Not medicare for all, medicare extra for all. Basically opening up medicare to the uninsured and auto-enrolling them.
https://www.americanprogress.org/issues/healthcare/reports/2018/02/22/447095/medicare-extra-for-all/
I can’t find a dollar figure. I’d guess around $100-200 billion a year but I’m not sure.
I don’t know why we would waste our time with this. There is a well thought out plan for Medicare for All which would reduce US spending on medical care to about half and cover everyone, in line with comparable societies, Europe, Japan, Taiwan, etc. End the misery of fighting claims, endless co-pays and deductibles Sweep the whole rotten system away. Society would be free to democratically decide how to allocate the savings.
This plan is opposed by both the Democratic and Republican parties. After all Big Pharma and insurance companies make a lot of bribes, I mean campaign contributions.
The Republican answer is a big FU, but the Democratic Party response to agitation for Medicare for All is to attempt to create a sort of Medicare for All Lite. That is what this proposal from the Center for American Progress, a Demo think tank is all about.
Some people who like their employer plan and fear change may be more open to this plan because it just gives the option of medicare extra without auto enrollment of everyone in medicare.
Medicare for all would save money, but it wouldn’t put us in line with other western nations. We’d still be spending 16-17% of GDP on health care with medicare for all (as opposed to 18% now). Other wealthy nations spend 8-12%.
I guess the appeal is that medicare extra for all, a medicare or medicaid buy in, lowering the medicare age to 50 or 55, etc. is that they are easier to pass politically. That is assuming you can tie them into budget reconciliation.
Also if democrats have been bribed into opposing medicare extra for all, why would they support medicare for all which is even harsher for the plutocrats who run our health system?
I don’t think this is a question that has a narrow GQ answer.
If it is part of a fundamental reform of U.S. healthcare to resemble the model of [any other First World country] then there’s surely a strong argument that it will save a vast amount of money in the long run, since every other country in the world spends far less on healthcare, and gets better value money for each dollar they do spend.
But it’s always possible to frame it as a much narrower question: assume other aspects of U.S. healthcare are expected to remain the same; consider only the short term; consider only any increase in direct general taxation without the offsetting benefit of savings elsewhere.
I feel like there may be a fairly rough estimate.
If you assume medicare extra for all will cover 30 million people, and it costs $7000 per person per year that means it’d cost $210 billion.
Medicare only spends about $5000 per beneficiary at age 65, so the spending for those younger will be even less. But then again you have the premiums and things not covered (which is why medicare has premiums, medigap and part D premiums) which add several hundred a month.
So I’m wondering if $7000 per person per year is a fair cost. But some of that would be covered by the patients themselves, some would be covered by lower medical spending. So the true dollar figure (for money spent by the public sector) is probably quite a bit less than $210 billion.
Here in the UK we have the remarkable National Health System.
It covers the entire country (about 66 million.)
Here’s why it’s cheaper and better than the US system (bolding mine):
"The vast majority of NHS services are free at the point of use.
This means that people generally do not pay anything for their doctor visits, nursing services, surgical procedures or appliances, consumables such as medications and bandages, plasters, medical tests, and investigations, x-rays, CT or MRI scans or other diagnostic services. Hospital inpatient and outpatient services are free, both medical and mental health services. Funding for these services is provided through general taxation and not a specific tax.
**Because the NHS is not funded by contributory insurance scheme in the ordinary sense and most patients pay nothing for their treatment there is thus no billing to the treated person nor to any insurer or sickness fund as is common in many other countries. This saves hugely on administration costs which might otherwise involve complex consumable tracking and usage procedures at the patient level and concomitant invoicing, reconciliation and bad debt processing. **
Of course the US insurance companies will not allow any reform…
Quick Google search shows that Medicare costs, currently, about $10k per person ($10,348 per person as of 2016 is the figure I see). I don’t know what Medicare extra costs per person, but assuming you want to cover every uninsured person that would be about $280 billion dollars extra per year. If Medicare extra is more than the current, you can do the math. Something north of $300 billion would be my WAG.
I’m having trouble finding more recent numbers, but as of 2011 it cost about $5500 for a 66 year old on medicare.
https://kaiserfamilyfoundation.files.wordpress.com/2015/01/8623-exhibit-1-3.png
Since medicare inflation is lower than regular medical inflation, I’m guessing the number in 2018 isn’t much higher. Yes average cost per medicare beneficiary is about 10k, but that is because people in their 90s spend 15k a year, but people in their late 60s only spend about 6k a year. It averages out.
However that is only part of the cost. You have part A premiums, part D premiums and medigap premiums. Those add about $200-400 a month.
Nonetheless, a 66 year old will have higher health care costs than a 41 year old. So I personally don’t think the cost would be 10k per person per year to buy into medicare because that 10k figure is based on the average cost of everyone age 65 until death, which is far higher than the cost of people under age 65.
The uninsured population tend to be fairly young and healthy compared to the medicare population, so the cost to cover them would be less. Plus part of the costs would be covered by the consumers in the form of premiums. So I’m not sure what the total cost would be, or what % would be covered by taxes vs covered by premiums.
I believe that $10k figure is the average. I just googled ‘how much does Medicare cost the US government per person’ and that was one of the figures that came up. If it’s less than that, that’s fine, but for a ballpark I’d go with that to give you something to work from. We are talking about adding 28 million people, so it’s going to cost quite a lot.
This might be do-able, wrt the cost, assuming that $10k figure is the max ($10k per year per person is actually not that bad…I think that my own healthcare costs along with what my employer pays is well over $1k per month…probably closer to $1.5k, loaded). I’m not sure it puts us on the road to single payer, but it would be a stop-gap for covering the uninsured.
Here is a PDF from CMS.gov that gives 2014 Medicare expenditures in a range of $12,600 - $8,200 depending on state. Since Medicare only pays 80%, I guess those must be increased by 25%.
Private insurance expenditures averaged $4,500 ($6,000-$3,400) but I don’t think that includes co-pays and deductibles.
Meant to include these links as well.
2014 Medicare spending by state ($11,000 average) and 2016 total healthcare expenditures - (Child $3,552, adult $6,632 and 65+ $18,988)
I doubt there’s an easy way to estimate how much it would cost to insure the currently-uninsured. Uninsured people are uninsured for a reason (relatively poor, have health issues, etc…). Sure, demographics of the uninsured population would tend to skew younger than the typical Medicare recipients, but you figure the uninsured would also cost more than equivalent persons who had coverage, on average. In the absence of granular demographics on the uninsured, my guess is you’d have to use a ballpark estimate of $7000-$8000 to be on the safe side.
The recent Mercatusstudy on Medicare for all put the price of additional coverage for the uninsured, adding the dental, vision, hearing, and removing deductibles at $370 billion per year in 2019.
First, understand what universal health care involves - Britain may have private alternatives to NHS - which results in the same doctor saying to an NHS patient - “I can do that treatment for you in 6 months on NHS< or tomorrow if you pay me twice the NHS rate.” Canada specifically chose to adopt a different standard - a doctor is either completely in or completely out. (The health schemes are provincially run, but the feds provide the guidelines.) If a doctor chooses not to accept the published fee schedule for all covered treatments, then neither he nor his patients get reimbursed. There is not a big enough contingent of pay-as-you-go patients to keep a community of doctors in green fees and gold club dues. There are no plans that offer private insurance to cover what government health care would otherwise cover, and no employers interested in signing. So… the government fee schedule is the only game in town. The government tells doctors what they can charge or they can’t play. Why doesn’t the USA have UHC? Because that concept would likely go over like a lead zeppelin in the land of the free.
the government(s) in Canada run all the hospitals, essentially. They health authorities give them money, assign their budgets, since the patients pay nothing. The same applies to what passes for “insurance”, the administration of health care payments and billing. Apart from the simplification of billing - no arguments of in/out of plan, what’s covered, etc - the system also seriously limits the gravy train compared to the USA. We don’t have presidents of hospital boards getting millions of dollars. The guy who runs the health authority for almost a million people (the first number google found me) got about $C500,000 or about $US400,000. They are a government body, not a profit center. OTOH, frivolous lawsuits and “pay to go away” settlements are a lot fewer. Suing and losing in Canada most often means the loser has to the winner’s legal bills, so malpractice insurance - another big cost in the USA - in less in Canada. Juries are a lot less generous when they are giving away their tax dollars. Hospitals rarely advertise, except the fund-raising foundations to do additional charitable works. All in all, the gravy train is a lot smaller in Canada. That it seems to me is another problem for the USA - with UHC, the number of people whose income will be adversely affected would be large, and they are the ones rich enough to lobby effectively. And, oh yeah, the major buyer of pharmaceuticals in Canada is the government(s) so prices are much lower than in the USA. That’s how the USA spends 16% while other countries spend 8% GDP.
The reason for the individual mandate in the USA was that if you waited until people figured out they needed health care, you only insure the sick ones and the price per patient is too high. The whole idea of forcing people to sign up was to spread the cost. If people could sign up for a form of Medicare then the effect is simple - any policy more expensive (when considering co-pay) or more annoyingly complicated to use, will quickly be dropped by anyone who can sign up with the government instead. Companies would probably happily drop their plans once their employees had a viable alternative. Again, doctors and insurance companies (and hospitals) have a vested interest in keeping patients on more lucrative plans.
To answer your question, you would have to determine whether there would be a trickle or rush of people singing up, and that depends how other plans compare. A lot of employers pay for part or all of their plans, so the cost to the employee may not always be a good measure of how competitive Medicare could be.
Medicare in Canada did not emerge without some friction - there was at one time a doctors’ strike in at least one province to protest being forced to accept government fee schedules, and occasional actions since then. Plus, once people have actual health care, they use it - there are waiting lists for procedures, and in many places, difficulty finding doctors with opening for more patients. Medicare enrollment in the USA may be affected by how the industry reacts to being forced into that box too.
It’s complicated.
For example, do you account for the fact that Medicare for All is likely to make people healthier once they reach ordinary Medicare age, lowering the cost of Medicare? Do you account for the economic benefits to large firms? What do you do with the out-of-pocket savings for consumers? What predictions do you make about the effect on doctor wages?
It seems likely that whatever it costs can be paid for by a progressive payroll tax that costs 99% of taxpayers less than they are already paying, directly and indirectly, to private insurers. There will be significant costs for highly-paid specialists, CEOs of providers, pharma, and insurance companies, and others.
It makes sense to me. Medicare already does, in effect, cover the most illness-prone cohort of the population by far. I don’t see any practical reasons to oppose it, only ideological ones.
Of course, the role of private insurers would have to be drastically reduced, or nothing would be achieved.
How much would the role of private insurers need to be reduced?
I ask because I turn 65 in a few weeks. Based on the huge amounts of US mail and vast numbers of phone calls I’ve received, Medicare Supplemental/Advantage/Medigap plans must be very profitable to insurers.
How much does the US government “pay” (in the sense of lost revenues) for employer-sponsored plans?
ISTR a Kaiser Foundation study from a year or two ago that said that family coverage costs about $15,000 per year on average – $10,000 paid by the employer, $5,000 by the employee. If that $15,000 was taxable, how much tax money would be realized?
Suppose that in addition to offering Medicare Extra to those on employer-sponsored plans with those opting for it paying the appropriate premiums, it was set up so that those opting to keep employer-sponsored plans would be taxed for the cost of those plans, with the tax dollars going to help underwrite the Medicare Extra plan. Now what would the net cost of the Medicare Extra plan be?
$260 billion in 2017 according to this paper from the Tax Policy Center. It is the largest single tax expenditure for the federal government.
I would do it the other way around - charge/tax employers to cover the cost of employees who sign up for Medicare Extra. Employers still keep paying premiums for those who stick with corporate policies. I would also make it an 80/20 like regular Medicare, then let people sign up for Advantage or MediGap if they want more coverage.
Whilst insurance is tier to employment and the private system is so bloated with cash nothing will change.