Medicare for All!

[sumpnz]

Haven't read the entire thread, but as a matter of math, there about 250million adults in the country.  At $3trillion/year that's $12k per adult.  So SWMBO and I would be forking over $24k per year.  Compared to a current ACA compliant policy that's probably pretty close.

However, in 2009 I had a policy that covered my family for $330/month with a $5k deductible and probably a $10k out of pocket max.  Even if we hit that out of pocket max EVERY year that's only $14k.  Even if you add 9 years of inflation it's still only $18k.

So please, someone explain to me why socialized medicine would be preferable to just going back to the pre-0bamacare status quo?

[De Selby]

https://data.oecd.org/healthres/health-spending.htm


In public systems you get fast care and good results at something like half to one third of those prices sump.

Dogmush - what’s missing from your post are comparative cost and outcomes data. The vast majority of Americans do not in fact get faster or better quality care than those public systems. They do however pay a lot more.

Again, there are horror stories from private medicine just like hawk moons. That’s why it is important to look at data. On the numbers there’s simply no cost or quality argument in favour of private medicine.

[De Selby]

We do not have poor healthcare.  We have excellent healthcare at a sometimes high price for some people.  It is simple supply and demand.  Everyone wants cheap healthcare and wants someone else to pay for it, but there is a limited availability of providers.  You want cheaper prices for everyone?  Lower the demand or increase the supply.

This is in fact not true. The United States has one of the worst performing health systems overall, even when considering only medicine available to people with insurance. It’s not terribly behind, but you’d think ant double or triple the price it would at least have better average outcomes.

https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-mortality-rates-fallen-steadily-u-s-comparable-countries

[dogmush]

https://data.oecd.org/healthres/health-spending.htm


In public systems you get fast care and good results at something like half to one third of those prices sump.

Dogmush - what’s missing from your post are comparative cost and outcomes data. The vast majority of Americans do not in fact get faster or better quality care than those public systems. They do however pay a lot more.

Again, there are horror stories from private medicine just like hawk moons. That’s why it is important to look at data. On the numbers there’s simply no cost or quality argument in favour of private medicine.

Not US public systems.

The public systems extant in the US today provide inferior care than the ...whatever the hell most Americans have.  That's why no one uses them unless they have too, and supplements them when they do use them.

Even the article you posted claiming the VA is OK had this disclaimer:

The RAND study found there was too little information related to timeliness, equity, efficiency and patient-centeredness to reliably draw conclusions about how the VA system compared to others across these dimensions.
 

Those are some important factors to gloss over with a hand wave. However:

VA facilities had similar or superior quality to non-VA facilities with respect to preventive, recommended and end-of-life

Never fear if you need a Flu Shot, or to die, they got you covered.  It's anything in between that's a problem.

I'm not saying it couldn't work.  But so far, in this country, it doesn't.  And since I have very good, albeit expensive, health care I see no reason to consider changing that until the US government manages to run a better socialized system in the US.  I also use both TriCare and the VA for some things, so I get first hand knowledge of which system(s) provides better care.  (Hint: it's United Healthcare)

[Ben]

However, in 2009 I had a policy that covered my family for $330/month with a $5k deductible and probably a $10k out of pocket max.  Even if we hit that out of pocket max EVERY year that's only $14k.  Even if you add 9 years of inflation it's still only $18k.

This has been my biggest pet peeve in all this ACA government intervention. While I'm a firm believer in preventative care,  I (and I think most people), can fork over $100-200 for a physical and bloodwork once a year. I'm happy to fork over several thousand to ten thousand dollars in a year if something serious happens to me (I realize not everyone can). What I can't afford without taking a big financial hit is say, being run over by a bus and getting $100K in bills in a year.

We used to have catastrophic care as a cost-effective option to take care of the really big stuff for those who can afford to pay out of pocket for the little to medium stuff. I've harped on this before, but it sure seems having catastrophic care available as an option would reduce health costs for a good chunk of the population. Forcing me to have pregnancy coverage, mental health coverage, etc., on my insurance seems like the opposite of cost effective.

I do still recognize that we need to come up with something to handle pre-existing conditions. Someone who gets cancer and loses their job (and employer paid insurance) shouldn't simply be told, "tough luck - go die now." There should be some way for them to be able to pay for medical care without going bankrupt and $500K in the hole.

I was piping in on another forum that it would be interesting if someone like Amazon came up with "Prime group health insurance" open to individual Prime members.

[230RN]

Hey, experts.  Any information on how much cheaper it would be if our health care benefits were restricted to legal residents?

Asking for a friend.

Terry

[Ben]

TriCare:  The gov run system to care for Active Duty troops and their families was so bad they hired a private company to run it.  And TriCare, while you will eventually get care is notorious among soldiers for long wait times, byzantine rules for referrals to see the provider you actually need, not enough providers at whichever facility you are at, and ER's chocked full of folks with colds.

You're not the first person I've heard complain about TriCare. It's actually surprising to me that they can suck so bad. On the civilian side, I spent my entire time on one or another of the GEHA plans. That was great and reasonable insurance. Even after I separated, I kept it for the 18 months, and paying the whole shebang myself was still way cheaper than what I'm paying now for my limited coverage, high deductible private insurance.

I had a major surgery while on GEHA.  I recall the hospital bill being something like $200K and I paid $100 of it. I don't understand how they can make GEHA so good yet suck with TriCare.

[brimic]

Hey, experts.  Any information on how much cheaper it would be if our health care benefits were restricted to legal residents?

Asking for a friend.

Terry

 

[KD5NRH]

When you have people that will call the ambulance for extremely minor injuries, go to the ER for minor colds, etc because they have the freeloader insurance, it doesn’t work.

This is why ambulances should have a minimum injury level for transport (outside of car wrecks, OTJ injuries and other situations where liability and/or hidden injury issues make it best to have the person in the hands of EMS ASAP and insurance is already covering it) and if you don't have that when they show up, they get to give it to you.

"You broke a fingernail?  Wait here while I get my +3 Cricket Bat of Qualifying."

[Hawkmoon]

In public systems you get fast care and good results at something like half to one third of those prices sump.

Then why is it that many people from countries with socialized medical care (like England) come to the U.S. when they really need to have a problem fixed?

[Hawkmoon]

Again, there are horror stories from private medicine just like hawk moons. That’s why it is important to look at data. On the numbers there’s simply no cost or quality argument in favour of private medicine.

My story isn't a story about the failure of the private system. Quite the contrary. I had to go into the private doctor market (via Medicare supplement) because at the VA hospital they had clear and convincing evidence that I had a rapidly deteriorating coronary problem, but they wouldn't let me see a cardiologist. If I hadn't been old enough to have Medicare as a backup, I'd be dead now. When I finally went outside of the VA system to a real doctor, they put me right into the hospital STAT, and a week later I was under the knife. But, because I had been regarding Medicare and the Medicare supplement as a backup to the VA, I had chosen a supplement plan with low premiums but higher out-of-pocket costs. Now that it's too late, I have switched to a plan with higher premiums, but if I ever need to use it again my out-of-pocket will be less.

But the sorry saga began in the VA "Health Care" system, which is a close analog to public, socialized medicine in other countries. In the VA system, you can't just call and get an appointment with a specialist. You must be referred by your primary care physician.

[Ron]

Socialism fails at the primary purpose of civilization.

Providing for those who are unable to provide for themselves while controlling for the free rider problem.

Rationed care, death panels and slow, poor service are the result of free riders in health care.

Paying customers won’t tolerate it and if other options are available they use them.

Socialized systems always try and outlaw competition.

[sumpnz]

https://data.oecd.org/healthres/health-spending.htm


In public systems you get fast care and good results at something like half to one third of those prices sump.

Reading comprehension fail, again.  I said $18k, if I hit my out of pocket maximum every year.  If I don't, and on average people will only hit their out of pocket max a couple years in their entire life, it would be MUCH less than that.  Premiums alone were about $4k.  Figure since I had 2 kids at the time we'd have been on the hook for maybe $1000/year in expenses subject to the deductible (and typical yearly checkups were not subject to the deductible) that's $5k.  Or closer to 1/5 of the "Medicare for all" costs.

Actual free market reforms would have reduced that cost considerably too.

[Firethorn]

Please explain to me the concept of health care as a right.

Mellard put it in quotes, so I don't think they actually think that it is a right, merely acknowledging that some/many supporters of universal single payer to view it as such.  

I do still recognize that we need to come up with something to handle pre-existing conditions. Someone who gets cancer and loses their job (and employer paid insurance) shouldn't simply be told, "tough luck - go die now." There should be some way for them to be able to pay for medical care without going bankrupt and $500K in the hole.

Personally, I'd say that to handle this you'd handle it like the VA and "service connected disability".  It'd increase premiums quite a bit initially, but here's how I'd handle it:

The Insurance that you have when you get or are diagnosed with a condition is on the hook to pay for it - forever.  Even if you switch providers or lose coverage.  Lose your job because of cancer?  You got the cancer while covered, right?  It's covered.  It's like if your car is in an accident.  Let's say that it's an antique, parts are hard to get, but you paid through the ass for a "repair covered at all costs" policy.  If you're hit and it's going to take 6 months to repair, no matter what, even if 3 months in you transfer to a new auto insurance company, they still have to pay the ongoing bills for repairing that accident.

Now, as a matter of convenience, I'd allow them to "buy" your next healthcare provider taking over the payments for a pre-existing condition.  Buy they'd have to pay the anticipated costs to the new insurance provider.  Let them figure out the exact details involving averages, actuarial tables, discounts for future costs, etc...

Socialized systems always try and outlaw competition.

We aren't necessarily talking about a true socialist system.  We could have universal coverage like Germany, where "Medicaid" has more or less been expanded to cover everybody without other coverage.  There are still private companies out there, but they have to compete with Medicaid, so you don't see the insane costs as you see here, because they actually have competition to worry about.

[brimic]

[MillCreek]

https://www.seattletimes.com/nation-world/too-little-too-late-bankruptcy-booms-among-older-americans/?utm_source=RSS&utm_medium=Referral&utm_campaign=RSS_all

Medical bills are a major contributing factor to the elderly filing for bankruptcy.

[Perd Hapley]

Can we please stop using the dishonest term "single-payer"? Under a "single-payer" system, every tax-payer pays the price. "Single-payer" is a lie.

[TommyGunn]

The "single payer" is the government.  It can print the money ... ALL THE MONEY .... it will need.

Noting will go wrong.  Nothing CAN go wrong. 

It's our GOVERMENT. They know best. 




If you believe the above, then I have a bridge in NYC that's for sale ... cheap.

[grampster]

By single payer what they really mean is EVERY SINGLE ONE OF US will pay.

[makattak]

I do still recognize that we need to come up with something to handle pre-existing conditions. Someone who gets cancer and loses their job (and employer paid insurance) shouldn't simply be told, "tough luck - go die now." There should be some way for them to be able to pay for medical care without going bankrupt and $500K in the hole.

Errr...

We used to have catastrophic care as a cost-effective option to take care of the really big stuff for those who can afford to pay out of pocket for the little to medium stuff. I've harped on this before, but it sure seems having catastrophic care available as an option would reduce health costs for a good chunk of the population. Forcing me to have pregnancy coverage, mental health coverage, etc., on my insurance seems like the opposite of cost effective.

You kind of have a solution right there, no?

[Ben]

Errr...

You kind of have a solution right there, no?

Only if we got catastrophic care back as a widely available option, and then if it covered pre-exisisting. It used to not do that.

I had high hopes for Idaho when they looked at offering "affordable insurance" (I think they are currently being blocked by the courts). I looked at the affordable options they were going to provide and was sorely disappointed in what I saw. It was affordable, yes, but it was almost the opposite of catastrophic care. There were still large deductibles, but stuff like hospital stays was capped at something like $30K, and lifetime benefits were in the low hundreds of thousands.

That's practically like not having insurance. I guess it would be okay for young, healthy people that never got into any serious accidents, but otherwise it seemed kinda worthless. I'll take the overly expensive policy I have now over that any day of the week. My annual physical may cost me eight grand, but at least if I'm hit by a bus I'm fully covered after my large, yet manageable (for me), deductible is exceeded.

[Firethorn]

Can we please stop using the dishonest term "single-payer"? Under a "single-payer" system, every tax-payer pays the price. "Single-payer" is a lie.

No, because it isn't dishonest, it merely means that all the medical providers are being paid by the same payer.

It may niggle you like "medical insurance" niggles me, but do either of us have a better term?

I had high hopes for Idaho when they looked at offering "affordable insurance" (I think they are currently being blocked by the courts). I looked at the affordable options they were going to provide and was sorely disappointed in what I saw. It was affordable, yes, but it was almost the opposite of catastrophic care. There were still large deductibles, but stuff like hospital stays was capped at something like $30K, and lifetime benefits were in the low hundreds of thousands.

And if you get that sick, you end up bankrupt and on the government dime anyways...

Or putting it on our backs by ignoring the bills coming in, declaring bankruptcy, forcing the providers to increase their rates to get the necessary income from those who do pay. 

It's just that the load of those that don't pay is such a high percentage it is doubling our bills or more, because the insurance companies are negotiating to not cover them.

Add in the expense of all the paperwork involved in trying to collect money from broke clients, and it starts getting ridiculous.

It's why there are "direct primary care" medical clinics out there that promise to handle all the basic stuff for very reasonable flat monthly rates.  Eliminate all the paperwork and billing nonsense?  Substantial savings. 

[Perd Hapley]

No, because it isn't dishonest, it merely means that all the medical providers are being paid by the same payer.

It may niggle you like "medical insurance" niggles me, but do either of us have a better term?

I don't think that's what "niggle" means.

If you want a better term, why not "tax-funded," or "government health care," or "socialized medicine," "government-subsidized," "fully-subsidized," "health control," or "government-run health care"?

[Firethorn]

I don't think that's what "niggle" means.

Niggle:
cause slight but persistent annoyance, discomfort, or anxiety.
or
a trifling complaint, dispute, or criticism.

Seems accurate to me.

If you want a better term, why not "tax-funded," or "government health care," or "socialized medicine," "government-subsidized," "fully-subsidized," "health control," or "government-run health care"?

1.  We already have tax-funded.  Most people get it to some level
2.  There are like six different government healthcare systems already
3.  Socialized medicine might be good, but there's still other forms of it.
4.  Again, we have government subsidized already, it's not necessarily single-payer
5.  fully-subsidized isn't accurate
6.  Health control isn't it. We already have way too much health control.  It doesn't imply paying
7.  too long.  Also, like with #2, we have like six different systems already.  Bringing that down to 1-2 would save money.

[Ron]

Single payer will not result in superior care.

Don’t listen to the leftists, they always confuse their good intentions with good results.

You don’t solve the free rider problem by making everyone free riders.

How ignorant of human nature do you have to be to recommend such a delusional idea?

Single payer is unsustainable like all socialist scams.

Reject being scammed.