My employer currently covers about 3/4 of my PPO premiums. I pay about $400/month. If that went to Medicare Part E (heh) instead, and the gov’t had the authority to negotiate prices, could I essentially trade 1 for 1 or would this hypothetical universal health care be likely to come up short? Any idea how short?
Thanks,
Rob
So what you are saying is, right now at your age and location, it is costing $1600 a month total for enough insurance to do most common useful medical procedures. That is, if a commonly used method exists to keep you alive, you are covered with enough insurance to have the work done.
Well. That’s hard to say. Private insurance generally uses the medicare rate as a base and pays some multiple on top of that. So yes, to the government, the medicare equivalent would be less than the $1600/month. But whether or not you would personally benefit financially is totally unpredictable.
There would need to be additional taxes levied to pay for this program. At your income level, this is probably a loss to you. You would be older - the earliest this could possibly happen is about 8 years away. See, right now, the districts are rigged in favor of the Republican party through a process called Gerrymandering. In 2020, there would be a redistricting, which if the Democrats get to rig it in their favor (I’ve read things indicating they may be able to), in 2022 and 2024, they would be able to flush enough Republican members of Congress to possibly do something like this. So to 2024 Presidential election would have to go to a Democrat.
Then, even if the new Democrat majority in Congress and in the Presidency - similar to Obama’s first term - goes right for medicare expansion, it would most likely be scheduled for another 4 years in the future or more.
I suggest cryonics. Get yourself frozen next time something goes badly wrong, and you might wake up in a future world with some sort of universal health care. I mean, the very process needed to revive you would need to be provided like that, or you wouldn’t wake up.
Semi serious, I mean, the best health insurance in the world can only buy you a few years generally if something major goes wrong, and cryonics is unproven but is better than the absolute certainty of death without it…
But I also mean it partially in jest. The fact is, if you’re old enough for your rates to be this high, by the time we have universal health care, you very well might already be covered by medicare, if you didn’t die of old age already.
It depends on what your employer does in that situation. If they would continue to subsidize your healthcare cost, i.e. give you a monthly “kickback” of $1200, then perhaps things would be on par with your current expenses. That however, is highly unlikely.
If your question is, will the $400/month you presently pay out of pocket, cover the entire cost for a comparable single payer plan… The answer is no.
You have asked a narrow hypothetical question here. Whilst remaining GQ-oriented and non-political, I don’t think it’s inappropriate to say that on any objective measure the U.S. healthcare system is horribly dysfunctional and urgently needs root-and-branch reform. There are many metrics, but googling US healthcare costs vs healthcare costs in other developed countries shows that US citizens pay several hundred percent more for equivalent care. And, of course, many citizens have inadequate healthcare or no healthcare at all.
If you are asking: what if the US system stays basically the same, but an existing single-payer component is expanded slightly, will that be good or bad? Well, I don’t know, but tweaking a fundamentally dysfunctional healthcare system is not a fair way to judge the merits of single-payer.
Outside of the U.S., virtually all developed countries have a “backbone” public healthcare system that provides all their citizens with a good standard of medical care. The key feature is not so much that the systems are necessarily technically single-payer (e.g. in the U.K. there are several public bodies that control funding and contract services), but that it is largely funded out of general taxation and largely *free at the point of service *.
Funding out of general taxation is the obvious way to address the size of the insurance pool and ensure that the system stays adequately funded with all citizens contributing their fair share. The principle may be seen as an application of the Rawlsian veil of ignorance. Rather than optional insurance, much of it funded under the US system by employers, all citizens are committed to funding the healthcare insurance pool as part of their social contract. And the marginal administration cost of funding healthcare through general taxation is zero.
If the U.S. fully reformed healthcare to follow the model of almost any other deveoped nation, the answer to your question is that the average cost of identical healthcare to the average citizen would be expected to drop by at least 50%.
There is no question that single-payer insurance is expensive. Quebec pays 47% of its budget on health care. On the other hand there is no fighting with insurance companies over what is covered. Short answer: everything. A longer answer would mention some exceptions. As an example, a doctor told my wife that if she wanted her eyelids raised she would have to pay for it herself. Unless they were drooping enough to interfere with her vision. Then the province would pay. But nearly everything you might think of is covered. No copay, no deductible. And overall we pay about 2/3 per capita of what Americans pay. BTW, the common figure of 1/2 the cost does not hold here. I think one reason is that it is too easy for a doctor to decamp to the US and make more money. Another might be that doctors are still paid by the procedure.
Yeah, under the U.S. system the insurance company would deny it and the patient would have to pay for it herself. Unless they were drooping enough to interfere with her vision. Then the insurer might pay for it if the patient jumps through enough hoops and clears enough hurdles. They might. (Of course, deductibles and co-pays apply.)
As I understand it, prior to affordable care act, the insurer could just slip into a several thousand page contract it made you sign an exclusion for this particular procedure and a few hundred others. So a reasonable person wouldn’t know they weren’t covered until they needed the particular treatment. ACA has mandatory minimums - but in general, this isn’t everything, I understand it’s a list of the most commonly effective procedures. Lots of things are still not covered.
So it’s just like the Canadian system, but 50% more expensive per person. And it doesn’t cover everyone. And you can have every dollar you ever made essentially stolen by the hospital if you get sick with something expensive during a period of time your insurance has lapsed.
Thank you for the insight. Would you please expand upon my snipped quote from your post?
All y’all can dig about for more recent figures.
Very rough guess using the WHO figures, you and your employer would pay about half as much, but ymmv etc.
There’s noting to expand on since I was merely speculating on the reasons. But I recently read about a Boston doctor who charges her patients between $25 and $125, depending on their age, to keep them healthy. Of course, she often has to refer them to specialists at their expense. A doctor could not practice that way here because he is paid only by the procedures he performs. Nonetheless, the system works much much better than anything in the US, AFAIK and this is what is keeping my wife and me from moving to the states where all three of our kids live (we are dual citizens).
In Ontario, Canada, I visit my general practitioner regularly who checks me over, follows up, and advises me on how to keep healthy. It is paid for out of our single payor system. When something comes up that is beyond her comfort level, she refers me to other doctors who’s fees are also covered by our single payor system.
I was just looking for something to give us here in the U.S. a ray of hope.
There is no simple answer to the question. However, this site, Physicians for a National Health Program, has lots of info on single payer.
As just on example, a proposal made last year stated that
Another study of 2013 data shows that the US Government alone (excluding employer and private spending) spends more than most developed countries spend to cover everyone in their country.
Under a lot of US insurance plans, i am thinking they would just prescribe her some scotch tape on a reoccurring prescription.
I wish i thought i was joking
Bottom line, Canadians are proud of their system (with all its warts), and Americans are embarrassed by theirs (unless they are rich). This was obviously not a big enough campaign issue because you guys voted in a guy named Trump.
I will leave it at. This may soon end up in GD.
To be more specific, the US government spends more money, adjusted for population, to cover 28 % of the US population than most developed countries spend to cover 100 % of theirs.
Well put. Thanks.
Astounding how exceptional we are.
Keep in mind, too - Medicare IIRC is mostly the elderly in the USA(?). My father lived in the USA and for the last few years was in and out of hospital, frequent specialist visits, and major surgery resulting in extended hospital stays. …it no be cheap.
Your cost ($400/$1600) is for someone who is at least healthy enough to show up to work, and initially appeared healthy enough for the employer to hire - presumably you passed a medical on hire too. One old saw about health care is that the majority of the money is spent in the first year and last year of life. So, your $1600 is not for a person experiencing severe arthritis, heart problems, cataracts, dialysis, etc. Odds are Medicare and Medicaid are covering a lot of these people already.
the other problem is that (USA) health care is a river of money flowing by; everyone wants to dip their bucket in and fill it up. For example, hospitals are generally provincial run institutions in Canada, funded by the government and administered by civil servants. The head of the health care commission for a moderate-sized Canadian city of about a million makes about half a million dollars a year. Compare this with one hospital in New York City I read about, where the CEO - not a front line doctor - makes $10M a year. Hospitals here don’t need to advertise either, less money to spend. Materials and medicines are negotiated and bought in bulk by the provinces. Etc. PLUS, there are not dozens of accountants in a hospital trying to figure out whether a procedure is allowed depending on the patient’s plan, how much is covered, chasing down accounts payable for $100,000 charges from patients who haven’t a hope in hell of paying that, etc. And there aren’t CEO’s of health insurance companies being bought Ferraris on the suffering of the general public.
there’s the standard arguments that any civil service is less efficient than private industry and there are problems. However, if any civil service activity is subject to deep and constant oversight by a concerned public, it’s Canadian health care.