And why you do suppose this is?
Yes, but while it’s “part of your compensation package,” you likely never see how much your employer is paying for their share of your health insurance coverage (unless your employer is a lot more transparent than most are). Your coverage, which you really like, is currently inexpensive (to you), but if you had to foot the entire premium bill out of your own pocket (if you lost your job, and had to continue buying it via COBRA), you very likely would not think that it’s inexpensive.
I agree with this but I ask you -
How can my (or any worker) cost be LESS when you add 120 million people to those of us who currently pay all the Medicare taxes?
I need to go to work now so I won’t be around for the rest of the day.
Ok, let’s see your accounting then.
For starters, what is the dollar value of the taxes foregone by the federal government in having your employer provide health coverage, and what would be the effect on the federal health care budget if that amount was paid by your employer to the feds instead of to an insurance company? (Remember, that would not change the amount your employer puts into your weekly paycheck, because you never see it anyway.)
You are correct; it does not. I learned something today; thank you. 
The trick lies in the “third party review”. So in reality, it’s more like "your doctor vs. the insurance company, and they send it out to an impartial third party to make the decision.
In the case of the company I worked for, we ran a huge network(500+) of urgent care and occ health clinics, and this was something our docs did in their spare time. We did have a few full-time review drs though, and a relatively large network of specialists and state-specific docs when regulations required them.
So what would happen is that an insurance company would think some sort of workers’ comp claim was medically unnecessary, but they weren’t sure, so they’d throw it over to our docs who would take a look and based on various medical industry treatment guidelines(sometimes state-mandated ones), they’d make a determination of whether the treating doctor was right or not.
More often than not, these were things like unnecessary surgeries or janky pain management- like say prescribing oxycontin initially for stuff like back pain without going through more conservative treatments and/or medications first.
Anecdotes != Data and all that…
As y’all know, I work in the health insurance field, specifically group health insurance - the health insurance you get from your employer, in other words, the subject of this thread.
Part of the process is we give in-person enrollment meetings, where we present the plans, explain the differences, talk about premiums, etc. This happens once a year when the benefits get renewed and people make their annual selections.
Yesterday, I was in a physical therapy office, meeting with about 18 people (we focus on the small business space). I’m standing up, giving my spiel, explaining how the AFLAC products can help pay the high deductibles when I paused, turned to the audience, and said
To be honest, we all… every one of us in the agency… wishes this shit would just get nationalized. (gasps) We’d lose a lot of money, sure, but we’ll just go do something else and the country will be the better for it.
They applauded.
This has been repeated ad nauseum but why do you think the per capita costs of healthcare in the USA are sooooooooooo much bigger than in any other equivalent nation? What accounts for that big difference?
Question about how that all played out.
I assume that the doctors were not doing this out of the goodness of their hearts, that they were getting paid, correct?
And the insurance company gets to choose what doctors that they want to use to get a third party opinion on a procedure correct?
Do you think that insurance companies would send it to doctors who have a higher or a lower rate of approving suspect procedures?
Do you think that the doctors would feel any pressure to err on the side of denying claims in order to continue getting these referrals?
Are you thinking that you total taxes will double, or that your medicare payroll tax would double?
AFAIK, it’s a mandated thing in the occ health insurance world, so the real trick is finding the one that was at the right price point and who can handle your case volume within whatever your regulatory agency’s time frames are. I don’t know that the determination rates are public knowledge; at any rate, the real concern was that they stayed consistent, not that they were particularly low or high.
In general, the occ health world is rife with fraud; that’s another reason for these third party reviews; it gives the insurance company another layer of protection from some jackass doctors who are using their patients to try and milk the system by doing unnecessary treatments or very costly procedures without actually trying more conservative stuff first.
Remember- there’s usually not a dramatic amount of discretion on these- there are treatment guidelines, the doctors read them, and then look at the case, and decide whether the treatment(s) adhere to those guidelines or not.
Here’s an example of a case:
*Patient presented with knee pain after a slip & fall. Initial treating physician diagnosed a knee sprain (S83.402A), with edema and pain. Treating physician prescribed rest, immobilization and 80 mg oxycontin. *
The triage nurse at insurance company or third-party administrator would look at that and think “Hmm… oxycontin for a knee sprain? And 80 mg? That’s for opioid resistant patients.” So they’d put it out for third-party review.
Reviewer gets the case, and reads the facts of the case. He reads the relevant treatment guidelines for a knee sprain of that type and severity, and notes that it calls for rest, ice, immobilization and something like 400mg of naproxen. He calls the treating physician to ask him why he prescribed oxycontin. Now at this point, it could go different ways- if the treating physician says something like “Well, last time she had an NSAID, she went into anaphylactic shock, Tylenol isn’t very effective, and she’s a opioid addict, so there wasn’t much else I could do”, then the reviewer might certify it. But if the treating physician says something less than kosher, or he can’t get hold of the treating physician, he probably won’t certify it.
I want to point two things out here- first, the point isn’t to deny claims as such, but rather to identify situations where the treatment given doesn’t conform to accepted treatment guidelines- for example, homeopathy would probably never get certified if used in a worker’s comp context. Second, this is all done under the auspices of an accreditation body to ensure independence and fairness.
Well, theres many ways to do it. Here is one of the simplest: Medicare currently spends roughly 700 billion to pay for, I think it is 55 million people. Medicaid spending is about 600 billion. So 85 % of Medicare. If these people are all being put on Medicare, it seems excessive to also have Medicaid for them.
Now unlike the people already on medicare, the 120 million are under-65s, and therefore on the average far cheaper. By a factor of 4.
In total, for 600 billion you should then be able to add 55 x 4 x 0.85 = 187 million of the younger and healthier general population. This is, as you will have noticed, about half again the number of people it has been proposed to add, so there is considerable savings.
Why is everyone missing the obvious math here?
Even if your Medicare taxes double – even if they *triple *-- you still probably come out ahead because you no longer have to pay for private health insurance. Plus no longer having to worry about losing your coverage if you lose your job, etc etc etc.
And I just saw this: Health Insurance Costs Surpass $20,000 Per Year, Hitting a Record
Will your Medicare taxes really exceed $20,000 a year?
These are some of the obvious points that the pro-insurance types like the OP seem to be totally missing. The other point that they always miss is the following: “Bureaucracy in the health care system accounts for about a third of total U.S. health care spending – a sum so great that if the United states were to have a national health insurance program, the administrative savings alone would be enough to provide health care coverage for all the uninsured in this country, according to two new studies”.
So that’s how you can add on all the presently uninsured and still come out ahead. When you have UHC for everyone, you don’t have actuaries setting rates and bureaucrats adjudicating claims: everyone pays the same, everyone gets full coverage, and no one is denied. Sounds “too good to be true”, but that’s demonstrably how single payer actually works. In effect, you come out ahead because you’re not paying insurance bureaucrats to interfere with your health care – one of the sad ironies of private insurance in American health care.
…so this happened to me yesterday (in humble New Zealand).
I went to see my cardiologist. 3 years ago I had a Pulmonary Embolism (PE). Damn near killed me. I saw him regularly after the PE, then every two months, and now I see him every six months, they do an echocardiogram and a consult. My cardiologist tells me the echo results look good.
Cost out of pocket? $4.00 for a car-park.
I tell my cardiologist that this week was a bit unusual and I was struggling with my breathing. He tells me to take an urgent blood test, just in case, which I do.
Cost out of pocket? Zero.
I hop in the car and drive home. I get out of the car and the phone rings. Its my GP. Well, not quite my GP as my GP is on holiday. Its the GP who was covering the other GP’s work. On a Friday, at 4PM. He tells me that the levels of whatever it was the blood test was testing for was elevated, and recommended that I urgently report to the Emergency Department for more testing. And he asked if I needed an ambulance to transport me in.
How much would it cost me out-of-pocket for an ambulance? Zero.
I declined, and (against doctors orders) I drove myself in. It took me minutes to get triaged, then a couple of hours before I was faced with a battery of tests. They all came up clean, but they wanted to do a CT scan to be sure. It was late at night, there wasn’t any urgency, so the scan was scheduled for the next day, and they sent me to stay in a ward overnight.
Cost out of pocket for all of this? Zero.
I had come of the warfarin a couple of years ago, and it didn’t look like I had PE, but they started me on clexane anyway, just to be safe.
Cost out of pocket for two doses of clexane? Zero.
This morning came along. I had the CT scan. A doctor reviews the results, no PE. I finish eating my hospital-provided-lunch and drive myself home.
How much did the CT scan cost me out of pocket? Zero. How much did parking in the hospital overnight cost me? Zero: because I was an overnight-emergency patient I was given a parking voucher.
And this, in a nutshell, are the fundamentals of a Universal Healthcare System. Each country that has UHC do it slightly differently, but they are all predicted on the following principals:
Its a system for delivering healthcare. Not *basic *healthcare for everyone and *full *healthcare for those who have more money. It just healthcare.
Its universal. Everyone is covered. Everyone has access. Nobody misses out.
Over the last ten years my family has had to access the healthcare system more times than I really would have liked for non-serious things and for complex life-threatening things, and the treatment I got today was the same treatment my family got, my friends have gotten, that I got three years ago when I first went into hospital. This isn’t extraordinary service, this is just how UHC works.
And it isn’t easier to set up UHC in a country like New Zealand with a smaller population. We don’t have the same economies of scale the United States has, we don’t and can’t match your GDP, we are on the ass-end of the world and its harder for us to (generally) do stuff than it is in the US.
Yet we have universal healthcare.
So lets bring this back to the OP. The OP won’t vote for someone who will “take (their) family’s insurance away”. Without context this sounds like a reasonable fear.
But the context is important. I feel that we no longer need to cite the fact that the US government spends more on healthcare per capita than anywhere else in the world. Then on top of that you’ve got people paying (the same amount again) in insurance, with companies contributing as an ‘incentive’, the US outspend the rest of the world by a fuck-ton amount of money.
In UHC countries the principle is simple: we provide healthcare for everyone.
The OP holds the principle “I’ve got mine. That’s all I care about.”
But I’m not sure I’ve got that correct though.
So to the OP: if the United States of America could start from scratch, if it were to re-write its healthcare system with universality at its core, that might result in an increase in taxes but virtually eliminate the need for you (or your employers) to pay for health insurance (leading to an overall reduction in costs), would you be willing to have your “health insurance taken away” if it meant that your neighbour would be able to get access to the same level of health care that you have?
Yes, I’m really curious about the OP’s concern. The title of this thread suggests he’s afraid his family will lose health insurance, but he’s never elaborated on why he thinks that, and hasn’t explained why he thinks his health insurance now is better than UHC. His concern seems to be taxes going up.
I’m really curious to know what kind of coverage he has and why he thinks it’s better than a UHC model.
Glad to hear you’re okay, Banquet Bear!
Possible rationale:
Taxes are bad. You are taking my money
Government is inefficient. Always. The private sector is better. Always.
America is unique. You can’t compare it to other countries with UHC
I don’t want to pay for those undeserving people’s healthcare (for various definitions of “undeserving”)
This seems to sum up the main arguments I’ve heard from folks who oppose UHC in the United States.
@ Linden Arden - Simple question: Suppose you know that the Democrat “wants” to take away your family’s insurance, but ALSO know that Congress will not approve of this, and that you WILL retain that insurance, at least for the next several years.
Given those stipulations would you still vote for Trump?
You seem to think that the funding for M4A will come out of the present Medicare payroll tax. I do not believe any politician supports that. The funding will come from corporate taxes, the progressive income tax, and perhaps wealth taxes. Sure, people who have income above some high level will end up losing money on M4A (at least before savings kick in) but whatever gave you the idea that the funding will come from payroll taxes?
And, whether or not you will like paying those higher taxes on your very high income, where do you get off calling a Senator Warren (or is it Sanders?) a liar? Even implying that she’s a worse liar than Donald Trump??
…thank-you