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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
I realize the conversation has now moved on, but to the original question in the OP: there’s another reason why Democrats are so concerned about whether “Medicare for All” will ban private insurance or not which is quite banal but potentially more relevant. And it has to do with branding.
To wit: Bernie Sanders’ original “Medicare for All” proposal was such a hit on name value alone that almost every other Democrat candidate with a healthcare proposal hijacked the name and called their own proposals “Medicare for All” as well. The problem being that the non-Sanders proposals run a wide gamut from completely revamping our healthcare system to making much smaller changes at the edges.
One of the main dividing lines between the dozen or so proposals to emerge in the past year is whether they leave our legacy system of employer-provided group insurance intact or not. Since employer-based group insurance is both the largest category of insurance in the US and typically the most popular form as well, it’s understandable that a number of moderate Democrat candidates would be hesitant to eliminate it (i”if you like your insurance, you can keep your insurance…”). But since the more moderate Democrat candidates intentionally tried to obscure their squishiness by adopting the mantel of “Medicare for All”, and because most Democrat voters are too lazy to actually look up the details themselves, the question “would you ban private insurance” become a shibboleth to see which candidates were true believers who would scrap the most popular leg of our current system.
The irony, of course, is that even Sanders’ original Medicare for All isn’t actually Medicare – his plan is infinitely more generous (and hence expensive) than current Medicare.
One thing that frustrates me when conservatives talk health care is that we never ask “are we getting our money’s worth?”. Yes, provision of health care, especially expensive procedures and medications, is hands down better and more accessible in the US. But I thought conservatives were also concerned with opportunity costs.
Taking the rough figures of 18% GDP vs. 12% GDP health care spending in nations with top-down rationing systems, that’s about $1.2 trillion a year we’re spending in the US to eliminate waiting lines for hip replacements and saturate Orlando with MRIs. That $1.2 trillion would also buy a lot of fighter jets, or veterans’ services, or school vouchers – not to mention new houses, college educations, and investments if it were passed back onto taxpayers. Are those trade-offs worth it so that an 82-year-old can get his hip replacement next month instead of next year?
I don’t have an answer, but I don’t like the fact that we never even ask the question.
As horrible as single-payer and centrally-organized healthcare systems are, they often have one distinct advantage over our system: the cost to the taxpayer for any given visit, procedure, or drug is fairly transparent, and allows society to decide whether their tax money is being put to good use. In the US, we don’t even have a workable method of determining how much taxpayer money was used to buy each MRI in Orlando, let alone determine whether they were worth the cost to us.
Yes, those are hot wire questions. Even among conservatives, you may have friends question whether they really want to associate with you anymore if you suggest that perhaps Grandma and Grandpa shouldn’t have a blank check for medical spending. Rush Limbaugh and Sarah Palin start talking about “death panels” as if it’s always been a conservative principle spend taxpayer money without limits on the elderly.
Except that is very, very much NOT what happened.
They were doing that to people who weren’t really dying in the first place.
“Hey, Zafar is in the hospital with an annoying but temporary condition that will get better if we just keep a saline drip and some antibiotics going for a few days, but we’re going to kill them because it’s cheaper and we don’t feel like treating them.”
The Nursing Times were lying their asses off, by the way. Their claims were the “official” stance on the LCP – but in actuality, it was “let’s save some money for the NHS and open up some beds by murdering people who didn’t want to die.” They pretend that all they needed to do was follow the official recommendations in the Pathway – but it was trivially easy for someone to claim they were following the rules while making sure plenty of problematic patients died despite their own wishes.
I did find some of the rhetoric during the Obamacare debate overblown, many conservative talking-heads portrayed it as a complete government takeover of health care and the final stand between socialism and freedom. This conveniently ignores the fact that the government already took over nearly half of the health-care system, back before I was even born, with the passage of Medicare — which most conservatives now oppose any attempts to reform, let alone repeal. Obamacare was a relatively modest reform by comparison, one that attempted to preserve and expand the existing system of private insurance rather than replace it with single-payer.
“Death panels” were probably the least troublesome parts of ACA. In fact if Democrats want to come together to actually save Medicare, discussions on limiting “blank checks for doctors to care for 85 yr olds”, can be a part of that. That doesn’t have much to do with trashing the current employer private market though or lowering its cost.
In a true market based economy, the government would not decide, because individuals would be free to choose. The tradeoff of wait times and level of pampering and cost has no right answer for *everyone*. The lack of transparency is a product of government regulation as written by the AMA and insurance companies. With all that money, something better would emerge were it not for governments and the medical guilds.
The funny thing is, once you get out from underneath the government and the insurance companies, medical care is reasonably priced.
When I sliced the top of my head open this spring, the total cost of the treatment was $300 at one of those little “urgent care” clinics. That included examination, cleaning of the wound by the nurse, twelve staples put in by the doctor, and (ten days later) removal of those staples by another doctor.
I ended up being reimbursed through Workers’ Comp, but the price didn’t change, and the check arrived in less than a week.
On the other hand, a guy I work with had quintuple bypass surgery this spring (for you medical professionals, no, that’s not a typo). The cost was well over a half-million dollars… to the insurance company. For one (full!) day of surgery, with a couple of weeks of hospital time, and rehab treatment. The doctors told him he only had a 20% chance of getting up from the table alive before he went in.
At that point I say “Nah. You guys don’t owe me that.”
At that point, I say “Nah. You guys don’t owe me that.”
Try this. Amortize the $300 cost for fifteen minutes’ worth of straightforward care to 12 hours of surgery and 14 days in the hospital, with perhaps 15 rehab visits. Don’t leave out the 80% mortality that was prevented. You will likely find that “well over a half-million dollars” is not unreasonable.
Your head injury was a trivial thing that you could have paid out of pocket with no pain at all. The guy from work had a once-in-a-lifetime medical expense. It is for the latter, not the former, that we have insurance.
I’m not sure I feel like my fellow citizens owe me a half million dollars.
That’s why we need catastrophic insurance, not “cover everything under the sun” insurance.
You used to be able to get catastrophic healthcare insurance for very low amounts – I was quoted $100 a month right before the Affordable Care Act basically did away with it, and some policies were even less.
By the way: assuming $1000 per hour for each surgeon or other medical professional in that open-heart room, and assuming there were eight of them involved, that’s just under $100,000.
Add another $70,000 for the hospital costs (at $5000 per day), and another $30,000 for rehab, you’re only up to $200,000.
And unless they’re giving full refunds if the surgery doesn’t work, you can’t count the “success rate.” They get paid either way. But at least the insurance company would save on the recovery and rehab costs.
On the other hand, my “trivial” head injury was literally a once-in-a-lifetime medical expense – it’s the most expensive medical procedure I’ve ever had.
But if everyone gets that same high-dollar mandatory coverage, my lifetime payments would be in the $600,000 range from age 20 to age 70, not counting interest. With a total payout of a fraction of that. It would have taken me from a moderately comfortable lifestyle to being poor – and at times it would have put me out on the street.
Oh sure. I mean so what if you have to wait a year for a new hip. Walking is overrated.
The medical industry is going the way of the education industry. I think its best days are probably behind it as far as quality of life, longevity goes. We seem to be living about as long as my grandparents, who never had a MRI, or took liver pills. I also think that better living conditions; electricity, clean water, conditioned environments, have improved outcomes more than direct medical care overall. One area medical care improved for longer lives is immunizations.
Everyone cannot be in the medical profession, and most people that go to work, have a skill care about others, do the best they can, and contribute a lot to modern life. I hope when government gets to run health care, they stay away from the food industry.
Yes, but the guy was quoted an 80% mortality without the surgery. What is the value of not dying?
Depends who’s paying. If I had to pay for open heart surgery that would cost $200,000 and would bankrupt my wife, I’d die. And I’m not really sure my fellow citizens owe me that kind of money.
I look at Medicare as an insurance program, one we are forced to participate in by the government. It operates on the same general idea of pooled risks, we pay our premiums via payroll taxes and then collect based on medical need.
If your house burned down, would you feel guilty about collecting $200,000 from your homeowner’s insurance policy?
I’ll have to think about that one.
Good argument for universal coverage. No?
You’re making a leap of logic that I can’t follow.
Yes, it is.
On most major political issues there are good arguments on both sides. In my view, the cons of a government-run single-payer system outweigh the pros, but I’m not going to deny that there are valid arguments in favor of such a system.
No, the guy quoted an 80% mortality WITH the surgery.
In other words, that $500,000 surgery was for a 20% success rate.
Which would make it a $2.5 million per-success surgery.
Odd way of looking at it.
I think the correct way of looking at is “nearly 100% mortality without surgery and 80% even with surgery”.
Again what’s it worth to you to have a shot at living?
Not $2.5 million.
Not even $500,000, right now.
I’m not so enamored with my own existence that I’d be willing to waste that kind of money in a desperate attempt to make it for another decade or so.
I’d assume that often new, cutting-edge treatments start out with very high costs and low survival rates, but over time as they refine the techniques, learn from mistakes, and train more doctors to perform the treatment the costs will go down while the survival rates will improve.
So it’s not necessarily a “waste” of money if you look at it as an investment in advancing the state of the art in medicine.
Surgeons have been doing coronary bypass surgeries for sixty years. It’s not, by any stretch, “cutting-edge treatment.” US surgeons perform about 200,000 coronary bypass surgeries per year, more than any other country. By some counts, coronary bypass is the most-common major surgery.
There have been advances in the procedure, but it’s not going to get much cheaper. Most of the “government healthcare” countries have much lower rates of bypass surgery.
https://www.weforum.org/agenda/2015/10/which-countries-have-the-most-deaths-from-heartdisease/
Yep – we lose a lot of people every year to various forms of cardiovascular disease – because we eat a crappy diet, weigh too much, and have other bad habits. You can only do so much with a 400 pound sedentary smoker.
However, that chart is more than a little deceptive.
For example, the US and Germany are very similar in rates, but that map makes it look like Germany is much, much better.
They’re the same color, implying similar rates.