While I can’t say I read policy papers on health insurance, I certainly keep up with the daily news. I certainly understand why Warren and Sanders would want Medicare for All, but I don’t know their argument for abolishing private insurance. The only arguments I’ve seen thus far just state an aversion to insurance companies making billions on the backs of the sick. I’m guessing that’s not their real argument because if Medicare for All were actually better than private insurance, then people would drop their private insurance insurance anyway. I’d think a politician would welcome private insurance to ease the burden on the government. My guess is these pols believe that somehow private insurance would interfere with the administration of MFA or the ability to negotiate with pharmas and doctors, but I’m not sure,. Can anyone please clue me in? Thanks.
From my understanding, Sanders (and others) want an expanded version of Medicare that would cover absolutely anything and everything with no deductibles and no copays. I think the only exception he said was for elective cosmetic surgery.
So, under such a plan, there would be no need for private insurance because, what is there to insure?
I assume it’s just disgust at how private insurance acts, and a feeling that based on their behavior of making money by being an unnecessarily middle man who makes money by causing suffering, the industry deserves to die.
However most nations with UHC have a role for private insurance. If anything systems without private care options are the exception rather than the rule.
As far as I can tell there is no plan to directly abolish private insurance, but I can be wrong since I’m just going from the statements I can find on the presidential campaign websites. It’s just that with a system covering the vast majority of medical needs the medical insurance industry as it exists today would be gone.
There are in fact potential issues with private insurance in a system of UHC. It can be observed in practice in Norway, where the public option is not an insurance system at all (unlike many countries with UHC). But I think that’s a topic for a thread that doesn’t start with a misunderstanding of the policy positions of Warren and Sanders.
Mathematically: Insurance is a pooled risk program. For the insureds, the pool works better the larger it is and the more representative of the population of a whole. In the arena of health care, where there does seem to be a general consensus towards the necessity of health insurance coverage, having private insurance breaks these pools apart, decreasing their financial stability, increasing the costs on the enrollees, and imposes additional costs by the duplication of effort - especially managerial and executive level effort - needed to run 6 major insurance organizations instead of 1.
Personal: Delores Claireborne works at The Texas Mental Health Association, a non-profit which is the major mental health services provider for a three-county area in Texas centered around Cotulla. Delores gets paid 26 times per year, has 1 child, and per her divorce agreement from that drunken bastard, has to provide the child with health insurance.
Delores has the following employee+child options (Plan, per paycheck, annual premium, deductible, Out of Pocket Max, amount paid out of pocket before insurance covers 100% of medical expenses)
- High Deductible, $234.06, $6,085.56, $5000.00, $5,000, $11,085.56)
- Medium Deductible, $295.34, $7,678.84, $2,500, $5,500, $13,178.84)
- Low Deductible, $362.57, $9,426.82, $1,000, $4,000, $13,426.82)
Oh, in addition to this, her employer covers $4,919.78 for her medical and life insurance. Group life is $20/month/enrollee (it’s cheap), so the employer pays, in addition to the 2nd item in each of the rows above, $4,679.78.
Total cost of insurance if Delores never goes to the doctor and has the cheapest plan: $10,765.34 ($6,085.56 out of Delores’s pocket)
Total cost of insurance if Delores has $5,000 of expenses: $15,765.34 ($11,085.56 out of Delores’s pocket)
Total cost of insurance if Delores has $700,000 of expenses: $15,765.34 ($11,085.56 out of Delores’s pocket)
Median household income in Cotulla is $34,567 - Delores earns $40k pre-tax, $37,500 after tax.
Out of pocket health insurance premium as a % of take-home income: 16.22%
Out of pocket health insurance as a % of take-home income, assuming Delores hits the out of pocket max: 29.56%
Notes:
- These are real numbers. Names are made up, I mixed and matched clients, we do business in Cotulla but not with anything called “Texas Mental… whatever”. But the numbers are real.
- This is, in no way, unusual for small business group medical insurance rates for the state of Texas.
- The employer is rather generous here - they effectively pay for the employees insurance, meaning this is the cost to cover her 1 child.
- The most expensive plan: $763.20 per pay period, $19,843.20, annually for employee, $24,522.98 total annual premium
The above is repeated… 4.7 million times… across Texas.
That’s my argument against.
Suppose you see a surgeon about whether or not you need an operation.
- Private insurance–you see him tomorrow
- Medicare for all–6 week delay for appointment
Surgeon says you need surgery immediately, sets up operation. If patient has Medicare for all pay for the operation then his private insurance has allowed him to jump the queue.
So with a private insurance option you would need complicated rules for a patient about switching between the two payment methods.
I got a little bit of clarification in the Elections thread, but I’m still confused by Sanders’ push to actually ban most private insurance.
I understand making MFA mandatory – right now Medicare acts as the insurer of last resort for a population that probably couldn’t get private insurance at any cost, and the result is that private insurers get to make billions of dollars on younger, healthier people while the government foots an increasingly large bill for older, more expensive people. If we’re going to have a shared risk pool, let’s not let people opt out of it just so a private company can make a profit.
I also understand that making MFA mandatory would effectively destroy the market for most private insurance. But banning it? Certainly enterprising insurance companies could find a way to offer supplement insurance for those who want it, even if Sanders’ MFA is the Cadillac plan of all Cadillac plans.
How exactly is this a thread that starts with a misunderstanding of Warren’s and Sander’s policy position? When Lester Holt asks in the debate “Who here wants to abolish private health insurance?” and they both raise their hand, I shouldn’t interpret that to mean they don’t want to abolish private health insurance?
Again, since the general consensus appears to be that all Americans deserve health coverage of one sort or another, mathematically when the pool is 100% of the population, you don’t want to break that pool into separate pools as it does nothing but decreases financial viability, and vastly increases administrative burden.
OTOH, if we decide that health insurance should be like chocolate - something you get when you want to pay for it - than separate pools might make sense (as they do with life insurance - but try to get an affordable life insurance policy if you have type-2 diabetes). But when the consensus is that everyone should be covered, they do not.
The risk pool element only matters for a private insurer to reduce variance of earnings. For free healthcare, a smaller pool makes budgeting a bit more difficult, but makes the avg cost lower. I’m sure the Federal Govt would rather not be sure if it’s going to pay between 4 and 7 billion then know for sure it’s going to pay 10.
Lol, you’re arguing that what Humana can do, the Federal government can’t do. How does that even make sense?
We keep hearing from the capitalist-libertarian faction that private enterprise can do anything more efficiently and cheaply than government. So private enterprise should always be able to outcompete Medicare in the market, right?
Except it doesn’t and can’t.
I don’t think they would be specifically against a public option if that were the case. If the public option were good enough, private insurance would die a natural death.
Is this addressed at me? Because I’m not remotely making that argument.
Here in the UK our UHC is the wonderful NHS.
We also have Private Insurance schemes.
I’ve paid taxes all my working life to help find the NHS.
A couple of my jobs also offered me Private Insurance.
There is no problem having both.
This would definitely be a potential problem and is the first reasonable criticism I’ve heard. This could be dealt with by legislation but it would come with extra cost to enforce it.
This one sentence:
Does just that. “free health care”? Who say’s it is going to be free - for Delores, her taxes will go up… but will they go up by 16.8% of her take home pay? “Earnings” are an additional burden placed upon the insured by a private industry, so not too sure why that first sentence even exists. Yes, the “risk pool” disappears if the pool is the entire population… but that is the entire point of getting rid of private health insurance - so they can’t game the pools to improve private earnings.
I am still not hearing any arguments for keeping Humana alive. I am quite interested in them, especially ones that aren’t based on faith-based systems like “capitalism is always good” 'n stuff.
Well I do think the private sector would certainly be more capital efficient. The problem is healthcare’s primary philosophy shouldn’t be efficiency.
Yeah, this. Private Insurance performs some useful, if luxurious, options for those that can afford it.
A more ‘hotel-like’ in-patient experience, with nicer rooms and menus.
Shorter waiting times for non-urgent consultancy or surgery.
Additional procedures which may have limited or no coverage under the NHS.