Ben Carson: Abolish medicare and medicaid, replace them with $2000 vouchers

[Broomstick]

@adaher

Give me a metric that shows that single payer is better than multi-payer other than cost.

Several studies have shown better medical outcomes. Does that work for you?

The US is 47th in ranking for “maternal outcomes” - that means we have more women dying due to pregnancy complications than such economically devastated places as Greece, or this place called “Kiribati” which, to be honest, I’ve never heard of.

We are 34th in life expectancy. Just below evil, communist Cuba. Worse than Lebanon.

Mexico has a better survival cancer rate than the US. So do Brazil, Venezuela, Peru, Oman, India…

On and on. Other countries do health care better than the US. Yet the current regime in the US, despite the internet giving Americans easy access to information in other nations, has somehow convinced the American public that their system is the best. It’s not. It sucks.

I’ve provided links from several sources. Googling will get you hundreds of thousands more. We spend more money and get worse results. Do some actual research and open your eyes.

[elucidator]

Which is known as Medicaid. “Medicare-for-all” is propaganda. Medicaid for all is the reality of single payer.

A crucial, if entirely semantic, distinction. You’re killing 'em,** addy**!

[Little_Nemo]

@Stringbean

If you think it will be less crappy, brutal, evil, and expensive if managed by the government, then you own a philosophical disagreement with those who oppose single-payer.

How do you suppose we will spend siginificantly less on healthcare, while still providing the same quality of care and access to treatment?

The answer: pay our doctors less, and pay less for pharmaceuticals.

The result: fewer doctors. Fewer new drugs. Fewer technological innovations.

If that is the trade-off you seek, so be it. Others, like myself, see that as too much to give up, when moderate reforms are a wiser solution.

But the people who want a single-payer system have reality on their side of the philosophical disagreement. That reality is that dozens of countries have single-payer systems that work better than our system. Meanwhile, you’re arguing for a system you claim works better in theory.

I prefer a system that works better in reality over a system that works better in theory.

[Broomstick]

@Wesley_Clark

My point is we don’t need single payer, we need reforms to drive down costs. There is tons of waste in the current system.

Yes, and the biggest source of waste is the health insurance industry which is an unnecessary middleman siphoning money out of society, an industry which insists continuing private insurance is somehow necessary when plenty of other nations have demonstrated that it is not.

@adaher

The economics of Medicare-for-all don’t work. As an earlier poster pointed out, Medicare is funded by the majority paying for the minority.

That’s how ALL insurance works - are you saying every insurance policy is a scam? EVERY insurance plan depends upon a lot of people paying in and only a small number collecting. Why is this OK with you as a private industry but not a public one?

If it has to entirely fund itself for everyone, it doesn’t work. Medicaid-for-all has always been the realistic way to think of single payer. Medicare is a special circumstance since it’s paid for by all but only the elderly get it.

Medicare-for-all and Medicaid-for-all are the same damn thing.

Other countries have demonstrated that it CAN work. I guess Americans are too stupid to manage it or something.

[Broomstick]

@adaher

As for treatments unavailable, NICE denies drugs all the time for failing to meet cost/benefit estimates base on quality life years remaining. Yes, a number is actually put on people’s lives.

We make the same decisions here. Not every drug approved in Europe is approved in the US. Doctors make decisions and counsel patients all the time in regards to benefits vs. negatives.

US insurance companies do the exact same thing - refuse to pay for treatments they deem too expensive. I worked in the insurance industry for 13 years, 7 of them in an area where they actually made those determinations. The difference is that in the US these decisions are made behind closed doors by private companies who do what the fuck they want (within the law) rather than by a public agency that the public has some chance of influencing.

Back in the 1990’s there was a brief rash of insurance companies trying to deny cleft-palate repairs to infants based on the condition being “pre-existing”. Of course, there was a law passed against that so they don’t do it anymore. In private insurance there’s a motive to deny ANY procedure that can possibly be denied, even if it’s not that expensive.

Add into that, while in the US a lot of treatments are technically available, you don’t have access unless you have insurance, AND your insurance covers it. You can’t get an organ transplant in the US, no matter how much you need it and how compatible a donor is available, UNLESS you have insurance of some sort - and tens of millions still don’t. How is that a better system?

But yeah, bravo on providing an example. Thing is, the latest and greatest treatment isn’t always that, and sometimes beating an extra day or two of life out of a patient isn’t the best course.

My dad died of cancer, but up until the last week or so he was still able to walk a bit, join the family at the table for a meal, and so on, largely because he opted NOT to undergo treatments that, according to statistics, would only extend his life a month or two at most. In contrast to patients my sister the doctor sees every day with similar cancers who did opt for those extra months and spend them bedridden and semi-conscious.

Admittedly, cancer is a bit of a bugaboo, but throwing more treatment at it isn’t always the best course, however much we portray it as some sort of war. There’s a LOT of incentive for drug companies to push their very expensive treatments, whether or not they’re actually in the best interests of patients. Life without quality sucks.

[Wesley_Clark]

NICE requires a medical treatment to cost <£35000 per QALY, which works out to about $54k. Also I believe the NHS will pay for treatments that are above this, but they will only pay for the first $54k of it.

That is a pretty high cutoff. I believe the main drugs that do not fall under this are some cancer drugs that extend life by a few weeks/months.

[Wesley_Clark]

@Broomstick

Yes, and the biggest source of waste is the health insurance industry which is an unnecessary middleman siphoning money out of society, an industry which insists continuing private insurance is somehow necessary when plenty of other nations have demonstrated that it is not.

I disagree. If anything the fact that private insurance isn’t strong enough to drive down costs for providers is part of the problem. The fact that providers charge too much for services and provide too many useless services is the main reason our health care system sucks so much.

http://www.pnhp.org/news/2013/july/‘medicare-for-all’-would-cover-everyone-save-billions-in-first-year-new-study

Friedman says his analysis shows that a nonprofit single-payer system based on the principles of the Expanded and Improved Medicare for All Act, H.R. 676, introduced by Rep. John Conyers Jr., D-Mich., and co-sponsored by 45 other lawmakers, would save an estimated $592 billion in 2014. That would be more than enough to cover all 44 million people the government estimate

That is 1/5 of our health spending that would be saved by medicare for all. It is a good amount, but that still gives us far and away the most expensive system on earth. If we spent 2.4 trillion instead of 3 trillion on health care due to a working single payer system we would still spend 14% of GDP on health care. Less than the 18% we spend now, but still far more than the 9% OECD average.

Single payer would get us halfway to where we need to go. The other half requires us to make care more cost effective and stop providing useless care because it is a moneymaker. Many nations like Israel, Netherlands, Germany, etc have health systems based on private insurers and exchange plans and they cover everyone with quality care for 8-12% of GDP. So the payer method isn’t the problem per se. Israel with a multi payer system is a humane, affordable system the same way Canada’s single payer system is a humane, affordable system. What they both have in common is strong public and private forces to keep costs in check. We lack that in the US.

[adaher]

@Broomstick

We make the same decisions here. Not every drug approved in Europe is approved in the US. Doctors make decisions and counsel patients all the time in regards to benefits vs. negatives.

The FDA only approves drugs based on safety and efficacy. Cost does not enter the equation.

US insurance companies do the exact same thing - refuse to pay for treatments they deem too expensive. I worked in the insurance industry for 13 years, 7 of them in an area where they actually made those determinations. The difference is that in the US these decisions are made behind closed doors by private companies who do what the fuck they want (within the law) rather than by a public agency that the public has some chance of influencing.

Yet the US has many times the PET scanners that any other country has, and many more patients getting proton beam therapy for their cancer. You are a lot more likely to have an insurance plan that will cover these things than you are to receive these treatments from the government.

The public has no influence over government agencies unless the public is willing to fire the elected officials in charge of them if the agencies perform poorly. What actually happens is that elected officials simply pretend they have no power over the decisions made by these agencies, which means the people have no power.

Single payer cannot work without an unelected, unaccountable bureaucracy making the key decisions. Notice how the ACTUAL first step towards single payer, IPAB, has been intentionally cut off from democratic accountability. that’s by design, we’re just more transparent about it than other countries.

And all the other problems you mentioned have already been corrected by ACA. So why do we need single payer now?

[Broomstick]

@adaher

The FDA only approves drugs based on safety and efficacy. Cost does not enter the equation.

Cost DOES enter the equation when the insurance companies get involved. In America, if you aren’t insured you don’t have access to those drugs/therapies period.

Yet the US has many times the PET scanners that any other country has, and many more patients getting proton beam therapy for their cancer.

Does the US need all those PET scanners, though? Having one means incentive to use one, even when it’s not needed.

And all the other problems you mentioned have already been corrected by ACA. So why do we need single payer now?

Ask any insurance actuary - the larger the pool of people paying in the better the whole insurance concept works because it spreads the risk wider. The entire population of the US is a bit over 300 million, which is about 7-1/2 times larger than the population of the most populous state (California, about 39 million). Much better to spread risk over 300 million people than “merely” 39 million or fewer. There are also economies of scale that could be achieved.

Of course, this has to be balanced by recognition of local conditions - not too much frostbite in Florida, very few alligator bites in Alaska.

Or we could do single-payer by state, if you’d prefer. That should still work, with a little tweaking.

The other thing is that the current system, as it is set up and working, means each insurance company negotiates separate rates for each provider. That means no one actually can find out the “retail” cost of a procedure, and you have problems with providers being in or out of network, resulting in unanticipated costs to patients. Single-payer means all providers are in the same system - no more in/out of network worries. And those who actually try to shop for the best price/value will actually have meaningful price tags to compare.

[adaher]

@Broomstick

Cost DOES enter the equation when the insurance companies get involved. In America, if you aren’t insured you don’t have access to those drugs/therapies period.

True. But many do have insurance that will cover these, and they won’t allow it to be taken away. Especially since the people with the best insurance are also the Democrats’ biggest financial contributors. From what I’ve read, France actually had to exclude the labor unions from their single payer system because they wanted to keep their better coverage.

Does the US need all those PET scanners, though? Having one means incentive to use one, even when it’s not needed.

Oh, no doubt. But I don’t see a way around that other than for patients to make those choices themselves with the best information they have, plus their own cost/benefit analysis.

Ask any insurance actuary - the larger the pool of people paying in the better the whole insurance concept works because it spreads the risk wider. The entire population of the US is a bit over 300 million, which is about 7-1/2 times larger than the population of the most populous state (California, about 39 million). Much better to spread risk over 300 million people than “merely” 39 million or fewer. There are also economies of scale that could be achieved.

300 million are already paying. Only 39 million are receiving. If you go to a model where everyone receives, then you’ll need a TON more revenue.

States really should handle this and the administration should give states as much leeway as possible to opt out of ACA and try their own ideas.

[PaulParkhead]

@adaher

The FDA only approves drugs based on safety and efficacy. Cost does not enter the equation.

I believe you are confusing two different things. In the UK, the NHS does not regulate drugs for safety and efficacy - that’s done by the MHRA. That’s the equivalent of your FDA, near as. The NHS, in deciding what it will and will not cover, is much more analagous to your insurance companies.

[adaher]

BTW, Carson has disavowed the plan as reported and now wants HSAs as an alternative to Medicare and Medicaid.

That I can get behind, assuming he can pay for it. Medicare is facing insolvency soon and I’d bet that as care suffers more and more young people will decide to go with the HSAs rather than trust the system.

[Johnny_L.A]

@adaher

Medicare is facing insolvency soon

We could euthanise the elderly, and sell their meat to schools in low-income areas.

[elucidator]

“Elderly” being persons 110 years of age or older. Subject to revision, as needed.

[Novelty_Bobble]

@adaher

Give me a metric that shows that single payer is better than multi-payer other than cost.

So you do concede that a single player system is cheaper?

With that settled then why don’t we return to the challenge I set you?
You tell me what you consider to be the best metric of an effective health care system and then we can compare how each stacks up.

I’ll even give you an option to start with, “%age of the population with adequate coverage”
UHC = 100%
USA = ?

[ElvisL1ves]

@adaher

Give me a metric that shows that single payer is better than multi-payer other than cost.

Cost alone isn’t enough? OK, another metric for its superiority is that universal health care is universal.

Now, having conceded at least the cost argument, what is left that you can claim, with evidence, is superior about multi-payer coverage?

[Wesley_Clark]

@adaher

BTW, Carson has disavowed the plan as reported and now wants HSAs as an alternative to Medicare and Medicaid.

That I can get behind, assuming he can pay for it. Medicare is facing insolvency soon and I’d bet that as care suffers more and more young people will decide to go with the HSAs rather than trust the system.

Medicare has lower reimbursement rates for providers and lower overhead, as a result medicare is something like 20% cheaper than a comparable private plan. A private plan that costs $500/month would only be $400 if done via medicare.

Why would medicare having problems drive people to adopt public plans? In a way that is like saying if you are having trouble making the payments on a 25k car, the solution is to go out and buy a 30k car instead.

The fact that medicare is cheaper and more efficient is why insurance companies fought so hard against a public option as part of the ACA. They knew they couldn’t compete with a program that reimbursed providers less and only spent 3% on overhead.

[Voyager]

@adaher

BTW, Carson has disavowed the plan as reported and now wants HSAs as an alternative to Medicare and Medicaid.

That I can get behind, assuming he can pay for it. Medicare is facing insolvency soon and I’d bet that as care suffers more and more young people will decide to go with the HSAs rather than trust the system.

Repeating the big lie again, are you?

From here.

he 2015 report of Medicare’s trustees finds that Medicare’s Hospital Insurance (HI) trust fund will remain solvent — that is, able to pay 100 percent of the costs of the hospital insurance coverage that Medicare provides — through 2030. Even in 2030, when the HI trust fund is projected for exhaustion, incoming payroll taxes and other revenue will still be sufficient to pay 86 percent of Medicare hospital insurance costs.[1] The share of costs covered by dedicated revenues will decline slowly to 80 percent in 2050 and then rise gradually to 84 percent in 2089. This shortfall will need to be closed through raising revenues, slowing the growth in costs, or most likely both. But the Medicare hospital insurance program will not run out of all financial resources and cease to operate after 2030, as the “bankruptcy” term may suggest.

2030 doesn’t seem soon to me. And if you care about Medicare, you had better thank Obama.

Health reform, along with other factors, has significantly improved Medicare’s financial outlook, boosting revenues and making the program more efficient. The HI trust fund is now projected to remain solvent 13 years longer than before the Affordable Care Act was enacted. And the HI program’s projected 75-year shortfall of 0.68 percent of taxable payroll is much less than the 3.88 percent of payroll that the trustees estimated before health reform. (See figure.) This means that Congress could close the projected funding gap by raising the Medicare payroll tax — now 1.45 percent each for employers and employees — to 1.8 percent, or by enacting an equivalent mix of program cuts and tax increases.

If the various parts of the ACA meant to cut spending more work things are even better, but I’m for a small tax increase just to be on the safe side.

[Broomstick]

@adaher

True. But many do have insurance that will cover these, and they won’t allow it to be taken away.

Bullshit. Most people have no idea what their insurance policy says. That includes people in the insurance industry. I actually demanded a copy of the policy that covered me back when I worked in the industry (causing surprise and consternation in HR - apparently they didn’t have an available copy the first time I asked!) After 9/11 the policy was rewritten to exclude any coverage whatsoever in the event of a terrorist attack. In other words - if I hurt myself flying a homebuilt, experimental airplane I was covered. If a terrorist blew the building I happened to work in I wouldn’t have been covered for so much as a splinter. I pointed this out to the people I worked under. They were shocked, being totally unaware of the change.

The hell things won’t be taken away from people - if that sort of thing can happen to the knowledgeable people in the industry itself the average person is screwed. Probably regularly.

On top of that - a lot of people can only afford minimal policies. Prior to the ACA some policies had maximum yearly limits of under 100,000 (I know this because I was offered one more than once). That doesn’t pay for jack if you have a major illness or injury. OK, we fixed that one, but it’s illustrative of the on-going problem that insurance companies have a definite incentive to find any way they can to avoid paying out.

Oh, no doubt. But I don’t see a way around that other than for patients to make those choices themselves with the best information they have, plus their own cost/benefit analysis.

The average person, no matter how well educated, is not capable of making that sort of medical determination - that’s why we have doctors! Neither you nor I are capable of knowing whether or not a recommendation for a PET, MRI, or CAT scan is reasonable or not, needed or not, mandatory or optional.

300 million are already paying. Only 39 million are receiving. If you go to a model where everyone receives, then you’ll need a TON more revenue.

Part of the problem is that a sizable chunk of those 300 million are paying not only for Medicare/Medicaid but ALSO for an additional private policy. How about, instead of forcing people to pay twice for coverage before 65 we just put everybody on the same plan?

States really should handle this and the administration should give states as much leeway as possible to opt out of ACA and try their own ideas.

My state actually started an alternative prior to ACA and went to court to keep it afterward. We’re currently expanding it. I pay a percentage of my income towards my healthcare, the state subsidizes the rest. It’s not Cadillac insurance but it’s kept the two of us healthy and out of the hospital. As my income goes up the percentage I pay is the same, even if the total dollar amount changes, until I can afford to pay for the plan without needing a subsidy. And I’m in a Red state. Thing is, the Obama administration tried to kill it, because it wasn’t THEIR plan - which just shows the Democrats are still in the pocket of the big business and wealthy.

[Maserschmidt]

@Stringbean

And, yet, trust in government rose precipitously and peaked during the Reagan, Bush, Sr., and Bush, Jr. administrations.

So maybe the American people agree with the negative consequences of bloated government and find a more limited form more trustworthy?

Most misleading description of a graph ever. Did anyone else actually click on the link? I’d pit Stringbean for this, but sadly we’re already in the pit.