Here’s what i found out- Sander’s “plan” and maybe Warren’s- is not in any way or form “Medicare for all”. Calling it that is disingenuous. It’s a new plan, with huge taxes and free for all. Nothing at all like Medicare.
**It’s socialized medicine at the point of a gun. ** That’s exactly what America doesnt work.
Look, Great Britain’s system works fine. They allow private insurance and still have a robust UHC that works.
Whose? There are like 20 plans out there. Sanders Plans and warrens is not- even remotely- MFA. they are just using that term as Americans kinda like the idea.
There’s a lot of difference. No politician or bureaucrat in a million years is going to describe de-listing a medical procedure as “cutting waste” anymore than they would claim such for cutting police or fire budgets. It would have to be defended on medical grounds. Budget does come into it, of course, but it comes down to stuff like “should we spend $3 million so an 85 yr old can live 3 more months”. Yes, the dreaded rationing.
In the US, I can’t imagine a Canada style system being implemented. Something like Germany or the UK that allows rich people to get quicker and more expansive coverage has to be included or it won’t fly. Too many Americans think they might be rich someday and don’t want to give up their daydream perks.
Ok. Does the proposed Sanders plan, which I think is titled “The Medicare for All Act of 2019” require out of pocket expenses?
Also, I noticed the bill calls for a 2.2% tax on incomes under $200,000. Does this bill do away with the current Medicare Payroll Tax, or would we have to pay both?
Grandma’s shit outta luck because, according to Stanford scientists’ inferences from kidney dialysis data, the US government values an extra year of human life at $129,000.
What is the private insurance industry’s valuation?
The objective reality is that public health insurance is not only cheaper than private insurance, but people like it better than private insurance. The world libertarians inhabit on health care is the exact opposite of reality.
Medicare and medicaid have lower reimbursement and lower overhead, so they cost less. The amount of health care that would cost $100,000 from blue cross may only cost 70k if medicaid or medicare paid for it due to higher efficiency.
https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/
Just giving people medicaid is cheaper than giving them subisides for private insurance on the ACA exchanges. Right now it is 2k cheaper (5k vs 7k in subsidies) but that number will grow with time and will be 12k vs 8k by 2028.
And medicaid has lower/no copays, deductibles, premiums, balance billing, out of network charges, etc. compared to private insurance.
You can get a 7k subsidy, along with 2k in premiums for a 9k a year private insurance plan. It’ll have a 5k deductible, copays, balance billing and no out of network coverage.
Or for 5k you can get fully paid for medicaid with no copays or deductibles. No balance billing and no surprise bills.
Two points - Rare diseases are just that - rare. No rare disease, no matter how expensive, is going to be more than a blip when your pool is the US. Currently most states have special funds for children with cancer and other extremely expensive diseases and there’s no discussion of getting rid of those.
There is a profound disconnect with your second premise. Why would anyone from another country demand more expensive care with worse outcomes from their medical establishment? I doubt the reason is because they aren’t used to it.
Get back to us after you’ve studied up on the subject and comprehend how it’s intended to work.
No you wouldn’t. If I seek care that’s covered by private insurance, I file a claim. Some services bill the insurer directly. Done and done.
None of this has anything to do with when I receive that care. If I need surgery or some other form of care immediately (and I’ve been in such a situation) I receive it immediately. Busted wrists can wait; busted spleens can’t.
Do you want an acknowledgement that private insurance also involves rationing? It does. Here you go. Use my quote against any statement that insurance doesn’t involve rationing, whether it’s public or private. PM me if you need support that private insurance involves rationing.
My point is that if someone supports Medicare For All and objects to private insurance, they’re either objecting to supplemental insurance, public-private combinations, or the current US private insurance system. The current system is obsolete with Medicare For All and I haven’t heard of anyone proposing public-private combinations. So you’ve got my analysis on why someone would object to supplemental insurance.
If you want to make an argument that public insurance doesn’t involve rationing, please make it.
What some call rationing, others call “triage.” Trying so very hard to get all exercised over the idea, having spent a goodly number of years without health insurance nor enough money to pay to see a doctor should I have really needed it.
In a world without infinite resources, there will always be some form of rationing of some kind for any good or service.
The question is not whether MFA will create an infinite supply of healthcare, the question is, will it be rationed less than it currently is by the private system? Will there be better access and better outcomes? The answer to these, as demonstrated by the examples of other countries that have done so, is yes.
Are you demanding that MFA provides infinite healthcare before you would get onboard? If not, then why do you keep harping on this? If so, then you will never be satisfied by any proposal of any kind, and therefore, your opinion need not be courted.
What rationing do you see in the current medicare system that you are concerned will be expanded if the system grows to include everyone?
Dental care, opticians and eyeglasses, physical therapy, private diagnostic services, addiction treatment, mental health counselling, and preventative care. This is specific to UK supplemental insurance, and you’re able to get all of the things I’ve listed on the NHS. However, many of them are means tested, and the others are limited. There genuinely is a tiered healthcare service for those able to afford private insurance, whether on their own, or through their employer. Whether or not that’s a negative is a different question.
Canada bans private insurance from paying for publicly covered procedures. The basic reasoning is that allowing competition can hamstring the public system because it has some legal mandates that would decimate it in the open market. First remember, most doctors and hospitals are paid on a fee for service basis in Canada. The provinces pay the fees, they don’t just give them a salary to work on whatever comes in.
Imagine the most profitable surgery is wart removal. So a smart doctor opens a wart removal clinic and sends all non-wart patients to the public doctor. That public doctor is now legally required to treat only the less profitable cases. Yes, the public doctor does have the advantage of patients not having to pay but there can be a sweet spot in the pricing that can mess up things. Lately though, recognizing that in some areas competition isn’t an issue because the public system is at capacity, they’ve loosened some of things that can be privately done.
I can only answer for the UK, but we have The National Institute for Health and Care Excellence.
I think they do an outstanding job, but they do face objections from the little Justin supporters that Shodan described.
But that’s not necessarily what’s happening; it’s entirely possible that the 75 year-old man is in generally good condition and paying for some 22 year-old kid who got drunk and fell down some stairs. I think what you’re trying to suggest is that those who are statistically less likely to have health problems would be effectively paying the same rate as those who are predicted to be less risky. You should be fine with that – the risk pool that JohnT is talking about makes access to medical care affordable for both the low risk and the high risk individual. Better yet, you don’t have to worry about whether the ambulance you rode in to the ER or the anesthesiologist who monitored you while you in surgery is “in network.” You don’t have to fight with private insurance companies over who’s going to pay for that $50,000 bill you thought was covered. The reality is that until you actually need your private insurance, you never really know whether it covers you the way you think it does.
You don’t know that – you actually may turn out to cost a LOT to insure. What you mean is that you are statistically less likely to be expensive. We’re talking about probability, not actual costs.
Because as a consumer the economics of using the health system are more predictable, as is the access, even if it’s demonstrably slower in some cases.
I’ll start with a cite for what Sanders’ Medicare For All bill from April actually does. There’s plenty of confusion because he used the terminology more loosely in his 2016 campaign. Some treat MFA as a synonym for UHC (Universal Health Care) in one of the models that’s been deployed in most other developed economy democracies. It’s not.
Some key quotes:
It will be a bit before I get to including insurance as part of the system. First let’s look define the problem in terms of MFA as Sanders has actually proposed it.
MFA would probably be the most expensive per capita UHC plan in the world. We’ll need to raise more tax revenue to pay for it than other countries with cheaper programs do. While there’s some important details for specific tax changes generally orthodox economics would expect negative effects on the economy from significant tax increases. Simply looking at a sum of government and household expenditures excludes those costs. Sanders didn’t introduce enough detail about funding to really evaluate what the dynamic effects will be. The Congressional Budget Office punted on even doing an in depth estimate of costs earlier this year. There’s risk of slowing of the economy, or at least it’s growth, as a result.
Medical care is relatively inelastic but not perfectly inelastic. (Cite) People really do consume more medical care when the cost to them is lower.* When the out of pocket cost is free, like in MFA, the evidence says that we should expect maximum demand and consumption. That will contribute to increasing costs even more in what is already likely to be the most expensive system in the world. That’s not just an increased cost to the government system. It’s an increased cost when you sum up all payers. We can reasonably be expected to consume more health care than other nations with UHC if we implement MFA as written. Increasing the total costs also feeds back to increasing the dynamic costs even more.
Now let’s look at why UHC with a role for private insurance might be preferable to MFA:
The net of effects and some of the details are important. Some of the potential negatives of not allowing insurance in a US UHC plan in a briefer form:
Again that’s potential and it’s not net effects. When you are looking at net costs it’s probably worth remembering not to compare against ACA. UHC w/insurance versus current ACA is an entirely different comparison. The question you asked was why we might still want to allow private insurance in a UHC system. Don’t confuse the comparisons.
Canada does not have copayments. Germany apparently abolished a 20 year experiment with copayments because, according to wikipedia:
But hey, what do the Germans know about efficiency?
Thats a nice cite. But bills dont really lay out the plan so much in a few talking points.
But altho that is entitled “Medicare for all” - it ain’t.