Quite rightly. But is rationing based solely on money more rational than rationing based on medical need?
Not if they all do it and all can bill the overhead to their customers while maximizing profits by refusing care when possible. The question whether the incremental dollar on overhead saves more or less of an incremental dollar in unnecessary payments?
My daughter’s boyfriend is now part of the overhead. I’ll have to ask him if he refuses more payments than his salary.
As mentioned, Medicare already exists as a demonstration of how government does it. I know we’ve argued about the true overhead, but is it anywhere near the cited 21%? Unlikely.
The insurance companies profits are part of their overhead. The more profits the insurance companies make, the less health care we get. They have a financial incentive to deny us health care. That, in a nutshell, is the problem.
It’s certainly an option, but answer these questions: Do you know a lot of people on Medicare that are happy with it? Do you know how Medicare actually pays (For example, a 5 month hospital stay, under Medicare, will cost the patient approximately $40k AND use up all of their lifetime flex days, from day 151 on the patient pays the entire bill. In addition, future hospitalizations will only be covered for 90 days or less, with the rest the responsibility of the patient. Contrast that with my current coverage, paid for by me, where that same hospital stay would cost me $7K, and I would still be covered 6,7,8 or more months in the hospital) Yea, true, most people don’t exceed 90 or 150 days in the hospital, but the coverage offered under Medicare isn’t all that.
I do not know Medicare’s budget. Can anyone provide data on Medicare’s budget and tax revenue? What I do not know is how self-supporting Medicare is from its taxes and premiums.
I can talk a little about Medicare from the user side since my husband is on it.
Part A covers hospitalization only. It does not have a premium for most people. It isn’t waivable. He was hospitalized twice last year, each time for a single night. This was approximately $2500. Those who are ineligible for premium-free Part A can buy it for up to $423 per month.
He pays $96.40 per month for “Part B.” This amount is deducted directly from his SS checks. Medicare Part B is basically equivalent to a private PPO, covering doctor visits, testing, etc. It does not cover prescription medication. This cost is the same for the majority of people on Medicare, with certain exceptions for lower income or late enrollees.
Last year, he paid $96 per month for a “Part D” plan, deducted directly from his SS checks. This is the prescription drug coverage for Medicare. This particular plan was extremely expensive up front as it had full coverage in the “doughnut hole.” We still ended up spending about $4000 additional on prescription drugs.
This year, he is in “Part C” instead of B and D. This is a Medicare Advantage Program which is administered by a private company (Humana in his case). The premium is $41 per month. It looks as if we will be spending between $4500 and $5000 additional on prescription drugs.
If Medicare is self-sustaining, these numbers don’t look too bad. Offering people Part B for $96.40 a month would be affordable to lots of people, and its coverage aside from the lack of prescription drugs is fine.
But Part A at up to $423 per month? Please.
And this is all assuming Medicare is self-sustaining, money-wise. I expect it isn’t and that general funds are used to pay for it.
And, frankly, Part D is stupid and was hamstrung by politicians who, in my opinion, wanted to guarantee it didn’t work.
I found this as of 2001:
Hospital Insurance is Part A, Supplementary Medical Insurance is Part B.
Some would argue that even having to pay the insurance companies as middlemen is overhead built-in to the system. And insurance companies must, almost per definition, spend money on things like marketing. When I see one of those dumb-ass Kaiser Permanente “Thrive” billboards, I can’t help but think of the Kaiser customers who paid for that billboard out of money that could have gone to doctors, nurses, medicine etc.
A profitable medical insurance company is one that maximizes premium intake and minimizes pay-outs for treatment. Cool for the insurance company and its shareholders, but frankly not that great of an advantage for sick people, who are (or should be) the focus of the entire enterprise.
And in a classic case of suboptimization, dealing with a multitude of insurance companies with differing policies, even if they are individually as streamlined as can be, is complicating matters for medical practitioners. US hospitals are much more expensive in administration per capita than other first-world countries.
First we pay to keep insurance companies in markting budgets and paper-shufflers. Then we pay for the people that the hospitals have to hire to interact with the paper-shufflers. This is not an efficient way of doing things.
As far as I know, I don’t know anyone who is on it.
I understand that Medicare doesn’t offer a cornicopia of provisions. It certainly has limitations from what I remember from my high school days as a cashier at Eckerd drugs store.
Some provisions, however, are a lot better than none. Surely we can all agree on that. If someone can’t get access to any healthcare because they either can’t afford private insurance on their own or because they have some kind of disqualifying pre-existing condition, I’m sure they’d love to have what Medicare could provide them, even if its minimal compared to what you have. The alternative for them is accept the status quo: risk going into financial ruin because their appendix ruptures unexpectantly or because their husband runs out of insulin and goes into ketoacidosis.
It’s the idea of American exceptionalism that always pops up in these debates, but rarely in others. Americans, according to this particular flavor, are uniquely incompetent in their government and citizenry.
Anecdotal: My mother had to wait 7 months after being diagnosed with cancer before she could begin her Medicare approved treatment. 7 months could have been the difference between successfully treating the disease and dying. Fortunately it went the other way.
Again, a good point. However is Medicare the best way to do that? To address your two examples, under the current system, the poor already have access to Medicade, and Maryland, for example, funds a high risk insurance program available to anyone in the state that has preexisting conditions, premiums on some options are as low at $190/month even for someone in their 60s. ( A program that ALL states should duplicate post haste)
I could provide dozens of anecdotes about private insurance just from my personal experience, as I’d bet many in this thread could. Of course, the number of anecdotes of being without insurance at all would likely overshadow both.
I’m wondering if the main reason why the premiums for Part A are so high is due to there being a high number of premium-free folks relative to the premium-payers. In other words, the cost of this system is being shifted to a relatively low number of people. If Medicare is expanded to include everyone who wants it, you’d be bringing more premium-payers into the system. And at the same time, the number of premium-free folks should stay about the same since they already are eligible. Because the costs of the system would be distributed across more payers, the premium should become more affordable.
According to that cite, the number of people currently paying premiums for Part A is very small, and it’s generally people who didn’t pay much into the system. So they aren’t paying for the premium-free people. They are only paying for themselves, and perhaps only a portion of what they cost. So it could be that adding each additional person costs $423 or $500 or $800 and anything over the premium amount is paid for through the revenues of the Medicare fund.
So it could actually mean that the premium would be higher than $423 if there is a lot of subsidizing going on through the Medicare fund.
It’s difficult with anecdotes to know what the medical facts were. It’s possible that the 7-month gap was a 7-month gap because there was little danger. It’s possible that those with private insurance faced the same gap.
In the couple of years since my husband has had Medicare, we haven’t encountered any situations where we have been channeled to different facilities or doctors because of the Medicare. Most of my husband’s doctors do not know what insurance he has. There has been no “Well, if you had private insurance, the waiting list would be X, but since it’s Medicare, it’s Y.”
If Part A is self-supporting, wouldn’t those paying the premiums have to be funding care for the premium-free? I mean, someone has to be paying for the premium-free folks.
Lets get one thing out of the way: Part A is “free” if you (or your spouse) worked your 40 quarters before you retired. The only people paying for Part A are those who didn’t. It’s a non-issue.
And no, my mother’s doctors wanted her to start treatment way back when she was diagnosed. Medicare took 7 months to approve the treatment. This too is a non-issue because I only offered it as one anecdote, not as any kind of proof of anything, but if you talk to any number of Medicare recipients (and I do, for my job), such stories are the norm not the exception.
The amount of the premium has been set based on something, and if the “something” is the self-sufficiency of the system, it gives us a beginning figure.
I don’t believe that any nation that currently has UHC ever had a system close to our current system…nor politics similar to US politics. Nor a political system or process similar to ours…nor the cultural attitudes that American’s have.
However, if you think it would still be useful to show how other countries enacted UHC and then try and build an analogy between how they did it (and for how much) and how we would do it, then go ahead. I don’t think it will be very helpful but far be it from me to hold you back.
What I’m really looking for in this thread is how it could be done…and what it would realistically cost. HOW would we replace the current system? What would the transition period be? What would it cost (that transition period)? What would it cost on an annual basis AFTER the transition period? What kind of coverage are we realistically looking at? How would this effect doctors salaries? Lab technicians? Other hospital workers? What would the unexpected backlashes be (say, what would happen to the current medical service providers, insurance companies, etc etc)?