# Ms. Ocasio-Cortez, on How to Pay for Medicare for All **URL:** \ **Category:** The BBQ Pit\ **Created:** [December 3, 2018, 6:43pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514 "2018-12-03T18:43:36Z")\ **Posts on this page:** 20\ **Page:** 27
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [January 15, 2019, 1:25am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/521 "2019-01-15T01:25:38Z")
> [@Railer13](#): > > I know what a high-deductible health plan is. And I know what a Health Savings Account is. And I know how the two work in tandem. In fact, that was my health insurance for the last few years of my employment. It worked well for my spouse and me. > > But I don’t know what a ‘ **universal HDHP/HSA entitlement** ’ is. And a quick Google search yields no explanation. > > Can you provide a cite that explains what this is? Sure. That’s cool that you had a good experience with your HDHP/HSA plan. What I’m advocating would be simply for the government to pay the premiums for such a plan, as well as contributing some amount (maybe matching?) to the HSA. Here’s a plan similar to what I’ve been proposing, from Ed Dolan, who is definitely more credentialed than the undergraduate economics major referenced upthread (Dolan has a Ph.D. in economics from Yale University). He calls it UCC, for Universal Catastrophic Coverage: > **[What a good conservative health care plan would look like](https://www.vox.com/the-big-idea/2017/7/12/15955782/health-care-senate-conservative-ideas-universal-catastrophic-coverage)** > > The Better Care Reconciliation Act fails to fix the flaws of Obamacare that conservatives most often complain about. > [@](#): > > The exact parameters of the program would be subject to negotiation, of course, but let’s sketch some possibilities, for the sake of discussion. Suppose the deductible is set at 10 percent of the amount by which a household’s income exceeds the Medicaid eligibility level, now about $40,000 for a family of four. Under that formula, a middle-class family earning $85,000 a year would face a deductible of $4,500 per family member, with a cap of twice that amount for households of more than two people. By the same formula, the deductible for a household with $1 million of income would be $96,000. > The high-deductible policy might be provided directly by the government, as an extension of Medicare. > [@](#): > > People could choose among several ways to meet their out-of-pocket costs. As you can see from the examples above, for middle-class families, out-of-pocket costs would be comparable to those now faced under individual policies purchased on ACA exchanges, while for high-income families they would be substantially higher. > One option for meeting those costs would be to buy supplemental insurance to cover all or part of the UCC deductible. Such supplemental coverage would cost far less than policies now sold in the market for individual insurance, since the UCC deductible would set an automatic ceiling on claims for which the insurer would be responsible. Alternatively, consumers could pay out-of-pocket expenses from funds accumulated in a tax-deductible health savings account — yet another conservative idea, and one that is already on the books. > Very likely, many middle-income families would decide simply to cover all of their routine health care costs out of pocket. After all, as the chart shows, the healthiest 50 percent of the population accounts for less than 3 percent of all personal health care spending, and the next 20 percent of the population for only another 7 percent of spending. People on the bottom half of the spending curve could reasonably pay their routine health care costs in cash, just as they now pay for oil changes or wiper blades for their cars. (After all, no one assumes that automobile insurance covers routine maintenance.) > [@](#): > > Fiscal conservatives might, quite properly, ask how UCC could be financed. A large chunk of it could be paid for with another proposal favored by many on the political right — abolishing the tax deductibility of employer-sponsored insurance (ESI), which currently costs the federal budget an estimated $235 billion per year. That oddity of the US health care system is a holdover from World War II, when employers lavished in-kind benefits on scarce workers to evade wartime wage controls. Both its liberal and conservative critics say it is long overdue for repeal. > Liberals object to ESI because it’s inequitable. Suppose the cost of health insurance to your employer is $10,000 per employee. If that were taxed as ordinary income, you would pay more tax — but how much depends on your tax bracket. If your taxable income is $200,000 a year, putting you in the 33 percent bracket, the exclusion saves you $3,300 annually. At $35,000 a year, placing you the 15 percent bracket, the exclusion saves you just $1,500. The inequity is even greater for minimum wage workers. > That’s because higher-paid workers (or their unions) often negotiate compensation packages that take advantage of the tax deduction by slowing the growth of cash wages while increasing the share of health benefits. However, for workers who are already at the minimum wage, there is no room for negotiation. Wages for such workers cannot be cut (and they must rise when the legal minimum increases). As a result, the entire cost of employer-sponsored insurance falls on employers. That is one reason minimum wage jobs are less likely to include health benefits. > [@](#): > > And what about the poor? Liberal critics look at the way the BCRA slashes Medicaid and conclude that Republicans simply don’t care whether the poor have access to health care or not. Maybe that is true for some, but not all. Medicaid is simply not the only way to provide health care for people with low incomes. > For the poor, an alternative to Medicaid > For example, the Hagopian-Goldman variant of universal catastrophic coverage could be implemented in a way that would render Medicaid unnecessary. Suppose, as in our earlier example, the UCC deductible is set at 10 percent of the amount by which household income exceeds $40,000, roughly the Medicaid threshold for a family of four. The deductible for families below the threshold would therefore fall to zero. These families would get “first dollar” coverage from their UCC policy, so there would be no need for Medicaid as a separate program. (Such a scheme would also increase work incentives for low-income households, who would no longer have to worry that extra earnings would cause them to lose Medicaid benefits.) I would also jack up taxes on the rich, but not on the middle class. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [January 15, 2019, 1:30am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/522 "2019-01-15T01:30:28Z")
> [@SlackerInc](#): > > Most people are happy with what they have personally, so they will feel threatened if you talk about taking it away and replacing it with something else. Most people don’t realize how awful the U.S. health system is because they have no experience of a better system, of UHC that’s free at the point of service. When I first came to the U.S. (as a young adult, having grown up in the U.K.), I did not know what any of these things mean: pre-existing condition deductible (as applied to healthcare) co-pay co-insurance That’s not because we have different words for these things in the U.K., like cookie vs biscuit. It’s because the _concepts_ don’t exist. I think very few people in the U.S. can imagine a healthcare system where you need healthcare, and the first thing you think about is _not_ anxiety over money. Under the U.S. system, physical illness is immediately exacerbated by mental anguish: am I covered, how much is this going to cost me, what kind of limitations will my insurance company impose? It’s quite reasonable to speculate that a major contributor to the worse outcomes shown in the statistics above may be the level of stress involved in obtaining reasonable healthcare in the U.S., even when you have good insurance. And most people in the U.S. don’t focus on the huge _cost_ of their healthcare because they never see the money in the top line of their paycheck. It disappears, paid out directly by their employer before it hits their paycheck. But it’s still a very real and very large tax tax burden that _is_ coming out of their paycheck, just as surely as if it were income tax. Anyone who _thinks_ they are getting good healthcare for their money in the U.S. healthcare system is great is simply objectively _wrong_. Look at the statistics above. And a major element not reflected in those statistics is the drag on the economy and the constraint on personal life choices when health insurance is provided through the employer - for some people, it’s a major constraint on what jobs they can consider, and may rule out self-employment or entrepreneurial ventures. If U.S. public opinion is that “we have great healthcare, we like it”, then U.S. public opinion is wrong. Those statistics don’t lie. It just underlines how much work we have to do to overturn decades of propaganda by vested interests, to _educate_ the U.S. public about how awful the system is here, and about how their government is failing them. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [January 15, 2019, 1:54am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/523 "2019-01-15T01:54:48Z")
You will never convince me that signing up for Canada’s system and its extreme wait times would be a benefit to my family, personally, given that her teachers union has negotiated an excellent pan as part of their contract with the school system. It would of course be a net, utilitarian benefit to society overall, but that is not how I live my life and not how most people do. ---
**Author:** ![galen\_ubal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/galen_ubal/32/4440_2.png) [@galen\_ubal](https://boards.straightdope.com/u/galen_ubal)\ **Post date:** [January 15, 2019, 1:56am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/524 "2019-01-15T01:56:11Z")
> [@Riemann](#): > > Most people don’t realize how awful the U.S. health system is because they have no experience of a better system, of UHC that’s free at the point of service. When I first came to the U.S. (as a young adult, having grown up in the U.K.), I did not know what any of these things mean: > > pre-existing condition > deductible (as applied to healthcare) > co-pay > co-insurance > > That’s not because we have different words for these things in the U.K., like cookie vs biscuit. It’s because the _concepts_ don’t exist. > > I think very few people in the U.S. can imagine a healthcare system where you need healthcare, and the first thing you think about is _not_ anxiety over money. Under the U.S. system, physical illness is immediately exacerbated by mental anguish: am I covered, how much is this going to cost me, what kind of limitations will my insurance company impose? It’s quite reasonable to speculate that a major contributor to the worse outcomes shown in the statistics above may be the level of stress involved in obtaining reasonable healthcare in the U.S., even when you have good insurance. > > And most people in the U.S. don’t focus on the huge _cost_ of their healthcare because they never see the money in the top line of their paycheck. It disappears, paid out directly by their employer before it hits their paycheck. But it’s still a very real and very large tax tax burden that _is_ coming out of their paycheck, just as surely as if it were income tax. > > Anyone who _thinks_ they are getting good healthcare for their money in the U.S. healthcare system is great is simply objectively _wrong_. Look at the statistics above. And a major element not reflected in those statistics is the drag on the economy and the constraint on personal life choices when health insurance is provided through the employer - for some people, it’s a major constraint on what jobs they can consider, and may rule out self-employment or entrepreneurial ventures. > > If U.S. public opinion is that “we have great healthcare, we like it”, then U.S. public opinion is wrong. Those statistics don’t lie. It just underlines how much work we have to do to overturn decades of propaganda by vested interests, to _educate_ the U.S. public about how awful the system is here, and about how their government is failing them. I had the opposite experience - I moved from the States to Australia, where UHC is called Medicare. I’ll call it Medicare AU to avoid confusion. I moved when I was in my late 30s. Medicare AU covers medical care, but not dental or optical. I imagine certain cosmetic and similar procedures are not covered, but I’ve never looked it up, and I don’t have the cultural osmosis to know offhand. You just cannot imagine how much _easier_ everything is. A few weeks ago, I noticed a feeling of a not-quite empty bladder when urinating, like maybe some sort of blockage. I’ve reached that age where the prostate may be a problem, so I made an appointment with my doctor (whom I’d picked), and got in when it was convenient for me, a few days later. We talked for a bit, and he prescribed some antibiotics ‘just in case’ and an ultrasound at the local hospital. The appointment cost me nothing. The pills cost me nothing. The ultrasound cost me nothing. All I needed to do was take the doctor’s order, schedule the ultrasound, and turn up. What does Medicare AU cost me? Well, let’s see. My income tax is slightly higher than it would be in the States. I’ve worked it out. 10.6% higher. But income tax is the only tax I have\*, and no other fees. I’m not paying SS or Medicare tax on top of that. I’m not paying copays or deductibles. I’m not having insurance payments taken out of my paycheck, and I’m not paying any private insurance premiums. All in all, I’m paying less, for health care that is at least as good in theory, and much better in practice. I don’t have to triage myself, wondering if I can afford the deductible. I know I’m covered. And that’s a load off my mind. Anyone who says the US system is better is either uneducated, or profiting off the current system and/or indifferent to the problems that system causes the nation as a whole. \*Well, there’s GST - sales tax - of 10% nationwide. Even that’s easier than the mishmash of sales taxes in the States. The price on the shelf is what you pay, no calculations necessary to find the final cost. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [January 15, 2019, 2:12am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/525 "2019-01-15T02:12:58Z")
> [@SlackerInc](#): > > You will never convince me that signing up for Canada’s system and its extreme wait times would be a benefit to my family, personally, given that her teachers union has negotiated an excellent pan as part of their contract with the school system. It would of course be a net, utilitarian benefit to society overall, but that is not how I live my life and not how most people do. Well, bully for you. Anecdotes are evidence, right? You’d better hope she never wants to take a different job, or start her own business or retire early to write a novel. And you’d better hope she never divorces you. Personally, I would not want the quality of my healthcare to be contingent on my partner always remaining in a particular job. Ultimately, this is what it always comes down to when you dig down through the deflecting bullshit with the likes of you and Shodan - you _are_ denying the statistics and the evidence. You deny the statistics that show that U.S. healthcare is objectively dramatically worse than all other developed countries, costing twice as much for worse outcomes. You claim that it’s _impossible_ to implement effective UHC funded out of general taxation, a model that for very obvious reasons is vastly superior the U.S. private insurance model, even when presented with the evidence that almost _every other country in the world_ has done so. ---
**Author:** ![galen\_ubal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/galen_ubal/32/4440_2.png) [@galen\_ubal](https://boards.straightdope.com/u/galen_ubal)\ **Post date:** [January 15, 2019, 2:13am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/526 "2019-01-15T02:13:38Z")
[Here’s a simplified tax calculator for Australia](https://atotaxcalculator.com.au/), if you want to do your own comparison. Couple notes: \*Remember to convert to and from AUD - as of 31 December 2018, the rate was 1 AUD = .7058 USD per the Reserve Bank of Aus \*Australia doesn’t have filing statuses - it’s all individual. I suspect, if you account for insurance premiums you’re paying or having deducted from your pay, many of you would come out better in Australia, or not very much worse off, in exchange for a much simpler system that is not tied to your employment. ---
**Author:** ![Evil\_Economist](https://avatars.discourse-cdn.com/v4/letter/e/c89c15/32.png) [@Evil\_Economist](https://boards.straightdope.com/u/Evil_Economist)\ **Post date:** [January 15, 2019, 2:42am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/527 "2019-01-15T02:42:17Z")
> [@SlackerInc](#): > > You will never convince me that signing up for Canada’s system and its extreme wait times would be a benefit to my family, personally, given that her teachers union has negotiated an excellent pan as part of their contract with the school system. It would of course be a net, utilitarian benefit to society overall, but that is not how I live my life and not how most people do. According to health care statistics in the report I linked earlier, 33% of Americans who sought medical care experienced an access barrier because of cost. That is, 33% of Americans with a medical problem “did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care.” So, many Americans are facing a wait time of “forever”, which may be slightly longer than the wait time they’ll face in Canada. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [January 15, 2019, 4:14am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/528 "2019-01-15T04:14:11Z")
> [@Riemann](#): > > Ultimately, this is what it always comes down to when you dig down through the deflecting bullshit with the likes of you and Shodan - you _are_ denying the statistics and the evidence. > > You deny the statistics that show that U.S. healthcare is objectively dramatically worse than all other developed countries, costing twice as much for worse outcomes. > > You claim that it’s _impossible_ to implement effective UHC funded out of general taxation, a model that for very obvious reasons is vastly superior the U.S. private insurance model, even when presented with the evidence that almost _every other country in the world_ has done so. There’s the straw man again—certainly as regards my own views (I can’t speak for Shodan). —I do not dispute that the U.S. healthcare system overall is worse than that of other developed countries in most ways. OVERALL. What I dispute is that middle class people who have jobs that provide good healthcare plans would be better off under a Canadian-style system, including its extreme wait times. —I don’t say “it’s _impossible_ to implement effective UHC funded out of general taxation”. I have in fact specifically advocated for a form of UHC (UCC) that would in fact be funded out of general taxation, although I would for political reasons want to confine it to taxation on the rich. —Furthermore, if the political hurdles could be overcome, and there were not a revolt that scuttled the whole program, I don’t dispute that it would be possible economically to implement a single payer plan that would cover much more than I’m advocating. You could put every American on Medicaid, as long as you had the funding in place. What I do dispute is that we would be able to do so while cutting costs. We would have to levy significantly higher taxes than other countries, because our health system is much more expensive than those other countries. Establishing a single payer would provide streamlining efficiencies on the bureaucratic side, but Obamacare already limits how much of health insurance premiums can be spent on overhead. Even if single payer reduced that further, and I expect it would, it wouldn’t get the costs anywhere near as low as what those other countries pay. The only way to do that would be to pay doctors, hospitals, etc. much less, to clamp down on the number of tests and procedures performed, etc. And to do that suddenly would wreck the health system and wreck the U.S. economy. To look at all these other countries and say “but they did it!” is simply throwing an ignorant tantrum. It’s like you live on a plot of land where your neighbors all planted hardwood trees 50-100 years ago, and now they are making handsome profits from the harvested lumber. You want those same kinds of profits, so you jump up and down and insist “they did it, so we can do it too!” When people tell you that if you wanted hardwood in 2018, you should have planted the trees in the mid-twentieth century, you just won’t listen. > [@Evil\_Economist](#): > > According to health care statistics in the report I linked earlier, 33% of Americans who sought medical care experienced an access barrier because of cost. That is, 33% of Americans with a medical problem “did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care.” > > So, many Americans are facing a wait time of “forever”, which may be slightly longer than the wait time they’ll face in Canada. Again, from a utilitarian perspective it would be better for the 67% to deal with longer wait times for treatment so the 33% can shorten theirs from “forever”. But in a democracy, 67% is still quite a bit larger than 33%, not to mention that voter turnout is much higher among that 67%, multiplying their electoral advantage even further. (I’d be shocked if the 33% made up more than 20% of the electorate.) ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [January 15, 2019, 4:32am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/529 "2019-01-15T04:32:42Z")
> [@SlackerInc](#): > > There’s the straw man again… And yet, a couple of paragraphs later… > [@SlackerInc](#): > > What I do dispute is that we would be able to do so while cutting costs. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [January 15, 2019, 4:57am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/530 "2019-01-15T04:57:24Z")
> [@Riemann](#): > > And yet, a couple of paragraphs later… …I said “it’s impossible to implement effective UHC funded out of general taxation”? Oh wait, no: that’s what you claimed I said, but what you quoted didn’t say that at all—only that if we do so, it’s not going to involve spending less in total than we do now. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [January 15, 2019, 5:06am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/531 "2019-01-15T05:06:55Z")
> [@SlackerInc](#): > > …I said “it’s impossible to implement effective UHC funded out of general taxation”? Oh wait, no: that’s what you claimed I said, but what you quoted didn’t say that at all—only that if we do so, it’s not going to involve spending less in total than we do now. Ok, then I apologize for the lack of precision in spelling out your idiocy. Let me try to do better: Almost _every other developed country in the world_ in the world has implemented some form of UHC funded out of general taxation; with healthcare costs 50% lower than the U.S. and better outcomes. Yet you claim that it’s _impossible_ for the U.S. to implement a similar system with _any_ cost saving. Have I stated your idiocy correctly now? ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [January 15, 2019, 5:23am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/532 "2019-01-15T05:23:41Z")
It’s not idiocy, but yes: you have mostly stopped strawmanning me for the nonce—except that you go too far with that word “any”, and especially in italicizing it. I did say that we could get some marginal savings from less bureaucracy and a streamlined administration. But the cost of the healthcare itself is not going to go down any time soon, not unless we want to massively disrupt it and the economy at the same time, and not in a good way. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [January 15, 2019, 11:58am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/533 "2019-01-15T11:58:04Z")
> [@SlackerInc](#): > > You will never convince me that signing up for Canada’s system and its extreme wait times would be a benefit to my family, personally, given that her teachers union has negotiated an excellent pan as part of their contract with the school system. It would of course be a net, utilitarian benefit to society overall, but that is not how I live my life and not how most people do. I have great insurance too, I don’t think I’ve paid more than a couple hundred in total out of pocket costs for any type of medical expenses over the past 3 years, that’s including an emergency room visit followed up by in-patient surgery, and an expensive endoscopy. I recognize that I am incredibly fortunate that I’m so well covered by my company, but I understand that in other countries I wouldn’t be incredibly fortunate, because that’s what everyone gets. Well, they get the coverage, they don’t get the dozens of bills to sort through and dispute because I should get the in-network rate instead of the out-of-network rate for that doctor I don’t even remember seeing, or the “holy crap that test was 3x what I thought it was going to be and I just blew out most of my HSA on it!” They just get the coverage. I’m reminded of the ads for St. Jude’s Children’s Hospital, a charitable hospital where they offer free care to children with cancer. One of the parents says “I cried when I learned I woudn’t have to pay”. And I always follow up to myself “just like every single parent in France”. American parents are weeping at their good fortune to get this amazing opportunity for care, that is only available to the few people who St. Judes can care for every year, and the 500 million Europeans who get it by paying half what we pay for health care. ---
**Author:** ![Gary\_Kumquat](https://avatars.discourse-cdn.com/v4/letter/g/4491bb/32.png) [@Gary\_Kumquat](https://boards.straightdope.com/u/Gary_Kumquat)\ **Post date:** [January 15, 2019, 1:14pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/534 "2019-01-15T13:14:01Z")
> [@SlackerInc](#): > > the cost of the healthcare itself is not going to go down any time soon So just how do healthcare companies provide the same drugs, analysis and treatment elsewhere around the world for less in markets outside of the US? ---
**Author:** ![Evil\_Economist](https://avatars.discourse-cdn.com/v4/letter/e/c89c15/32.png) [@Evil\_Economist](https://boards.straightdope.com/u/Evil_Economist)\ **Post date:** [January 15, 2019, 2:17pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/535 "2019-01-15T14:17:05Z")
> [@SlackerInc](#): > > Again, from a utilitarian perspective it would be better for the 67% to deal with longer wait times for treatment so the 33% can shorten theirs from “forever”. But in a democracy, 67% is still quite a bit larger than 33%, not to mention that voter turnout is much higher among that 67%, multiplying their electoral advantage even further. (I’d be shocked if the 33% made up more than 20% of the electorate.) You’re assuming that all the 67% were happy with the way things worked out, which is clearly wrong. And that the 67% don’t care at all about the 33%, which is also clearly wrong. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [January 15, 2019, 2:26pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/536 "2019-01-15T14:26:37Z")
> [@Gary\_Kumquat](#): > > So just how do healthcare companies provide the same drugs, analysis and treatment elsewhere around the world for less in markets outside of the US? Easy. There’s a huge, captive, sucker market to cover all those costs, and ample executive bonuses too, right here in the Land of the Free. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [January 15, 2019, 2:28pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/537 "2019-01-15T14:28:51Z")
> [@SlackerInc](#): > > The only way to do that would be to pay doctors, hospitals, etc. much less, to clamp down on the number of tests and procedures performed, etc. And to do that suddenly would wreck the health system and wreck the U.S. economy. Who’s asking to do it suddenly? ---
**Author:** ![Folacin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/folacin/32/3195_2.png) [@Folacin](https://boards.straightdope.com/u/Folacin)\ **Post date:** [January 15, 2019, 3:08pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/538 "2019-01-15T15:08:43Z")
> [@Cheesesteak](#): > > I have great insurance too, **I don’t think I’ve paid more than a couple hundred in total out of pocket costs** for any type of medical expenses over the past 3 years, that’s including an emergency room visit followed up by in-patient surgery, and an expensive endoscopy. I recognize that I am incredibly fortunate that I’m so well covered by my company, but I understand that in other countries I wouldn’t be incredibly fortunate, because that’s what everyone gets. Well, they get the coverage, they don’t get the dozens of bills to sort through and dispute because I should get the in-network rate instead of the out-of-network rate for that doctor I don’t even remember seeing, or the “holy crap that test was 3x what I thought it was going to be and\*\* I just blew out most of my HSA on it\*\*!” They just get the coverage. My emphasis - although my company throws some money into my HSA, it’s mostly mine - so I would consider that an out-of-pocket expense. ---
**Author:** ![Railer13](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/railer13/32/9742_2.png) [@Railer13](https://boards.straightdope.com/u/Railer13)\ **Post date:** [January 15, 2019, 3:14pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/539 "2019-01-15T15:14:47Z")
> [@Folacin](#): > > My emphasis - although my company throws some money into my HSA, it’s mostly mine - so I would consider that an out-of-pocket expense. Exactly right. Those who would have us believe that an HSA-based plan will solve many of these problems seem to forget that it’s the individual’s money that’s primarily funding the HSA. It’s money, that instead of paying insurance premiums, is now in a savings account that can only be used for medical-related expenses, some of which might have been paid by a lower-deductible plan. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [January 15, 2019, 4:28pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/540 "2019-01-15T16:28:32Z")
> [@Folacin](#): > > My emphasis - although my company throws some money into my HSA, it’s mostly mine - so I would consider that an out-of-pocket expense. My company throws a LOT of money into my HSA, enough that it basically fully funds the in-network deductible, so my true out of pocket costs are very low. I can only get into real trouble if I go out of network, where a separate deductible applies. They are exceptionally generous with these benefits, and I still don’t feel that it’s better overall than UHC would be. Not the least of which is the fact that it’s twice as expensive for my company to offer than UHC is in other countries. [Previous page](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514.md?page=26) [Next page](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514.md?page=28)