not the answer.
2
@Grace Thank you for your thoughtful comment. I had no intention of blaming doctors, having two of them in the family. It is the system that must change, and we cannot ask those benefiting most from the system, to voluntarily relinquish the privilege they inherited. I am on my way to the doctor now, and yes, I am glad his help is available, and know he and his family have worked hard to achieve his role.
"According to the Center for Responsive Politics (opensecrets) the Hoover Institution gave 94% of donations to Republican candidates during the 2016 election cycle." Atlas works for a right-wing institute that usually is noted for factuality with a conservative slant to its interpretation. This article loses the factuality, ignores confounding facts like lack of access to insurance in the US, and ramps up the rhetoric. Sounds like desperation to me.
22
As a person who has just lost access her surgeon and the #1 hospital in the world for her condition for having believed the hype over private providers of Medicare, I beg to differ with Mr. Atlas' premise -- specifically regarding the "quality Americans enjoy today" thanks to private insurance.
Medicare for all is exactly what we need. In every sector, our capitalist society argues the benefits of economies of scale. --except in healthcare. Now, why is that?
The NYT's extraordinary legacy series "The 1619 Project" features an excellent analysis of our healthcare quagmire: “Why doesn’t the United States have universal health care? The answer begins with policies enacted after the Civil War.”
10
Dr. Atlas, how many ordinary people in the countries that have socialized medicine do you know personally? I know a lot. When I tell my sister about the cost of prescription drugs, how a family can go bankrupt over an illness like cancer, how millions of people have no access to health care, her response is “how can that be, that can’t be right!”
I have an elderly family member in the U.K. with a rare and aggressive type of lymphoma. She gets the latest treatment.
So, your statement that “single-payer systems like those in Britain and Canada hold down costs by limiting the availability of doctors and treatment, even for the most serious life-threatening diseases” I know is not true and is fear-mongering at its best.
In the U.K., paying for a procedure out of pocket, like cataract surgery, or with private insurance is allowed, so I actually do disagree with the “Medicare for All” with no premiums for anyone proposal. Many countries have a mixture of single payer access and insurance. Medical costs are not outrageous like in the U.S., making this a feasible option.
The statement “liberalizing health savings accounts” is laughable. Most families are unable to do this financially.
People should have access to basic, quality, affordable health care. Think about the next time you go to a fancy restaurant or your golf club, would the staff stay home or seek health care if they are sick? Most likely not. Good luck with that in the era of Coronavirus.
13
They have no choice but to work because along with no healthcare, they get no paid sick leave either.
1
Dr. Atlas, how many ordinary people in the countries that have socialized medicine do you know personally? I know a lot. When I tell my sister about the cost of prescription drugs, how a family can go bankrupt over an illness like cancer, how millions of people have no access to health care, her response is “how can that be, that can’t be right!”
I have an elderly family member in the U.K. with a rare and aggressive type of lymphoma. She gets the latest treatment.
So, your statement that “single-payer systems like those in Britain and Canada hold down costs by limiting the availability of doctors and treatment, even for the most serious life-threatening diseases” I know is not true and is fear-mongering at its best.
In the U.K., paying for a procedure out of pocket, like cataract surgery, or with private insurance is allowed, so I actually do disagree with the “Medicare for All” with no premiums for anyone proposal. Many countries have a mixture of single payer access and insurance. Medical costs are not outrageous like in the U.S., making this a feasible option.
The statement “liberalizing health savings accounts” is laughable. Most families are unable to do this financially.
People should have access to basic, quality, affordable health care. Think about the next time you go to a fancy restaurant or your golf club, would the staff stay home or seek health care if they are sick? Most likely not. Good luck with that in the era of Coronavirus.
2
Wait, so Medicare for all would BOTH reduce quality of care by reductions in payments to providers AND cost much more money than does the present combined private and public does? That doesn’t sound right.
5
"It is pure fantasy to believe that the access and quality Americans enjoy today would hold if private insurance were abolished."
That 'access and quality' only exists for people of relative means and with good employer-provided insurance. The poor or underemployed or under insured have almost none of that access or quality. Medicare for All would not be a magic bullet, but it would almost certainly be better than having 1/3 of our population be uninsured or underinsured. To say it another way, I am a person of relative means and with good employer-provided insurance and I want everybody to enjoy the access to health care that I and my family enjoy. And I would be happy to trade a slight downgrade in my healthcare access if it meant that every American had access to healthcare on demand, without fear of co-pays, unaffordable medications, or bankruptcy as a result of medical debt.
14
I am a Canadian who has had two heart attacks and open-heart surgery for valve repair ... I never had to wait extensively for ant treatment that would have cost millions in the US 'for profit' health care system.
18
So, what's YOUR big idea for tackling health care in America?
I'm 63-years-old with the single health issue of chronic back pain since a botched back surgery in 1997. My wife is a year younger and has asthma.
"Health care" has been costing us between $10,000 and $20,000 a year for the past several years. We are on a fixed income, so the future looks bleak unless some drastic changes occur.
What ya got?!
11
So, your 80 year-old grandmother can sit and figure out which of 28 plans will be best for her. What an advantage. And so many of those not yet eligible for Medicare just love their private insurers' exorbitant premiums, deductibles, co-pays, and surprise bills. And then there are the 27 million uninsured, who certainly don't receive quality medical care; they receive little medical care at all.
The author embraces the notion, popular among the Republican elites, that if every American could obtain the medical care they need, those currently with the means to obtain adequate medical care would have to wait longer to see a doctor, i.e. those currently uninsured or underinsured must serve as sacrificial lambs for the well-insured.
Instead of repeating the trite question of how much will single payer cost, I would like the news media and think tanks to start asking how much does our current system really cost, not only in dollars, but also in lives.
15
The author’s claims are based on a false assumption. We do not have access, choice and quality for most. A false premise leads to erroneous and misleading conclusions. While I agree that people overestimate the benefits and underestimate the perils of M4A, that doesn’t mean that the status quo is acceptable.
4
Sheer fantasy Mr. Atlas? Experience and evidence say otherwise. I have used the Japan's national health care system for many years and have no complaints. It covers much but not all. If you want all, there are private insurance choices available.
4
Every time a major change in our country has been proposed (e.g. SS) the conservatives tell us about how it will destroy our country and lead to all kinds of disastrous outcomes. And then they try to legislate their prognostications into reality (e.g. ObamaCare). Our current system is failing regardless of the metric you use. Our high deductible insurance is really a scam. It has become a way for insurance companies to cover only what is required by law, and then force the individual to cover everything else ... until you spend so much that you must be a cataclysmic situation. How is that a better outcome? How is living through cancer only to be devastated in your finances a good outcome? I think the insurance companies have so misbehaved with the public trust that they have to be abolished. Profiteering on the public fears and pain and suffering should be illegal.
9
Talk about an assassination attempt built on gauzy information and plain untruths. Great Britain and Canada no more limit expenses based on limiting doctors and available treatments (except maybe for breast enhancements and chin tucks). In fact the US medical establishment does all it can to jack up the cost of medical treatment by seriously limiting the number of medical schools and entry of well trained MDs from other countries. Further, the frequent use of supplementary private insurance is due to inadequate funding of Medicare by Republicans, who then turn around and blame the problems caused by funding inadequacy on some mysterious innate defect of the program itself. But thanks for making it clear that Medicare for all must be part of a sweeping reform in health care that includes reducing the costs of high profit medicines, hospital stays, and medical office visits. Yes, it's a vastly complicated system that would actually be greatly simplified by a one-payer system. But the primary obstacles to good, affordable and universal health care in the US are the special profit interests determined to squeeze every last dime from the American people.
7
Universal healthcare and single payer are not synonymous. Likely the most successful healthcare systems in the world are those of Japan and Switzerland, both of which are multi-payer. The catch is that these systems require the most rigorous regulation possible, and regulation is a filthy word in American politics. No system is going to be completely flawless, that's obvious. But it needn't be a question of either barely regulated private insurance or M4A. That this writer undoubtedly knows this and fails to discuss it makes his argument too tendentious to be taken as anything but a political diatribe.
3
You can only come up with tripe of this magnitude by ignoring the other side of the argument completely. For example, in the current piece, Mr Atlas describes Medicare for all as if everyone would suddenly be shoved into a new program. However, the single biggest benefit of such a program would be the MILLIONS of people brought into the healthcare system. A balanced discussion needs to include all the benefits and costs, not just those that favor the biases of a think tank.
10
Seriously, when nearly all other advanced countries have superior outcomes compared to the U.S, are we to believe the fantasy of this article? The U.S. is way down the list compared to other countries that have a single payer system, private systems or a combination of both. Great system if you are privileged, not so much if you don't have money.
How in the world can a system that denies quality health care to a large portion of its citizens be ethically defended? All you have to do is look a the myriad ways that other countries provide quality health care and take it from there.
We should also talk about the cost of a public system and statements that are made that such a health system is unaffordable. Are you kidding? How much are you paying now?
10
Why is it that no one seems to understand some very simple concepts? Yes, your taxes would have to go up, but at the same time your insurance bills would go down to zero. The down would be more than the up. That's why european healthcare costs are half or less of Americans. The government run system is far more efficient than our insurance companies. The issue that the hard Medicare left misses is that we can't just suddenly put all the millions who work in insurance out on the street. It needs to be done gradually by adding incrementally to the affordable care act.
9
Is putting those in the insurance industry out of a job any less ethical than leaving a human being without the legality care they need?
Besides, the new system would need employees. Employees who already worked in the healthcare industry such as these insurance industry employees would be ideal.
1
No, no, no!! This article is wrong in so many ways. For one: the so-called Medicare Advantage plans, managed by private insurance companies, actually limit coverage for elderly hospitalized patients. They should be called Medicare DisAdvantage Plans. As a physician working in geriatric psychiatry hospital care, I see limitations of care imposed by the for-profit insurance companies, whose middlemen invoke Medicare guidelines while managing to deny coverage, by "allowing" fewer hospital days. People are being seduced into signing up for free perks, but need to know: these managed plans are just another way for insurance companies to profit at the expense of patient care. Plain Medicare, while not perfect, is superior to the managed plans.
7
Regarding expense...
In 2018, total U.S. spending on health care was $3.65T (https://fortune.com/2019/02/21/us-health-care-costs-2/). CDC estimates 91% of the public was covered by health insurance.
In 2017, the CDC indicates that total U.S. spending on health care was $3.5T The CDC states total 2017 US health expenditures to be $3.5T (https://www.cdc.gov/nchs/fastats/health-expenditures.htm). CDC predicted 2018 expenses would be 4% higher - pretty much in line with the $3.65T quoted above from Fortune Magazine.
Joe Biden has frequently stated that Medicare for All would cost $3.4T/yr, and has stated that this is too much to be supportable/sustainable.
But notice that we actually spent MORE in both 2017 and 2018 than the figure Biden quoted. Biden's figures would have represented a 6.8% reduction compared to the actual 2018 expenditures. And rather than covering just 91% of the population, 100% would be covered.
When Biden talks about expense, pay close attention to his wording. He quotes figures about total health expenditures, but then never compares them to the overall expenditures already being made under the current approach. He invites you to think these are increases in overall expenditures. They are not.
3
The existing system is rife with dangers. It kills people. It causes great suffering. The private insurance companies harass people already suffering from health problems to get out of paying bills. It preys not only on the poor, though that would be enough, but also on the working and middle classes. It makes access to health care either complicated or impossible to too many when we're gripped by threats of the Coronavirus. How can you scare us away from a potential solution when we're already IN the scare? It's like warning someone living in a horror movie of the horrors that await them if they try to escape. Instead, how about a viable solution?
5
Judging from the comments, Mr. Atlas needs to get on board or get out of the way. At the very least, give us your plan instead of a snide disingenuous rant.
12
The right wing slant of this article is not a surprise, seeing that Dr. Atlas hails from the Hoover Institution. Not exactly a hotbed of progressive thinking, or any thinking to my mind.
The medical industry has been sucking exorbitant value out of this society for it’s entire existence. It’s the perfect ploy, the truism “Your health is priceless” is used to justify “charge what the market will bear”. The market being those who can pay, the rest are just flotsam. Profit and loss are calculated relative to the industries grossly inflated prices, resulting in a foregone but false result. This industry will continue along the path of systems based on human greed. It will take more and more, without restraint, until it breaks. Oh, and all that noise you hear in the background being single payer systems throughout the world running to convert to that in the U.S. NOT!
3
Let me guess, Mr. Hoover has gold plate healthcare provided by his employer.
10
Yeah. The "...but what about the Seniors?!" argument rings hollow to me. I know more seniors with recent knee replacements than I know young people who have had a physical or dental cleaning in the past five years.
4
which means hat knee replacements for seniors are financially rewarding for surgeons, hospitals, rehab centers, and PT practices (after all, people under 65 are not people who get their knees replaced). So... maybe we should take it with a grain of salt when MDs and hospitals say that Medicare is killing them.
@Paulie The Hoover library was established by President Herbert Hoover and eventually became the Hoover Foundation. Although Hoover was a republican president I think he would be appalled that this foundation carries his name.
1
Gotta start questioning the NYT's decision makers--especially those who choose op-eds. Atlas? Hoover? Really!? This is pure ideological drivel--we all know you know that! Remarkable you allowed him to get away with rhetoric like "citizens died" etc. What happened to basic op-ed standards? Reminds one of GOP's pre-ACA "death panels" rhetoric. Sad that the Old (Gray) Lady has thrown its weight so hard behind the moderates (who deeply dislike Medicare for All). I guess the defense is that "We just can't risk another four years." But, of course, had you not done the exact same thing four years ago (back the moderate), perhaps you wouldn't have put yourself in such a position.
8
You fail to point out that Medicare Advantage plan providers are paid by Medicare to provide these plans and that over the past three years they have overcharged Medicare by $30 billion dollars. No wonder they are expanding these plans when they realize they can use them to funnel public dollars into their pockets. Private insurers would not have an incentive to provide insurance to such a high risk pool if it wasn’t for this public money. It’s basic economics.
8
@Henry Whittaker If this is true the money is not going into the providers (better know as doctors, nurses and other providers) pockets. They go elsewhere into the system to be used to prop up a program within the system that is failing.
This reads like a speech that Trump would give at one of his rallies. Private insurance depends on profits. Every penny that goes to profits is a penny that does not go to health care. Insurance companies make more money when they deny care.
8
The Medicare tax cap should be eliminated, why do the wealthy get this tax break? At one point I was making 1/2 of what my father was and we were paying the same amount in Medicare taxes, he was topped out. And the income where it tops out is really not very high.
5
Ok, second try at a comment.
I am extremely disappointed that this propaganda piece stuffed with falsehoods was printed in the NYT. Propaganda and lies are destroying my country. We don’t need them in the NYT.
Secondly, the fact that the person who wrote these lies is associated with Stanford University is another punch in the gut. While others here were well acquainted with the policies of the Hoover Institute to support this level of propaganda, I was not.
Please — and why should we have to beg— hold your opinion writers to some minimum level of honesty. Please!!!!!!!!!
14
Distortion is lying. And you are distorting big.
I am just simple, and i look just at simple things, like the CIA-factbook ( https://www.cia.gov/library/publications/the-world-factbook/rankorder/2225rank.html ) which tells me, that the US spends 17.1% of their GDP on healthcare, while france spends 11.5%, germany spends 11.3%, denmark 10.8% and canada 10.4% of their GDP, and by the way they all have medicare for all.
The i look at the WHO-ranking of the nations, and US ranks 30th, below kuba and mexico and far beyond all the europeans with their universal healthcare.
In my simple mind i just get these numbers 17.1% of the GDP for rank 30. But i guess Atlas just shrugged as he was decommissioned.
7
@Mathias Weitz he was ‘commissioned’.
No one need worry about abolishing private health care plans.When people see what M4A does private health care will go the same way the buggy whip did.
6
"access, choice and quality":
Life expectancy at birth (2015-2020):
Both Sexes:
United States of America, 78.81 Years, Rank in the World 47.
Canada 82.22 Years, Rank in the World 17.
France 82.46 14.
United Kingdom 81.15 29.
Italy 83.28 7.
6
The rich Democrats and Republicans know that if the American people get affordable healthcare they will know they were lied to and ripped off by the corporate owned politicians for the past 40 years.
8
While I agree that most of what this writer says is pack of lies and fantasy, I disagree with many commenters that this should not be published.
In fact, it's exactly what should be published in order to showcase the lies and fantasy promulgated by the purportedly no-government Republicans and their think tanks.
Sunlight is a great disinfectant, and this silliness needs exposure in order to wither in that bright glow.
4
Ye gods, Scott, that could have been written by the American Hospital Association. Why does the USA have worse stats for longevity, child mortality and out of control medical costs than all the major industrial countries including Europe? We are more than double in medical costs, and medical induced bankruptcies than any other country. So far, the response has been to attack any attempt at securing a universal health care system. Obama care is under constant attack with no solution from the right. Time to return to your roots and see the impact.
4
First off - it's pure "fantasy" to think that Americans currently have great access with private insurance, and pure fantasy to think they "enjoy" the precarious nature of private insurance at the whims of their employer. And seniors do not "enjoy" supplementing Medicare with private coverage that costs twice as much. This country needs to join the rest of the industrialized world in acknowledging that a person's health is not a product, your healthcare is not a "market" one can feely participate in (every single person on earth will get sick or injured - your health is quite literally your life therefore participation in a for profit market is not voluntary and people are not rational when it comes to trying to save their own life, etc.). The desperate pleas from conservative think tank flunkies like this Hoover Institute author are just that - the desperate, dying gasps of those who benefit from the current system, which is definitely not most Americans.
9
The biggest danger I see to the successful deployment of Medicare for all is a constant attempt by Republicans to sabotage or repeal it as they have done with Obama Care.
9
America's health spending is already enormous, but also mostly private sector. Mr. Atlas prefers private sector provision and payment, so why has this failed to give America the most cost effective health system in the world? What is meant by "empowering seniors"? I am one of those, so Mr. Atlas says I will shop about for the cheapest cancer care, orthopedic care, dermatological care, and so on and and on and on? He ignores the power of local area health care providers to set fees, usually to what they know they can extract from the insured (not the whole population) and from the wealthy (not even close to the entire population). Opposition to socialized health insurance and the cost/income controls that come along with that, derives from very strong wishes to protect very high incomes for specialists, hospital executives, insurance corporations, and the pharmaceutical firms which, when not pushing opioid pills for all, charge fantastic sums for long copyrighted drugs and pay their executives and directors quite lovely sums -- rent seeking. With its complex billing systems American health care is far more bureaucratized and litigated than in the other societies Mr. Atlas names. It is merely ideological to claim that the distorted, faux markets here out perform health care elsewhere.
6
It's always nice when NYT graciously invites a sophist to write a column written almost entirely in bad faith.
You can write whatever the heck you want, the fact is that it will always be cheaper to have a system in place that doesn't need to profit off of the healthcare that we receive. Anyone telling you otherwise is just another joker like the guy writing this article.
13
What a pack of lies!
10
I'm getting really close to canceling my subscription to the New York Times. Publishing such biased opinions has become the norm and I'm questioning whether I should continue to pay $45 a month to read them.
10
@Chef G
The NYT seems determined to show Trump that they are "fair".
@Chef G
Yes, Chef G; this piece reads as if it just came out of the White House Information Office. About as credible as Trump.
I think NYT is going downhill posting right wing garbage like this piece. I pay my subscription fees for fact based journalism, not some half concocted argument designed con the American people into making choices that goes against our interests.
12
The only danger currently in existence is allowing a clown like this to write such an article in the NYT and expect people to buy in to it.
7
When I was defecating blood it took me nearly 3-months to get a colonoscopy, and that's with excellent insurance.
Where is this "access and quality" again?
6
Whatever is Mr. Atlas talking about? Our system is probably one of the worst in the developed world. One can only hope, legislators can see a workable model in most of European countries with socialized medicine. Spain has one of the highest ratings for healthy people. We come about 37th in mortality rates.
There is no limit to how much the pharmaceutical industry can charge for their products, as seen by the Epi-pen debacle. Insulin- dependent people are starting to struggle, but that's the tip of the iceberg. Costs are getting worse in most facets of medical care, and insurance companies are driving the amount of time we may spend with our physician. Why? To any question, the answer here is the bottom line and shareholder value. So, to achieve greater shareholder value, research and development has been curtailed, prices on drugs increased, hospital supplies decreased, staff decreased, health outcomes ignored, the public be damned, and greed prevail, for the benefit of the stockholder...and CEOs , of course.
5
You mean the access and quality enjoyed by rich Americans like you? You need to get out more often, meet somebody not just like you.
5
I received better care, for free when I lived in Japan and France. And no one but the extremely wealthy in this country can afford those few doctors who foreigners come see that some use as ‘proof’ we have the best medicine in the world. We would lose our homes and be living in tents while we still had an IV. How is this civilized? How is this remotely acceptable?
5
Taken from the Hoover Institute website ( Mission statement):
"By collecting knowledge, generating ideas, and disseminating both, the Institution seeks to secure and safeguard peace, improve the human condition, and limit government intrusion into the lives of individuals."
With this focus, it is no wonder that the author is so profoundly against any health care options based on existing governmental programs and only proposes anti-governmental economic-based ideas ( at least as described in this article - the publication in his byline at the end of the article may be somewhat different).
4
Another pack of lies and distortions from the Hoover Institute, a corporate propaganda arm that pays shills like Dr. Atlas to put out misleading information. I am sick of having my body be a profit-center for Dr. Atlas’s clients in the medical industry.
5
This piece is just total nonsense. Shame on you for trying to scare seniors and everyone else. Let us know when the health care industry agrees to all the price transparency reforms that will destroy a big chunk of their profits. The "access and quality Americans enjoy today"...really. You should be ashamed of yourself.
3
I went on a golf trip a couple of years back with three conservative friends. We met up with a foursome of Canadian guys our age (50-ish, middle class, kids in college, also politically conservative).
I was the lone liberal at dinner that night. The discussion ranged from politics to culture and back. I mostly listened. At one point, just for fun, I asked the Canadian guys what they thought of their health care system versus ours. They all laughed. One said to me “Our healthcare is great. You guys are idiots.” They then offered several personal examples of excellent care, from emergency room trips to cancer treatments.
On the course the next day I asked the Fox News viewer I was paired with if he would change his opinion on this, now that he had new info from the “real” world. I’m sure you can guess his response.
I don’t go on that golf trip anymore.
7
Now you can tell us how trickle down economics is great too, mr Hoover.
2
The Canadian system is so bad, we live four years longer.
8
Dr Atlas stop insulting our intelligence. Your opinion piece is nothing but propaganda. From someone who lived in the UK for 35 years and whose very elderly parents in the UK get prompt, exceptional care.
8
I live in Canada. The writer clearly does not what he is talking about.
8
Another parasite from the Hoover cheering for kleptocrats and billionaire thieves.
Meanwhile the life expectancy for Americans is the lowest in the industrialized world.
Coronavirus for all is so much better than medicare for all!
4
I really did expect something better from someone at the Hoover Institute but sadly this was garbage!
2
And yet, we have analyses that show how M4A will both create jobs and increase wages. Gosh, whom to believe?
https://www.newsweek.com/bernie-sanders-medicare-all-would-likely-increase-wages-create-jobs-new-economic-analysis-shows-1490800
1
Stanford should be embarrassed to call "The Hoover Institute" part of Stanford. It is nothing but paid Republican hacks.
NYT should only publish this stuff with a paired editorial from an equally rich progressive group. If there were such a thing. Koch brothers don't fund them.
3
A questionable article that lacks substance.
3
I can hear my European relatives from here! They are laughing their heads off!
4
This is the most embarrassing shameful display of hackery i've seen in a paper that routinely goes out of it's way to ruin it's own reputation on a daily basis. (Dapper White Nationalist trendpieces anyone?) You may as well have had an editorial saying why Pepsi is the choice of a new generation written by Pepsi's marketing staff. Nothing stated in this article was remotely true, the case it made was tired and discredited decades ago, and shouldn't be given space on the paper of record.
6
The Hoover Institute is a corporate bordello. It would be nice if the Times would refrain from publicly broadcasting the sounds of the Hoover Institute "staff" servicing their corporate customers. It's kind of disgusting.
6
New York Times: publishing this kind of fact-free fearmongering is, at the least, irresponsible. There is no need for "balance" when one side is lying to push an agenda.
8
Between the histrionic anti-Sanders nonsense the times posted the last couple of weeks and this sort of thing I’m beginning to consider ending my subscription.
It’s not that the writer is clearly deeply biased against a public healthcare system. Not is it that he’s nearly wrong about everything he says. It’s that the times would print it.
Do your editorial duties and stop spreading disease. Just like a public free healthcare system would if we had one.
4
Medicare for all is an unnecessarily extreme proposal to replace an undeniably broken system. The name has become a catch all, obscuring the many forms a successful reform might assume.
There are several misunderstandings about other systems compared to our own. In fact, most European systems are not pure social one size fits all. Most countries with more socialized forms also provide for additional private insurance. Countries like Germany and Switzerland require private or employer paid insurance of all residents and limit the amount of profit the insurance providers are permitted. Those plans are heavily subsidized, so that no one need go without coverage. The costs of procedures, furthermore, are limited, as are what may be charged for pharmaceuticals.
The American system remains broken due to the profit driven conservative obstruction of improvements and changes based on policies which have proven successful elsewhere.
Let us see what the next regime is able to provide, although the most promising possibilities are all based on the universal mandate so successfully opposed by Washington Conservatives.
2
There is so much contempt for fellow humans, for a world where everyone has inalienable rights, in this opinion that one can't help but draw conclusions about the author's mindset. Universal healthcare is a longstanding and successful human right and social service in EVERY other advanced nation (and some third worlds). Has the author never traveled outside of America? I lived in Norway for many years and I can tell you firsthand that everything posited in this opinion about Medicare for All is wrong. Norwegians are more than free to buy private insurance if they like. But everyone must still contribute to the social healthcare system --- and, frankly, everyone uses it and loves it.
7
Let's say Medicare for all... Let's say as part of that Doctors are paid a HUGE amount... BUT they are on SALARY. Eliminate fee-for-service. Doctors on salary see 5 patients a day.. on another day see 10 patients - same wages..... Poof - no more unnecessary tests to create income.
3
If this country care about 'those deplorable other 47%rs' then our current health care would need a Bernie Sanders to save it from being a Oligarchy..fair and balanced news and take the money out of politics!
"Voters must realize this. It is pure fantasy to believe that the access and quality Americans enjoy today would be maintained if private insurance — used by more than 217 million Americans — were abolished and everyone used Medicare for All." What access??? What quality??? When billions of dollars are going to line the pockets of the insurance company, A MIDDLE MAN, then we all lose out. Medicare for All will take a while to move into and smooth the wrinkles out. But we won't be wasting our money on people who want us sick and want us paying them to deny us coverage.
5
As soon as I saw that were were supposedly no benefits to a single payer plan, it was obvious this was just a conservative hit job. What an obvious hack. This is why trying to compromise with Republicans is a fool's errand.
4
I had to stop reading the article when the author claimed a Medicare for all system would limit access to the latest drugs. Our current system already does that. Next bogus reason please?!
4
"The Dangers of Doing Nothing"
The title of my op-eds on:
Keeping the existing for-profit medical industry
Keeping the existing for profit prisons
Keeping the existing environmental policies
Keeping the existing level of funding and immediacy for education
Keeping the current capitalist system
Change is hard. Why did we decide investing in PEOPLE was too expensive? Why am I even reading this silly, alarmist oped?? Actual experts know that it could save money and lives. See the Lancet study.
6
Should someone tell Mr. Atlas that his timing for presenting this article couldn't be worse? Not woke.
Also that his clearly bespoke words indicate that he has been drinking a lot of late—of Koolaid. I saw the CPAC agenda. It's this article in a nutshell.
2
Dr. Atlas is employed by an organization at Stanford that screams its right-wing bonafides at every opportunity it gets.
Do you even need to read it to know exactly what it is going to say? No, and save yourself the migraine.
4
As if "the access and quality Americans enjoy today" is so good.
2
What planet are you on? US is ranked BELOW almost every major industrial nation in terms of health care outcomes.
5
That the author is a senior fellow at the Hoover Institution tells me all I need to know about him. Another screed about why we Americans can't have what the rest of the developed world has, and why we need to support the parasitic private insurance business, with it multi-million dollar CEOs who profit by denying care to the sick. And why we should never elect someone who threatens those profits--like Bernie.
I'm sick of the NY Times printing this stuff.
7
Ok. So seniors should be afraid because:
1. Medicare is being threatened by Medicare for all, so we don’t want Medicare for all
And
2. Medicare is unsustainable anyway
So, the answer is less regulation on a healthcare non-system that is already providing the worst healthcare in the developed world for the highest price.
Does Mr Atlas also have a bridge to sell us in Brooklyn?
One thing I am getting sick of is paid shills, writing propaganda, masquerading as opinion writers. Scott W. Atlas, having failed to take down Obamacare in his previous life, is back defending the interests of the health insurance industry yet again by writing more insurance industry propaganda and defending a healthcare non-system that is throwing millions of Americans into bankruptcy and costing lives.
It would seem this would fall under failure to hold up his end of the bargain on his Hippocratic oath.
For shame.
This passes for acceptable at Stanford? Really????? My god.
5
I would love to know where I can see the statistics which support these assertions
" ... that single-payer systems have shown to have worse outcomes than the United States system for many common diseases like cancer, high blood pressure, stroke, heart disease and diabetes. Or that tens of thousands of additional citizens died because of wait times for nonemergency treatment. "
Let us see that data please.
Or this assertion:
"The Trump administration has begun the process of breaking down anti-consumer barriers to competition by improving transparency essential to value-seeking patients."
This is the problem with applying simple economics to healthcare, there are not 'value' consumers. When you are sick you need treatment and if you are very very sick you need it now. Cost isn't isn't the only varialbe which drives the decision its also outcome - risk. While I am all in favor of transparency I doubt that will have any substantial impact as consumers are seldom in a position to shop around and will rightly want the best care, not the 'affordable' care.
I do agree with the author we have a problem which needs to be addressed but nowhere in his opinion piece does he offer a suggestion. If Medicare for All isn't the solution what is because what we are doing isn't doing it.
We need real suggestions.
2
Interesting that the underlying assumption of the arguments against Medicare for All is that the emergent system will very poorly designed and full of irresponsible flaws and miscalculations that virtually guarantee its failure.
As pointed out by many of the comments, the existing system, in which insurance plays a major role, is hardly the best of all possible solutions, leaving millions without affordable health care.
Given the enormous experience we have had in designing, implementing, and financing the current mixed system, why couldn't we learn from all the mistakes, take advantage of all the expertise, and study systems in other countries, to develop a good system of affordable universal health care?
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 pay $3.6 Trillion a year for healthcare.
That averages to $11,000 per person compared to $4,500 to $6.500 for most of the other first world industrial countries.
We pay 18% of GDP compared to 9% to 10 % for most of the other first world industrial countries.
They get some form of universal healthcare. We have parts of the US with infant mortality rates of a second world country.
Not to mention the hassle of dealing with insurance companies, surprise billing, max out of pocket costs, out of network charges, and medical bankruptcies.
And we don’t have better quality healthcare. Many surveys rank the US at number 10.
Take all the money we and our employers are currently paying to insurance companies and put that into Medicare for All.
And a Yale study published in Lancet shows that Medicare for all would save about 10%.
You would think corporate America would be happy to no longer to be responsible for their employees’ healthcare.
One study showed that Warren’s plan would cost $50 Trillion over the next ten years. But it also showed that if we keep what we have it would also cost $50 Trillion over the next ten years.
All the other countries can do it why can’t we. What about all that American Exceptionalism I hear from Republicans.
What is the Republican solution?
10
I only have to ask the writer one question. Do you have affordable health care? Can you pay the premiums? Can you afford the prescriptions? The only people I ever meet making these arguments have it or can afford it.
6
“It is pure fantasy to believe that the access and quality Americans enjoy today would hold if private insurance were abolished.”
It’s pure fantasy & lunacy to believe that the access and quality Americans get today from private insurance is good, when it’s not the case.
-One Million Americans will go bankrupt this year because of medically-related debt.
-Over 18,000 Americans die every year because they don’t have access to a doctor of their own.
-Despite spending almost twice as much per person we lag far behind many other nations, in such health care outcomes as life expectancy, infant mortality and preventable deaths.
-Almost one in every three dollars spent in this country on health care goes for administration, bureaucracy and profiteering.
9
Ironically, it’s transparent deceit like this from the medical industry, that assures my vote for Bernie Sanders or any politician that will give us M4A.
6
I have Medicare. I pay a monthly premium for it. I also have private seconary insurance that covers what Medicare does not.
Why can't we have both? Medicare, which comes with a low cost insurance fee, and private secondary insurance available for those who wish to have it either through their employer, their union, or purchased privately as an individual choice?
The all or nothing free Medicare seems like a limitation on the choices which lacks consideration of the current Medicare choices enjoyed by our citizens 65 and over. It is a great system that just needs to be extended to younger Americans.
2
@HEH
What you describe is essentially the system in France. And it’s working there.
Fool them with the mystique of the private. Overwhelm them with insurance options yielding minimal coverage, masked in their "choice" that covers the minuscule. Bate them with ads that promises eternal life. Gouge them with astronomical secret costs and fees to charge on credit or go bankrupt on. Sedate them with instant addicting drugs so they need more healthcare. Romanticize the eating of unhealthy food. Make medical school, nursing school so expensive that you drive the motive for profit into the actual providers while they are training, straining the actual practitioners who provide actual care. Employ millions in the game who have job security in customer service, marketing, accounting, pharma sales and hospital administration whose sole purpose is to have people pay the highest for their right to just live. This is the reality of healthcare in the U.S. We have no system. We are commodified and our right to life has been hijacked by the industries who profit. This industry will not address cure rates or positive outcomes. Sickness pays and prevention halts profits this op-ed is just another tactic to obfuscate. Pandemics where even 1% of the population get sick will overrun our system causing more sickness. We overwork our public health officials, docs and nurses actually care about healthcare outcomes, mortality rates and life expectancy so they are always at risk of burnout and sickness. We are in deep trouble, we need public action. Talk is just talk.
5
Your opinion on this issue is probably worth something at the Hoover Institution. It is completely worthless in the real world. It is sad to know that the Hoover Institution's "research" is not based on facts and the experiences on real people.
5
It is pure fantasy to believe people with ACA bronze plans have access to healthcare.
It is honestly quite sad how out of touch the PMC is with the rest of the nation. I am sure Stanford provides exceptionally health care benefits.
Oh to walk a mile in someone else' shoes.
3
I received better care, for free when I lived in Japan and France. And no one but the extremely wealthy in this country can afford those few doctors who foreigners come see. We would lose our homes and be living in tents while we still had an IV.
5
"It is pure fantasy to believe that the access and quality Americans enjoy today would hold if private insurance were abolished." Mr. Atlas, please try telling this to those poor people who have lost almost everything to the medical bills.
2
As a Canadian I marvel at the disinformation constantly tossed out by Americans regarding our health care system. Yes there are wait lists for knee replacements but cancer, heart issues etc are dealt with immediately. We also do not hesitate to see a doctor as visits are cost free. That means we catch issues early. It is a tribute to the arts of propaganda that Americans are so confused about the immense benefits of single payer medicine.
8
"The access and quality Americans enjoy today would be destroyed..."
Yes--but the "access and quality Americans enjoy today" is marginal in much of the country (hospital closings and lack of physician coverage) today and unaffordable. "enhanced with better access and quality of care" would be far closer to the truth.
No--Medicare for all, if it was like Medicare, would provide for a "Medical Advantage" or similar add-on policy--exactly as Medicare does today.
For most Americans today, any medical emergency will ruin them financially--Medicare can sometimes save them from financial ruin -- or not.
Stanford should be deeply ashamed of themselves to be on an editorial that is so deeply flawed.
Any "Medicare for all" solution would provide better care at lower cost to most Americans. (Recall that measured in outcomes like life expectancy, most of Europe with its variations on "Medicare for all" have longer life expectancies--that are still increasing, while ours is decreasing (both slowly)).
1
Here's a thought: every person holding a professional healthcare degree and licensed by a state is automatically enlisted in the Officer Corps of the US Public Health Service for 7 years. The nation picks up 100% of their educational debt and covers their malpractice insurance, provides government salaries and uniforms, etc. In exchange, they go to serve where needed and are not allowed to take "private" patients.
Each rural county has at least one general clinic staffed by USPHS folks and each city of 50,000 folks gets a hospital and two clinics: for each additional 50,000 folks an additional hospital and two clinics are added.
Generic prescription drugs are purchased competitively by HHS through Medicare in bulk and distributed by USPHS dispensaries or contracted private pharmacies.
Folks may take out supplemental policies on their own nickel.
Thoughts?
3
@smfrmrinfrisco
So you propose we should just be drafted into service? Uprooted from our homes and communities if we are needed in a different area. Nice try. I wonder what job you do, and if you think it would be acceptable for you to be automatically enlisted as a government employee, against your will, and told where you will go live and work.
I was for some type of single payer program but after reading the arguments of this op-ed I now see the errors of my thinking in spite of my own dismal experiences with our health system. Of course the US does health care better than any other country in the world and the citizens of these other country are suffering from the lack of care that is the result of flawed single payer systems. Furthermore the author explained how the Trump administration is making our great health care system even better. The US does it better and we would be foolish to try to upgrade to a single payer system which would be a disaster. Also it should not be overlooked that our health care system generates more profits than in any other country and this is for the good of all. Thank you so much Mr. Atlas for correcting our greatly misguided opinions.
1
I'm on Medicare. And I'm not for Medicare for all. But also feel everyone should have medical coverage one way or another. Medicare for a middle class American is not free. So far I've only been turned away once when seeking care. Ideally, I want the healthcare plan that the Senate and Congress have! "If the Affordable Care Act is repealed, members of Congress have a fallback plan. They would be able to return to the FEHBP. Twenty million other Americans won’t." Overall, I don't see any universal free healthcare costs.
Medicare Advantage has a price. My monthly Medicare expenses (a middle class human): Medicare is based on income. Lowest pay nothing. As income goes up, Medicare recipients pay something. And it's going up next year. For 2019, monthly $144.60 for the standard Medicare premium, $57.80 for income-related monthly adjustment, and $12.20 for Medicare Part D=$214.60; deducted monthly from my social security benefits. Then pay $49 per month for HMO United Healthcare policy. TOTAL per month $263.60
Then there's Medicaid thank goodness for those in dire need. "Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services."
"... access to America’s hospitals and doctors for those on Medicare depends on higher payments from private insurance. According to a report by the Centers for Medicare and Medicaid Services, while private insurance often pays over 140 percent of the cost of care..."
This argues forcefully for the elimination of private insurance. If Medicare becomes the single source of payment available to providers, they will not have the option of turning Medicare beneficiaries away as second class citizens.
The 140 percent private payment rate above the cost of care represents an opportunity to extract a 40 percent system wide saving.
And the cost of medical service inputs would fall, from the rents on medical office buildings to the price of surgical staples. These cost reductions would allow the actual health care providers to still make money at a lower price point.
2
Our son is eligible for a government program and we are moving him on to that because our private plans through United Health and Aetna have co-pays that make them prohibitively expensive to use.
It seems the take away from this article is that we need to adequately fund whichever system we adopt.
3
With all due respect I think Dr Atlas is flat out wrong. What more do we need than the proven models for universal healthcare in so many other countries? When I was a teenager many, many years ago I was on a high school trip in France for a month. One of the kids came down with appendicitis while we were in Paris. Do you know that he was operated on and out of the hospital in three of four days ave we did t pay a single penny. It was high quality healthcare without the surprise billing or other other ridiculous loopholes we find in the American system. The bottom line is that wealthy Americans live far longer than poor ones for the simple fact that they can afford healthcare that the poor cannot. That is a massive injustice and must stop. Maybe healthcare quality would drop just a bit for billionaires but that’s about it. Dr Atlas is perpetuating a badly broken system for the sake of profits, not equal access to healthcare for all.
5
Primary care, Geriatrics and Psychiatry are among the least popular choices for medical students. They are also among the least compensated and most in demand. This would further exacerbate the shortage of available providers. Many may leave the field altogether due to increased work loads, stress, burnout and bureaucracy.
1
At the heart of every argument in favor of private insurance is this meaning: We can not afford to provide the poor a level of quality health care that those of us with private insurance consider to be essential.
6
Many Americans just do not want to pay for other people's health care. This is how America differs from the rest of the developed world, where there is a strong consensus in favor of universal health care. In America a substantial minority if not an outright majority do not want to pay for others. Call it individualism or call it greed but that is the way it is. These self-reliant people may find Mr. Atlas' arguments useful to buttress their convictions, but they are going to hold them anyway. This is a matter of belief not facts.
No country with universal health care has had to overcome such a large and militantly recalcitrant bloc. The US will probably not do so either.
If you want Medicare - you will get it. By waiting until you're 65. That will be sooner than it will arrive by olitical reform.
8
The central point here that a better system is pure fantasy is founded on the presumption that something never tried will fail to be as good as what we have now.
Sorry to point out that what we have is not that good.
It might be OK for the author and all of the members of the congress that get free healthcare for life. Of course they want to hold onto it.
Fearmongering based on speculation is as bad as overselling.
6
Atlas's argument doesn't correlate at all to my experience with the public health care system in Canada, where my very elderly parents have experienced several catastrophic health events and received, in a timely way, every necessary test and treatment needed to keep them alive and active. Actually, I've been quite amazed. When I see this first hand I ask myself, Where is this terrible system which people (in the USA) fear? I think people in the USA are having the wool pulled over their eyes.
10
I don't know where Scott Atlas got his "information" about health care in Canada, but his statement that health care "even for the most serious life-threatening diseases" is limited in order to keep down costs is not true. And as far as access to the newest drugs is concerned, this is true primarily for what are termed "orphan" conditions (few patients) for which the costs of the medications are exorbitant but usually end up being made available anyway. Furthermore, while it is conceivable that some people may have died while waiting for nonemergency treatment" his statement that "thousands of additional citizens died because of wait times" is an over-the-top exaggeration. And regarding private health insurance, it is readily available for services and treatments not covered by the government plans. We are free to go to doctors and/or hospitals of our choice and not to those covered by an insurance company.
I am disappointed that the NYT published this article without any apparent fact-checking. While the Canadian medical coverage is not perfect, it is certainly not the disaster that Mr. Atlas claims it to be and no Canadian resident has to fear that having majpr health care issues would lead to bankruptcy.
10
Is Dr. Atlas worried about healthcare in America; or is he worried about preserving the high fees of top echelon health care professionals?
9
Anybody who has a problem with their Cardiologist's salary can go to undergrad get stellar grades for four years.Then med school for another four and be at the top of their class. Then complete a five year residency, with an additional 1-2 years of fellowship working upwards of 100 hours a week. All the while, you're 200,000$ in loan debt is accumulating interest, and your youth is spent in a hospital. After that, expect to work 60 hours a week you're entire career. So yes, they deserve to make more than a social worker. I'm a social worker.
2
@Randeep Chauhan
I see. So its your brother in law who's the
Cardiologist.
Have to say that should we embrace a public option, in lieu of Medicare for all, the outcome would be sufficiently gradual for very little loss of access or coverage. The reason is simple. Once employers see that they no longer need to offer healthcare coverage to remain competitive, they will be glad to rid themselves of that overhead. With more money to put toward their businesses they'll look for more operationally driven ways to expand their competitive advantages. It will be good for job growth and with more pressure on private insurance there's more incentive for transparency on pricing. Likely too to bring about the disappearance of deductibles and other malpractices.
3
In the past 25 years I’ve not met one person who says they like the American system.
Well, just one. That would be my mother who has been on Medicare since 1994.
The piece is nothing but a bunch of carbon fiber.
9
As usual, what Atlas is saying is good healthcare coverage for the likes of me, not for thee. In the thick of the Coronavirus pandemic, wouldn’t it be good to have everyone tested without fear or favor? The fact is that, for example. KKR’s Henry Kravis and the Blackstone’s Stephen Schwartzman, both cannibal billionaires are destroying the US economy, own the two medical outsourcing companies that monopolize outsourced Drs. Nurses, EMS workers and ambulances to ER hospitals across the country. Neither company accepts insurance and both overcharge, forcing Americans to go bankrupt. Add to this the fact that Israeli Teva Pharma, the ultimate manufacturer of generic drugs has been hacking prices and gauging Americans and you see why the cry for Medicare for All makes sense. Of course, it can be tailored for the US, not copied in the British mold and make it work. Can medical education be made more affordable as well? Of course it can. Atlas, like Milton Friedman and Ayn Rand shrug the truthfulness of their agenda.
5
Perhaps the author can explain how all these countries with single payer systems that he implies are terrible compared to ours still beat us hands down on medical outcomes.
- they have higher life expectancy
- many have half of our child mortality
- many have one third of our maternal mortality.
Isn’t it amazing how they manage that with systems so inferior to ours?
And finally, we would like to hear his great plan for great healthcare at lower cost. Perhaps he could provide it to Trump and the GOP, who’s “Repeal and Replace” mantra still doesn’t have a “Replace” after 10 years.
4
Wow. More scare tactics and lies from the MSM against progressive values. Highlighting of course an opinion from the conservative Hoover Institution.
Medicare for all is overdue and will serve the well being of Americans. The dissenters are part of the Insurance-Big Pharm complex. That includes Dem Elites and the corporations that own the MSM.
The suffering of the uninsured and underinsured will only grow. Joe Biden’s incrementalism is easy to embrace for all who have good healthcare. But for the rest of us, a progressive effort and Medicare for all is our last best hope.
5
This absurd analysis is picture perfect example of what Albert Hirschman called, "the perverse effect" -- one of the most pervasive form of reaction rhetoric. It goes like this: You think that making sure everyone has access to clean water is good. But "in truth" given everyone access to clean water will mean more, not less, cholera outbreaks.
3
Most people I know are one serious illness away from serious life changing financial detriment. More robust HSA’s and “price transparency” and “competition” somehow don’t quite make a comprehensive health care system. Price transparency, seriously? As I am racing my loved one to the hospital as he suffers a stroke. Quick, quick.. call them and find out how much this will cost! Or, wait, call that other hospital!
What a lofty perch you are sitting on, Mr. Atlas. It is you that tries to spin the fantasy — a web of deceit that the Trump administration and the current Republican Party is actually doing something to address the very real and problem of healthcare for most Americans. When the reality is to serve the health care industry.
Your biggest, and short sighted, fear is that the health care industry will be disrupted.
Let’s us just see how this lofty system works in face of the coronavirus. I’ll just start calling around now to see how much my local hospitals are charging for coronavirus testing. Oh gosh, if I find out it’s too expensive maybe I’ll just skip it. Or wait until my HSA gets more robust.
2
Hoover Institute is a right-biased regarding economic issues favoring conservative right policies. It gave 94% of its donations in 2016 to Republican Presidential candidates. Scott Atlas is a 65-year old physician who practices in the very highly-lucrative field of radiology. Should anyone be surprised that Atlas is against the public sector option for health insurance? I am disappointed that the NYT did not require Dr. Atlas to give a more complete resume so people might understand potential biases Dr. Atlas might hold.
1
Every time one of these articles run, the comments from Europe and Canada keep telling us how good their healthcare system is.
Many Americans are one job loss away from being left uninsured and if they have a preexisting condition,
they look for bankruptcy lawyers.
2
I think the US healthcare system needs fundamental change - including the way care is delivered. Just arguing about who to pay (medicare for all or not) is NOT going to solve the problem.
Perhaps it is time to examine how other countries (beyond the European ones) and go to Asia even to see how they are doing it. Asians have different mindsets and upbringing. For example, as part of their Asian Confucian value system, Asians view community as above self (and less individualistic as compared to US/Europe). Due to these different values, the way they structure their care will be different.
Hence, US should learn from them all and embark on holistic change - beyond a simple "medicare for all" slogan.
Perhaps this NY Time article from last year is a good starting point, about my country of Singapore, located in South East Asia.
https://www.nytimes.com/2019/04/22/upshot/singapore-health-system-lessons.html
2
As a kid in the 1950's, I watched as the Medical Associations assailed "socialized medicine", linking it to the dreaded Red Menace.
And still today, medical care is delivered to poor people as some sort of welfare, not as something that is a human right.
Of course the game is rigged, and nowhere is it more apparent than how the medical monopoly restricts care to the poor and the powerless, so the wealthy can be milked for every dime.
National Health Care for the United States is our greatest need, and the war against it is killing people.
Hugh
2
Private GOP insurance they support has been the down fall of capitalism insurance. With greedy CEO’s charging 5 times more for premiums the 99 percent of Americans cannot even pay. Why keep a greedy system that charges 100.00 for an aspirin when a person is in the hospital . I liked the GOP fake response we will let the consumer over state lines for better deals. Well in our capitalist society every state was costly for insurance. The NYT’s did an article not long ago where it said there are just a few rich men in America keeping the prices high for us all. The article said low prices would enable more people to get help but we don’t want that. We need to arrest them for crimes against society and then be able to have a good affordable health system. I am for closing all the rip off private insurance firms. They have been around the last 100 years and look what the caused. 99 percent can’t afford their prices.
1
Over 70% of the American population has come to the conclusion that health care is human right, not an opportunity to profit from human misery. The corporate interests that the author represents will be the biggest losers when MFA is enacted. Rather than falsely claiming that the average America will suffer if private insurance is abolished, it would have been more honest to layout how the private powers that he serves will be impacted when their gravy train is finally derailed and then beg for mercy, the same mercy he wants to deny the American public.
1
We are supposed to take seriously an opinion piece from a conservative think tank named after the president who brought us the Great Depression, on the same day we might be witnessing the start of a new one? Honestly, I don’t know why the Times prints this stuff. Insurance is a relatively simple accounting function. It operates most efficiently with the largest pool, with the broadest possible shared risk. Private insurance has a different definition of efficiency from public insurance. Private insurance exists to draw away profits from a service we all need, while providing reduced quality coverage in an effort to keep profits high. This isn’t rocket science. Public insurance like Medicare for All works for patients, not shareholders.
2
The "quality of medical care" we enjoy today is awful.
The only people who get good care are the healthy ones. And that is because you don;t have to do anything for healthy people.
2
Why are conservatives so hellbent on wishing the whole premise of universal health care would just go away? Could it be because the pharmaceutical industry is one of the primary financiers of the Repub party and less money will mean less power? Have we really come to that?
2
What a bunch of propaganda this article is. To imply that the US system is cost-effective and has superior outcomes is simply not true. We pay twice what other large countries pay, and we only compete favorably in a few outcome measures. In many diseases our outcomes aren’t in the top 10 vs other countries. He seems appalled that M4A would cost 32 T$ over ten years (3.2T/year). Healthcare spending in the US was 3.7T$ in 2019. In 2026, it will be 6 T$. My healthcare premium now is almost $25,000 per year for my family. And that’s if nobody gets sick. The author makes no mention of what Americans are supposed to do about these outrageous costs. He sounds like a Republican Insurance Company speechwriter.
3
"It is pure fantasy to believe that the access and quality Americans enjoy today would be maintained...."
Yes. That is precisely the POINT. Especially to the 30 million Americans who have no insurance.
2
Dr. Atlas makes the claim that countries with universal health care have inferior health without providing any supporting evidence. The landmark Institute of Medicine study "Disease and disadvantage in the US and England" is one of dozens of major scientific studies all of which have drawn the opposite conclusion. https://jamanetwork.com/journals/jama/fullarticle/202788 My personal experience of the inefficiency and greed of the private health care system, although purely anecdotal, is consistent with this. The first priority of private health insurance is profits for its executives and stockholders, and those profits come out of our patients' care. The only reason Americans buy into "Medicare Disadvantage" is that when you reach 65 you are inundated by advertising for these plans cleverly designed to suggest that they are official communications from the government and you have no choice.
Dr. Atlas appears to make his argument entirely on the grounds of his own bias. I respectfully suggest a modicum of objectivity.
5
A highly contagious pandemic is going to show the inadequacy of private, for-profit health insurance, cynicism about government, and contempt for expertise, all championed by the Trumpublican establishment.
1
I don't understand it. Most countries on this planet (including the whole western world and lots of third world countries) has universal healthcare for all. Both rich hardcore neoliberal capitalist rightwing countries has it as well as left wing countries. On every side of the political spectrum people in all sorts of different societies agree on this subject. Apart from the USA and a handful of poor instable corrupt countries in Africa and Middle East. It's tragic for so many Americans.
2
Other nations do it because they do not pay for what we pay for. We pay for everything because the people demand it. You cannot have what we have no and pay for it. Care will be cut. Necessary care? Probably not. That shoulder mri that you think you need? No way. That “try anything” drug for pancreatic cancer that may extend your life a few weeks? No way. I have worked in Canada. You do not know what you are asking for.
1
What nonsense! And your handle implies you’re A New York surgeon?
My wife and I had our children, five dollars a day for a semi private room.
My wife developed breast cancer and received full treatment and recovered thank God, no cost whatsoever. This was months of radiation therapy and chemotherapy and rehab.
In the province/state of British Columbia, Canada, my *optional* extended health through my employer, to help cover eye health, root canals,etc. is $35 each. Hospital visits, emergency visits, ambulance ride, heart surgery, and whatever else similar is no cost to us. through the government plan.I pity you in the US. If you ever get a decent medical plan for everybody it will take years.
@Philip
Nothing your wife got was wasteful. I admire the Canadian system tremendously. There is little or no waste. What we have here now is nothing like what you have. We throw money away. That is what needs to stop.
1
This is alarmist nonsense. We have insurance tied to our employer. The “best” plan, is a high deductible plan that costs nearly half of our salary monthly. The insurer picks and chooses what they will pay for in network. It sometimes takes several weeks to get this approval, then get stuck with an astronomical copay. The insurance and health care industries are out of control and need to be reined in by any means necessary. Medicare for all would spread out the risk pool between old and young, which would lower costs for everyone. We are literally dying out here and I’m one of the “lucky” ones.
3
I'm not sure what planet you are on but I'm on Earth and live in the United States. My employer provides a health plan that discourages me from seeking care due to high out of pocket and I am talking HIGH out of pocket costs. God forbid I develop cancer. Super God forbid if I need to get a knee replacement or back surgery. I will have to file bankruptcy. Our insurance situation in the USA is a JOKE.
1
"It’s not just because single-payer systems like those in Britain and Canada hold down costs by limiting the availability of doctors and treatments, even for the most serious life-threatening diseases like cancer, brain tumors and heart disease."
Wow, this old whopper appears in just the second sentence of this opinion. It is simply false that the Canadian model limits the availability of either doctors or of treatment for cancer, brain tumors, or heart disease. False. The population of Americans without health insurance of any kind is greater than the total population of Canada. Talk about "jeopardize[d] medical care."
It is too much to hope that American doctors with a lot to lo$e in a switch to Medicare for All will speak and write truthfully about that policy change. But it should not be too much to hope that the New York Times would edit opinion articles for truthfulness on a topic that matters a lot to millions of Americans, and matters a lot to non-Americans like me with many relatives in the USA who suffer for lack of decent affordable care. Articles like this are shameful roadblocks to improving their lives.
5
"...empowering seniors to seek value with their money with more flexible coverage and larger, liberalized health savings accounts, stimulating competition among doctors and hospitals, and increasing the supply of medical care generates what Americans most value and expect from health care — access, choice and quality." This is pure garbage Mr. Atlas. The last thing seniors need or want is to complicate health coverage what you just stated above. When I'm a senior I don't want to be presented with a complicated set of options for my health care. It should be as simple as issuing each senior a Medicare card that they can present at any medical facility or pharmacy with no questions asked.
2
Dr Atlas says Medicare does not pay doctors and hospitals enough. If you look at his CMS reference, you see it applies to future reductions in Medicare payments. His other reference is from the American Hospital Association, hardly an unbiased source. He also gives percentage, not numbers.
Let's look at doctors. Here are some figures from 2012. They would be higher today:
You can find results with data at http://healthaffairs.org/blog/2012/10/02/do-medicare-and-medicaid-payment-
rates-really-threaten-physicians-with-bankruptcy/
The author, a private practice orthopedic surgeon, looks at orthopedists and family doctors. He finds that an orthopedist who had only Medicare patients would have a take home income of $411,000. I could live on that.
A family doctor who had only Medicare patients would end up with $137,000, a lot less, but you know I could live on that, too (which is more than I ever earned) if I didn't serve Chateau Petrus on weekdays.
What about hospitals? Dr Atlassays that because Medicare does not pay enough, the hospitals are forced to shift the cost to private insurance. i.e. there is causality. If there were such causality, then hospitals with a greater percentage of income from Medicare would have to charge private insurers more than those with a smaller percentage. So there would be a correlation between the percentage of income from Medicare and the fees to private insurers. But there is MedPac data that shows no such correlation exists.
2
Lies! This opinion against universal healthcare, such as Medicare for All, rolls out the usual suspects of distortion, misrepresentation and, yes, lies to support its thesis.
The only reliable fact in this piece is in the first clause: "It may seem counterintuitive, but ...".
2
I hate to tell you, but you’ve misplaced Dr. Atlas’s opinion piece. If you had a Fiction section, that’s where it should be. I could barely get beyond the first paragraph, where he asserted that in places with universal healthcare (like Canada, where I live), people get second-rate treatment for critical conditions and abysmal treatment for everything else. I lack Dr. Atlas’s credentials, and I can only offer two small personal examples to make my case, but here they are. When I was diagnosed with bladder cancer five years ago, I had surgery within two weeks and have had a course of treatment (not universally available in the US) ever since. I remain cancer-free. My husband’s two arthritically wonky knees were both replaced last year within four months of each other, and he’s back playing tennis three times a week now. We paid nothing, beyond our taxes, for either situation. I could go on, but you see what I mean. And we are far from atypical. Americans drink way too much of the kind of Kool-Aid Dr. Atlas peddles.
5
I see the dangers of our current healthcare system every day.
I have a son with a fledging business in Europe who can’t afford to come back to the US because of the cost of healthcare. He has Spain’s federal healthcare plan that covers all citizens and also has a private plan that covers additional items like dental. His cost for the private plan is 45 Euros a month. His business taxes are 300 euros a month which include healthcare coverage. He has no deductibles. He has had no issues with accessing healthcare. If he came back to the US, his costs on a base plan would be at least double with huge deductibles and limitations on doctors and hospitals.
If the Republicans have their way, preexisting conditions will no longer be covered.
I looked up information about the Hoover Institute on Media Bias Fact Check.
“The Hoover Institution receives nearly half of its funding from private gifts, primarily from individual contributions, and the other half from its endowment. Funders of the organization include the Taube Family Foundation, the Koret Foundation, the Howard Charitable Foundation, the Sarah Scaife Foundation, the Walton Foundation, the Lynde and Harry Bradley Foundation, and the William E. Simon Foundation. According to the Center for Responsive Politics (opensecrets) the Hoover Institution gave 94% of donations to Republican candidates during the 2016 election cycle.”
2
Why limit this discussion ( unless you are from a conservative “Think Tank”) to the U.K. and Canada?
IF someone like Warren or Sanders were president, I would assume they’d be looking at the best world healthcare “models”. Germany, Switzerland and France, as well as Norway, Sweden and Denmark.
This “column” is simply the talking points for insurance companies and big pharma. No other country allows the profit motive to control their healthcare.
2
Anything from anyone at the Hoover Institute is going to be pro-corporate, pro-profit, and for those reasons without care for individual citizens. Nice try, Dr. Atlas.
2
If everyone had the same access where is the infrastructure? We are short of Doctors and nurses now. Could the system stand the shock? We need to stop talking fantasy and get down to the nuts and bolts of universal care.
1
Because only 32 of 33 developed countries provide healthcare to all their citizens. It would never work in America?
2
Anyone who thinks healthcare in this day of modern medicine is something you want to be subjected to, regardless of where you stand as an insured customer is imho, nuts. For profit healthcare sees you as a profit node. That is why we need socialized medicine. So we can be seen as humans again.
1
The Common Wealth Fund rates the US last in comparison with 10 industrialized countries on cost, outcomes and access. The US still has 30 million uninsured, 40 million under-insured and 45,000 people that die because they can't access this system.
If Obama care hadn't outlawed "pre-existing conditions" clauses then 125 million Americans would still not receive care for specified illnesses.
Yes Bernie's plan would cost $32 trillion over 10 years. Our current system costs $34 trillion over ten years. So how do we pay for it? We use the same money we're using now minus $2 trillion dollars. What a ridiculous op-ed.
3
Conservative defeatism. Americans used to rise to a challenge and had faith that "we can do it, and we can do it better." Conservatives think "we can't do it," and ignore the vast inefficiency and ludicrous expense of health-for-profit. Canada and Germany and the UK can do it, but we can't?
Conservatives have lost faith in America.
2
It's just too hilarious to bother commenting on, except to note that these kinds of misleading reports, and artful disinformation campaigns, will ramp up as we approach the Democratic convention, and no effort and expense will be spared as corporate America faces the reality that Bernie Sanders might still prevail.
The Lancet, a most respected publication, debunked the lies of corporate America and our corporate owned government, see excerpt and link -
"Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017)."
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext
3
Simply glancing at this opinion piece from a high-level clearly illustrates how needlessly complex the healthcare system is in the United States.
Multi-part Medicare supplements...private insurance supplements...inconsistent “invisible” pricing...thousands of divergent private insurance plans…myriad forms and paperwork...no single, encrypted electronic health record. Why, it’s enough to drive one crazy, or—worst case scenario—keep one from being insured at all (let alone going bankrupt due to medical costs).
We need one, collective “pot of money” to pay all of this from, we need one highly-encrypted electronic medical record to use among all patients, we need a single, A.I.-based scheduling system to ensure that everyone gets to see the doctor or specialist they need to in a timely manner, we need to drastically lower the cost of going to medical school to ensure that we have more doctors and nurses and we need a highly progressive tax structure to pay for all of this.
Speaking of taxes, our entire tax system needs an overhaul. If I had my way, taxes would be spent with the following priority: 1) climate and the environment, 2) healthcare, 3) education, 4) infrastructure and 5) defense. Obviously, other items would be intertwined within that list, but that would be the over arching priority.
1
Why is Dr. Atlas given credibility ? Because he is a "Dr." ? Nonsense. Fellow at Stanford -means little. Here is the Medicare for All arguement in a simple to understand version:
A. America spends 2x as much on Healthcare as W. Europe
B. America USED to spend the same - 8% of GDP
C. America gets HALF the Health Outcome
So: America spends TWICE as much for HALF the Health Outcome.
Facts: We could save 10% or more of GDP per year or $2.5 Trillion a year with M4A. This should appeal to Conservatives
Fact: M4A is Family Friendly: Eliminates Jobs-For-Healthcare - parents home instead of 2nd or 3rd jobs - also argueably a Conservative credo
Media, Analyists, Politicians all Over-Complicate M4a
2
simple reason US cannot afford free medical for all, $1,000,000,000,000 for defense and off budget' wars
2
Here is one concern with a single-payer system. What happens when Hannity or the Papa John is the next GOP president? That person will then run your healthcare. Having a healthcare system that one party wants to rip to shreds every time they are in office isn’t good for anyone.
So give us a public option!
1
The motivated reasoning is strong in this one.
expert cherrypicking of statistics that the Hoover institute is famous for.
1
Two facts: First, in Canada and the UK (or any other western European country with a similar system) nobody goes bankrupt, or just plain dies, because they can't afford health costs. Second, the life expectancy at birth in those countries is higher than in the USA, and the gap has been increasing for several decades now.
2
Did the authors miss the news about Covid 19? If there is any silver lining to the pandemic, it is that universal health care will finally be seen as truly good for everyone. "My" health care only have value when everyone is served - and protected. When I pay for my health care insurance, I know I am being cheated and exposed to health risks because the system excludes so many of my fellow countrymen.
1
Dr. Atlas is looking at choice, access, and quality from a perspective of privilege. For the world largest economy, pro rata, there are far too many people who simply do not have the choice or access. Quality is moot in the latter case. Having said that there are countries that have worked out how to have private and public healthcare (Australia) and the system is quite transparent.
1
"...the Medicare for All Act by Bernie Sanders could cost an estimated $32 trillion in its first decade, more than double all currently projected federal individual and corporate income tax collections."
The Medicare for All Act would actually decrease medical spending by controlling the price of medical goods and services. Spending simply shifts from private insurance premiums, deductibles, co-payments, and uncovered services, to taxes or Medicare premium payments.
2
We all recognize that costs in the American healthcare system are bloated - it is expensive because it is a huge industry, employing 21 million people, most in high paying jobs. Of course they don't want to give that up but the fact is, if we cut costs in healthcare, it will mean some of those jobs will be lost and if we have less people providing the same services we will indeed experience a change in quality. But this is not a consequence of Medicare for All, it is the consequence of making American healthcare more affordable.
Personally I think the whole question is moot - our system is too corrupted by lobbyists for Congress to buck their influence and pass legislation that will have a major impact on the medical-industrial complex. We have not even been able to make progress on the simpler problem of drug costs so how will me make progress on something bigger and more complex? I cannot see it until perhaps we have another Obama-like confluence of a Democrat President, House and Senate, and even then it is a big maybe.
Stop with the nonsense. Read the comments. I am a dual citizen of Canada and the United States, with the rest of my family in Norway. The staggering issue in the United States is ignorance and stupidity. The United States is a backwards country racing for the ninth century. We even talk about abortion as if it is a topic worthy of debate.
I came here at 16 for school and am grateful for my superb education in high school and university, but out of those environments I see nothing but dumb, dumb, dumb. It's embarrassing.
19
@Linda Hard to understand, then, why you're still here rather than in the far more enlightened countries of Canada and Norway.
1
@Carl Yaffe
Gee. Maybe its for reasons other than our healthcare system?
I think you'd get more traction by refuting his arguments with a blistering, fact filled refutation of his positions.
Dear Dr. Atlas, The whole point is to remove profit from basic healthcare. If you have the means, you will still be able to charter the luxury suite on the hospital's top floor.
26
Mr. Atlas it is so obvious that you are part of the propaganda machine try to protect the healthcare insurance industries huge profit making machine. Which healthcare insurance companies are funding your supposed research projects? We the American the people are fed up with the notion that profits come before all else.
What happened to the Hippocratic Oath? Does it no longer exists in the American healthcare system. Doctors may have take a modest pay cut, so that all Americans can have the right to healthcare services without having to worry about how they will pay for it. Or if it will bankrupt them. Do doctors care more about the fancy car they drive or truly caring for their patients? I would hope and think most doctors would take a modest reduction in pay to truly help their patients.
The big loser, if we get medicare for all, would be the healthcare insurance industry. For decades they have been spending huge amounts of money for lobbyists and propaganda to destroy the possible idea of Medicare for All.
Recent studies have proven that Medicare for All is very doable and it would save money over all. Doctors and healthcare facilities would have to take a modest reduction in their profits but how much money is enough? The industry has been making record profits for decades.
The wife and I now pay $1000 a month in healthcare insurance premiums through my employer. I for one would gladly take that money and instead use it to pay taxes to cover Medicare for All.
28
@Rick
I pay similarly, AND have a 5K deductible.
2
"We also must not ignore the fact that Medicare is already facing serious financial challenges. A projection in the 2019 Medicare trustees’ report states that the Hospital Insurance Trust Fund, one of two Medicare funds, will be depleted in 2026."
This is a cogent argument for one of both of two policies: either raise Medicare taxes on higher-earning individuals, or fund Medicare from general revenue funds, perhaps by decreasing spending on the endless wars than undermine rather than bolster national security.
2
Agreed on the spending for wars. However, any significant military cuts will result in base closures and demobilization. What happens to all the newly unemployed?
The military is also a de facto training and social program that any cuts would have to account for.
"It may seem counterintuitive, but single-payer health care proposals like Medicare for All COULD very well destroy Medicare as we know it and jeopardize medical care for seniors."
Leave it to someone from the conservative Hoover Institute to promulgate scare tactics to a consistent voting group, the elderly. Think for yourselves; do NOT allow the conservatives to provide the narrative.
3
Where to begin? Seldom have I seen so many straw men in one short editorial. I’ll pick just one example:
“And it’s not just because the Medicare for All Act by Bernie Sanders could cost an estimated $32 trillion in its first decade, more than double all currently projected federal individual and corporate income tax collections.”
So? Where’s the relevance in comparing the cost of healthcare to the cost of government (= federal income tax collections, plus deficit spending)? That’s comparing apples to oranges; it’s not a valid comparison. Mr. Atlas needs to explain that — if he can. He also needs to acknowledge that Senator Sanders’ healthcare plan is likely to SAVE around $5 trillion in its first decade according to a recent, comprehensive third-party academic study (https://www.washingtonpost.com/business/2020/02/20/lancet-medicare-for-all-study/). Then Mr. Atlas could compare apples to apples: $32 trillion for the Sanders plan versus $37 trillion for the status quo. THAT’S a logically valid comparison. The numbers may be off, but at least it’s logically honest.
3
Bad timing on that article. The coronavirus is shining a spotlight on the "world's best health care" and spoiler alert...it's not for everyone!
If America is too incompetent to run a heath care system, then give the contract to France or Australia. In every other country in the world a medical education is almost free, doctors are widely respected but not overpaid, and they don't have a bottomless pool of rent seeking non-medical workers that feed off the skills of actual health care workers with direct patient contact. My doctor has a receptionist. You pay your bill, they enter the cost into the computer, and the government pays your rebate back into your checking account overnight. No insurance billing department. There are not more non medical employees than medical employees in the office.
Pundits who bash the Canadian system and Britain's NHS pop up right on queue this time in the election cycle. Every. Single. Time. They never seem go after France or Australia or Singapore, or Switzerland or Slovenia...so look somewhere else.
The US health care system is not working for the majority of citizens. People don't even get on a waiting list because they can't afford to take time off work and can't afford to go to a doctor. Health Insurance companies already ration health care by not paying for it. The medical education system already rations health care by restricting the number of graduates.
Address how the US already rations health care and how that could change.
6
I was very sick, I thought it was just a cold, I cold the Dr to see her and I was told I needed to pay extra $75 to see her that day, but if I waited 3 days, I wouldn’t have to pay the extra fee. I went 3 days later, and I found out I had the flu. Unfortunately, within those 3 days I had to go out to pick up my children from school, so I’m sure I must have at least infected 10 people during that period. At the same practice, I called to get a flu shot. In spite of my Cadillac insurance, I was told that for me to get a flu shot, I needed to get a full check up, over $200, which wouldn’t be covered by insurance, as I had already had a check up. I went to Costco and got the flu shot for free.
3
Although the main arguments in this article are correct, it is incorrect o say that a public option will undermine medicare. It won't as long as it is an "option" and not mandatory. It is likely that the insurance companies implicitly collude especially using government mandates as ways to coordinate. A public option is abetter way to act as a check than arbitrary "over regulation" of health care.
1
One only needs to browse Wikipedia's map of countries with universal health coverage to understand that the U.S. stands alone amongst developed nations with their 'pay for/for profit' healthcare system.
I watched an American woman on tv yesterday discussing the sheer costs of her heart medication and insulin, and how she couldn't afford both. She decided to prioritize the heart medication and said "I know my diabetes will eventually kill me, but with my heart condition being more serious, I should get the most years out of prioritizing my heart meds over my insulin versus the other way around."
The fact that American's tolerate this from the world's wealthiest government is an absolute travesty.
And this commentary on private insurance being abolished serves as pure fear mongering.
I pay into an insurance plan at my office here in Canada. Not everything is covered for free in our system. Tons of things have costs, even small things like doctors notes.
We essentially run a semi private/public health care system, which is really what the U.S. needs and I imagine is talking about.
Private insurance stays, choice stays, and oh, you can still pay for certain operations in Canada and "jump the queue" if you'd like.
The misinformation in this discussion is outrageous.
4
Other countries have universal health care for all and private health care insurance in addition for those who wish to pay for it. Why would a similar system not work here? If you have private health insurance you do not opt out of universal healthcare. But you do have access to your own concierge medical team and perhaps faster access to a specialist, that's all. Politicians should clarify all this because there is a lot of confusion out there as to exactly what medicare for all actually means.
1
"Here’s another truth — abolishing private insurance would impact today’s seniors on Medicare, because more than 70 percent of Medicare beneficiaries use private insurance to supplement or replace traditional Medicare."
The Sanders' Medicare for all plan would eliminate deductibles and co-payments, obviating the need for these supplement plans.
3
I don’t believe we have better outcomes. Part of a compromise will be retaining supplemental private insurance to the national health insurance, as they do in the UK and Europe. The private system should be heavily regulated and not-for-profit. Medicine in this country is a racket. US physicians make far more, nearly double, the highest in Europe. Why would they want to give this up? We need to break the Dr shortage and AMA monopoly by paying to educate Drs and health care professionals. We can’t afford not to.
3
I'm battling a cold right now, and under the circumstances, I probably ought to see a doctor, but every doctor visit I make results in a minimum co-pay of $500 plus whatever prescription drugs I have to pay for out of pocket and I don't have that disposable income available.
Since I haven't recently that traveled in an affected area, or been around anyone who has (I hope), and since a reliable COVID 19 test is apparently not available in my rural area, I'm making the decision that this cold is about the same as the one I get every year about this time, and I plan to tough it out and go to work
At work I will interact with at least 150 people each day. If we had real access to universal health care, I would be seeing a doctor today and staying home from work, and that would be the smart decision. But I can't afford to miss the work day and I can't afford the doctor bill either.
2
In the first paragraph you already came to the greatest problem of the U.S. health care system; that it is profit driven. Hospitals rely on the higher paying private insurance only so they can keep profits up.
Health care should not be profit-driven. It is an essential service, and therefore it is immoral to deny it to people based on their social and economic status.
6
I would like Mr. Atlas to meet my English mother. She is 80 years old. A year ago she was diagnosed with metastatic lung cancer. She was immediately whisked into (NHS) hospital. Surgery was done (lasting 14 hours) to remove her lung, breast, ribs, collar bone, and part of her chest wall and to reconstruct her insides with a kind of medical concrete--and then plastic surgery. She was in the hospital (in a private room) for weeks after that surgery. After she got out, visiting nurses came by twice a day for a couple of weeks, then aides came by three times as day to help her get out of bed, bathe, eat, for a few more weeks. Her meds are mailed to her in one big package once a month, all sorted into daily doses. (Anyone who's ever taken care of a very sick person knows how complicated it can be keeping track of what meds to take when.) For all of that, she didn't pay a single penny: rather, since the day she got her first paycheck, some 60 years ago, she has paid a premium (small, compared to the insurance premiums Americans pay) to the NHS out of every paycheck. Now, when she really needed it, the advanced (and immediate) care was there for her, and money was the last thing she had to worry about.
Now meet my American husband. He died a few months ago from cancer. And, he died a bankrupt--with all of the shame that bankruptcy brings to an otherwise hard-working man, a man who had worked all of his life but, when faced with the medical bills and co-pays, ended up with nothing.
13
Lack of health care kills people. Inadequate coverage causes people to end up in bankruptcy court. Getting sick or injured should not result in two anxieties - the illness and the expense. Is that better than Medicare for All?
When did the USofA become the country of can't instead of can do?
3
We have a problem. Health care is twice as expensive in the US as in any other developed country, and many millions of citizens cannot afford access to regular healthcare at all. This is evidently a problem that can be solved, since all of our peer countries have found ways to provide universal health care access at half the cost. If Medicare has to be subsidized, it is because (1) seniors are less healthy than the general population, which is going to remain true in any system and (2) our health care already too expensive by a factor of two. There are many very different solutions to providing universal health care; Medicare for All is possibly not the best solution for the US - the German or French public/private systems might be a better fit for us. Let's start with admitting we have a problem, and find a solution.
1
If all of these countries with single payer insurance have worse outcomes for heart attacks and diabetes, why does the author fail to cite the studies where these results have been published? For all we know, he could be making this information up. I would love to see those published studies (even though I doubt they exist). For being a fellow at Stanford, he seems to have forgotten the basics of academic writing, cite your sources.
2
Wait times?
I am a surgeon in the U.S., and approximately 30% of my patients do not have a primary care doctor, and the ones that do, many of them say they never have seen their doctor or they say they never can get into their primary. So they show up at the ER in extremely poor condition, I admit them, perform surgery, discharge the patient and get social services involved to try to get a primary care office visit to manage their diabetes, opioid overuse, tobacco use, hypertension, etc. It is still difficult to get him in for weeks, if at all!
43,000 Americans die of treatable diseases each year due to lack of health insurance. Canada zero.
Eternity is a long wait time.
This article is false in many regards.
14
Well said! The numbers and facts in this article are presented to warp the opinions of the reader. When on vacation in England ten years ago, one quick call set in motion a cascade of excellent care for me. A car was dispatched from 35 minutes away, arriving promptly and whisking me into the distant town to see a family doctor, swab samples were taken, and medications given to me with an RX to use, depending on my condition the next day. An RX for a possibly needed MRI was provided to me and written instructions with a phone number to get a quick appointment. A follow up call would be made to me. The car then came back to pick me up and drive me back to the hotel 35 isolated miles away from the doctor. My cost for this excellent service => ZERO.
True, thee taxes there are very high, but there are few other health costs involved. There aren’t high profit health companies taking the dollars, the gov’t agencies do the paperwork.
I Don’t think this would work in the United States, because the population simply appears unable to add up the numbers, preferring instead Alarm and refusal to even try to understand the numbers. In fact we could finally get a substantial benefit from the taxes we pay.
With many Canadian friends, I have never heard them complain about their overall health costs, indeed they brag about their system. There may be deaths while waiting for ‘non-emergency surgeries, but such cases occur in the U.S. all the time.
We need a compromise system in the U.S..
2
I don't know how to respond as a Quebecer whose local University oversees health education and welfare. We are a couple of hours from Harvard but our local research hospital is a world leader in brain research and our healthcare as a right has evolved for over 70 years.
We are not Americans and do not have the same ethics and values. Greta is our hero and we have kicked God out of our schools, courtrooms, and public spaces. We are humanists and what matters is healthy productive life and our expectation for a better future. Our population is less than Michigan's and it is hard for me to imagine healthcare worse than I experienced in deepest darkest Red Michigan. I suspect now they are working on the best leech to apply.
I wonder what happens after the next USA election if the best and brightest from all over the world look to other countries to ply their trade.
I have USA Medicare and Quebec Hospital Assurance and I never use Medicare despite the closest hospital is in Vermont and it has a sterling reputation.
Your next election will be between fear and loathing and I don't know which is more self defeating.
Election shouldn't be the lesser of two evils.
Since Reagan when we were well behind in quality of life we have moved to the head of the pack while the USA has fallen behind except for those privileged with the best healthcare, education and life skills. We know what American privilege looks like we call it decadence even when it is grandchildren.
11
That is what my GI guy told me 20 years ago when he was the chief of staff at a local hospital. The reason Medicare was able to get lower prices was because private insurance paid more. Granted, hard to know what cost of service is when Medicare + my supplement paid 15 grand when the hospital bille me 75 grand. Also, my cousin who lived in the UK died because her needed heart surgery was delayed almost a year.
I think things worked better before they started trying to improve them. (As in the sixties and seventies.)
1
I think the only way Americans can get the sort of low cost cover all and everybody health care that most rich (and even middle income) countries have enjoyed for years will require just one radical change...but is sure to get results faster than anybody may think.
Withdraw the Medical Health Care Cover/Perks currently enjoyed by all State and Federal politicians and make their health care as proportionately costly, stressful, difficult and confusing as it is for so many people. Also give them a taste of the insecurity , desperation and hopelessness many of them so easily deny those too poor or "deserving" of health care/coverage ...the 20 to 30 million people who have none at all.
Put the Politicians on an as unequal footing as the majority of Americans and also give them a taste of the insecurity and hopelessness that 30 million less fortunate Americans must survive with...
Do these things to THEM and watch how fast they start working to provide a better,more affordable healthcare system for all Americans...including and mostly for them!
That will motivate Congress to get things done like nothing else...guaranteed.
8
This is an example of series of over-simplifications, biased interpretation of studies, over-use of technical words with very little actual meanings, abuse of irrelevant numbers, self-contradictions, etc. It is certainly true that “Medicare for All” could bring his share of problems, but we need honest people to criticize it with a decent level of objectivity, not opportunistic wheeler-dealers.
7
@Frederic Calon That's what Mr. Atlas gets paid for.
1
What is it with the American right wing?
Every point in the opening paragraph about the Canadian medical system is incorrect, every point.
In Canada, you can see any doctor you want, as often as you want for anything you want. Care is NOT limited to save money. Access to effective drugs is NOT limited. Our system has BETTER outcomes for cancer, heart disease, stroke, diabetes and high blood pressure. Wait times for non emergency procedures has NOT resulted in the deaths of tens of thousands of people.
The right wing specializes in flinging so much mud that it becomes impossible to see the truth, but when lives are at stake the immorality of doing that is shameful.
24
An additional benefit to Medicare for All is the freedom it will provide to workers- especially those in their late 40s, 50s and early 60s- to scale back from the full-time workforce and do consulting or start businesses, freeing up jobs (at higher salaries) for new graduates (at lower salaries). The mission of the Hoover Institute at Stanford is to "promote economic opportunity and prosperity, while securing and safeguarding peace for America and all mankind." I'm disappointed he is overlooking this significant related economic benefit.
7
It is well known that while the US has the world's most expensive medical care we do not have the best health outcomes and come in well behind the other first world nations in overall health indices. The private fee for service system is very inefficient.
9
Western European countries provide socialized medicine. People are healthier by many metrics and they live longer. In addition, no one had to go through medical bankruptcy.
If people keep buying into fear mongering, them they have no one to blame but themselves for the continued way in which we provide healthcare.
10
I believe I’m familiar with each of the discredited studies from which Dr. Atlas draws the falsehoods which pad his opening paragraph.
I can’t be certain, since his presenting these speculations as fact includes his omitting any mention of which study each is drawn from.
I believe I know the studies, though, because each became notorious for drawing conclusions directly contradicting those of larger, better-conducted studies, as well as for contradicting the lived experiences of pleased universal healthcare recipients. What these failed studies have in common is a reliance on opaque and often fishy decisions to “weight” their datasets unusually.
One study infamously adjusted mortality rates by weighing deaths in countries with a high per capita population of doctors more heavily than deaths in countries with fewer doctors. So an Eastern European country where cardiac events had a high mortality rate but where doctors were few was “adjusted” so that its mortality rates appeared lower than England’s… on the basis of England having more doctors.
These small discredited studies, often lacking peer review and employing “proprietary data” not subject to public scrutiny, fail to reflect reality… but they do succeed in aligning perfectly with the preferred policy prescriptions of the private insurance and pharmaceutical industries.
That Dr. Atlas bases his entire presentation on them should tell you everything you need to know about the value of Dr. Atlas’s conclusions.
14
Healthcare is the largest “industry” in Philadelphia. and in many other cities as well
Anyone care to figure out the unintended consequences of completely altering a large portion of our economy?
3
@SN Many wish that Cigna would disappear from the face of the earth.
I’ve worked with hundreds of Canadians over a twenty year period and make a point of asking if they’d trade their health care system for ours. Every time, they are adamant that they would not. I follow up by asking if they have to wait to see a doctor. Their answer is usually not, only in rare circumstances. They have all expressed a general satisfaction with their health care system. Every one of them.
The facts are that Canadians pay, on average, about half of what Americans pay for health care and get better results in terms of life expectancy, heart disease and child mortality. I’d trade for that in a heartbeat.
15
Access maybe. Quality, not so much. Americans pay double what all the other "developed" countries do for health care yet our actual outcomes are overall worse. So, no, we do not have "quality." Also, numerous studies have shown that price has no relation to quality - some of the most expensive places are also average or worse quality.
Really, what we need is simply better regulation of quality and pricing. Indeed, other studies have shown that the primary difference between European countries cost and US costs for the same procedure come down to the fact that the US companies simply charge more. For the same procedure. Using the same methods, equipment, etc. We simply price gouge. Why? Primarily because of the secret collusion between insurers and medical providers. No one, not even the medical providers, can provide a definitive price for a procedure. It is all just "negotiated" between entities in private and in secret.
Indeed, I can tell you from working decades in the medical industry that none of these medical providers want you to know their actual "cost" because it is far lower than their "price." They love being able to keep it all secret so they can charge whatever they want.
13
Mr Scott Atlas is amazing at missing the forest for the trees. Even more so when a national health emergency, the coronovirus, is making it plain for everyone to see that the lack of single payer makes it, sadly, more likely that many people will stay undiagnosed and untreated and the virus will spread faster. Whether because of no insurance or because of the co-pay or the unexpected billing.
Even then: declining life expectancies, one of the worst national health outcomes versus other OECD countries, shall I continue?
Even the author is trying to say that the price to pay to get universal health care is that some of us may have to wait a little bit longer, yes, that’s most likely right. It’s also a selfish me-first argument at a time when the virus make it clear your neighbors health is also your problem.
9
When our healthcare system is rated 37th in quality and 1 in expense by the WHO, losing our current healthcare doesn't sound like such a bad thing.
13
@davemicus
However our private health care system generates more profits than any other country and in the US that is what matters more than anything else.
2
Aside from all the inaccuracies in this article pointed out in many comments, I find the suggestion that seniors appreciate greater “choice” in private supplemental plans laughable. For most seniors it is a burden to figure out each year which plan covers most of their medications and at what price. To make this decision in an “economically rational” way, as assumed by the right-wing Hoover Institution, EVERY YEAR seniors would have to create spreadsheets involving a complex matrix of their own medications and all the various plans’ coverage policies, something that is beyond not only my capabilities, but certainly those of most seniors. There has to be a better way!
4
As of the end of 2018, the number of health insurance home-office employees in the U.S. was 529,800 (per Google search). If private health insurance is abolished, what is the plan for these people who would be put of a job?
1
Fair point, but not a reason to continue down this path.
2
@Carl : Some of them could be absorbed by the need to administer the new system. Then there are those--an unknown number, but I know one person who works part-time doing data entry for an insurance company because it's the only part-time job that provides health insurance and allows him to spend time on his musical career.
As for the insurance executives, many of them make so much per year that they could retire and never have to work again, if they watched their pennies.
Anyway, did anyone care about the many more workers who lost their jobs when the garment, steel, furniture, shoe, and other industries moved off shore?
2
This piece is all about why Medicare for All won't work. What is proposed as an alternative "paradigm" is the Trump administration's plans for transparency in health care costs. But who can take plans for "transparency" seriously when it comes from the Trump administration. Surely the author is joking with us. And choosing the word "paradigm" is an academic slight of hand, making promises of "transparency" an alternative to medical care to all. Atlas, you can not honestly write to intelligent readers in this way.
It's a shame Warren's alternative to Sanders' Medicare for All didn't take center stage. Warren proposed a three year trial period during which she would expand Medicare services, using her 2 cent wealth tax for funding. If she did not make Medicare the better option in three years, then we won't go there. I've always wanted government and private enterprise to compete with each other and why not? We all like to keep our options. And what ever system(s) prevail, regulation against corruption must be enforced. This is Warren's approach: choices and regulation against corruption and, IMHO, it is far smarter and more comprehensive than the thought processes of this Hoover Institute scholar and Sanders.
2
I wonder, if Mr Scott W. Atlas has got to know about the health care system in Finland? It is top quality and literally free. People can of course have also private insurances, but in the worst cases, like cancer, heart attack etc., it is not needed. Private insurance may help if your child gets an ear pain in the middle of the night. The public sector hospitals are great.
9
The only thing wrong with "Medicare for All" is it would wreck some parts of the corporate profit extraction sector of the health care "Industry"
9
@Ozark Ork
Indeed it would, and I for one will dance in the streets when I see Medicare for All occur here in America.
And it will.
3
I salute you Mr. Atlas - you do well on your Hoover Institute credentials!
Now to be serious - this article is full of disingenuous arguments that reject plain facts that other commentators have highlighted including those such as: (i) the fact that the US does not have better overall health outcomes than other industrialized countries, (ii) the fact that healthcare prices in the US are arbitrarily set by healthcare providers so the idea that private market prices are "real" prices is flawed at best, (iii) the fact that the much touted "transparency" initiatives that Mr. Atlas talks about have high potential to lead to collusion in regions with a low density of healthcare providers, (iv) the fact that the costly administration system that backs our current system is somehow not a contributor to overall healthcare costs in this country, and finally (v) the fact that this is a system that the vast majority of Americans abhor.
Get real - something needs to/must change. I'm sure Dems in Congress would be happy to engage if the "do nothing" party would just propose any reform at all. The solution cannot be to just sit around and wait while millions go without healthcare, and insurance company executives and the medical profession get fat off of profits that they wouldn't make in any other right-thinking nation.
9
The M4A proposals are all better than Medicare today. Nobody on Medicare gets what M4A would provide, so it's lunacy to unleash this plan Once healthcare is free, it loses all value, and will suffer the tragedy of the commons, when doctors and drugs are turned into nothing more than commodities and the price plummets.
1
A little knowledge is dangerous, and a iittle distortion goes a long way.
1
1) Yes, Medicare pays little compared to private insurance for most provider services.
2) Yes more transparency will reduce costs.
3) Yes other countries, spending much less than we do have some problems paying for some health care.
BUT:
1) Medicare For All (M4A) can pay more than Medicare, but less than private insurance does, and still pay enough to keep everyone happy. And any Public Option would only work if it paid providers less than Medicare does.
2) We can get some more transparency out of our system, but when every employer has a different negotiated price for their employees' insurance fees, and often patients have to select a provider without having the luxury of time to research prices, etc, transparency will only have a small benefit -- albeit better than nothing.
3) Other industrial countries have excellent outcomes from their medical system. They just spend too much less than us. So spending more than they do, but less than we are now, will provide us with plenty of extra funds for a system better than anyone else.
Rather than list a bunch of ideological tropes that do not rely on evidence, or rely on distorted evidence, be honest.
How much should doctors get paid? If part of M4A was free tuition at medical schools, would that help reduce the needed high salaries for doctors? Would more use of highly trained PAs and nurse practitioners ease the burden on the medical system?
4
@Just Thinkin’ : An acquaintance who lived in Israel said that free medical school tuition and no artificial enrollment limits are two ways that country keeps costs down. With no loans to pay back and ability to argue for high prices on the basis of scarcity, providers have no excuse for high prices.
1
The coronavirus crisis illustrates better than anything why this country needs Medicare for All or some other public option available to all Americans. The tens of millions of Americans currently without any or inadequate health insurance are likely to be the last people to seek medical help for suspected coronavirus. They will spread it unknowingly to other people. There is talk coming from the Trump "administration" that when and if a coronavirus vaccine is developed that it may not be free for all. Many Americans' irrational fear that someone else may be getting something to which they are not "entitled" may kill thousands of people.
4
Universal, single-payer health insurance would be what WE want it to be. That´s the point. WE decide what gets covered (100% of hospital and medical costs, plus vision, dental, hearing and prescription drugs). And the question isn´t how do we pay for that. The question is how in the WORLD are we going to be able to keep paying the ever increasing charges of for profit insurance companies?! They are in it for the money and as long as we base our system of health insurance on companies whose goal is to maximize profit, there is no fix and that´s just a fact. Denying that is like denying that human activity or the burning of fossil fuels have anything to do with climate change.
Right now, our tax dollars are being thrown into a money pit that just keeps getting bigger and bigger. As Wendell Potter and so many others know, it WILL fall apart; the only question is how many billions of dollars will we waste between now and then. More subsidies, more premium supports, less and less percentage of costs covered.
Other countries have better outcomes, happier people, longer lives and more money to spend on other things. They don´t have half a million bankruptcies every year. They care for one another.
We´re now faced with a public health crisis that we can´t deal with properly, for a number of reasons. But the fact that so many millions of our fellow Americans have no insurance or inadequate insurance is going to be increasingly significant.
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The writer fails to mention France, where universal health care delivers better outcomes at a fraction of the cost.
Our current health care system is unsustainable, bloated by profit seeking. Doctors are under pressure to see more and more patients. Patients have no clue about the real costs.
Every time I see a right wing think tank expert screech about the danger of universal health care, I also notice there is never a solution offered.
7
@Emily Clark...
All I know is that I have been receiving Medicare and Medicaid since 1996... and during this time I have received the absolute finest health-care that I have ever had.
There have never been any restrictions on where I can go or who I can see.
The only co-payment I ever have to pay are for pharmaceuticals at either 1.5O for generics and 3.OO for non-generics.
So I have to say that I simply do not understand all of the doom and gloom that this author is talking about.
For it simply has nothing to do with the past 24 years of my personal health-care experience.
Is there any possibility that this Doctor doesn't actually know what he is talking about... or that he is motivated by some unacknowledged bias or personal investment?
2
@Emily Clark
A solution would be the death knell of the right wing ideology, so no solution ...
2
@TOBY
He is not an M.D..
He has his PhD, a Doctorate Degree, nothing to do with medicine, simply a "learned" character, although I wonder how its possible given his obvious myopia, but I suppose myopia is what prevents the "upper" class from being aware of the rest of humanity and it's travails.
There are none so blind as those who will not see ...
2
No mention of co-pay, surprise billings, or personal bankruptcies. Why?
No mention of the millions walking around without coverage. Why?
No (honest) mention of the successful universal health care systems in every other developed nation on the planet. Why?
Folks, your premiums would be cut in half, with no co-pay, and low deductibles. Everyone would have coverage. This is actually proven by every other universal health care system in every other developed country in the world.
The great USA does not have this system, and this expert, while praising Trump tells us it won't work. Why?
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Who fears "the dangers of Medicare for All?"
Insurance company CEOs and shareholders.
Pharmaceutical company CEOs and shareholders.
Pharmacy company CEOs and shareholders.
Hospital CEOs and shareholders.
Doctors, and to a lesser degree, other health care providers.
These fear Medicare for All, because with any change, there is a possibility that they will personally do less well than under the existing system.
Lastly, there is a group of consumers who fear that they will have to wait longer for their test or treatment because someone "less deserving is getting it for free."
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@chris it's not easy to become an MD, especially with the cost of 8+ years of schooling. MD's are underpaid for what they do, especially surgeons.
2
Warren Buffet explained is like this:
The US spends ~18% of our GDP on healthcare while
other developed countries spend ~11% of their GDP on
comparable healthcare.
The additional 7% of of our GDP translates into a cool
1.4 Trillion dollars *extra* that the US spend on healthcare,
*every year*.
And still we end up with millions uninsured or underinsured
Explain that away. !!!
7
As many commenters imply this piece just ignores the facts. And not only is no reasonable alternative proposed, if we look at the facts no Republican or Health Insurance company is interested in producing a better Healthcare system for our country. If they wanted something better, they'd propose it. If Insurance companies wanted even marginal improvements they would work with their (and I do mean their) legislators, and for a start they could insist their legislators have a universal standard simple form that doctors have to fill out to get reimbursed. That alone would bring some cost savings. There are plenty more simple things that could be done to reduce costs. But I guess what is the point, it wouldn't be enough and it might cut into profits.
11
Maybe you should tell the public how much the current health insurance system cost per year in the US..3.5 Trillion. Let's see.. 3.5 trillion x 10 years = 35 Trillion. This and the fact that it doesn't cover roughly 30% of the population..paints a very different picture. You need to remind your fellow "scholars" at the Hoover Institute (aptly named given the current economic meltdown) that M4A is a system for PAYING for healthcare not providing healthcare. There's nothing wrong with people in this country paying taxes to get healthcare.There's nothing wrong with big pharma and the medical profession making a little less.They'll get by. Maybe you're not aware that there's a shortage of doctors in this country. Hospitals currently are moving to using "hospitalists" to meet the demand. I'm guessing you've never had a serious condition affecting your health while on private insurance. You'd be surprised at the hurdles put up by private insurance companies. While on MediCare,I was treated for cancer at Stanford within two days of the diagnosis..just down the street from you.I paid a total of $1700.Because I'm in a higher income bracket,I gladly pay $400/month into MediCare.Compare this with the $1800/month I was paying for private insurance when I was 64.I was recently treated in Finland as an inpatient for 7 days(pneumonia) and paid just $921.The top tax rate there is 51%.Can you imagine Jeff Bezos having to get by on just 100 million/day if he paid a 51% tax?
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@Iamcynic1
I keep noticing that even Bernie has dropped this ball.
" private insurance — used by more than 217 million Americans"
That leaves 110 millions without...
I don't know the fine details of Medicare for all. But the black and white picture painted here of private vs public is simplistic and false. I also wonder why the author takes Canada and the UK as examples and not France or Scandinavian countries or other European countries. In some a mixed regime is applied but public expenditure in any case is the majority of the funding. But, of course it is not so great for business as a privatized sector.
Money is needed for a good health system. However, money from health is often a killer.
5
My guess is the author only used Canada and the UK because those countries speak English and he doesn't trust "foreigners".
1
Such a disingenuous article from Dr. Atlas. Having lived under single-payer and pay for care systems I can say that nothing is better than not having to worry about money when you are sick.
Also, the idea that care for essential treatment like cancer therapy is delayed in single-payer health care is nonsensical. It costs more to treat when illness is in an advanced stage. Since taxpayers pay the bill it isn't in their interests to delay care and increase costs. A lot of the money in single-payer systems goes to preventative screening and tests to catch diseases early and prevent the costs associated with treating advanced stage illness.
Its sad to see such a naked defence of narrow economic interests.
21
What a poorly cited article for an academic. It takes a bunch of time to find the NIH statistics that they author has misrepresented, apparently hoping that we won't actually check on his data. One look at the cited article for the Canadian data, and immediately saw that it was from the Fraser Institute, a think tank that is known for publishing misleading data to support their ideology.
Unfortunately, the author is also being disingenuous, especially when it comes to "Medigap" plans, as the point of eliminating private insurance to have Medicare take care of the gaps that shouldn't be there in the first place.
What he also leaves out is that the profit model for insurance it to collect as many premiums as possible, while paying out as few claims. When you don't have to make a profit, the incentive to deny people needed care is eliminated.
It is obvious, once you do the research, that the real danger is that the author's rich friends, donors to the Hoover Institute, might have to pay a higher tax rate on their obscene wealth.
11
@NobodyOfConsequence
Propaganda, designed to instill fear, does not require research.
1
the line "It’s not just because single-payer systems like those in Britain and Canada hold down costs by limiting the availability of doctors and treatments"
And how do you think multipayer systems hold down costs? By not agreeing to pay them, of course. I'm fighting with Blue Cross Blue Shield right this minute because they have now twice denied my brother in law's claim for Nudexta because they say he hasn't shown proof that it's working for him.... he's been on it before, the doctor's continue to prescribe it for him, and yet they have abruptly decided do deny his claim. It's $1500 a month out of pocket.
Yeah, it's for a brain tumor, the exact condition Mr. Atlas says we treat so much better over here. I guess, if you're lucky.
"Or that tens of thousands of additional citizens died because of wait times for nonemergency treatment."
One might wonder how the non-emergency leads to death, which is generally considered an emergency. Or is this someone who died while waiting for their 2nd knee replacement? This canard needs to die a quick death itself.
"while private insurance often pays over 140 percent of the cost of care, Medicare and Medicaid pay an estimated 60 percent of what private insurance pays for inpatient services, and an estimated 60 to 80 percent for physician services."
and what is the % of the actual cost to provide that care, as in price for material, labor, & overhead? Absent is the % of PROFIT baked into the current system.
13
I don't get the logic. If the system only runs because private insurers pay more than Medicare then aren't we collectively paying more now than a single payer plan? Doesn't this mean the money is there in the system? Why assume that we would be doomed to pay low rates(ala current Medicare) and make the system collapse if the money is basically there? And what about the legions of administrators and bureacrats that exists mainly because of the crazy complicated insurance environment and billing schemes?
Also this author seems to selectively leave out the active efforts of the Trump administration to undermine Medicaid and Obamacare. He makes it sounds as though the administration has actually studied and wants to fix our system.
9
Oddlly enough, however, every other developed country has something similar, gets far better health outcomes, and has greater satisfaction with their heathcare systems. For profit medicine is quite simply an abomination. Markets simply do not exist where buyers effectively have no choice and generally have little or no information to make comparisons, as is the case in healthcare.
9
What about the dangers of for-profit healthcare, like the most expensive healthcare system in the world and some of the lowest health indices in the developed world. And what about all those aging seniors who will likely lose theirs homes to pay for medical care. Canadians do wait for elective surgeries but if you have any serious health problem you skip the queue, that's why we have waiting lists.
17
Your arguments are specious and morally suspect. Here are some fact you don't mention. Canadian polls reveal that 8.6 in 10 Canadians not only support their single-payer health care system but they want to expand their single-payer health care system. Countries that offer universal health coverage are about 13% more satisfied with their health care. Satisfaction with our private health care system in the US is 56% while satisfaction in countries with a single-payer health care system is greater like France (85%) or Sweden (75%). Medicare overhead expenses are at 3-5% while private health insurance overhead is 20-50%. The cost of a Medicare for All system is often cited by opponents but that cost appears way out of line. The wealthy nation in the world cannot afford a health care system that less wealthy can? Absurd! The Lancet, a British medical journal, recently released a study showing that a single-payer, universal healthcare system in the US is likely to lead to a 13% savings in national health care expenditure, equivalent to more than $450 billion annually. A few advantages of a single-payer system. There would be far less than the current 500,000 medical bankruptcies due to medical bills, employees would not be tied to their employers health care choice making it easy to change jobs and health care would become a right; not a privilege. Your article appears to be a shrill for private insurance industry.
15
I have lived in Switzerland, Norway, Brazil, and the USA. The worst of them all: the USA hands down. The whole system is so piecemeal, so complex and confusing and nobody can explain it to me. Now, the Coronavirus is pulling the curtains away from the Wizard.
16
I’m in my mid sixties with two chronic health issues related to my lungs and spine for which I have been receiving exemplary treatment by the fine doctors, specialists, technicians, surgeons, and a myriad collection of other health professionals all paid for by the Ontario Health Insurance Plan (OHIP). I have zero complaints about access times or quality of care. This article is a pack of lies. A modest proposal: Create a bipartisan task force to, without prejudice, examine the public health care systems in place in most advanced industrialized nations. Kill the spin, get the facts and then devise solutions to your hyper expensive broken health care system.
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@Bruce It is operating exactly as it was designed-which is to move peoples assets and savings into the pockets of our healthcare Providers soCEO can make a million a month and own 6 houses!
9
If I may borrow a word from our illustrious leader, I have a “hunch” you are correct in asserting that a single payer system will have a big impact on health care. The impact will be positive for those who have had little to no health care benefits, while others will experience the frustrations that many citizens are already familiar with as they try to navigate our current system. In terms of quality care, I am sure those of us with good benefits can tell some stories where our care was less than stellar.
13
Simon's rule: When you change from a bad system to a good system, for a while things actually get worse.
We need serious changes in our health delivery systems. We'll just have to endure the transition period.
9
The U.K. has rationing by need. The USA has rationing by price, or effectively an individual’s wealth. I know which system I prefer.
19
So because Medicare for senior citizens will be affected, if we were to believe in the author’s logic, younger, working people must to continue pay, and over-pay, the price to fund their subsidized healthcare. The author argues that this system should be maintained.
That’s how this country eats away at the younger generation and justifies it.
The author is 65 years old.
11
@H.Z : I would be fine with losing Medicare if it were folded into a system that covered everybody.
Adding younger, healthier people to the system would actually stabilize its finances.
1
At the very least a gradual phase-in should be on the table, which could be done initially by making the eligible age 55. It's not practical to propose an immediate blanket phase out. I also believe the topic is so complex that expanding a public option for the ACA is a good step. "Medicare for All" has become a buzz phrase. Workable details that all will eventually agree on are the key.
2
@JUHallCLU So delay a bad health care system, you say so all those uninsured can suffer longer? Good plan?
As a Canadian with cardiac issues, I tried to find myself within the shortages and denials of treatment referred to but not specifically pointed out by Mr. Atlas. I do know that my initial heart attack (ambulance, 4 days hospital, stent, post op care) resulted in a note (not payment) that my treatment had cost the provincial medical system $13,000 CDN. Likewise, a later incident requiring cardiac intensive care and implanted cardiac device is followed up with regular clinical oversight and evaluation. I see the cost for this in higher wine prices, but I also see our country higher on international scales of well-being, average mortality, education and infant mortality. On all of the OECD rankings the US sits in the lower ranking of 40 countries. And there is no one across our country declaring bankruptcy or losing their home as a result of inability to pay their medical bill, unlike <650,000 Americans annually.
25
So, every other major economy in the world can do it, but the US can't? Give me a break.
12
Who would believe anyone from the Hoover Institute?
Rather than transparency, the Trump Admin. Is trying to shift Medicare to private insurance and destroy the basic premise of the program. There are enough homeless people on the streets already. BTW, cutting taxes does not help, either.
13
The good doctor could have mentioned that the Hoover Institute is a conservative/libertarian think tank with a bias towards elimination of federal government involvement in American lives. This piece is one-sided as one would expect.
25
Hi
This article doesn't pass the smell test:
A free universal health care system is actually much cheaper.
US has a very expensive health care system compared to contries with free universal health care systems.
Just look at the numbers of total health expenditure pr capita:
In eg. 2016 US had a very high spending of 9,892 US $ pr capita of total health care expenditure pr capita.
Denmark had in 2016 a spending of only 5,205 US $ pr capita. And Denmark has a free universal health care system.
The price for this universal health care system in Denmark is only 52,6 % of the spending in the US health care system.
A system that leaves so many people uncovered for medical help.
I know what I'm talking about as I'm so lucky to be a Danish citizen. Everybody in Denmark can go to see the doctor when they're sick, and you don't have to pay a dime for it.
If people need much medicine, the state even helps you to pay the drugs.
This mean that for the first medicine you need in a year you pay full price, but as your spending increase during that year the state helps you by giving a refund of up to 85 % of the cost of the medicine for people who has the highest need for it.
This makes our country much more resilient for fighting diseases, including the corona virus.
If you want to check the numbers yourself you can compare various countries total health expenditure pr capita on wikipedia:
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
19