What are the arguments against Medicare for all?

Great Debates
281

All powerful? Not really, unless they are all powerful strawmen.

Having power over your personal medical decisions, leaving you in a situation where they effectively are playing god with your life. Yes.

And no, you cannot find a million approved claims for every denied one. You can find 5 or 6 approved claims for every denied one, and that is not getting into claims that are partially approved, or approved for a procedure that is cheaper but not what was recommended by your doctor, or other “problems” that are not outright denials.

At the very least, there are delays. When I had pretty good insurance, I still had to wait for the doctor to submit a claim and get it approved by the insurance company before we could schedule a procedure.

They are not doing it to be evil, there is no reason to even think that they are evil. They are doing it because the more claims they deny, the more money they get on their paycheck.

Another strawman. There is no UHC that gives the executive as much power over healthcare as we already have. Yes, because of the compromises that were made in the ACA to appease conservatives, there are little things here and there that the executive can do to deliberatly sabotage the healthcare of millions of people. That’s a problem that can be addressed with a more robust bill that doesn’t spend as much time trying to appease those who do not want to see any sort of universal healthcare passed.

Trump is also messing with our trade policies and international relations and everything else. Poor governance is not a reason to advocate for non governance, it is only a reason to advocate for good governance. Electing people like trump does more damage to just our healthcare system, which, as has been reminded to you numerous times in this thread, is far more untouchable, both legislatively and politically under every other form of UHC than the ACA is.

It is not that insurance companies are evil. Your attempts at anthropomorphizing a non-sentient entity are useless. A company exists to make a profit, and that profit comes at the expense of the health of its customers. The goals are at odds with eachother. You want good health, they want low payouts, and any compromise on that comes at a compromise in health care, not their profits. The entire industry as a whole sucks money out of the healthcare sector, diverting resources that could be used on getting better health outcomes for patients, and instead giving that money to insurance agents who find ways of denying claims.

There are no scare tactics, just pointing out exactly what happens to millions of people every day. Some of whom chose not to get health insurance because they’d rather spend the money on consumer items, some of whom cannot afford a health insurance plan, some of whom have insurance, but don’t have a chance to actually find out whether it meets their needs until it fails to. That 75% of people that have insurance answer a survey question as to whether they are happy with it does not mean that we have a good insurance system, it just means that the vast majority of people never have major claims to have to wait on approval for. I had a friend that had insurance through work, and he thought it was pretty good, until he had a heart attack. He survived, they took him to the ER and did all that. But he also went bankrupt due to all the bills that were not covered by insurance. He lost his house, his car, everything he had.

Next time a survey like that is done, the respondents should give a copy of their policy to the surveyors, so that they can determine coverage. Explain exactly what that coverage would look like in a catastrophic situation, and ask them if they still like it. I bet we see a much lower satisfaction score.

282

And yet, every other civilized country in Earth has already figured out how to solve these problems. This means one of two things:

  1. America’s health care problems are completely unique and no other country in the Western world faces the same problems we do.

  2. America’s health care problems are not unique, but we’re just too stupid to implement the solutions that have already been proven to work in other countries.

So you tell me: Which is it? Countries like Britain, Canada, Germany, and Scandinavia have single-payer healthcare and - somehow, inexplicably - they have avoided or resolved all of the challenges you mentioned. Please. Tell me: Is America just that much sicker than other countries, or are they just smarter than us?

(PS: “Death panels?” Seriously? You’re actually repeating discredited claims sold to you by the second-stupidest human being to ever run for public office? Really? Here’s a tip: If it came out of Sarah Palin’s mouth, it’s probably a load of dogshit.)

283

Minor nit-pick: Germany is Universal Health Care, but not single-payer. It relies on a mixture of public insurance and private insurance. However, the statutory requirements for the insurance policies are so detailed (it is Germany, after all :wink: ) that the coverage is pretty much the same regardless of the insurance provider.

284

As has been explained many, many times, single-payer does not necessarily mean it is under the control of the federal government (I appreciate that this thread began talking about Medicare expansion, which is a federal programme, but it’s since morphed into a general discussion of health care).

You can have a system that has the general framework set out by the federal government, but the administration and payments are done at the state level. That’s how Medicaid works, isn’t it?

In other words, take advantage of the federal system, including the checks and balances that come from dividing tasks between the federal government and the state governments.

Plus, the President only has the power to make decisions about a system, as the current President has been doing with ACA, if the Congress gives him that authority. If there’s a concern about giving too much discretion to the President, the statute need not do so.

285

Exactly. Design a single-payer system where the actual payments are made at the state level, and the regulation of the hospitals, doctors, nurses, etc is also at the state level, with the general public funding framework set by the federal government. That approach takes advantage of the role of the feds in setting national standards, but leaves the implementation, both of the payment system and the medical regulation, to the states, to implement to meet local condition.

Take advantage of the federal system, in other words, and don’t have a system that uploads everything to the federal government. That can be done, and provide a single-payer system.

286

What?!? You mean actually leverage the uniqueness of the American governmental system in order to make things better? It’ll never work!

287

Federalism isn’t unique to the United States. :stuck_out_tongue:

288

Nitpick on your nitpick: You’re correct, but JB99 is effectively correct, too.

Germany doesn’t have single-payer in the technical sense that there are multiple regulated payers in the public system, not just one. The public system has a large number (somewhere around 120 or more) separate “sickness funds” constituting a “statutory”, or public, insurance system (Gesetzliche Krankenversicherung). One might argue that these sickness funds aren’t even “public” but non-governmental non-profits that might even be mistaken for US-style insurance companies. But they totally are not. The key difference is that they are highly regulated in every respect and they are community-rated, meaning that everyone pays the same and gets the same benefits. So the net result is a public system that works just like single-payer, and just happens to be structured differently.

Also, it’s true that Germany has a mix of public and private insurance, but that needs some clarification because some here have tried to imply that such a “mix” means that public insurance must be terrible and there’s a need for private insurance to supplement it. In fact, private insurance exists in Germany as a substitute, not a supplement – mainly as an alternative to the public system. It’s available only to those above a certain income bracket and subscribed by only about one-tenth of the population; of those who are eligible for it, most elect to stay with the public system.

289

Medicaid is not single-payer, because state governments also are a payer, as well as the Feds. I think there are some private plans in Medicaid, too, where the recipient has to pay something in some states (maybe). Not as sure on how all that works. But in any event, no, it’s not single-payer.

The only true single-payer we have in the US is Medicare for age 65+. That’s essentially single-payer for the elderly.

290

I think when we see “1 out of 5” or “1 out of 6”, that should be taken with a grain of salt. Politifact busted an ad that over-stated the true denials rates, where they found data to support just a few %.

It’s more than 1 in a million (I was exaggerating to make a point). But I think what gets accepted as a common number is overstated, and that’s without even getting into the reasons.

Medicare is single-payer for the elderly, and they deny claims. You have said repeatedly that claim-denial doesn’t exist in single-payer schemes, but that’s not true at all. You should drop that as a talking point:

As I’ve said repeatedly on this thread, my comments about Trump and his attacks on the ACA are an example of a government doing something to hurt people, in bad faith, in the healthcare arena. You correctly mention that these items impacted are not in single-payer systems. And that’s exactly why I’m glad we don’t have single-payer in the US. If we only had single-payer, and an idiot like Trump attacked it (he would attack it, because Obama liked it), it would hurt everyone, not just some. Our fragmented system limits the damage Trump can do to health insurance in the US, precisely because it’s not single-payer. I think my point is pretty straight forward. I’m not sure why you keep arguing it, unless you’re arguing against something I’m not even saying.

291

Those rates came directly from insurers. Are you suggesting that where required by law to state denial rates, Cigna and other major insurers are lying about the true rates, and are actually overstating their own denial rates? :smiley:

And that the Department of Labor is lying, too?

Come on, you’ve got to try harder! The thing that you debunked was a stupid TV ad that I never cited.

That combination of sentences bears no relation to anything I’ve ever said or to any reality on this planet. And I would ask you, first of all, to kindly not refer to my lifetime of experience with true single-payer as a “talking point”. It is not a fucking “talking point” that I have never had a claim denied and never will have a claim denied under single payer. You know how I know? Because there’s no fucking claims adjudication process with which to do so. When I see I doctor I get treated and go home. The billing to single-payer happens days or weeks later, the payment is completely automated, unconditional, and it has nothing to do with me. Do you think the doctor is going to later come after me for payment? If you think that, you are once again clueless about how single payer really works. Canadian doctors with some exceptions generally don’t even HAVE patient billing systems, because they always get paid in full by the public system. It’s an intrinsic, foundational part of how the system works.

Secondly, I’ve never claimed that Medicare doesn’t deny claims. I know it does, though I believe the denial rate is much lower than private insurance. The root of your misunderstanding with Medicare is that “single payer” is a bit of a misnomer. It actually has less to do with how many payers there are than with how the system is structured: community-rated, universal, non-discretionary. That’s why, as I noted above, Germany’s public system is functionally single-payer even though it really has hundreds of payers, and Medicare functionally is not, even though it nominally only has one. The problem with Medicare is that it’s inextricably mired with the totally fucked-up structural mess created by the private insurance system. Even Medicare Part A is entangled with private so-called “intermediaries”, part B with private “carriers”, and with others like QIOs, all of which meddle in the clinical process. It’s a totally different system from the way true single payer works.

I’m going to be charitable and assume that you just didn’t understand my point. With true single payer the way I’ve described it and the way I’ve lived it, there aren’t a lot of levers for the government to pull, because all those awesome complexities that you keep mentioning don’t exist and it’s a simple “pay in full for all medically necessary procedures” principle enshrined in law. Other than foundational changes that would be political suicide, the only things evil governments could really do would be to reduce funding or delist covered services, and that, too, would be politically risky because in a UHC system everybody depends on them.

Your argument is also philosophically rather shallow. You appear to be saying that because governments can do bad things, or they can do good things and then undo them, that therefore governments shouldn’t be relied on to do anything much at all. This is, frankly, a uniquely stupid attitude found almost exclusively in America, where suspicion of government is a sort of hallowed tradition, and nowhere else in the world, where governments can and do provide robust health care and social services and have been doing so for a very long time.

292

Just a quick clarification: when I referred to Medicare Part A intermediaries and Part B carriers above, I was using outdated terminology. Since 2003 they’ve been called Medicare Administrative Contractors (MACs) but for purposes of this discussion the point remains the same. Here in fact is an outline of what they do, which includes “Determines whether the claim should be paid” and “Conducts redetermination on appeals for claims”. This is necessary because the system is so staggeringly complex and so loaded with conditions and limitations and potentially intertwined with other payers.

True single-payer, as in Canada, is fundamentally designed to be the opposite. The Canada Health Act lays out five foundational principles for all the provincial health plans: public administration, comprehensiveness, universality, portability, and accessibility. “Comprehensiveness” simply and very significantly means that all medical procedures performed by doctors and hospitals must be covered if a doctor deems them medically necessary. It’s a fundamentally different approach to health care that is simply unknown in private insurance, or in Medicare. It’s not a “talking point”. Significantly, it moves the responsibility for clinical decisions about your health care away from some faceless insurance bureaucrat or contractor, and empowers your doctor – whoever is looking after you – to decide what’s best for you, regardless of cost.

293

You said in #278 that “claim denial” does not exist in single payer. That’s simply not true. You saying it over and over doesn’t make it so.

https://www.reuters.com/article/us-column-miller-medicare-idUSBRE8AC16F20121113

As for your last paragraph, I’m actually arguing for an increase in Medicaid coverage and for more subsidies. I’m not arguing for less government, but more government. You’re misrepresenting my argument (again). I don’t say, nor have I ever said, that government shouldn’t be relied on to anything. I just think there are limits to what we need from our government in the US. I don’t want Medicare for All. It’s that simple. And I’ve explained my point on Trump many times. We’re living through a real-life experiment of what happens when a demagogue is elected, and it’s very ugly. It has real consequences. And the only reason he hasn’t wrecked our entire healthcare system is that there are so many parts to it. He’s focused on the easiest part to demonize, and he’s going after it. I’m insulated from his wrath because I live in the private side of healthcare, not public.

I can explain all of these things to you, whether it be Medicare claim denials refuting your talking point on single payer, whether it be the Trump factor, whether it be that most people in the US like their healthcare. I can also repeatedly show that I’m not anti-government by advocating for a rounding-out of th ACA to what it was truly meant to be.

I can explain all of that. But getting you to understand it, or even admit if you do understand it, is apparently not possible.

294

Doesn’t matter. Medicare is single-payer. It denies claims. Period. End of story. It’s just as much of a “true” single-payer as Canada, except it’s limited to ages 65 and above. Your earlier talking point was wrong. Just admit it and move on.

295

And yet your PM felt it necessary to apologize for the delays in medical treatment.

296

That’s correct, single-payer doesn’t deny claims because it doesn’t meddle in the doctor-patient relationship on a case by case basis. This is a very important feature of single-payer and most UHC systems in general. Medicare is completely different. Show me where I have ever, here or anywhere else, claimed that Medicare doesn’t deny claims.

You’ll recall that in #277 you stated “I’m sorry, but in the US, we don’t need single-payer for many reasons.”

You’ve repeated this frequently. For example, #132 “Keep in mind that I’m not arguing against what other countries do. Single-payer works great in many places. I’m just saying that the US could get to universal coverage without throwing out the systems we have.”

Or how about #163 (emphasis mine): “But for the US (for many reasons I’ve laid out), I just want to keep what we have, and tweak the ACA to get us to our own version of UHC. I don’t want single-payer. I want what we have …”

So, you say again and again that you don’t want single-payer, you want what you already have. But now you claim Medicare is single-payer! :rolleyes:

You’re clearly just playing games now and wasting everyone’s time. You know and I know what is meant by “single-payer”: a universal public health coverage system with non-discretionary coverage for all medically necessary procedures. Medicare as it exists today is nowhere even close to that, and you obviously know that.

I’ve spent a good deal of time presenting the facts and trying to educate you and I see that it was a complete waste of time. You clearly have no interest in arguing in good faith and just want to play stupid word games. I hope that other folks learned something, though, and will continue to do so. But I am done discussing this with you. If I happen to add anything further to this or any other thread please don’t bother to respond as I will not be wasting my time with you further.

297

Medicare is single-payer for people above age 65. That’s a stone-cold fact, whether you like or not.

When I say I don’t want single-payer for the US, I’m talking about the entire system. I don’t want “Medicare for All”.

I’ve been very consistent in what I’m been saying. And I’ve argued in good faith.

I’m fine if you don’t want to engage any further. I’m tired of constantly correcting your misrepresentations of my arguments.

298

We’ve discussed in good faith our preference for on-demand health care yet you ignore the delays inherent with a UHS system.

Personally I don’t understand this incessant need to inflict this on other people. It’s great that the wealthy people in your country can afford to go outside the system and seek treatment in the US or other countries. We would prefer the same care afforded those people and we get that with private insurance.

299

I have not see a single time that wolfpup has ignored your claims of delays. Every single time you have made these claims, they have been thoroughly debunked. That you ignore this and continue to make claims that have already been shown to be false is on you, not on him.

We do not have an on demand health care system, we have a healthcare system that is available to you when an insurance bureaucrat decided it is ready. I have had to wait for procedures for weeks waiting on the insurance company to approve a procedure before it could even be scheduled.

It’s great that wealthy people of our country wanting elective procedures can afford to cut in front of the sicker people with less means who need life saving procedures, but some of us would prefer the same care afforded to those people, which we do not get with our system that puts profits over health outcomes.

300

I would assume there are limitations on coverage, probably a “medically necessary” limitation. If so, that’s the same limitation as on US Medicare coverage. There are certain things that are not covered, like vision and dental, for the most part. And Part A (hospital) coverage has a coverage limit. But generally, medically necessary care from your physician is covered. I would be a bit surprised if the Canadian provinces didn’t have a similar setup.

If there are things that are medically necessary, there are probably things that are considered not medically necessary. And someone has to decide that. I would be very doubtful if doctors get to declare anything they want medically necessary.

With Medicare in the US, denials of claims generally come when there is a disagreement about medical necessity. A lot of the time, this is a paperwork problem because the provider didn’t say why she was doing what she was doing. The treatment should match the diagnostic code. If the provider knows or has reason to believe the treatment will not be covered, they are required to tell you in advance.

If Canadian provinces do not require medical necessity or have some other mechanism, I would be interested to hear it (though it should likely go in another thread).