Medicare-for-All Isn’t the Solution for Universal Health Care?

[vegas giants]

that's not common at all in the US unless you have Medicaid.
Its a difficult workers comp claim (they are fighting you)
You have VA (notice two government programs).

Otherwise that's extremely rare.. and I would bet because you wanted to wait for a specific person. (unless you have Medicaid etc).

I did not wait for a specific person. Anyone would do and I saw the doctor for a grand total of five minutes so he could write me a prescription. And I have very good insurance for my state

 

[fmw]

And yet that didn't happen in Canada for instance. By creating a single payer system we will drive down the cost of all healthcare because we set the price

What happened in Canada is six months to year waits to see a doctor. Drive down the costs and you drive down the quality. I think you will get your way but it won't be pleasant.

 

[ALiberalModerate]

It is quite common in HMO's. The hope is that you die waiting or give up so they never have to pay for you at all.

There are not many true HMO's around anymore and the largest, Kaiser Permanete, has some of the best results of any private insurer. Furthermore, a single payer system would almost certainly work like a giant HMO. Otherwise, how could they control costs at all.

 

[ALiberalModerate]

I did not wait for a specific person. Anyone would do and I saw the doctor for a grand total of five minutes so he could write me a prescription. And I have very good insurance for my state

Are you in a small market?

 

[ALiberalModerate]

None.. its mostly paid for in a DRG system. Which means the cost is the same regardless if you have one aspirin.. or none. or a million.. its based on your diagnosis.

If the hospital can reduce its costs with you and get you out and well fast enough.. they make money.. if you stay too long.. or use too many aspirins.. then they lose money.

In all fairness though, they are scanning each and every asprin they give you and it all shows up on the bill. The only reason you don't pay it is your insurer will not pay them 15 dollars per asprin (nor will they pay $546 for 6 liters of salt water).

 

[ALiberalModerate]

What happened in Canada is six months to year waits to see a doctor. Drive down the costs and you drive down the quality. I think you will get your way but it won't be pleasant.

If Canada's system is so bad, why do they not move to a system like our's? Its not like it would be difficult for them. American insurers would jump at the chance to build provider networks in Canada and start selling policies like they do here (I am not talking about the supplementary policies already sold in Canada). Yet Canada doesn't go to our system. Why? It is because despite the faults of their system, the vast, vast majority of Canadians know their system is still superior to ours and they would literally revolt against their government if their government even suggested going to a system like ours. In fact, the citizens of any other modern industrialized country would literally revolt against their government if their government even suggested they got to a system like ours.

Critics of Canada's health system like to point out that 50,000 Canadians come to the United States every year for care. This is true, wealthy Canadians do come here some times for elective procedures and retired Canadians that over winter down here get care here while they are here. However, those critics ignore the fact that 1.4 million Americans travel abroad for healthcare every year. 1.4 Million Americans Will Go Abroad for Medical Care This Year. Should You? | The Fiscal Times

 

[Greenbeard]

the government has proven itself 100% inept at handling healthcare. even with medicare you still need private insurance to cover everything that it won't.
the average cost for a medicare suppliment plan is about 250 bucks a month. so wth am i doing paying for medicare in addition to the additional insurance.

friggen stupidity.

I don't get you. In literally every thread your position is that we need a single-payer plan (and probably based heavily on public hospitals), as long as it has high-deductibles that are paid out of mandatory HSAs. Literally every thread that's your position. You bring up Singapore's model literally every time you post in a health care thread.

And then you write stuff like this.

 

[Grand Mal]

What happened in Canada is six months to year waits to see a doctor. Drive down the costs and you drive down the quality. I think you will get your way but it won't be pleasant.

What a crock.
I've had both hips replaced, waited five weeks for the first one ('09), two weeks longer for the second ('12). Where do you guys come up with this crap?

 

[ttwtt78640]

And yet that didn't happen in Canada for instance. By creating a single payer system we will drive down the cost of all healthcare because we set the price

That (bolded above) is a common claim and any state is free to do so yet none have made this happen.

Can you explain why that is? Crickets....

 

[SmokeAndMirrors]

Given the likelihood this will be a key issue for the Dems over the next few years, it's worth starting to consider some of the challenges behind the Medicare-for-all slogan. A provocative article in The Nation this week gets the ball rolling: Medicare-for-All Isn’t the Solution for Universal Health Care.

Some of the factors considered are: Medicare has a private option that's been growing in popularity every year; most people in employer-based insurance have coverage that's more generous than traditional Medicare (sometimes folks overcompensate for this fact by suggesting single-payer coverage be more generous than coverage that exists anywhere in the world); the (big) issues inherent in rapidly transitioning from here to there remain largely unaddressed; loss aversion suggests that forcing everyone off their coverage is politically fraught.

Of particular note is a bit on international comparisons and the often related assumption that adapting some other nation's model implies enjoying that nation's health care cost structure:



That's an important point that needs to be contemplated under any effort to move toward Medicare-for-all or single-payer or anything similar. No more magic asterisking away the U.S. cost structure if the debate is about to turn serious.

Anyway, I endorse the underlying message:

Good piece. And don't underestimate what you get with those doctors who make a damn fine wage. They are damn fine doctors and very dedicated (very good doctors exist in national health care countries obviously, but they often don't work for the government). Equipment is a lot better too. And that shows in Americans' health outcomes, which are extremely good for the people who can afford it. It's the people who can't that drag down our average life expectancy, and yes, that's a travesty we need to fix. But to some extent, those superior resources are also worth paying for.

Where's the balance between not losing that fabulous quality, and not letting the poor simply die due to being unable to bare the cost alone? Not sure Medicare-for-all can achieve that, to be honest. But, like this article points out, most "free" systems aren't actually, well... free. There's the tax, yes, but in the UK for example, you also pay for prescriptions, dentists, etc. And just about every country has some variation of that. You do pay less, and the price is set by the government (ex: all prescriptions cost £8.50 or something like that, no matter what it is), but it ain't free.

So how do we organize that in America? What's the pay scheme that works for keeping some of that superior quality while reigning in the sheer insanity of costs, which are far beyond market because we've been letting them get away with it for so long?

That's a complex question, but I agree America needs a unique solution. Perhaps freezing costs is a place to start that would be easier to achieve than immediately going for a big reduction, and negotiate from there.

 

[DarkWizard12]

The way we have done healthcare before the ACA wasn't working. So what do you suggest be done?

To the contrary, it was, depending on the state of risk pools. If you had large employers like Kroger, everyone could get insurance for as little as 20-50$ a month. Now, people are paying as much as 400 to 700, and that's after subsidies have been considered. Things weren't perfect back then, but things aren't working now either.

 

[Greenbeard]

That's a complex question, but I agree America needs a unique solution. Perhaps freezing costs is a place to start that would be easier to achieve than immediately going for a big reduction, and negotiate from there.

We came close to that in Massachusetts this year. The GOP governor proposed something along those lines in his budget in January:

To make insurance more affordable, Baker said the state should cap the prices many hospitals, doctors and labs are paid for the next three years. (The administration says three years seems like a reasonable period of time to test the impact of price caps on the health care market.) Providers would be divided into three categories. Insurers would continue to negotiate contracts with hospitals and physician groups. But the state Division of Insurance could reject the contract if insurers don't follow these rules:

-- Tier 1 -The lowest-paid hospitals and physicians would face no cap on price increases.
-- Tier 2 - Those providers with moderate rates could get an increase of up to 1 percent a year.
-- Tier 3 - The most expensive doctors and health care facilities in the state would not be eligible for any increase.

There are a couple of caveats in Baker's proposal. Primary care physicians and behavioral health providers would be exempt. And any provider in any of the tiers who is in an Accountable Care Organization (ACO) could receive an additional 1 percent increase.

By leaving the contract negotiations to insurers, Baker is suggesting what his aides call a hybrid between a free and regulated market. He's not setting rates, but he is setting limits.

Didn't take, though.

 

[Greenbeard]

To the contrary, it was, depending on the state of risk pools. If you had large employers like Kroger, everyone could get insurance for as little as 20-50$ a month. Now, people are paying as much as 400 to 700, and that's after subsidies have been considered. Things weren't perfect back then, but things aren't working now either.

Some people may be paying that. But the average after-subsidy premium in the exchanges in 2016 was $106/month.

Table 3 shows the resulting net premiums for the 85 percent of Marketplace consumers who receive tax credits. The average net premium—that is, taking into account tax credits— in 2016 among those who qualified for tax credits was $106 per month. The average net premium was $102 for tax credit recipients in 2015. Therefore, between 2015 and 2016, the average out-ofpocket premium obligation consumers’ with tax credits paid rose just 4 percent, or $4 a month.

 

[ludin]

I don't get you. In literally every thread your position is that we need a single-payer plan (and probably based heavily on public hospitals), as long as it has high-deductibles that are paid out of mandatory HSAs. Literally every thread that's your position. You bring up Singapore's model literally every time you post in a health care thread.

And then you write stuff like this.

I have never brought any of that stuff up nor have i ever advocated for any type of single payer plan nor any heavy use of public hospitals.
you are simply making stuff up at this point.

Yep i like aspects of their model and i think parts of it would work here. I have never stated i want to implement their entire thing because i don't.
some of it would work other parts of it wouldn't.

if you can't be honest about what people argue you should probably stop.

I have always stated something similar to what they have not exact. words matter and there is a difference.

In an HSA the government has no control and 0 power over you and your health decisions.

 

[Greenbeard]

I have never brought any of that stuff up nor have i ever advocated for any type of single payer plan nor any heavy use of public hospitals.
you are simply making stuff up at this point.

Yep i like aspects of their model and i think parts of it would work here. I have never stated i want to implement their entire thing because i don't.
some of it would work other parts of it wouldn't.

if you can't be honest about what people argue you should probably stop.

I have always stated something similar to what they have not exact. words matter and there is a difference.

In an HSA the government has no control and 0 power over you and your health decisions.

It's a bit confusing when you hold up a particular country as a model, then say you disagree with the entire financing and delivery structure of their health system.

If you like HSAs, just say that.

 

[vegas giants]

That (bolded above) is a common claim and any state is free to do so yet none have made this happen.

Can you explain why that is? Crickets....

Because it only works on a federal level. No country has done it on the equivalent of a state system

 

[vegas giants]

Good piece. And don't underestimate what you get with those doctors who make a damn fine wage. They are damn fine doctors and very dedicated (very good doctors exist in national health care countries obviously, but they often don't work for the government). Equipment is a lot better too. And that shows in Americans' health outcomes, which are extremely good for the people who can afford it. It's the people who can't that drag down our average life expectancy, and yes, that's a travesty we need to fix. But to some extent, those superior resources are also worth paying for.

Where's the balance between not losing that fabulous quality, and not letting the poor simply die due to being unable to bare the cost alone? Not sure Medicare-for-all can achieve that, to be honest. But, like this article points out, most "free" systems aren't actually, well... free. There's the tax, yes, but in the UK for example, you also pay for prescriptions, dentists, etc. And just about every country has some variation of that. You do pay less, and the price is set by the government (ex: all prescriptions cost £8.50 or something like that, no matter what it is), but it ain't free.

So how do we organize that in America? What's the pay scheme that works for keeping some of that superior quality while reigning in the sheer insanity of costs, which are far beyond market because we've been letting them get away with it for so long?

That's a complex question, but I agree America needs a unique solution. Perhaps freezing costs is a place to start that would be easier to achieve than immediately going for a big reduction, and negotiate from there.

You can't freeze costs until you control the market. Single payer controls the market

 

[Greenbeard]

Because it only works on a federal level. No country has done it on the equivalent of a state system

Many of our states are larger and wealthier than the nations that have single-payer systems. And Canada's system is administered at the provincial level.

 

[vegas giants]

Many of our states are larger and wealthier than the nations that have single-payer systems. And Canada's system is administered at the provincial level.

Canada has a single payer system that is administered on the province level but they must meet certain standards in every province and it is supported by the federal government

 

[ttwtt78640]

Because it only works on a federal level. No country has done it on the equivalent of a state system

I was under the impession that Canada handles its medical care on provincial, rather than only national, level.

https://en.m.wikipedia.org/wiki/Healthcare_in_Canada

 

[vegas giants]

I was under the impession that Canada handles its medical care on provincial, rather than only national, level.

https://en.m.wikipedia.org/wiki/Healthcare_in_Canada

Your link states that most healthcare costs are funded by the federal government

 

[DarkWizard12]

Some people may be paying that. But the average after-subsidy premium in the exchanges in 2016 was $106/month.

106$ a month is about a month's worth of food, you know. And that's only after subsidies, a lot of people, including myself, do not qualify.

 

[ludin]

It's a bit confusing when you hold up a particular country as a model, then say you disagree with the entire financing and delivery structure of their health system.

If you like HSAs, just say that.

i am very clear on how it operates. if you would bother reading which you don't do.
which is 99% of the problem.

 

[SmokeAndMirrors]

You can't freeze costs until you control the market. Single payer controls the market

The market isn't out of control. The insurance companies are out of control.

Single payer also can't control the market beyond a certain point. That's why single payer countries can lose doctors and access and experiencing rising costs (and more fees for patients) just like we do. See recent news on Canada and UK for examples of this -- in the latter case, a quite shockingly bad example.

And beyond all that, you cannot simply tell a million people with an average of $300,000 worth of school debt to just give up most of their paycheck. Even in established single-payer countries, guess what happens when they try to do that? Doctors quit, and move somewhere else that will pay them properly since having a medical degree can get you a visa basically anywhere in the world, and hospitals collapse from understaffing.

Single-payer is not a magic genie that you can just poof into existence, which will then just cause everything to be perfect. That is not how this works. It takes effort as much as anything, and things can go wrong anyway. You have to consider everyone's needs -- including those of the doctors -- like everything else. Even in smaller countries, they did not simply poof single-payer into existence like a magic genie. And in a country as massive as the US, the idea that we could, or should, do that is ridiculous.

 

[vegas giants]

The market isn't out of control. The insurance companies are out of control.

Single payer also can't control the market beyond a certain point. That's why single payer countries can lose doctors and access and experiencing rising costs (and more fees for patients) just like we do. See recent news on Canada and UK for examples of this -- in the latter case, a quite shockingly bad example.

Single-payer is not a magic genie that you can just poof into existence, which will then just cause everything to be perfect. That is not how this works. It takes effort as much as anything, and things can go wrong anyway.

Not perfect just better. The evidence is overwhelming