I like how the Overton window on health care has moved so far to the left that John Delaneys plan is considered the centrist plan now.
Sounds good on paper, but it would be expensive as hell. Even if it was a plan with a $10,000 deductible, covering everyone would be very expensive.
Even if you leave the medicaid and Medicare system alone, that still means you need to buy sometime like 180 million people health insurance.
I think it costs an average of 5k to cover someone with medicaid. Which has low reimbursement rates. Even if you had a high deductible version of medicaid, it would still cost at least 2-3k per person per year. Half a trillion dollars.
And that’s with medicaid reimbursement rates. If you had private insurance levels of overhead and reimbursement it’s probably closer to 5-8k per person for a high deductible plan.
Plus he discusses abolishing medicaid, which covers some 70 million people. So if it’s private insurance and abolished medicaid, so you needed to cover 250 million people, that’s easily 1-2 trillion dollars a year.
I’m not sure why he discusses getting rid of medicaid. Medicaid is the most cost efficient health care program we have.
Total medicaid spending is about 550 billion a year. I think government tax credits for employer health insurance is about 300 billion.
So maybe it’ll be affordable if that money goes to the new system. But if it’s as expensive as private insurance it’ll cost quite a bit.
“An ounce of prevention is worth a pound of cure.” So you don’t go to the doctor when you get the first symptoms because it is so expensive. And when you finally do go it is too late to cure the disease–but massive amounts of money are spent in a futile attempt to do so.
The problem with government run *anything *is that the government has no incentive to contain costs. They can spend the hell out of it and make it up in taxes. It would be a disaster, just like Obamacare.
I’ve had it, and it seemed pretty reasonable to me. Oversight was outsourced. There were annual limits for certain things. My dentist had to provide before and after scans. Many services required preapproval. Not really seeing your doomsday scenario.
To the OP, it seems like it costs a lot, but the people who can currently afford it would just be paying through taxes instead of employer insurance. And simplifying the payment system would save a lot in bureaucratic costs.
I think that adding yet another plan that does not deal with the fundamental reasons why US healthcare costs are out of control could be quite expensive.
Anyway, in the above example it’s about $5k/year per person. Multiply that by 300,000,000 and you have $1.5 trillion.
And people freak about having the government pay for this, but think it’s OK for some lady making $40k/year to spend 16% of her post-tax income on health insurance, and her non-profit employer to spend an additional 11.5% (that’s 27.5% of her income!) of her income on health insurance. :rolleyes:
Total wages and salaries in the US are $8 trillion.
If we were to fund this SOLELY by a tax on wages and salaries, Delores and employer would be subject to a cumulative tax of 18.75%.
Iow, they would save about $4,000 if we went to a single insurance pool funded by a wage tax of 18%, compared to the current, private, system which costs a whopping 27.5% of income.
Its acually the exact opposite. Government run health care is cheaper than private health insurance for two reasons.
It has lower reimbursement rates (a procedure that private insurance may pay $500 for, medicare will only pay $400 for it and medicaid will only pay $300 for it).
Public health care has lower overhead, so more of hte money goes to care. Private insurance may spend 20% of their money on overhead while public plans spend closer to 3%.
So its the opposite. As I mentioned, its cheaper to give a person medicaid (which has low/no copays, deductibles or premiums) than it is to subsidize private insurance.
If we gave everyone a high deductible version of medicaid, I’m guessing it’d cost about 2k a person. But because medicaids reimbursement is so low, that won’t happne. Hospitals, pharma, the insurance industry and physician groups would all oppose it.
But if we kept medicare and medicaid, and gave everyone high deductible medicaid as base insurance that would be about 360 billion. Not a huge sum, and could be covered by taking away the tax deduction for businesses that offer health insurance.
Yes exactly. But nobody wants to address the reason our health care costs so much because a lot of rich and powerful people like having an overpriced health care system.
Any legitimate attempt to reduce costs will be opposed tooth and nail by pretty much everyone in the health care industry. No politician wants that kind of heat, so they won’t do it.
Even a true public option is basically a pipe dream, because it out competes private insurance and cuts reimbursement to health care providers.
Vermont found a strong public option would provide 2/3 of the cost savings of single payer, and they still didn’t implement it. No state has implemented a true public option (washington state created a public option after increasing reimbursement rates to 160%).
Anyway, I agree. The real problem is cost. Sadly if the political will was there, the cost issue would be solvable. Its just that nobody wants to do it. IMO the only way to get costs under control is with ballot initiatives designed to force health care to become more affordable. Politicians won’t touch the subject.
Right now I am spending about $1500 out of my own pocket for health insurance. That’s just for the insurance - deductibles, copays, etc. are on top of that. So I am already paying for half of what you claim it will cost. My employer is paying more than that for my coverage. So it seems to be we are all already paying that.
If we went to government as single-provider instead of me and my employer paying that money to a private, third party (which is these days may well be seeking a profit on top of providing coverage) we would be paying it in taxes to the government for health care purposes. In other words, I doubt the average person would see a difference in their bottom line and everyone would get healthcare in this country with less hassle and paperwork.
So I’m baffled why you think it would be more expensive to the common man or more of a disaster than our current system. You do realize that dozens of other countries have made this work, correct? Or do you think we’re too stupid and cruel to duplicate those results?
If you read my posts you’ll see I’m a huge proponent of UHC in various forms. I’d happily pay more in taxes for UHC.
And I’m glad the overton window has moved so far to the left that Delaney’s plan is considered ‘moderate’, because a few years ago it would’ve been the radical option. Of course democrats in congress won’t vote for any health reform that makes rich people mad, so its all a pipe dream right now but its progress.
I’m curious what the costs of high deductible insurance for everyone not covered by a government plan would be. If there are about 130 million covered by medicare and medicaid, and I’m assuming another 20 million covered by VA and other public programs, that leaves about 180 million people who need coverage under the new high deductible system.
I’m guessing it’d cost about 2k for a medicaid high ded system, around 2500-3k for a medicare high ded system, and probably about 5k per person for a private insurance high deductible system.
Half a trillion to cover everyone with high deductible medicaid is a good deal, esp if it is paid for in part by retracting 350 billion in tax cuts to private employers to buy coverage.
A $10,000 deductible each would be too expensive for most people in the US. Adding higher taxes on top would be impossible.
We keep hearing from people that the government is corrupt. If that is so, why do the same people want to give it even more control over our lives? Does anyone think public healthcare won’t dictate to us which medical facilities we can use, which caregivers we can see, and what treatments will be paid for?
Most countries spend 8-18% of GDP on health. The US spends more than most countries with much more universal care. In theory, with adequate political will and professional goodwill they could have a much better system. I don’t think this will happen soon.
The problem is broad system reform may be needed. A big deductible isn’t that helpful without addressing costs. These could be very much reduced with an efficient system for centralized purchase of the most sensible medications in each class, insurance reform, covering basic dentistry, eye care, physio, rehab and psychotherapy… but the more changes made, and the bigger the potential savings… the harder it is to get agreement and the more toes stepped on. Designing an efficient system is hard; reducing corruption, greed and vested interests harder. Even in countries without private hospitals, medical transport or insurance HMOs. Even measuring efficiency and making changes is very tough.
The US could reduce costs from 18 to 10 percent of GDP. With a magic wand, since this would make many powerful businesses and practitioners unhappy.
Private insurance already has those restrictions worse than the public plans do, and it costs more.
Its a no brainer. Why would you want to pay 10k a year for a private insurance plan with tons of loopholes and high deductibles when you can pay 8k for a public plan with far fewer loopholes and lower deductibles? I don’t consider myself ‘free’ because I pay more for inferior, more brutal private health care.
Also the 10k deductible means people can purchase private insurance to cover that 10k, like people purchase medigap insurance to cover what medicare doesn’t.
In order for this UHC to be meaningful, it has to be low-deductible - at most, low enough that Americans could know with confidence that they won’t be facing a hit of more than $100 or $200 at most every time they see a doctor, especially for emergencies.
Psychologically, also, it is dangerous to have high deductibles. If deductibles are high enough, they deter patients from seeking help. You could have a patient with appendicitis who balks at the thought of paying $500 for an ER visit and decides he’s going to just tough out his lower-right-abdominal pain and fever and hope it gets better - and woot, within days, he now has peritonitis and is looking death in the eye.
One more time: * instead of paying premiums to a private 3rd party you’d be paying them to the government.* It is NOT higher taxes on top of what you’re already paying, it’s a reduction of what you’re paying, then a specific tax for the purpose. If instead of my paying $1500 to Blue Cross Blue Shield of Michigan I pay the “healthcare tax” of $1500 then end result is no different from my financial viewpoint.
You mean… like private insurance already does? You think your private insurance doesn’t dictate to you?
A big difference is that with universal healthcare ALL the providers are “in network”. It should lead to more choice, not less.
I think that public healthcare won’t dictate which medical facilities I can use, which caregivers I can see, and what treatments will be paid for. Why do I think that? Because I live in a country with public healthcare.
If I require a hospital stay, I can pick which hospital I want to go to, and chose between private and public hospitals. All treatments that are medically necessary will be paid for. I can chose my own doctor, and go on the internet to change if I’m not satisfied. There are some variety between systems but overall you should have most of these things in any halfway functional system.
I have required a doctor when on vacation in the UK, so I’ve piked one and gone to see her. My partner required a doctor when we were on holiday in France, so we went to see one in the local hospital.
CelticKnot, why would you think you can’t do these things in a public system? Its the 21st century, you can ask people from all across the world how their systems work and get it straight from the horses mouth. To me, they seem to be mainly restrictions peculiar to the US system which some people find difficult to comprehend do not exist elsewhere.
Also, I find it strange that the people who are fearful of the government having control of part of the healthcare system are often the same people who are perfectly OK with the government having the power to execute people.
Increasingly, I think it’s a major ideological difference: Americans seem conditioned to assume government is bad, and can’t provide services efficiently.
I dunno. Maybe that is true of the US, based on all the DMV threads we see. Heck, they even have extensive wait lists for the death penalty!
Or maybe it’s because the US health insurers control what doctors you can see (only in network), and charge gobs of money, and contest claims, that maybe some Americans just can’t conceive that there could be a better way.
In Canada, there’s one network. It’s every doctor and hospital in the country. My health card works anywhere in Canada. No premiums, no co-pays, for the services of doctors and hospitals. I chose my GP, based on word of mouth recommendation. When I need a specialist, my GP gives me the options in my city, and I pick which one. I choose the hospital I go to (subject to which hospital my preferred doctor has admitting privileges.)
If the best specialist for a particular condition is in another city, I go there and it’s still on my healthcard. If it’s out-of-province, healthcare covers it.
Maybe it is the case that US government is congenitally inefficient, and comments about a government-healthcare plan being inefficient are actually accurate, within the US framework. I dunno.
But if it is that basic, that US governments are grossly inefficient and corrupt, I pity you.