UHC: Has to be affordable, high-quality, and also *not* have long wait times

I knew Theresa May reminded me of someone…

I know I’m sort of a gadfly when you make claims like these, but once again I have to disagree. My whole point in the last paragraph in #198 was that the Swiss system is nothing like the ACA model once you get into the details. The resemblance is extremely superficial.

Switzerland has only private insurers, true, but they function as private insurers in the conventional meaning of the word only with regard to optional supplemental insurance (called “complementary insurance” in their terms). For medically necessary coverage, the kind that is mandatory and universal and unconditional, those same insurers are so tightly regulated with regard to all the essential factors like accepting all patients, community rating, uniform benefits, unconditional coverage, and non-profit operation in that sector that they are effectively little more than payments processors – which is essentially what single-payer is. It’s a slight simplification but it wouldn’t be wrong to basically think of Swiss health insurers as being in the supplemental insurance business from a business standpoint, while being required by law to also function as single-payer agents for medically necessary procedures. To call them “private insurers” in this context is nearly meaningless. Whereas most if not all US insurers are aggressively mercenary parasites who frequently prevent their own customers from getting essential medically necessary health care.

I hear this sort of anecdotal generality a lot from defenders of private insurance. Let me put it this way. You claim to have little to no hassle with paperwork or claim payment. Others do. My brother certainly does (just recently, his doctor was furious when the insurer refused coverage of a prescribed medication and insisted on a drug that was cheaper but far less effective) and I provided cites about the high percentage of nation-wide claim denials and bankruptcies. What are all these millions of people doing wrong? Meanwhile here under single-payer I have no paperwork or hassles at all, ever. Zero. As it should be. You claim you have “reasonable” co-pays, whatever “reasonable” might mean. ** I have none. **Zero. As it should be. You claim your deductibles are “reasonable”, whatever “reasonable” might mean. I have none. Zero. As it should be. How are you going to achieve that with the present system?

That much? I wouldn’t stand for it!
I would sit in my comfy chair with a glass of Jameson 18 Yr. Old on the rocks and be happy.

Reasonable is total yearly out of pocket costs for me in the hundreds of dollars. Prescrptions are typically 5 to $10 bucks, although some of them are $0. Doctor visits are usually $0 for wellness checkups, and $25 if I’m sick. What I pay is tiny, and I have a family member with Diabetes and another family member with some medical complications. We don’t pay much, and we don’t get hassled. And we have private insurance.

I would also note that people who are in Medicare, which is the basis for 99% of the single-payer proposals in the US, have fairly high deductibles compared to me. That’s why a lot of them buy supplemental policies.

It’s funny how everyone on this board produces anecdotes. But somehow, my anecdotes are the only anecdotes you ever question.

But the point I was making, which is a valid point, is that the structure of both systems relied on 3 things: Companies must sell, individuals must buy, subsidies must be provided for individuals who can’t afford to buy. The concepts are the same, even if the application is different.

Where the ACA had a problem is three-fold:

  1. The Individual mandate penalty wasn’t strong enough.
  2. The subsidies cut off too early, leaving middle class buyers in a pinch.
  3. The Supreme Court made Medicaid expansion optional. This made the application problematic for states that didn’t expand, as some poor people were left with no Medicaid and no subsidies…

Even given all of that, the ACA has been very helpful in giving 20+ million people access to Healthcare Coverage.

Anecdotes are like pictures in a book. They help illustrate the narrative, but they are not statistics and they are not necessarily accurately representative. They may be helpful illustrations, but only if they’re consistent with established objective facts.

And incidentally, I don’t consider polls about how happy people supposedly are with their private insurance to be much more than just aggregated anecdotes, because not only are poll results critically dependent on exactly what is asked and how it is asked, but much more importantly, the only things that really matter objectively are how the health system performs on objective metrics, how much it costs, and whether it’s unconditionally universal. The present system sucks on all three criteria. The US, by far the most expensive in the world, stands at #37 in the World Health Organization overall performance ranking, and is outperformed by Costa Rica and the little Caribbean island nation of Dominica. Never fear, however, it’s ranked better than Slovenia.

If the ACA had been much stronger, the system would be much better. This is not in dispute. We can agree on that much.

The point I’m making is that you greatly underestimate just how much stronger it would need to be to match the performance of most European countries. So much, in fact, that when it was all done you would have the health insurers basically acting as almost interchangeable agents of a single-payer system, at least with respect to medically necessary coverage. And government involvement in it would have to be significant.

Someone mentioned companies self-insuring as a way around the big insurance companies. Except those self-insured companies use the big insurance companies as their third party administrators (TPA).

Well, guess what - you get constrained to operate in that TPA’s network under that specific TPA’s rules of coverage. You haven’t eliminated any of the bureaucratic mess that comes with the private companies, because they still administer the plans like their own.

I was working for Walmart, they self-insure. They theoretically had several TPAs, but which TPA was available to you was determined by the store you worked for. You got one company, just a couple of plan options. (And we had to use Walmart’s pharmacy, but that’s a separate issue.)

I agree with those who say that people who rate they are satisfied with their insurance coverage and insurance plans just haven’t had to rely on them and are not aware of what the alternative actually would feel like.

Axios has an interesting article today.

Health care spending is more than just the parts you see that points out the actual cost of employer insurance. I would bet that very few people actually have a firm grasp of these costs.

I have three words: Jesus H. Christ! :eek:

Here are the health premiums in the province of Ontario. Minimum is $0, maximum is $900 per year, depending on income. It maxes out at $900/yr if income is over $200,600.

Of course, most of the money actually comes from general taxes, but personal taxes are not really dramatically different from personal taxes in most US states.

And for that, you get unconditional full coverage for anything that a doctor deems medically necessary, without paperwork, without any deductible, without any co-pays.

I apologize if some of you are tired of hearing this. Sometimes I get tired of writing it. I just feel it’s a story that has to be told, given the vast amount of propagandizing misinformation out there.

Just having to deal with “copays” and “deductibles” would indeed be considered a nightmare by much of the world. American insurers making inroads in Spain have had to get rid of the concepts straightaway, as they weren’t familiar to people, weren’t explained in the policies at a Sesame Street level and therefore the policies were ruled “deceitful”. FWIW, my Swiss insurance also didn’t have any.

And also, “the Swiss system is somewhat like the ACA” makes it sound as if ACA was first. No, ACA was a failed attempt at something similar to the Swiss model, and it never completely broke the link between employment and insurance, which is the second rotten leg of the American medical-slavery system. The Swiss model has no such link.

“medical-slavery”…Um. Yeah, I’m enslaved. (eyes roll)

They should actually- since for the last few years the employer contribution has been listed on the W2. My employer contributes $23K and change and I pay about another $6K for family coverage ( which is now just me and my husband). Let’s call it $30K total - there are jobs at my employer that only pay $30 K a year. And that $30K only covers the premiums- then there are copay and deductibles

Yes they are both government insurance. But Medicaid recipients are poor, and are probably living in places with not so great medical care. Medicare recipients come from all income levels (except perhaps the very top) and are distributed throughout the country.
There are 74 million people on Medicaid, 44 million on Medicare, so you can compute the Medicaid satisfaction level yourself. (Clearly much lower.) And without Medicare the satisfaction level for everyone else would be lower, as I said.
If we had Medicare for All, the insured population would look a lot more like the Medicare one than the Medicaid one, except for being younger.

I didn’t either. When the insurance rejected a claim we called someone at the very big insurance department of our clinic to take care of it. Not much of a hassle for us - maybe a bigger hassle for them. And expensive for everyone.

My company self-insured also, and the only real benefit was that if enough employees complained about an insurer they’d change the next year. So you have a bit more recourse than if you bought the insurance yourself.

My point is to talk about the disruption that will occur if and when Single Payer is implemented in the US. About 3/4 of us are happy with what we have. So, if you’re going to throw out what half of America uses to get health coverage, be prepared for some blowback…including by me.

Also, if you have issues with anecdotes and what they mean, that’s fine. I understand their limits. But if that’s how you feel, don’t talk to us about you or your brother, and then turn right around and flip off my situation. My anecdote is just as valuable and just as meaningful as yours. I represent about 3/4 of America, which is more than the entire population of Canada and then some.

I have a friend who worked as a “case manager” for an insurance company. She is a nurse. She got a very good salary and a company car, and a bonus that depended on saving the company money. I will leave you guys to guess how she saved the company money for her bonus. During this time she did no actual healing and never met a “patient” in person, just on the phone. She didn’t actually do it very long because she’s not venal and she had the skills to find another position.

Insurance is a business, and it’s the business of making money. Health care and who gets it should be determined by the people who provide it.

One of the things the ACA was supposed to solve was that lots of Americans did not have health “insurance.” ACA fixed this by charging fines for people not having health “insurance.” No health insurance 'cause you can’t afford it? Well there goes your IRS refund! And you still don’t have health insurance!

Wow, that’s amazing, since I can only claim to represent myself!

The specific value of my particular anecdote is that people who have deep lifetime experience with health care in other first-world countries and then come to the US as adults are a valuable source of comparative information, and the veracity of their information is of course supported by actual health care performance metrics. So my anecdote is merely an instance to illustrate the documented statistical facts. Like a picture in a textbook.

It’s not rocket science. First, I’d give Medicare the ability to negotiate drug prices. I would also put actual teeth into IPAC, which was established by the ACA to help control costs. I would pass legislation that requires local hospitals/providers to post actual costs for various things and procedures, so that people can compare. Also, getting UHC would lower the % of people that use the ER for primary care, which would lower costs. Employers could also form purchasing alliances, such as what we’re seeing with Burkshire Hathaway, Amazon, & JP MorganChase. You don’t need single payer to lower the cost curve.

Electronic Benefit Verification would save a ton of money. Again, not rocket science. There are still too many healthcare providers in the stone age. Digitizing & standardizing processes would make a big difference. This has nothing to do with single-payer, and more to do with providers/hospitals/companies being resistant to change.

There are claim denials in Medicare, too. It’s not just insurance companies that deny claims. Medicare For All!!!

The ACA mandates something much closer to community-rating. On the exchanges, the old-fashioned practice of rating by gender, use of health-care services, and health status, is no longer allowed. Companies must offer a policy to anyone who applies, and rate differentials by age, etc, are greatly restricted compared to the old days. Also, there are certain basic benefit packages that must be offered with any plan. So, I support the mix that we have now. The next step is to beef up the subsidies to make it more attractive and get more people onto the exchanges.

Putting together all of your criticisms, I don’t see anything that requires single-payer to fix, or the abolition of private insurance. Did I mention that I like my private insurance?