I think the average for Part D is $34. But Part D has so much variation, it’s hard to compare plan to plan. (Medigap’s uniformity is a real boon for comparison!)
I am a big fan of Medicare (both personal experience and in my job) but affordability is a perennial issue, especially for people just above Medicaid/Medicare Savings Program incomes. And the lack of a cap in traditional Medicare or Part D can be brutal.
Actually, a lot of it is a lack of mechanisms leading to doing unnecessary stuff. The US has 600 000 people working in health care insurance at good wages. It has people doing gatekeeping, liaising with insurance, credit-checking, billing, etc. Countries with what is known as Beveridge systems (NHS style, used in Scandinavia, the British Isles, Iberia etc) mostly don’t see the point in these jobs. There are some of them in the private sector where billing happens but mostly, these huge areas of activity are just irrelevant.
Also, in the US large procedures tend to be very profitable. It is probably not a coincidence that the US tends to do more of them with no real improvement in outcomes.
And the current US setup costs far more than any other system, and yields very poor results without managing even something as basic as covering everyone. And yes, by first world standards that is basic. I don’t think what you are doing is working out for you.
It is working out much like the branch of economics known as Health Economics predicts it should.
Thats not actually correct. Swedens system, as I understand it, is devolved to areas analogous to states, and its hard to recruit health care personnel to remote and rural areas. The longest waiting times are in Västerbotten, and its 271 days. However, prostrate cancer is very slow growing cancer. Far more people die with it than from it. In many cases surgery would impact the patients quality of life more than just leaving it. “Watchful waiting” is very common with low-risk cancers and/or men of an advanced age.
I’ve worked in health care in Norway for close to twenty years, and I’ve never heard of any crisis of scarcity on Sweden. I believe they are not as fond of letting patients choose their own hospitals as we are, so there may be local bottlenecks. In general, saying that “this is happening everywhere” is fantasy land, especially from a US perspective. While the US do well in access to specialists, wait times for access to a family physician is, I believe, poor.
And, of course, millions of poor Americans will never see an oncologist if they get cancer. Emergency rooms do not do oncology as far as I know. ***That is what we call a crisis of scarcity.
Nonsense. America produces no more new inventions that its population would indicate. A touch less per head than the UK, which has single payer. America spends far more money per head on biomedical research, but America spends more money on every aspect of healthcare than other nations without any improved results to show for it. There is no reason to expect research should be an exception.
Interestingly, here in Norway, one of the most expensive nations in the world, a hip replacement costs about 17 000 $. And lots of people find medicine lucrative.
It is a right for me. And obviously most people in the developed world. It is not for you. It is what is known as a claim right for me, similar to the right to a lawyer or an education. You have a similar right to a lawyer, and to a basic education, but no right to a higher education or health care.
Quite the opposite. It is provided by every first world society except yours. It is not realistic to say that it cannot be in one of the most wealthy ones.
LASIK has something known in economics as price elasticity. That means that a customer can refuse the product if the price is too high. This is not the case for many areas of healthcare, and there is a vast asymmetry of information that means many purchasers are badly equipped to determine what they actually need. Similarly, liposuction works pretty well in a market. Cancer treatments do not.
We have single payer, NHS style universal healthcare here, and a lot of it is setting up regulated markets that work.
Thats just you. In the rest of the developed world the indisputable fact is that it is a right like a basic education, and beyond official complaining to get a bigger budget, its not really a problem. I mean, Berlusconis Italy did it, you can’t pretend its some kind of impossibility.
Actually, Beveridge style single payer delivers the greatest quality healthcare per dollar spent. To everyone, but every system does that. The fact that you’d even add “to the greatest number of people” like it was acceptable not to deliver healthcare to some people sounds medieval to me.
Actually, I do have a right to food and shelter from the elements at least. I think most nations in the developed world provide that if needed again.
There is an entire filed of economics that says that that will lead to soaring prices, inefficient delivery and people going without healthcare while you spend massive amounts of money on it. It is generally supported by real-world experience.
**
Tl,dr:** You say you care about access to quality healthcare at a reasonable price while championing the approach that leads to low quality at the highest prices in the world. No, other nations do not have a scarcity crisis, while you have millions of people uninsured or under-insured. No, you do not produce more research per head than other large nations. Beveridge style single payer is the most cost effective delivery system. It is not the only one if you want to prioritize other things than cost and are willing to pay for it. But they are all vastly better than what you got currently.
I’m in the Bay Area, so I doubt I’m getting a discount. There are Medigap plans which go up with age, and ones which average over all ages and go up more slowly. That’s the one I have, since I plan on living a long time.
Medicare Advantage plans also vary a lot by location.
That was post #413 from you, where you implied that I was lying…which occurred after you implied I was selfish from your it’s “all about you” comments…
My response on #419: "As for you saying that you suspect that I don’t want UHC, that’s not true. "
Now, you say I didn’t answer you, which is strange, since I did. The rank dishonesty on your part is getting comical.
…you do seem to be taking my posts extremely personally.
I didn’t imply you were lying. I don’t actually think you want Universal Healthcare because I don’t actually think you know what Universal Healthcare is. Your dismissal of my experiences with the New Zealand healthcare system as a “mere anecdote” demonstrates this. Universal healthcare looks after everyone regardless of insurance or ability to pay. If you concede that your system will have 2-3% of people with no coverage then you don’t have universal healthcare. And if the system you are advocating doesn’t cover everybody then you aren’t advocating for universal healthcare.
I didn’t call you selfish. If you got that impression I apologize but I stand by everything I said.
The question I’m referring to is the same question I’ve been referring to over-and-over again. Post #368. You’ve simply mistaken what post I was referring to. You haven’t answered it. You won’t answer it.
Let’s agree that each one of those 600,000 non-essential people make $150,000/year (i.e., more than the average yearly doctor’s salary) and that we eliminate every single one of them (because, as you say, they’re doing stuff that’s irrelevant). You’ve saved $90 billion. You’re 6% of the way to your savings target. I think you don’t get there.
Costs are high because everyone is using other people’s money and there’s noone around at the all-you-can-eat buffet to say that’s all you can eat (and if someone does, God help them - see the mammogram brouhaha).
You are making this unnecessarily personal. Dial it back, especially the repeated comments about dishonesty and lying.
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Your #368 is the one I answered on #370. Your definition of me “not answering” a question is when I answer a question, but you don’t like my answer. Part of the pretending.
OK, but BB is being very dishonest on this thread, and I’m calling him out. I’ll stop with it at this point, based on your request though.
There are some who use Medicare Advantage plans, but those are still under Medicare & claims are paid by the federal government. There are supplemental plans which some pay for, because Medicare by itself doesn’t pay enough (in the eyes of the buyer of the supplemental policy). But there are other examples in the world of single-payer systems where supplemental policies exist. It doesn’t invalidate calling medicare “single payer for those above age 65” if supplemental plans exist.
The 600 000 are just the people who work in the health insurance industry.
You also have everyone on the provider side who deals with them. Filling claims, negotiating bills, chasing down records etc, but dealing with a very large number of insurance companies with different systems. Entirely anecdotally, some hospitals have more people working with the bills and finance than they have beds.
Then you have the people doing the gatekeeping work. And the people working with the self-financed, doing billing, credit-checking, negotiating, claims, bankruptcies and debt collecting etc.
I’ve seen rough estimates that the excessive bureaucracy is 1/3 of the excess costs in the US.
Billing and insurance related costs total approximately 470 billion dollars per year.
There are several mistaken assumptions here. One is that, as Grim Render points out later, the total direct and indirect costs of the massive bureaucracy associated with the fragmented private insurance system are a substantial portion of total health care costs and far higher than your estimate. Additionally, the ability of a central regulatory authority to control costs across the board introduces additional substantial economies. While this may not seem palatable to free-market oriented individuals, it is intrinsic to the concept of health care as a public service and is practiced in one way or another in every advanced country in the world with UHC.
The analogy with an all-you-can-eat buffet and having someone put limits on it is just flat-out wrong. In fact, such gatekeepers to consumption exist throughout the system, especially among private insurers but even in Medicare, and all they do is block access to essential medical care while costs continue to soar. In a properly structured system, the gatekeepers are the doctors themselves, and, significantly, NOT insurance bureaucrats. Doctors are the trusted gatekeepers who ensure that those in medical need get access to services in a timely fashion in accordance with a triaged level of urgency. In the single-payer system to which I’m accustomed, I can’t get a particular form of surgery performed simply by demanding it, but OTOH if it’s medically necessary, no one will block it no matter how expensive it is. That’s how clinical decisions should be made, and never based on costs and cost-avoidance artifices. That the latter is intrinsic to how private insurance works is its fundamental failure.
Your constant bickering over what “single payer” means is getting tedious. Single payer such as in Canada means that if you have a medical problem, it gets treated by any doctor or any hospital at no cost to you, with no exceptions and no conditions. It’s just that simple because it’s that comprehensive. Anyone who thinks there is any comparison whatsoever either with Medicare or any private insurance plan – all of which have plans and contracts approximately the size of the New York City telephone book spelling out conditions, limitations, co-pays, and deductibles – just doesn’t understand health care.
Quite true. The rest of the cost savings come from the single-payer authority or government regulator negotiating a fair and manageable common fee structure among all providers.
I’m not bickering over it. Another poster asked me a question related to Medicare & single-payer, so I answered him. That’s not bickering, but just answering a question. I think you’re more bothered about it than I am. I think Medicare is not a great system currently, and if I’m modeling a single-payer for the entire country, it wouldn’t be from Medicare. It has its strengths, too, and it’s not all bad.
But whether or not Medicare is efficient or has enough coverage, etc, doesn’t detract from whether or not it’s a type of single-payer system. It is single-payer for age 65+.
Survinga: when most people use the phrase “Medicare for all”, it is simply a shorthand for universal, single payer insurance. Most do not mean a program which duplicates all the various idiosyncrasies of traditional Medicare. For example most private policies provide maximum out-of-pocket expense of a few thousand dollars at most. There is none for traditional Medicare:
https://www.planprescriber.com/medicare-insurance-news/medicare-costs/
This no limit on out-of-pocket expenses is why so many people get a Medicare Supplement plan–and is certainly something people wouldn’t want in a “Medicare for all” plan.
Yes, in reality, when people say Medicare for All, different folks mean different things. Some actually do mean the current Medicare program extended to younger ages. Others mean something different. It’s a catch-phrase meant to communicate single-payer. And actual medicare is single-payer for its target population.
I don’t think single-payer will ever get enough support to happen. But if it does, I sure hope they don’t want the current traditional medicare version of “Medicare for All”.
Sorry for the hijack: This pressing concern from the President of the United States deserves a GD thread of its own. But I hope someone else starts that thread because I’m not entirely sure what this great stable genius even means by
Not in the traditional sense of “single-payer”. A single-payer UHC system handles everything, straight up. US Medicare does not. I know this because my very good friend has plumbed deeply into the morass to make sure our other good friend was proper covered when he turned 65. And one has to enroll several months before turning 65 in order to avoid a coverage gap, because private insurers terminate coverage on that Magic birthday.
There are many ways that US Medicare is not like single-payer UHC, even for those over 65. But those who advocate Medicare-for-All see the present program as a good foundation upon which to build out to a sensible solution to our current FUHC.
I think people see the present program as a good rhetorical foundation, not a good actual foundation. Most proposals (the ones that do more than handwave) do not build on Medicare at all.
Oh, good grief. I did it, and while it is a tad complicated (thanks to Medicare Advantage, the Republican sop to insurance companies) it was hardly a morass. And why is the requirement of signing up before 65 such a problem? It’s not like your birthday is a surprise. Even if you forget, every insurance company in the world is sending you mail to remind you.
The Medicare site is not the greatest in the world, but I’ve seen a lot worse. Getting price comparisons on plans was fairly simple. It took a while for me since I was exploring all options. When my wife signed up, it was even faster.
Yeah, and it is about as close as we get here.
I’m glad your experiences were okay. They are not universal.
Signing up for Medicare is difficult for many. Many of those who are not automatically enrolled are not aware they are required to sign up or face lifetime penalties and that they will lose ACA Marketplace subsidies. Those who are transitioning from expansion Medicaid to Medicare are especially at risk for misunderstanding the enrollment need and coverage periods, some of this due to deliberate state obfuscation of program names and explanations.
The gaps in coverage are completely inexplicable and unacceptable.
Studies demonstrate pretty conclusively that most people do not end up in the best MA or Part D plan for their circumstances. The tools like MPF are inadequate, do not even contain up-to-date networks or formularies, and are confusing for many. (The network information on the websites is notoriously flawed. There have been several GAO reports on their ridiculous lack of accuracy.)