Did anyone ever bring a case against the funding of NASA? I’m not saying they would have prevailed, especially since the power to fund for “common Defence and general Welfare of the United States” has been interpreted pretty broadly by the court.
Just to be clear, I’m not saying that I think “medicare for all” would be found to be unconstitutional. I’m just saying that if you ask the question “Is it forbidden by the constitution” you will sometimes come up with the wrong answer as to whether an action by the feds is constitutional or not. Better to ask “is it allowed by the constitution”.
To the extent that this is true, what does it tell us? What it tells me is that a two-tier public/private system in the US would quickly devolve into the public system being a second-rate poor man’s health care, with private insurance monopolizing most of the resources and all the best doctors and facilities, for which they would pay lavishly and charge their clients accordingly. Which, really, is exactly what they’re doing today, and which is what’s driving US health care costs to such astronomical levels – because there are no cost controls and there is actually disincentive for the insurers to even try to implement any. If they had to differentiate themselves from public insurance, it would be even worse.
This is exactly the reason that two-tier health care, specifically, private health insurance for medically necessary procedures, is prohibited in Canada as a condition of federal health transfer payments. Limited participation in private health insurance does exist in Europe, but only by virtue of tight regulation and a more cohesive social culture.
That’s funny, because many doctors today claim they can’t continue to practice because they’re frustrated beyond endurance by the trials and tribulations of having to constantly battle insurance companies to get paid. Indeed I read an editorial some time ago claiming that potential medical school candidates were declining to enroll because for doctors in private practice, getting paid by insurers is a major ongoing ordeal.
But in what way would a public plan “underpay” doctors? In my experience with single payer, service fees are negotiated with each jurisdiction’s medical association on behalf of the practitioners, and while they definitely get paid less than with private billing, doctors accept the arrangement because they get paid reliably and without hassle and with no need to maintain a large staff simply to deal with and chase down insurance companies.
Simple answer to that: it doesn’t happen. UHC exists in many countries; there is no need for speculation. Where I live, there is no cost at all to see a doctor – not a dime. Turns out, people have better things to do with their time than go to see a doctor for no good reason.
Now, do people go to a doctor who need to see a doctor, and who would otherwise not do so because they couldn’t afford some outrageous amount that it would cost them for any of the myriad reasons that insurance companies have invented to gouge their customers and discourage access? Absolutely, and this is a feature, not a problem. Early diagnosis can avoid serious complications, save a lot of money and avoid a lot of unnecessary suffering, and even save lives.
So to that extent, yes, UHC would increase demand, if only because millions of Americans are presently uninsured and under-insured. I’m not sure that claiming that you will be faced with greater demand because your neighbor will now have health care – the one who right now would be left to die if he got sick – is a particularly good or ethical argument.
Hmmm… “indentured”? I sense some kind of ideological spin here. With public insurance like single payer, the doctor works on a fee-for-service basis, with fees set by negotiation with the single payer, and then is paid in full by the public insurer, usually in a seamless EFT transaction.
With private insurance, the doctor works on a fee-for-service basis, with fees set by the insurance bureaucracy, and then is either paid or not, or maybe paid partially, and sometimes only after a great deal of time and effort, by the private insurer.
The only major difference I see is that with private insurance the doctor may not get paid, and often doesn’t. And which is the “indentured” one again?
Add to the number of employees – many large companies have one or more persons in their Benefits Department whose job is primarily to work with the insurer on behalf of other employers. If Lee from the warehouse calls HR to complain about a claim not being covered, many employers will for ER purposes step in to find out what the problem is and if necessary battle it out with the insurer on the employee’s behalf.
But I’m not sure “Medicare for all” will necessarily greatly reduce the number of employees in the health care insurance and related fields. Medicare covers only so much; it seems to be a reasonably good safety net. But nearly every senior who can afford it has some kind of Medicare Supplemental plan to help with uncovered expenses.
These plans have to be vastly profitable for insurers. I will turn 65 in December. I am not eligible to sign up for supplemental insurance until September (to become effective December 1). I am already getting on average 3-5 phone calls per day trying to sell me supplemental insurance, and 10-15 pieces of mail every week. When open enrollment starts in October, the TV airwaves will be inundated with commercials touting the superiority of various supplemental plans.
Yes, if people no longer need insurance for catastrophic coverage, the number of privately-insured will go down. But much of the slack will be taken up by supplemental plans. I imagine employers will routinely provide such coverage.
Please post a cite showing that Medicare recipients go to the doctor for every sniffle. I sure as hell don’t.
People fortunate enough to have jobs with excellent insurance also can go to the doctor with little or no co-pay. Do they go all the time also?
Obviously you don’t. The “death panels” that piece of shit Palin ranted about were simply a provision to pay doctors to have end of life discussions with patients well before end of life.
Since most people who died are covered by our single payer plan already, it seems unlikely that we’d need death panels for new Medicare for all recipients under 65.
I’ve been on Medicare for a year and a half, and I’ve found it simpler than my employer paid plan, which was very good.
Granted understanding it enough before I reached 65 took some work, but since then it has been a snap. No more denials from the insurance company, no more multiple requests to certify that my wife doesn’t have her own insurance.
When my wife went on it was very simple, since I had figured it out already.
It’s almost as good as living in Canada.
Be sure you study these plans carefully - ‘supplemental’ is a common catch-all term but there are two main types of plans. The differences are large.
One type actually generates more marketing pitches because the government actually pays more for it than it pays for standard coverage. The insurance companies love that - especially when they can lock you into their (often narrow) networks of hospitals and providers.
My personal view is that society is best served by having a healthy, well-educated population free to live however they want as long as they don’t harm others. I’m for universal health-care, and I think if you can pass a college entrance exam then college should be paid for because why wouldn’t we? It’s absolutely amazing to me that people love to go on about how great the US is, then say that things “lesser” countries do are impossible here because, um, the wealthy’s net worth would go down ten percent or so.
Driving long distances to find a doctor within your plan is a feature of the US private insurance model, not of single-payers. I had never heard of that, or “is the doctor in your network” until I started reading these boards and seeing posts from Americans.
I can go into any walk-in-clinic anywhere in Canada, show my Saskatchewan health card, and get service. I don’t have to worry about the doctor being in network.
And yet, doctors are practising medicine all over Canada, content in general to have a single payer who pays them at a clearly known rate, without needing to have several staffers in their clinics whose sole function is to figure out the billing systems of numerous insurance plans.
I don’t know about you, but I have better things to do with my time than going to a doctor and sitting in the waiting room, when I can just go to the pharmacy and buy some Sudafed. Oh wait, you’re not allowed to do that in the States.
The argument from scarcity would make sense if in the US, people were not turned away by insurance companies for being out of network, or because they were under-insured, or because the company wanted to make more money that week. You have scarcities in the US, due to the private insurance system, as your own example shows of drivcing to find a doctor in network shows. The difference is that the scarcities are entirely under the control of the insurance companies, whereas in Canada, if a scarcity problem emerges, that’s what governments are for - to find ways to reduce the scarcity. And believe me, governments are very conscious on the effects on their electoral fortunes if the health care system isn’t operating well.
Medical doctors in Canada are not government employees. They’re private contractors, operating businesses, who get paid for their services by the government, at a clear, fixed rate that the government negotiates with the doctors on a regular basis.
I had a very interesting discussion with the Piper Cub’s paediatrician the other day. He said that he did his training in the UK and then emigrated to Canada. He practised medicine here for a while, and then thought he’d give the US a try. He only lasted in the US a couple of years, and then came back to Canada. He said that he wanted to practise medicine, not spend half his time talking with his patients about what their insurance companies would cover, and then wonder how he could provide meaningful treatment if the patient had no means to have the test they needed, or the surgery, or the medication…
He found it much more personally satisifying practising medicine in Canada. “There is much more to being a doctor than getting paid” was how he summed it up.
Medicare fraud is a real problem, but that’s yet another reason to expand the program to cover everyone. What is fraud? It’s someone trying to get something out of the system that they’re not entitled to. But if everyone is entitled to it, then where’s the fraud?
As for most people liking the plan they already have: The problem there is that most people have no idea how good their plan is. Suppose I have a plan, and the price is reasonable, and every time I have a question, I can call up an agent, and get a nice, friendly explanation with no wait time. If you ask me if I like that plan, what do you think I’ll say? And then, if I get cancer and start racking up bills, and I try to get my insurance company to pay for them, only for the insurance company to discover that I forgot to include a hyphen in my name back when I signed up, and hence our contract is completely null and void (except for all of the premiums I’ve already paid), do you think I’ll still like my plan? But I have no way of finding that out until such time as I do get cancer. Well, maybe I never will, but the whole point of insurance is that I don’t know.
Northern Piper, you may or may not have noticed that I also responded to CelticKnot. No worries, we gave much the same answers, and it’s good to reinforce the points. CelticKnot’s screed bears the distinctive aroma of Republican dogma from the Holy Scripture of the American insurance lobby, a lobby that has been in mortal fear of public universal health care ever since it was first enacted in Saskatchewan and its success promoted its spread across Canada.
I wanted to point out this thread, in which a Doper is nominally just asking about getting a discount on his ambulance costs for a recent medical emergency. But what struck me rather shockingly in reading that whole story was how different the whole thing was, from a cost perspective, from my own experience in Canada with a similar medical situation.
In both cases, thankfully, the medical problem was dealt with promptly and competently after a short hospital stay. But this person – who apparently had good insurance – was still left with a $4000 hospital bill, and additionally, it appears, the ambulance company is billing $2000 for the ride to the hospital. I shudder to think what his hospital costs would have been if he had NOT had good insurance!
In my case, the total hospital cost was exactly zero. Not a dime. There was no ambulance involved, but if there had been, the maximum cost to the patient is $45, the rest is covered by the public plan, although in many cases there is no cost to the patient at all because the public plan covers all of it.
And this is why Canadians love their medical system, and when the American insurance lobby tries to tell everyone how terrible it is, being “socialized medicine” and all, we just laugh.
We already have Medicaid for the poor. Perfect or not, nobody objects to it. Your projection of what other people think is based on your biases and not reality.
We can see the problems we’ve had with VA medical system in the US as well as those in other countries with UHC. The argument as I see it revolves around delays in healthcare.
Budget cuts are not the same as objecting to a program. Budgets for social programs increase and decrease in relation to the economy. Right now the economy is doing better than it did 3 years ago.
My statement stands. Nobody objects to the program.
