I appreciate your expertise and your willingness to repeatedly step up to put down misinformation. Keep up the thankless endeavour.
I think a lot of attacks on non-profits (be they hospitals or blue plans (yes, I know many have converted)) are driven by ideology more than reality of what those entities deal with.
I agree with you about Medicaid expansion and just about everything else on the ACA that you mentioned. I’m not as sold on the need for a public option. I think strong subsidies paired with a real mandate and full acceptance of the Medicaid expansion across the country would do the trick. But in the political situation we’re in, I’m willing to go along with the public option on a state-by-state basis.
Keep an eye on the Medicaid expansion. Red states are trickling into it gradually. It might take another decade to get them all into it…
Going back to the OP. Even if I thought that the Democratic nominee was going to destroy my family’s health insurance (I don’t) it would be a small price to pay to get rid of Trump. I guess I’m a patriot. I would pay any price, bear any burden, meet any hardship, support any friend, oppose any foe, in order to assure that motherfucker is gone by 2021.
Say it with me: MFA = Medicare For Anyone.
Like your employer-sponsored health plan? Keep it!
Lose your job, or want to strike out on your own as an entrepreneur? Welcome to MFA!
Yes, I realize this is just the “public option,” but Medicare For Anyone is a much better brand, and it doesn’t freak people out by abolishing private insurance or denying people the ability to choose what they think is best for themselves.
Since everyone will pay higher taxes to fund MFA, what if we made private insurance premiums partially tax deductible to slightly level the playing field?
That’s probably the most realistic way to approach this.
The whole discourse on this seems a little misleading to me. The truth is that Medicare for Anyone is likely to seriously injure the private insurance market if it is anything like what Bernie and others are proposing it will be in terms of benefits and out-of-pocket costs. Moreover, by not eliminating private health insurance you do not get the kind of cost controls and benefit to the labor market that come from a single-payer system.
I see very little *policy *case for Medicare-for-all-who-choose. There is a political case for it because of people who feel inexplicably emotional about Aetna. But it isn’t totally obvious to me that these hybrid approaches are more politically palatable in the long-term. There is a (false) simplicity to Medicare-for-all that I suspect means it will overtake the popularity of Medicare-for-all-who-choose within the time horizon of it actually mattering to actual policy–e.g., abolition of the filibuster.
The MFA discourse is also weird. They claim, for example, that doctors will no longer have to fill out insurance paperwork. Do they not understand how Medicare works? Still plenty of forms! Maybe marginally fewer, I guess, but it’s not like doctors offices won’t need all that administrative staff any more.
Anyway, voting for Trump because of a policy proposal that has 0% chance of becoming law seems like the sort of thing a Trump-voter would do.
I don’t see where it’s an “attack” on non-profits by merely pointing out that the term “non profit” is a tax designation only, and these organizations still make profits which are then used for things like executive salaries and bonuses and payouts to shareholders.
This is not an “attack” in my view. It is more like “sharing relevant and accurate information”
I think that part of the reason people like their existing employer-provided health insurance is because most of them don’t realize what it costs. Well, and there’s not much reason for them to care what it costs so long as their part is small.
According to Kaiser Family Foundation, the average employee with family coverage paid $5,431 in 2018. Their employer paid $14,134. Both these shares of premiums were not taxable – the employer deducted them as compensation expense, but the employee did not have to count them as compensation for tax purposes.
So I propose that we start by changing this – employee contributions will be made on an aftertax basis, and employer contributions will be included in the employees’ taxable income. Thus an employee in the 12% tax bracket would see his federal tax increase by about $2,350 per year. This additional tax revenues generated by this would go to help underwrite MFA.
I have a theory that if we implemented MFA on a buy-in basis for whoever wants it, employers may well reconsider whether they want to supply health insurance at all. Suppose that the buy-in for Medicare for a family of 4 would cost $16,000 per year. (I have no idea how reasonable this number is.) The employer could say, “Look, if we stop our company-sponsored plan, we will increase the salary of those on family coverage by $12,000 per year. This, in addition to the $5,400 premium you’re already paying would more than coverage your MFA premiums.”
Employees will see a bonus of $1,400 per year. Employers will have compensation expense decline by $2,100 per year per employee PLUS they get to lose the headaches and additional expenses incurred with providing coverage.
MFA would become the standard by attrition.
(Sort of ninja’d by Akaj.)
If you lose your job you lose your insurance. Hope you’re never laid off.
Type I diabetes and epilepsy (outside some rare exceptions) are NOT the high cost illness/trauma I’m talking about. Cancer will dwarf those costs in a heartbeat. Major trauma. Long term care for someone permanently disabled.
I’m glad your experiences have been positive. I hope you keep your job. I hope your employer keeps offering an insurance option.
The thing is, those under UHC in other countries NEVER have to worry about any of that. And the vast majority of them are just as satisfied with their coverage as you are with yours.
Actually, it was Blue Cross Blue Shield, not some random unknown LTD provider. That IS the “blue cross plan”. All of the people on that LTD plan were former employees of Blue Cross and Blue Shield, and it was the BCBS LTD plan. The third-rate companies are even skeevier.
I was so disgusted I transferred to a different area of the company as soon as I could. But I couldn’t quit working for them - my spouse had the distinction of maxing out a Blue Cross health insurance policy by the time he was 20, so outside of being the family member of an employee Blue wouldn’t have him as a customer (which was perfectly legal in those days). Given how much he’d cost the Blues, no other insurer would touch him, either (which was perfectly legal in those days) or cranked up the premiums to impossible levels (we were quoted monthly premiums that exceed our gross income by 50%). The only way I could get health coverage for him was to work for the industry.
I was laid off in 2007. We lost our health insurance. We went 14 months without it, during which time my spouse’s vision deteriorated and he started to suffer from peripheral neuropathy from untreated diabetes. His doctor cut his fees in half, and handed out samples, and there was some local charity help, but it was inconsistent and sometimes he went without. It was also during that period I needed a tetanus booster and that turned into a pile of stupidity. It wasn’t until we were poor enough to get on a type of Medicaid we got any relief and then, ironically, the spouse could get his regular doctor visits, his needed medications, and so forth. Government health care was GREAT for him. For both of us, really. It paid for his cancer treatment and his last few weeks of care. With Obamacare adding vision and dental to Medicaid I could get new glasses, we both got our teeth fixed. I could get regular gyno visits, mammograms, and checkups. He got urinary “procedures” to keep his kidneys working.
The only thing we paid out of pocket during his terminal illness was one $25 ER co-pay.
So, from my experience, even the crappy US version of “government” healthcare was a crap-ton better than none at all, and better than some private policies I’ve had in my life. Bring it on. Let’s go to UHC.
30 miles? It is to laugh. 30 miles is is nothing in many places in the US. What do you think people do NOW?
My college roommate had her medical education paid for by the Federal government. In exchange, she went where they sent her for the first seven years out of medical school. We’re talking about a woman who used to hike solo through places like Yellowstone and Yosemite and they put her somewhere so far outside civilization SHE could hardly stand it. 150 miles to get to the nearest store that sold basic groceries and 150 miles back. Ambulance rides were usually by helicopter, not ground vehicle. She delivered more babies by the side of the road than in the actual clinic.
Make it contingent that new doctors serve under served communities. A year or two of service. Make it an option for other people to provide support services in return for forgiveness of the costs of advanced education.
Also some damn fine salaries for the non-executives - when I worked for a non-profit health insurance company I was a secretary making enough money to fly airplanes as a hobby. I enjoyed it while it lasted.
Not ninja’d at all – you thought out the details far more than I did.
But wouldn’t making employee and employer contributions aftertax be a double-whammy for those who want to stay with private insurance, since their taxes would also go up? This would definitely hasten the end of private insurance, but might be politically hazardous enough to prevent it from happening in the first place if there are enough people like the OP.
That’s awfully optimistic to assume they’d up people’s pay if they discontinued a benefit.
Some of our employees opt out of our plan, since they have a spouse with a better plan, or other reason. We pay them more, but not the whole amount we’re saving. For employees on our plan, we pay 100% of the premium, and contribute to their HSA. I think it’s about $18,000 per employee per year. (I’ll never understand why the business community in this country isn’t lobbying hard for some kind of government health insurance for all)
That can be true, but it simply depends on how big a component of the whole system the private insurance sector is and therefore how big its deleterious effects are. In the US, where private insurance is dominant, Medicare hasn’t been able to do much to control costs. In countries that have single payer or its functional equivalent, the private insurance sector is invariably small, on the order of about 10%. The fact that they’ve been successful on controlling costs is self-evident from any comparative chart of health care costs.
This is categorically false. I’m in Canada and I have never in my life seen a single form or other paperwork related to health care services, not in my doctor’s office, not at any specialist, not during the course of a week-long hospital stay. If any of these providers have to deal with forms, they certainly keep them well hidden. I can tell you for a fact that my doctor’s office has just two staff, a receptionist who answers the phone, and a nurse/technician who does everything else. For every consultation he does, the doctor just submits the procedure code(s) and insurance number electronically to the Ministry of Health, and receives the set fee by EFT. Done. Whereas doctors’ offices in the US typically have accounting staff whose sole job is to deal with insurance paperwork. The difference is night and day. The reason Medicare in the US still involves paperwork is because it’s an unholy mess that has to coexist with, and indeed in many cases depends on, the private insurance industry.
Of course it’s always possible to implement single payer badly, which is what some fear the US government might do. Any good idea can have a bad implementation. But that’s not been the case in other countries, and in the US, Medicare actually works pretty well, considering what a compromised mess it had to be in order to function at all in the present mercenary health care environment.
I’m sorry if it’s a rudimentary question but could someone please shed some light on the reasoning for using the term “Medicare…” in all these UHC proposals? Do I just have a blind spot somewhere? I just dont get it. Is it because Medicare and Medicaid are the only recognizable terms for most Americans re single payer health care? And “Medicare” is less stigmatizing than “Medicaid” because Medicaid is a “hand out” to people who “refuse to work” while Medicare is “earned” after a lifetime of legitimate work?
If this is the reasoning, will this new meaning for “Medicare” supplant the old one? When/how will that transition proceed?
My guess is that it’s just smart branding. People know what Medicare is and in general have a pretty positive perception of it, even if they lack firsthand experience. Whereas “universal healthcare,” “single-payer” and other terms need to be explained, pretty much any idiot knows what’s meant by “Medicare for All” – even if the term is less than 100% accurate in describing various proposals.
Yes, I have a supplemental policy, but like other baby boomers, I grew up in a time when the standard health insurance policy paid 80% with a 20% copay.
Those types of policies started to disappear in the 1980s, when healthcare costs started going through the roof, even though the typical health insurance policy still made us pay 20%. Yes, even back in those days, we healthcare consumers could see prices rise and still have no bargaining power.
And, just like now, the insurance companies played little games to deny coverage, or cancel you entirely when they decided you had been sick enough for long enough. Then they came up with ideas like “preferred providers” and “in network” vs. “out of network” coverage.
During those years, my parents navigated Medicare through my mother’s long battle with cancer with relative ease, compared to my insurance company refusing to pay for my daughter’s bronchitis.
So yeah, I’m delighted with plain vanilla Medicare compared to the private insurance I had - back in the good old days as well as back in the pre-Obamacare days when I paid $7,000+ per year for an individual policy and was scared shitless I’d be canceled when one of my colonoscopies showed polyps. The fact that I can afford a decent supplemental policy is just the cherry on top.
What’s more: some folks pitch, what, “Medicare For All Who Want It,” right? As far as I can tell, that’s smart branding: you don’t lead off, like Warren, with a line about not knowing anyone who likes their health insurance; and you don’t bring up the idea of killing private-sector health insurance, because you don’t need to say it; you force the other side to mouthily connect the dots on that.
(See, you just want to make it available to people who’d find it useful, you say, and then you just smile and stop; and if the other side wants to introduce the idea that it’ll be so great it’ll soon put uncompetitive companies out of business — well, hey, they can make that case, if they want, but you don’t need to; you can even take the opposite position, innocuously saying, aw, shucks, I heard tell of plenty o’ folks who sure do like their plans, and I done figured there’s enough satisfied customers to keep them corporations up and runnin’; golly, are you sayin’ it ain’t so?)
The ACA fixed many (not all) of the things you talk about, such as people maxing out on what their policy would pay, having to wait for Medicaid to get something subsidized by government. If the subsidies within the exchanges were beefed up across the country, then people losing their jobs wouldn’t be that big a deal. If you lost your job, you could then go get a policy on the exchange and so forth, and they couldn’t cut you off for having too much claims.
Your horror story plays out differently today to a degree, and tweaks to the ACA would mostly fix it.