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My Medicare For All Question
Having watched the Democratic debates a few weeks ago, there is one thing I cannot understand. There was a lot of talk about Medicare For All, and most of the candidates want some version of this. Although I disagree with people who want MFA, I can understand the motivation for it. A low-income Democrat – or even Republican – might say, “If the plan necessitates an approximate doubling of federal income taxes and I’m currently only paying $2500 a year in said taxes, who cares if those taxes double? I’ll be paying an extra $2500 a year, but saving $5-12K per year by not having to buy health insurance. Yeah, it stinks for the people who are already paying $100K in income tax and will see that double, but that’s not my problem.” If they are a hardcore leftist, they may see that as a feature, not a bug.
I don’t condone this kind of selfishness, but I understand that a lot of people will be motivated by it. Here’s what I don’t understand. Why do politicians like Bernie Sanders and Bill DeBlasio insist that we also outlaw private insurance? What harm would be done to the public if a small percentage of Americans decided that they want to keep and pay for their current health insurance policies? Either way, they’re still paying the taxes for MFA. And if they are using private insurance they’re not costing the government any money at all, like those who are signed up for MFA would be. I should think that such people would be applauded.
Of course, the emotionally satisfying answer is to simply declare that socialists are just stupid, but there’s got to be more of an answer than that. There must be some semi-logical reason for wanting to go beyond providing everyone with “free” healthcare, and also outlawing private health insurance. What am I missing?
Published in Healthcare
Trust me. Medicaid is far far worse. Ask any patient that has it or any doctor that tries to deal with it.
But somebody will eventually notice that the government spends more per patient than the private insurers are spending, which would rather undercut one of the major arguments for having government provide medical care.
We already have a real time “private vs socialism” competition going on in the current Medicare program….and private is increasingly winning. Meanwhile, the Democrats grand plan is to get rid of that option, and stick the whole country on the option thats losing with seniors (especially poor ones) already. Its lunacy, but this is what happens when you embrace an inexperienced goofball with lots of promises (thats Bernie, not Trump)
Agreed. Besides the common nightmare of earning yourself medical-debt peonage while you can’t even refuse it — I admire the chutzpah of those who dispute such debts, but I wouldn’t bank on those being disputes the patients can win:
people seeking maintenance treatments to manage chronic problems, treatments which are in theory predictable monthly expenses, often find the bargains they’re offered on maintenance treatment unstable.
In our social circle, people’s coverage changes more than it used to, as workplace seem to switch coverage providers more often, and as those providers make changes from year to year based on arcane bargaining those who use the plan are nowhere privy to.
I do try to be one of the cooperative, conscientious consumers, who actively consults the formulary to go with recommended equivalents, only to find patient portals not working, or formularies listing equivalent dosages between options wrong(!). And it’s not like my doctor can write an open-ended prescription for “whichever’s the cheapest device or drug meeting these generalized specifications” — no: when formulary preferences change, you as the patient can’t change with them until you’ve pestered your doctor for a new prescription. Which doctors are usually available to do in a timely fashion, but each extra hurdle to jump introduces the prospect that someone, sometime won’t clear it…
A few of these hassles, you take in stride. And sometimes you get lucky and happen on a regimen that isn’t, for whatever reason, subject to wildly-fluctuating payment and clearance rules. But the more disparate hassles like this pile up, the more frustrated and helpless people will understandably feel, a kind of frustration that’s no longer easily soothed by telling them the alternative — a world where not even jumping hoops could get you the treatment — would be worse: Because, God forgive us, at least that alternate world sounds more restful and less likely to blame you, the hapless consumer, for not knowing the right arcana.
And, at a certain point, when your coverage provider and hospital system could simply exchange a fax or two among themselves to settle a problem they created but would both seemingly rather blame on you, and each claims not to “know” the other party’s appropriate fax number, while each guarding their own fax numbers like some Vital Government Secret, yes, even the most swivel-eyed of libertarians could be forgiven for wondering…
I find it astonishing how many of our fellow citizens live in a fantasy world.
This is exactly right. The Democrats are pitching Medicare for all when what they really intend is Medicaid for all.
Americans will be paying enormous amounts of money in taxes for dwindling services.
Double? Hah!
Quadruple, at best.
Right now, just under one in four Americans are covered by Medicaid.
And you’re paying for them, not yourself.
You won’t be paying $2500, you’ll be paying $10,000.
For a level of health care that, according to everyone involved, sucks.
My first instinct was to point out that the US spends about 18% of GDP on healthcare compared to about 10% spent by most other advanced countries (which have universal insurance via single payer and pretty comparable health care provision), but according to these people – while single payer would definitely reduce admin (and marketing) costs significantly, healthcare is more expensive in the US for several reasons:
Why is American healthcare so expensive?
That said, it makes
littleno sense for people to pay for universal insurance via their taxes (or via a levy) and then to buy private health insurance that covers the same things. Surely private health insurance companies would adjust to the advent of universal single payer and tailor their products accordingly?That depends whether they are really “the same” or not. It would equally make no sense to pay for public school via taxes and then send your kids to private school, but plenty of Americans do just that, believing that private schools can provide their children with an education that is better, safer, and more in line with their values than public schools.
Instead of forcing public schools to raise their game.
Also education, where teaching values come into it, is different from health care. A C Section is a C Section, right? If one is okay with it then what matters is quality and the price rather than whether the provider agrees with you on social issues or not.
It matters to some people whether they are forced to pay for services they consider immoral, such as abortion, contraception, or gender reassignment surgery.
It also matters very much to health care professionals whether they are forced to perform services they consider immoral. Under a private health care system, they can seek jobs with employers who share their values or open their own private practice. When the government runs the whole system, all such questions become political and result in one-size-fits-all top-down mandates.
Besides, we live in a world where people think it matters whether the fast food chain that makes their chicken sandwiches agrees with them on social issues.
Or public education. Or defence. The list could go on.
And people are already forced to pay for these (and probably a bunch of other things) through taxes.
In terms of principle, the issue of forced contributions via tax has been ceded – or at least not opposed as a matter of principle.
Yes, I’m talking about universal insurance (single payer) rather than universal provision (single provider).
Single payer accommodates individual choice (by seller) in a way that single provider might not.
A single payer has monopoly power to impose any terms and conditions it wants on providers, they have no choice but to accept or go out of business.
And I would rather see the current public school system replaced by a voucher system where parents can apply the money to a private school of their choice.
Currently the power is all the other way, and as a consequence the US spends about 18% of GDP on healthcare compared to about 10% spent by most other advanced countries (which have universal insurance via single payer and pretty comparable health care outcomes).
If you look at this clip, also, you’ll note that the US has fewer doctors/hospitals per head than other OECD countries (most of which has some version of single payer):
Why is American healthcare so expensive?
So there’s less competition, not more, which they argue is one reason health care costs are higher in the US.
Me too, but that still forces some people to pay for other people’s children’s eduction.
I’m fine with that, btw, just saying.
I don’t. Not with the government schools, Universities and MSM propaganda.
“It’s estimated that across the 10 provinces the total number of procedures for which people are waiting in 2017 is 1,040,791. This year, Canadians could expect to wait 4.1 weeks for a computed tomography (CT) scan, 10.8 weeks for a MRI scan and 3.9 weeks for an ultrasound.”
“The pan-Canadian benchmark specifies surgery within 2 to 26 weeks (14 to 182 days), depending on how urgently care is needed. As there is a lack of comparability in urgency levels, provinces are reporting the percentage of patients treated within six months.”
“According to the data, approximately 30 per cent of Canadians are waiting longer than the recommended six months for hip and knee replacements as well as cataract surgery”
I don’t remember where I heard it, but hospitals average 5% profit. If Medicare pays 80% of what they approve, and rely on the individual to pay or have a suplemental policy. It seems that doctors and hospital workers will have to take a pay cut in order for it to work. I also think that is one of the reasons Vermont repealed their single payer; not only would they have to raise taxes, the medical community didn’t want to take cuts.
In Canada we are not allowed to have private primary health insurance, although we can have private secondary coverage for drugs, private rooms in hospital, ambulance coverage etc. Private brings in “two tiered medicine” and the claim is that private coverage will suck up all the good health professionals and allow rich to jump the long line.
They don’t have the votes for the taxes. They need to create incentives to leave the private market and take away the customers. Congress may not have the votes to raise taxes, but they usually have the votes to spend money. That’s the slower way to socialism.
Congress never banned private healthcare for the elderly, but Medicare took away their customers, and there is virtually no private health insurance available for the elderly. Private medical care will still exist for the very wealthy but everyone else will be stuck with the post office, the failing public schools, the public hospitals and the government that runs them all. Socialism. Yay.
I suspect the ACA gives the Secretary the power to create a public option right now anyway. If I’m right, the next Democrat president pulls the trigger and then rams the taxes through Congress. That’s the faster way to socialism. There are still the courts to intimidate because there will be legal challenges, but that process is well underway, as the Senate Democrats have shown. They will roll over everyone in their way.
Democrats don’t anticipate a lot of push back from the very rich. Democrat politicians understand the very rich very well. Why? Because they are the very rich. So are their friends. And so are their children. This is a pretty small world.
The opposition to socialism comes from, but is not limited to, these groups: religious people, the middle class, the upper middle class, small business owners, and classical liberals and libertarians. Upper middle class voters will be an enormous pain in the you know where for Democrats when they realize that the politicians they’ve been voting for all these years are forcing them to make changes and sacrifices that they don’t like.
The basic idea of any insurance is to cover the individual against unexpected, catastrophic financial loss. This is done by spreading the risk among large numbers of people, most of whom will not suffer a loss. However, health insurance has gone beyond simply covering losses to paying for regular health care, which are expected expenses.
Health insurance plans aren’t supposed to cover all costs, but lots of folks think they should. This supports the notion people will be receptive to Medicare For All. What they don’t know is Medicare doesn’t cover all costs either, but no doubt the Dems will say they’ll change the law so it does . . .
“Pretty comparable” is one of those vague phrases that should set off alarm bells.
A number of years ago, one of the researchers who helped invent the MRI – a physician from the UK – was giving a presentation at a medical conference in Orlando. He pointed out that, as of that date, there were more MRI machines in Orlando than there were in the entire United Kingdom.
Things have changed, I’m sure – but it’s always like that, especially with advanced treatments and medical technologies. We have some horrendously expensive medical tech here, but the “free health care” countries don’t have it at all – until the US uses it enough that the price drops dramatically.
Drugs are a major part of that, of course. Yeah, you’ll see stories about “evil drug company charges a million dollars to treat disease X,” but nothing about “it’s only available in the US because the British NHS will never, ever buy it for their people until the patent runs out and they can get it for pennies on the dollar.”
Meanwhile, we keep finding out that the NHS has a problem with doctors and nurses effectively euthanizing patients because they cost too much (or are too annoying) to keep alive. Look up “Liverpool Care Pathway” if you want a bit of medical horror in your life. Basically, they just stopped hydrating a lot of patients and let them die of dehydration, because it was easier and cheaper. They were under-the-table-euthanizing over 100,000 people per year, without consent.
The NHS stopped using LCP in 2013 when it made the news, but they’re apparently still doing the same sort of thing.
Yup. Bernie claims that his plan will cover everything. No deductibles, prescriptions will be free, no out of pocket expenses at all. I’m not saying I believe that President Bernie Sanders would get this plan through Congress, I’m just telling you what he is promising.
It’s not all about social issues. While some people spend money to send their kids to private schools for religious reasons, some people do it simply because they believe that a particular private school is going to give their kid a superior education. And it’s not just rich people. There are middle class Americans who scrimp and save to send their children to a better school.
I don’t know that a C Section is a C Section. Even among government run VA hospitals in the US, there is a wide range of quality of service. It seems that some are quite satisfactory and others are dreadful.
The vast majority of people would take the Medicare if we’re being taxed for it, but there would likely be some refuseniks who want to hold onto their private insurance. Even if you think it makes no sense for them to do it, why should it be illegal?
Fair enough. Specifics:
https://interactives.commonwealthfund.org/2017/july/mirror-mirror/
Sorry, that is pretty much what I would want if I was dying and God had decided I could no longer drink by myself.
https://www.nursingtimes.net/clinical-archive/end-of-life-and-palliative-care/what-is-the-liverpool-care-pathway-08-11-2012/
This happens all over the world. I think it’s a combination of not feeling they can hold their elected Government accountable (or it’s too much bother) and the desire to limit the social class their children grow up with.
I don’t think it should be illegal.
If there were enough refuseniks to make providing this kind of insurance profitable. (I suspect there may not be) then having to compete with Medicare would definitely make it better value for money (than it is today).
What scares me more are the number of folks who think government can do a better job. You can talk yourself blue in the face talking to them about how screwed up the VA is but they won’t listen.
And yes, I know there are some great VA centers . . .
I have no problem with you choosing for you. I just don’t want you choosing for me or my loved ones.