Then insure every single person in top tier private health care entirely paid for out of the government’s pocket.
But of course you will not do that. Instead you will simply let people suffer and die for lack of top health care.
That’s where proponents of single payor health care need to spread the gospel on how people will live longer and live in a healthier condition longer (as pointed out by wolfpup up thread), while paying less for it out of their own pockets and less for it through their tax dollars, while being entirely free to go to which ever doctor or doctors that they chose.
For the most part, Americans are big on belief, such as belief in god, guns and anti-socialism. Deeply held beliefs tend to be impervious to fact and reason. Change will be generational.
Perhaps I did not make myself clear if that was your takeaway.
The point was that those good ideas can and do work in an environment that uses insurance companies. Those good ideas are perhaps even more important than whether or not the system is single payer or a competitive marketplace.
And I’d quibble with a can’t get there assessment. I think public option will demonstrate its superiority and the move to single payer will be inexorable. But not overnight and gradually enough that many of the job losses will be by attrition. And by proving itself first.
But glad to see that agree on the current practical politics of it.
I’m all for increasing the level of subsidies in the exchanges, and for letting people with good employer coverage (that they overwhelmingly like) keep it. I’m also for expanding Medicaid, even though it’s not as good as private, because Medicaid offers a good way out for people who are uninsured.
That’s not letting people “suffer and die”, and you’re misrepresenting what I’m saying.
Well, Bernie and Warren want a plan that has no co-pays and deductibles and no premiums, but pays much less than Private. It sounds an awful lot like Medicaid for All, even though it’s named (incorrectly) “Medicare for All”. And in this election environment, I think we need to point out that private insurance in the US is superior in outcomes to Medicaid, hence my links, which are just a few among many. This is not worthless. This is true. And the reason I originally posted that is Muffin’s point about private insurance burning money for no good cause, which flies in the face of the superior outcomes in the US for people with private insurance. You can call it worthless, but that’s just nonsense.
Americans need health insurance, not self-righteous points that attack what the majority of us have, who like what we have, who are doing better than those that don’t have it.
How do you know people who provide care are unlikely to lose their jobs? And how do you know healthcare employment numbers mean nothing? And how do you know that no one will care if an entire industry is wiped out by Sanders/Warren version of M4A?
I think in the political campaigns, this will be far more problematic than you will admit.
This Kaiser link says that 2 million jobs could get killed, even though it says, “that’s OK”…
Analysis: A Health Care Overhaul Could Kill 2 Million Jobs, And That’s OK - KFF Health News
Let’s see how that holds up in an election against Republicans, and in the face of a country where 80% of Americans like their own healthcare, and 70% like their own insurance.
…and better than people with Medicaid…
Those kinds of attacks generally don’t work in politics, and aren’t persuasive. Attacking voters or attacking people who don’t agree with you… I sure hope the Dems don’t do that in 2020, as it sort of reminds me of Hillary’s Deplorables comment. Didn’t work out for her at all - even though I voted for her - and it won’t work in 2020 either.
survinga, no, Medicaid for All would also not be at all apt and making a compare and contrast with private insurance is specious at best.
Here are some facts.
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Medicare is administered by contracted private plans now for about a third of all enrollees; Medicaid is up to about two thirds, using risk-based models. This is not the model of the proposal.
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Medicaid is not a universal program taken by all providers. Many providers refuse to play in the space. Access to care, even to basic primary care services, is sometimes so poor as to be as unto nonexistent. Hellavu lot better than no insurance but still an issue. The Canadian-style system proposed would not have that problem. Provider access (referral for specialty care required) would be better in the proposed Canadian-style system that under the current American private insurance model.
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Medicaid specifically takes care of population inherently different from the general pool. Poor, with all the structural challenges associated with poverty, but also sicker. It provides
To be fair Medicaid as a plan performs amazingly well given its role as a high risk pool buffer taking care of very vulnerable patients not infrequently with disabilities and complex chronic illnesses who often have very limited resources. But it usually pays crap for the work involved and many I know will only participate as a function of civic responsibility, and then only if they can limit their panel size, as they often effectively lose money in the process.
Really though, what is proposed is a Canadian-style system for All. Not Medicare for All, not Medicaid for all, at all.
Look, I know that Sanders plan isn’t Medicaid or Medicare for All. I was just taking his comments about no premiums, deductibles, co-pays, and lower reimbursement into account in my post.
I’m not against Medicaid, by the way. Many doctors don’t take it. I know people in my extended family who have Medicaid, and they are limited in the doctors that will see them or treat them. But I know that it’s helped millions of people, and I wish the rest of the red states in the US would finally accept the Medicaid expansion.
But in this country, the best outcomes are associated with private insurance. I think that should be pointed out to people who post wtte that private insurance is a waste that burns money while people die, etc. In this country, the best path to UHC is to expand on what we have - which does include more government involvement - instead of throwing it out, and completely replacing it with something very different.
It also sounds exactly like the foundational principles of health care in Canada, which is Bernie’s point. It also sounds very much like UHC in most of the civilized world, which is also Bernie’s point, except for the minor aspect that in many systems there is a nominal co-pay. That part is just an implementation detail – the important thing is that public UHC systems eliminate the interference and gross inefficiencies of a useless middleman trying to profit by mediating access to something that is a basic human right.
Well, pointing that out is certainly a job that you’re trying to do, and Republicans along with the lobbyists at America’s Health Insurance Plans™ thank you. But you’re wrong, for the reasons I itemized, which you’ve chosen to just ignore so you can plow ahead with the same talking points again and again. Private insurance is definitely the best thing to have in the US at this time, but only because that’s how skewed and broken the system has become: all forms of public insurance are relegated to being a second-rate poor cousin, and that’s by design. That’s not how it is in other countries, where that is NOT the design. You can go ahead and ignore that, too.
No, in the final analysis Americans don’t “need” health insurance, Americans need health care. If you confuse the unnecessary and meddlesome middleman with the final product, then the next step is to argue that if Americans “need” health insurance, then what better way to provide a wide variety of “choice” than through the wonderful mechanism of the “competitive free market”? Those words would warm the heart of any free-market ideologue, and certainly bring in donations from the health insurers and their lobbyists. But as other countries have discovered – and they discovered this a long time ago – what people actually need is unimpeded and guaranteed access to health care.
The irony of it all, of course, is that in the name of “choice” and free-market “competition”, Americans actually have far less choice in the real end product – actual health care – than the people of other advanced nations, because access to actual health care in America is controlled by health insurers and limited by their fiduciary duty to minimize claims, control medical payouts, and herding patients into their own provider networks. As I’ve often said, quoting the late health care economist Uwe Reinhardt, physicians in other countries would be horrified at the degree to which American health insurers meddle between patients and their caregivers.
How can anyone “need” health insurance when I’ve never had health insurance in my life, and that’s just the way I and all my fellow citizens like it? I simply have lifetime access to any needed health care from any provider at any time, at no cost to me.
Good thing I’m not a politician running for office.
Abruptly abolishing private health insurance in the early 2020s is a stupid idea, whether viewed as a matter of policy, or as a matter of electability. And Elizabeth Warren is anything but a stupid person.
We bought into Obamacare as the first step in a gradual process: increase subsidies, impose patient-friendly rules, add a public option; the problems of private health insurance would gradually wither away. I hope Elizabeth Warren clarifies that her plan is something along those lines.
Instead of “Medicare for All” I propose “VA Healthcare for Some”! Contrary to right-wing propaganda, the VA provides good health care efficiently for 9 million-plus people. How hard would it be for VA to serve 10 million-plus? With the extra million being ordinary people who volunteer to hire the VA as their insurer, at a price set by VA to make a profit.
It might be impractical to expand VA Healthcare to serve a large portion of the population, but if it served a few million it could provide a useful comparison on services and prices charged by the private sector.
And furthermore, the free market is efficient when people make informed decisions based on an analysis of the costs and benefits. The costs for health care are completely opaque, whether with insurance or not, and ironically, the system for government-run health care is more transparent.
In terms of health outcomes, insured Americans and Canadians are very similar.
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.4.1133
Our main problem is people who aren’t insured. If we could get them signed up via Medicaid, that would be good. If we could subsidize a private policy for them, even better…
If you ignore costs and knew these private policies wouldn’t require substantial personal costs for healthcare, yes. But those are respectively wrong and unlikely assumptions. To put this thread back on track, the unlikelihood of private insurance not being a bankruptcy trap houkd be emphasized. The “pencil pushing middleman” should be emphasized as the major source of job losses, regardless of how precisely accurate that is.
“Higher levels of inequality” in the USA? Here’s how to solve it:
Put everyone, rich or poor, of every ethnic group and geographic location, into the same pool with the same medical resources and the same access to those resources.
H
Wtf is wrong with you and wolfpup? Why the hell do you think this is an “argue how awesome UHC is” thread?
IOW you propose lying?
To the first part … as has been pointed out in this thread already to very significant degrees current Medicare and more so current Medicaid are in fact functionally subsidized “private policies” in which the terms of the policy coverage are standardized and very explicitly laid out by the government. They (because of the specifics of those terms) are delivering on costs and quality, value, over what the FFS model administered by government itself does.
wolfpup, you really had a point that the Canadian model has been the victim of disinformation in the United States. It is a shame that you couple that with so many falsehoods about the American one. Your doing that really weakens your position tremendously.
I guess a candidate could emphasize that, and get plenty of attaboys from the Sanders wing. The problem is that the number of “medical bankruptcies” is GREATLY exaggerated, and that private insurance is in fact not a bankruptcy trap.
“We calculated this estimate as follows: the graph shows that, on average, a hospitalization increases the annual probability of going bankrupt in the following 4 years by 0.004. Multiplying this figure by the annual hospitalization rate of 7.8% for our population (which we calculated using the 1999–2010 Medical Expenditure Panel Survey) reveals that 0.031% (0.004 × 7.8%) of the population goes bankrupt each year as the result of a hospitalization. Given that the annual household bankruptcy rate is 0.8% among the nonelderly,4 hospitalizations cause about 4% (0.031/0.8) of bankruptcies among nonelderly adults. A similar calculation for a subsample of uninsured adults reveals that even in that population, hospitalizations are responsible for only 6% of bankruptcies4; for this population, the effect of a hospitalization on the likelihood of bankruptcy is (not surprisingly) larger, but the hospitalization rate is lower than in the overall nonelderly population.”
So, while I agree that the prescribed talking point would probably be a popular talking point in a primary, it will be shredded in an election where everyone isn’t trying to “out-Bernie” each other on healthcare.
Right. When I first heard Bernie talking about medical bankruptcies, I actually naïvely believed that he meant cases where people had a car accident or serious illness that bankrupted them all by itself. But the reality is that he counts every case where someone declared bankruptcy and listed medical bills as one of the many things on the pile of debt. That’s not honest.
Whoa, talk about fallacy of the excluded middle! How about giving poor and low income people health plans that are much better than what they have now, but not quite as good as the coverage a wealthy or upper-middle-class person has?
Yes, and if we were having that wonky policy debate, I would make a strong pitch for my preference, which is an entitlement of an HDHP/HSA plan along with transparent medical pricing and consumer choice. But no politician is proposing that, and furthermore people probably wouldn’t like it very well. The dislike is actually a necessary component, because the idea is to get people to “bend the cost curve” by shopping around and fretting a bit over their healthcare costs, but without being vulnerable to a massive financial wipeout. Therefore it is sadly a political nonstarter.
Nice. Notice that in that study, Canadians in the fourth and fifth quintiles, 40% of the population, were slightly more likely to have an unmet healthcare need than were comparable Americans. That’s the group I have been talking about, who cannot lose even an iota of the health coverage they have now or they will freak out. And they vote and contribute to candidates in huge numbers.
SlackerInc rings in first, and Alex Trebek calls on him:
“How do you get wealthy and upper middle class people to freak out and ensure a GOP landslide in the next election?”
LOL, sad but true. :smack:
This, 1,000%.
Well, blow me down! We do agree. Now please tell this to the millions of people supporting Sanders and Warren.