To pay for Medicare For All (MFA) the average worker would pay $23,000 in annual Medicare taxes

Great Debates
81

If your household is earning $500,000 a year, there is some truth to this. Because of course you should pay more for healthcare, just like defense, schools and everything else, under a progressive tax system.

The astonishing thing is how the Republican Party has convinced their “base” of poor working class Americans that this “socialism” is bad for them. This bizarre fantasy of the MAGA rednecks that their tax dollars are going to lazy pigmented people because of evil socialism… as they draw their welfare and farm subsidy checks and (for the first time in their lives) get a half-reasonable level of subsidized healthcare under ACA.

82

I’m not really understanding your argument as the numbers just don’t work on the macro scale.

I sell health insurance. I just ran a group quote for a family for a HDHC plan of $1,878.55/month*. The HDHC plan features:

$6,500 deductible, Individual
$13,000 deductibe, Family
no Co-pays
Maximum out of pocket: $6,500/$13,000
Typical ACA protections (no spending caps, no pre-existing conditions, free wellness checks, maximum out of pockets, all those things which didn’t exist prior to the ACA.)

If they have no health expenses, their annual medical expense is $22,299.36
If they have medical expenses of $3,000, their annual medical expense is $25,299.36
If they have medical expenses of $300,000, their annual medical expense is $28,299.36

This above plan is most expensive way to configure a group health insurance plan as it is, literally, a group of 2 people (the minimum allowed), a man and a wife who own their own real estate appraisal company.

(And these rates are HMO rates, not PPO rates. PPO rates are higher.)

So, to counter:

  1. The above actual quote is close to your $23,000 figure. What would this family be missing out on if they paid $23k in taxes to see any doctor they wanted, as opposed to $22,300 in premiums to see only those doctors on the Humana HMO network?
  2. If the cost of group insurance decreases as the size of the group increases, and your $23,000 figure comes oddly close to the actual premium for a 2-person group, then is it not financially most efficient to place 100% of Americans into 1 group which consists of 100% of Americans paying into the same group? Would not the figure of $23/k per 2-person group dramatically decrease as the size of the group increases from 2 to 325,000,000?

I’m really more interested in the OP’s response to question 1 as question 2 is more rhetorical as the answer, of course, is “Yes, the per-family price would shrink as the pool expands.”

*Family owns a very successful 2-person small business and they are paying this through the business, taking advantage of tax breaks. But, still, though expensive as all hell, these rates are not uncommon in the small group market here in Texas.

83

“If they have no health expenses, their annual medical expense is $22,299.36
If they have medical expenses of $3,000, their annual medical expense is $25,299.36
If they have medical expenses of $300,000, their annual medical expense is $28,299.36”

I made a simple math error - I applied the expenses against the individual deductible ($6k) and not the family deductible ($13k). Had I used the family deductible, that last number would have been $35,299.36

84

This is exactly right. The ONLY group that has any kind of argument against single-payer UHC is the wealthy – those who get first-rate gold-plated health care now, and who would likely see their taxes rise more than their health care cost savings. Everyone else – as noted in the New York study I cited earlier – would pay less with single-payer, and would benefit from an efficient system focused on patient care rather than insurance industry profits, one that might actually spend more on actual health care than the present system, but much less on paperwork and administration. People in general would get more essential health care, get it at lower cost, and would likely live longer and healthier lives as a result, as indeed they do in most similar countries that have UHC. It would almost be like health care was a basic human right, the way it is in every civilized country in the world.

Thus, the wealthy might be said to have an argument against single-payer and the socialization of medicine (and this is the group that also railed against the prospect of Medicare in the early 60s, and bankrolled protests against it), but it’s a reprehensible and morally bankrupt argument, just as it was when they opposed Medicare. It’s an argument of boundless selfishness and astounding myopia that rejects all societal benefits in favor of maximizing their own personal monetary gains. It’s the same mentality that drives them to cut funding for public schools, and when society crumbles badly enough, to move to gated communities and wall themselves in. What is remarkable is that this ideology has been spun into the most amazing scam, where a majority of non-wealthy ordinary middle class conservatives believe that being gouged by private health insurers – and by the entire dysfunctional mercenary system it has spawned – somehow benefits them, too.

Living as I do under socialist single-payer, I can assure you that they’d be missing out on more than just the wonderful requirement to only be allowed to see designated doctors in the Humana network. Yes, we single-payer patients have to put up with the ability to see any doctor or provider or hospital we prefer, and you can imagine the stress this choice causes! But the [del]victims[/del] clients of private health insurance would miss so much more than that! They – and their doctors – would also miss the wonderful insurance industry practice of having an insurance bureaucrat always standing between patient and doctor, adjudicating each and every claim, second-guessing the doctor’s choices and the patient’s preferences at every turn to try to save a buck. With single-payer, their doctors just get boring automatic payments and the patients get unconditional coverage with no drama and essentially no paperwork. Patients would also miss the life-threatening thrills of having their claims denied outright for any mercenary technicality imaginable. Those who enjoy being robbed would also miss having to pay extortionate deductibles and co-pays. Those who enjoy forms and paperwork would be out of luck with single-payer, too, and so would those who enjoy spending hours on the phone arguing with insurance bureaucrats, although most of that is spent on hold listening to elevator music. Life just wouldn’t be the same!

85

(Emphasis mine, of course)

May I presume that this is how you make your living?

If my presumption is correct, and I am also correct in inferring that you are in favor of M4A (as am I), good on you for your selfless willingness to have your job evaporate out from under you. Also, how do you propose to make your living under M4A?

I understand that there are also one or two other people whose incomes rely on the continued existence of the health insurance industry. In other words, where is there a road map that leads from here to there?

I’m tempted to start thinking that one of the fundamental truths of economics is that wealth is created by inefficiency…

86

Another factor : clout. Medicare would represent an enormous chunk of all healthcare dollars. Basically all. It doesn’t have to agree to pay the sticker price for a pharmaceutical drug that went up in price 1000% the last year. Or $800 for a bag of saline. Essentially, healthcare providers and drug companies would either have to accept whatever medicare is willing to pay, or close shop, as for most of them there would not be enough patients from other insurance plans or who could pay cash to stay in business.

This is one huge source of savings. Now, the downside of this is also that Medicare isn’t going to agree to pay for expensive treatments that don’t work. This is that so called “death panel” thing in practice. The problem with complaining about it is that Aetna and Blue Cross and all the rest have death panels as well…except these private firms tend to be fraudulent about it. They often will decide not to pay for expensive treatments that do work because they don’t want to pay for them. And then have their medical “review” staff rubber stamp whatever decision they have decided on for cost reasons. Example here.

87

Don’t forget another big annoyance. Your nation uses a nationwide system, right? So if you travel to a different region to see family or just because you want to move, you aren’t suddenly unprotected by most insurance coverage if you get sick, right? (because you are “out of network”)

And if you need to go see a doctor urgently, and the lab they use is “out of network” or you get some surgery and a nurse or anesthesiologist is “out of network”, you don’t suddenly get shafted with absolutely ridiculous bills that have no relation to the true cost of the service, right? Basically legalized theft, where you have to agree to pay whatever and agree not to sue if you die, since you were told that death was a side effect of the procedure.

And then if you survive, after the fact, weeks later, you will get a massive bill mailed to you. And it won’t be just 1 bill. No, it could easily be 5 or 6 separate bills. And for whatever bizarre or stupid reason, if you can’t pay these bills (trivially could be tens of thousands of dollars), somehow credit scoring agencies count these unpaid bills the same as if you didn’t pay the power bill or some other service of a reasonable price where you knew ahead of time what the cost would be.

And don’t forget that despite these absurd and immense costs, the medical system intends to fail you. They know you will die eventually and they won’t even make a modicum of effort to do anything that might help like flash freeze your body just in case some future advances in medicine are made. No, they fully intend to let you rot, after robbing you of almost 20% of every dollar you will earn in your life.

88

The shitty part is that we can’t fix the problem. So many of us know we have a serious problem, but what can we do?

We can’t depend on politicians to fix this. The GOP are plutocrats who want to destroy what little humane health care we have. They want to abolish the ACA, medicare and medicaid.

The democrats are spineless wimps who aren’t going to do anything to offend the rich and powerful, and instead will (at best) pass tepid reform that subsidizes people’s ability to buy into the broken, evil, overpriced system we have rather than reform the system to make is affordable, humane and functional.

Ballot initiatives have all been failures. The Colorado initiative only got 20% of the vote.

Maybe in a decade, some state will pass M4A via ballot initiative. But i don’t forsee politicians passing it anytime soon. Even in California where Democrats control 3/4 of the state assembly seats, they aren’t going to pass it. THey’ll just talk about it endlessly while making sure they don’t offend the rich by actually doing it.

Living in a plutocracy full of tribalistic politics fucking sucks.

89

Actually, it’s often a proposal for a whole new program that would subsume Medicare and Medicaid. The Sanders bill (currently the most talked about version, I think) would basically abolish Medicare and completely replace it with a whole new program called…Medicare.

90

It’s a bit disconcerting how effective the “somebody is getting away with something” argument works with a significant number of Americans. Shout “voter fraud!” and boom, instant support for systemic disenfranchisement. If someone invokes their civil rights, you’ll find no shortage of Americans accusing that person of having something to hide or evading justice on a technicality. It’s probably the readiest explanation as to why to so-called “land of the free” has an astonishingly high incarceration rate.

Material for another thread, I’m sure.

91

You could throw into the pot what looks from the outside like a comparatively enlarged tendency not to trust professional judgment, but rather to try to tie everything down in nitpicking legislation. Granted, if you elect people as legislators, legislate is what they’re going to do, but is there a different balance from other countries’ political systems, as between (a) holding politicians and officials in charge of government operations to administrative account, and (b) tying their hands with legislation?

92

No. Canada’s system is run by the provinces, not the federal government. Though the federal government lays down the basic rules, single-payer healthcare is looked after by the provinces. All provinces have reciprocity with the others (one of the federal government’s rules), so if I need medical care in Ontario, I just show my Alberta health care card at any hospital or doctor’s office in Ontario, and I get it. It may look like a nationwide system, but it is not.

93

Maybe someone’s figured out a way to do it but I can’t see M4A happening on the state level because of free interstate movement of Americans. It has to be done federally.

94

In Japan, my daughter had to go to the emergency room for a glass cut on the side of her head, entitling numerous stitches and follow-up consultations over a three week period.

Total out-of-pocket cost to me, including the ambulance ride and such: 0.

My son gets middle-ear infections on occasion. Total cost per occurrence (not trip to the doctor) including prescriptions: equivalent of about $2.

Taxes here are by no means outrageously higher (or lower) vs the US.

You don’t really hear of people filing for bankruptcy in Japan due to medical bills. That’s something that only happens in the good ol’ US of A.
Yep, America, land where you’re far more likely to be the victim of gun violence, and be forced in to bankruptcy to pay for it.

95

Its pretty much the same in the EU/EEA area. If I need medical care in the UK, Italy or France say, I count as a citizen of those countries. There are other bilateral agreements too, Thailand for example.

96

I’m not JohnT and I don’t sell insurance. However, many universal healthcare countries still have some form of private health insurance that’s on top of the universal stuff. I think this is fairly prevalent among big companies in Canada. Maybe you get lower co-pays or access to special hospitals or clinics, I’m not sure.

Even here in the US, there are supplemental plans for people on Medicare.

I don’t know what proportion of current insurance salespeople and companies would be able to be supported in this much smaller role, though.

97

Does healthcare in Canada vary by city? Is it any different in Vancouver than the other one?

98

There will be variations in facilities depending on where you live. If you’re in a major city like Vancouver, Toronto or Montreal, then some of the hospitals will be teaching hospitals attached to universities, and there will be more doctors and more specialists, than if you’re in a little town in the country.

But the key is that even if you live in a little town in the country, you have the right to go to those major centres and access those facilities and specialists, if your medical condition warrants it, and at no cost other than travelling costs.

I don’t want to downplay the travelling issue - that is a major issue of access, especially if you don’t have a lot of money. But that’s not part of the health care system. There are subsidies through the Social Services.

And, because we are thirteen separate systems, as Spoons pointed out, there will also be regional variations, depending how each province and territory allocates its resources in its health system. But to my mind that’s a feature, not a bug, as I’ve mentioned several times in these threads.

The Canadian system takes advantage of the strengths of federalism: the federal government sets the general ground rules for the system and provides funding. The provinces design their health-care systems to meet local conditions, and are not subject to federal regulation.

If one province has a particular health problem, say an opioids abuse issue, it can adapt its system reasonably quickly to respond. It doesn’t need to wait for approval from Ottawa. My own province, Saskatchewan, has one of the highest MS rates in the world, for reasons that are not clear. That means there are proportionately more doctors here who are trained in MS treatment than in other provinces.

PEI, because of its size and compactness, has a different health system than huge provinces like Ontario and Quebec. And so on.

There are issues, of course, but the bottom line is that all Canadians get health care, without cost up-front, without worrying about co-pays, “in network”, or being tied to a particular job to keep their health care. Our “network” is Canada.

99

In so far as high doctor’s salaries are a price-driver, we could fix that by increasing the number of med school and residency slots and making med school free. The actual ROI on being a doctor is actually pretty pathetic these days: you don’t start making money until you are 30, and you have a half-million in debt to pay off. Furthermore, medical practices would be more profitable if you didn’t have whole positions dedicated to dealing with insurance.

People make it sound like no one with the talent to be a doctor would want to be one if it paid 75% of what it does now. But I think they would, if they didn’t have tons of debt to worry about–and I think a lot of people would becomes doctors who don’t now because 1) they can’t stomach the thought of all that debt 2) they can’t get into med school because it’s so competitive. Tons of qualified candidates aren’t even given a chance.

100

You might not remember, but I am the guy whose family was big into delivering telephone directories, we had a $25,000,000/year business up until 2007-ish, and then Steve Jobs released the iPhone, completely destroying our business, careers, etc.

I’ve already been down the path of “societal change destroys a career”. And it’s OK if it happens again, probably better than OK.

Because of the phone book experience, long story short, I went into a field where I can be gainfully employed for the rest of my life - sales.

So, I am completely fine with having the job of selling health insurance disappear on us - I’ll be fine because I am good at selling, not because I’m good at selling health insurance, if that makes any sense.

My agency is full of Leftward tilting people… hell, we got a Christmas Card from Mother Jones magazine, which we subscribe to… and we fully support the idea of MFA as it literally is the only thing which makes sense if the goal is to cover as close to 100% of the people as can possibly be done. Financially, we will be fine if the Health Insurance goes away for there is property & casualty, life, supplemental, disability, group life/disability/etc, event insurance, cybersecurity insurance, etc etc etc etc etc, and I can imagine even in a MFA world there will be a market for supplemental insurance.

So, we’re good with seeing this stream of revenue disappear. We’ll survive and the country will be the stronger for it.