I’m not knocking Canada at all. I think your healthcare system is just fine. I was responding to another poster, who had mentioned Saskatchewan as a rebuttal to my point about the costs and dislocation from a switchover to a Nationwide system.
The thread is about “Medicare for All”, which I took to mean as a nationwide system, like the Medicare we currently have on our elderly in the US. I prefer a system that’s more state-based, and I’m OK with a mix of public & private coverages.
So, I’m not sure if Saskatchewan is a good analogous example, if we look at the costs and dislocation from switching from the mixed system that the US currently has to a Medicare system (single payer, nationwide, not-state-based currently except for Part D I think, everyone gets the same basic plan).
Understood on the employment thing. That’s one thing that Obamacare was supposed to eventually address. If more people had switched to the ACA-exchanges to get their insurance, then eventually employer-based insurance was going to wither away. But that hasn’t happened, and at this point, I don’t think it will. Our government is actively trying to sabotage Obamacare. If Republicans had been more on board, I think you would have eventually seen more and more people going to true individual coverage.
On the 85% thing…eh…OK, I was off. It’s more like 65- 75%. I’m attaching a link from a Gallup poll. I think these numbers vary from year to year. But most people are satisfied with their own healthcare, about 2/3 of the population. They may think the US needs to change, but they’re satisfied with their own situation. Obviously, the uninsured are the least satisfied, and we need to get that number down to zero.
On this thread, I don’t want to come across as being negative on other countries and their healthcare systems. I’m very familiar with the fact that other countries have universal coverage, and it costs less. But I’m worried about how we “get there” in the US, and then I want a system where states are still in the game, because I don’t want an edict from Trump or some Trump-like character to destroy what we have.
Health Insurance companies have a lot of data on procedures, conditions, and outcomes. This data is being mined to help with preventative type care. It’s helping companies design products where good outcomes can be rewarded, and affecting the types of care people receive. I know this can happen in any healthcare system, not just in the US. In addition, some insurers are experts on managing care for specific types of populations. For instance, Medicaid managed care companies are doing well in the ACA exchanges.
The idea that insurers themselves are innovators is not alien.
My question to you is, are you under the impression that a single-payer system doesn’t do this, and doesn’t in fact do it far better? Well, it does, which makes your whole point rather moot.
In Ontario, for example, OHIP (the public single-payer plan) has instituted significant innovations in recent years geared specifically to preventative care and improved outcomes, such as patient rostering (also called the patient enrollment model), the idea of creating a monitored patient-to-doctor relationship where doctors are eligible for bonuses and incentives for delivering specified preventative services like immunizations and screenings for high-risk conditions.
But there are at least two crucial differences when a public UHC system does this. One, a public system has a far better database than any private insurer from which to infer results and outcomes because it covers the entire population. And two, anything a private insurer does, it does for mercenary reasons with a view to the bottom line; do you really think they would institute a preventative program that cost them more money, even if it saved lives? A public system is, at least in theory and usually in practice, accountable to the public and much more likely to be concerned with clinical outcomes than with revenues and profits. It’s the same fundamental difference that drives private insurers to scrutinize each individual medical claim, something that single-payer doesn’t do. The problem that one always comes up against with private insurance is that the goals and motivations of private enterprise are often directly at odds with the fundamental ethics of health care.
The way Medicare Fraud works is that a doctor either submits a code for a non-existent patient, a code for a patient that they have bribed to get their information, or a code for a more expensive treatment than was actually done. Because of the way Medicare is set up all payments are done as soon a the code is submitted. If you expanded Medicare to everyone fraud would work the exact same way. The biggest difference is that their would be vastly more codes to deal with and thus it would be correspondingly easier to hide fraud.
This is untrue. While in individual cases preventative care can save money, in the system as a whole preventative care costsmoney. This is important because one of the reasons people advocate for a universal system is supposed cost savings. However, if the uninsured start going to the doctor more that means that the system will cost more because it is providing more services. Thus you can expand coverage or you can keep costs down, but you can not do both without massive cost cutting in other areas.
No, I’ve never said that innovation doesn’t happen in single-payer countries. I know that innovation happens in all types of systems. The other poster asked about health insurers, as if the concept of innovation was foreign to insurance companies. And I wanted to point out to him that private insurers absolutely do have innovation and contribute to the innovation in an overall system.
I would point out that private insurers can do a lot of pilot testing at more granular levels than you might typically see in a single-payer system.
Also, in the US, there are a lot of private insurers that are non-profits. Some are for-profit, some are non-profits.
The cost savings of a universal system are not “supposed”, they’re real and they’re very big. You’re taking this discussion around in circles. You need to accept the reality of the cost savings as an established fact.
There are three things that you are persistently failing to understand.
One, as noted, the cost savings of UHC are real and significant.
Two, getting medical care for the presently uninsured, which includes going to the doctor instead of being neglected, is the goal of UHC. It’s a feature, not a bug.
Three, yes, you can expand coverage and keep costs down. This is the most important factor that pulls it all together. In all the places where UHC has actually been done, as opposed to just argued about on Internet message boards, it costs far less than the private insurance system despite providing coverage for everybody. And the reason it costs less is because when you cover everyone under a public system, you no longer have risk ratings and individual plans, you no longer pass claims through a vast bureaucracy whose sole purpose is to try to avoid paying them, and you no longer have health care providers staffed with another vast bureaucracy fighting with the first bureaucracy to collect payments. And since provider overhead is now much lower, provider fees can be lower, too, so the cost savings cascade down through the whole system. Furthermore, getting rid of that counterproductive bureaucracy means that doctors can wholly focus on the medical needs of their patients instead of on what their insurance may or may not cover.
Those things are business innovations, not medical innovations. If they benefited the patient but not the business they wouldn’t do them. Unlike single-payer innovations, they’re not driven by the public interest. I didn’t claim businesses can’t be creative. Some of them have been so creative their executives have wound up in jail. This is not the kind of ethical or organizational model I want involved in my health care.
I’m aware of that. I have family in the US, and I’m also aware that the non-profits are just as money-grubbing and just as much of a pain in the ass to deal with as any others. Some of the BCBS companies are non-profits, but many of the licensees are for-profit, and others are in sleazy gray areas, who claim to be non-profits but have had their tax exemptions pulled. Others have been sued for a variety of reasons. All operate under the private insurance model, all routinely deny claims, and none treat health care as a guaranteed right, no matter how good a plan you have.
Innovation is innovation, and if it helps the patient stay healthier or gives them more control over their healthcare dollars, it’s a win-win for everyone. When people act as if no innovations occur in health insurance, they have no idea what they’re talking about.
Government bureaucrats also deny claims and deny eligibility (my own brother has had to deal with government bureaucrats multiple times who tried to deny his eligibility for Medicaid who was rightfully qualified for, and left him without coverage for months). When a company does something unethical, they can be sued easier than some faceless government bureaucracy.
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. We already have 90% coverage, and we could easily whittle the uninsured down to 4or 5% of the population, many of whom would be illegal immigrants. The biggest problem in the US is politics, particularly on one side of the aisle. It’s not the insurance companies themselves, the great majority of whom do good work that benefits society.
Would you feel better if I said that no innovations occur in private health insurance that don’t also occur more effectively in public UHC? Or that no innovations occur in private health insurance that aren’t motivated by mercenary considerations, and those that don’t benefit the company simply don’t happen?
That’s a completely irrelevant deflection from the point. Sure government bureaucrats can do some nasty things, and governments are known for intractable bureaucracies – in fact those are arguments that UHC opponents falsely try to use against “government-run” health insurance proposals. But that’s because they don’t understand how it works, or are misrepresenting it. There are no bureaucrats involved in individual case decision-making in any UHC system that I know of. It’s intrinsic to how the system works, and it’s the diametric opposite of how private insurance works. And that means that payments flow efficiently from payer to provider and necessary health care is never subject to denial.
It’s no surprise that the system is full of coverage denials when everything is discretionary and subject to an often bewildering plethora of conditions.
We can certainly have extended discussions about how to get there. It’s not an easy problem. One thing that’s fairly evident from an examination of other systems is that typically the larger the role of private insurers, the higher the costs.
That’s very much a matter of opinion and perspective. You might feel different after reading this book. The problem isn’t that insurance companies are necessarily evil, which isn’t a useful avenue of discussion. The problem is simply that they’re businesses, and in the area of health care access and funding, the fundamental goals of a business are often directly opposed to the ethical and moral imperatives of health care. It’s as simple as that.
So if someone has a serious health issue, to say that it will not be covered and they are denied treatment because of an exclusion found in the fine print on page 197, paragraph 393(b), part 2(a) is wrong, immoral, unacceptable, and should never happen. Yet it’s a perfectly legitimate and even necessary business practice. The only workable solution is to remove the business enterprise paradigm from health care decision-making. It’s not a role for business, period. But these companies and their lobbyists are actively campaigning – and literally spending tens of millions on Congressional lobbying and overt and astroturf campaigns – to vigorously block and subvert any chance of public UHC becoming a reality. In fact they’re so adamant and paranoid about it they even came up to Saskatchewan in the 60s to try to block the next important step in the evolution of that system to full UHC. In that sense they are counterproductive parasites that directly cost the health care system at least half a trillion dollars a year while blocking important progress and contributing nothing to actual health care.
In terms of innovation, I’m not all that worked up about comparing private and public, as I think the main point I was making is that yes, in fact, private insurers have driven some innovation. My guess is that innovation can work good anywhere, regardless of the system.
I don’t think pointing out problems in working with government bureaucracy is irrelevant deflection, since you yourself were talking about claim denials. How is that irrelevant when discussing exactly the types of things you were bringing up?
Do you think that government always has your best interests at heart? I’m willing to admit that insurers aren’t always alter boys. But what about government? If you think that government always has the best interests of the public at heart, then Donald Trump has a mansion he’d like to sell you in Florida for pennies on the dollar. I can tell you that I thank God every day that I have health insurance through my employer, and that my premiums didn’t go up because of the nonsense that Trump has tried to pull with the ACA. There’s no doubt whatsoever that he doesn’t have the interests of the public at heart, and not having single-payer is probably the best defense against him.
Very small number compared to the number of doctors in the country. And, most importantly, notice that they were not patients. Expanding Medicare would not change the number of doctors, would it? That’s the point.
What claims denials was I talking about? This is exactly what I said in my immediately preceding post, with emphasis added for extra clarity:
There are no bureaucrats involved in individual case decision-making in any UHC system that I know of. It’s intrinsic to how the system works, and it’s the diametric opposite of how private insurance works. And that means that payments flow efficiently from payer to provider and necessary health care is never subject to denial.
Perhaps you were confused when I was referencing claims denials in the system that you are trying to defend. Not the one that I’m defending.
There are good governments and bad governments. But private enterprise is always going to be self-serving, which is not necessarily always bad if it’s a good fit for the customers’ best interests, but it’s very, very bad when those self-serving interests (say, to minimize medical loss ratios) are diametrically opposite to the best interests of the patient (to get health care).
Pay attention here because I get the impression that you tend to misinterpret some of the important things I’m saying:
Government isn’t always good or beneficent, but a democratic accountable government is, to repeat a quote that you may have heard somewhere or other in connection with the founding of a great nation, the last best hope of mankind. Government is the only institution that is empowered to advance the public interest and is accountable to the public.
Despite all the faults of the ACA and tremendous right-wing opposition to it, even a Republican-dominated Congress with Trump as cheerleader wasn’t able to dismantle it. Now look at some other countries – any country in Europe, for instance, but let’s look for examples at the UK, and closer to home, at Canada. Both those countries have single-payer systems that are extremely popular. Canada recently had a regressive right-wing federal government, the province of Ontario has one now, and the UK has one now. In none of those cases was any existential threat to the single-payer health care system even remotely on the agenda. Why? Because it would be political suicide. The people wouldn’t stand for it. Think about that carefully. There are a lot of implications wrapped up in that simple fact.
Your brother didn’t get a claim denied, he got insurance denied. Exactly what wouldn’t happen in a UHC system. Kind of like how in the pre-ACA world insurance companies could refuse to cover you if you had a pre-existing condition.
So far the government people at Medicare hassle me far less than the private people at my old employer-covered insurance. And I had it relatively good.
I’m glad your experience has been good. My brother was denied coverage because the faceless bureaucracy was “losing” his information that he sent to them via mail, and then “lost” what he showed up in their offices to give after they told him they didn’t have what he sent the first time. They finally didn’t “lose” his third set of the same information that he’d already sent.
This is Medicaid, which has been around for 50 years. And yes, I know Medicaid varies some from one state to the next.
My father-in-law had a very good experience with the VA, although he had to drive 90 miles in one direction every 6 months in order to keep his prescriptions current. This is because the VA is very restricted in where they operate.
I’m not against government-provided healthcare. I’m also not against private. I’ve had a very good experience with my employer-provided insurance, as has the rest of my family. And we do submit claims. We’re not super-healthy all the time…
My parents have Medicare, but they have supplemental they themselves bought, and they’ve needed, because Medicare has alot of copays and deductibles, and they’re not in the best health. Their supplemental is private. Alot of countries that have single-payer UHC also have a big private supplemental system riding beside it, because the government system isn’t rich enough in benefits.
Not the one that I live in. The following simple words describing one of the major points of the Canada Health Act speak volumes:
Comprehensiveness: All necessary health services, including hospitals, physicians and surgical dentists, must be insured.
I’ve been retired for many years and never even considered supplemental insurance. It wouldn’t add a damn bit of value. It might be useful for some people in some circumstances, and is a handy little perk of employment, but to describe it as “a big private supplemental system” is just sheer, absolute bullshit.
OK, but I think you’re also missing what I’m saying. I’ve said repeatedly that I don’t have a problem with government-provided health insurance. I know it exists all over the world, and I know it achieves UHC. But what you see are different ways to get there, with some countries using private policies as the approach, with government subsidies (switzerland, for example), while other countries use a government national plan (Japan, for example).
And while you haven’t seen these systems get dismantled, you have seen cutbacks. Japan had to cut back their co-payment from 80% to 70% a while back. And that spurred an explosion of private supplemental plans in Japan.
And other governments that you mentioned (UK, for example) have not had a demagogue like Trump (not yet). He is different, and he attacked the ACA simply out of spite to Obama. I’m glad as heck that there were other coverages besides ACA exchanges.
I’m simply arguing that private insurance has a place. That’s it. Nothing more than that. I’m glad the US has private, and I hope we never go to single-payer, “Medicare for All”. I think we can get to UHC while keeping private in the mix.
