How to Fix our Healthcare System: Medicare for All? A Public Option? Other Ideas?

This thread began in the Welcome to Trump World thread, but it deserves one of its own.

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Originally Posted by Canadian Visitor

If the promise is the Canadian model, then what you should expect would look something like what we have up here...

I don't know that overpromising is what I would worry about, I would suspect the missing key is how will it be paid for?

That's what makes a hash of everything. Assuming it was done entirely through taxes. It would likely mean between 2.5 Trillion and 3.5 Trillion per year.

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Thanks for your account of the Canadian system [[follow the link above to see it). But your estimates of how much a similar system in the US would cost don't paint the full picture. They make it seem much more costly than it would be in reality.

Why? Because your estimate considers only how much the government would spend to provide the insurance, not how much we spend already, nor how much would be saved in reduced costs. At least according to researchers who have dug into this deeply.

The costs of the current system it would replace must not be ignored. They are paid for by a combination of the government [[taxes), employers, and largely, everyday Americans -- and we already pay a ton. $3.2 trillion in 2017 according to a study from the Political Economy Research Institute at the University of Massachusetts. Far more than any other nation, and more than twice as much per capita as Canada, according to Johns Hopkins.

When a renter paying $1000 per month moves into a $1100 apartment, the effect on their budget is $100, not $1100 in higher costs.

Here are the two important questions to consider:

1) How much more or less will it cost than we already spend?
2) How will it affect care?

Since we are talking costs, I'll put them in that order, and focus on #1. #2 is obviously important too.

The Mercatus Center at George Mason University conducted another study of the issue. They are a conservative think tank sponsored by the Koch brothers.

They estimated the outlays to provide the insurance would be about $32.6 trillion over 10 years, which is in line with your estimate.

That is also in line with the $32 trillion estimate from a study by the Urban Institute. It's about 11% above the $29.3 trillion estimate in the study from the University of Massachusetts.

But they also estimated the plan would result in $482 billion less health care spending and more than $1.5 trillion less administrative costs than if we changed nothing. Over 10 years, we'd spend $2 trillion less.

In other words, we'd pay $32.6 trillion for the new plan. But that would replace roughly $34.6 trillion we'd otherwise spend into our current health care system.

You see, our healthcare "rent" is already outrageously high. And our rent would go down.

Of course estimates are just estimates, the devil is in the details, and it's impossible to know precisely how all the details will play out.

And when Sanders gleefully pointed out the Mercatus report shows a $2 trillion savings [[that was not what their sponsors wanted to hear!) they said some of their assumptions regarding cost savings may have been too rosy.

But that is just one estimate, from the right side of the political spectrum.

Other studies have estimated lower costs and more savings, like the one from the University of Massachusetts, which says under the Sanders plan healthcare expenditures would drop nearly 10 percent, to $2.93 trillion per year. It estimates we'd save over $5 trillion over 10 years.

And don't forget the results!

• Everyone will have stable access to good health care.
• We will no longer need to pay copayments and deductibles.
• We will no longer be at risk of being thrown under the crippling cost of an accident or any other costly health event.
• Employers and employees will no longer need to contribute part of workers' pay into an employer-sponsored heath plan, so wages effectively go up.

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Read more about this [[or google it yourself):

Economic Analysis of Medicare for All
https://www.peri.umass.edu/publicati...dicare-for-all

'Medicare for all' could be cheaper than you think
https://www.umass.edu/sbs/news/facul...aper-you-think

U.S. Health Care Spending Highest Among Developed Countries
Americans on average continue to spend much more for health care—while getting less care—than people in other developed countries
https://www.jhsph.edu/news/news-rele...countries.html

The Costs of a National Single-Payer Healthcare System
https://www.mercatus.org/publication...lthcare-system

The Sanders Single-Payer Health Care Plan: The Effect on National Health Expenditures and Federal and Private Spending
https://www.urban.org/research/publi...ew/full_report

Did conservative study show big savings for Bernie Sanders' Medicare for All plan?
https://www.politifact.com/truth-o-m...gs-bernie-san/

Koch-Backed Think Tank Finds That “Medicare for All” Would Cut Health Care Spending and Raise Wages.
https://theintercept.com/2018/07/30/...th-care-wages/

Excellent post, bust!

It really is refreshing to see a guy like Sanders not be in the frying pan of corporate interests. The reasons for which Health Care costs in the US are so high are many. The cost of educationbfor practicioners, the runaway, unchecked pricing of drugs, and the multiplicity of high end equipment in hospitals are some of them. I can see where a decentralized galaxy of private insurance companies needs to be sold as competitive to Americans, but clearly isn't.

I laff when I read pundits like Richard say: the US is much too big, this is not our way of doing things, etc... Socialism rearing its ugly head, etc...


What is more socialistic than pouring vast amounts of National wealth on defense budgets, and letting health and education costs run rampant?

Sorry, I have to go feed the hungry children up here in Canuckistan, this a.m.

CV asked in the other thread, how many Americans support this. The answer is a majority.



https://thehill.com/policy/healthcar...dicare-for-all

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A vast majority — 70 percent — of Americans in a new poll supports "Medicare for all," also known as a single-payer health-care system.The Reuters–Ipsos survey found 85 percent of Democrats said they support the policy along with 52 percent of Republicans.

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As has been proven time and again during this administration, it doesn't matter what the vast majority of Americans WANT, it's getting it voted on by the senate. And passed.

Medicare for All Town Hall with Bernie and friends yesterday.


https://youtu.be/Qvg9uRk1uTM

14 states have Democratic trifectas; a Democratic governor and legislature. Not one has passed a single payer system similar to that of any Canadian province. Obama's big accomplishment was passing the un-ACA. That was supposed to be a huge step forward. When it didn't work without changing rules and funding, the happy talk switched to a national single payer program.

Canada has a generally successful single payer system that is about 40% cheaper than medical care in the U.S.. Taxes are higher but savings are made by greatly reducing health and medical liability insurance, limiting doctor liability so they don't have to pass on as much of their liability insurance costs on to patients, hiring a lot of foreign trained doctors to save on training so many of their own doctors, buying medicines in bulk to get a better price, less duplication of medical equipment, and by greatly simplifying billing to get rid of a wing of bureaucrats in each hospital. All we have to do is kick the insurance companies, lawyers, and bureaucrats out and costs come way down.

California worked on having a single payer system but left those groups in. The result was that state income taxes would have had to gone up by 250% to pay for that. Just like the un-ACA, the affordable part was neglected. All the hogs were left feeding from the health care trough.

Then, at the second Democratic presidential debate, all 10 candidates raised their hand to affirm that they supported free medical care for illegal non-citizens. We don't even know whether there are ten or thirty million illegal non-citizens in the U.S. because Democrats won't let us ask in the census. Free medical care would incentivize millions more to come. With all the hogs left feeding at the trough and Democrats inviting millions of foreigners to share medicare for all [[and they mean all), I would be nervous about trusting my health care to these clowns.

What I think would be more prudent would be for some Democratic states to copy any Canadian provincial plan, changing the wording as necessary, e.g. 'ministry of' = 'department of'. If it works, other states will be quick to copy. Doing so would be completely Constitutional under the 10th. Amendment.

^^^

Isn’t Vermont trying to implement something along those lines?

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Originally Posted by canuck

^^^

Isn’t Vermont trying to implement something along those lines?

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I don't know what is happening in Vermont now. During Obama's presidency, Vermont did create a single payer plan. My understanding is that ACA bureaucrats ok'd the plan but only if all of the un-ACA was included at its core. That probably involved keeping lawyers, bureaucrats and insurance companies more involved. That didn't save any money so Vermont's Governor gave up on the idea. I don't know why the federal government just didn't step aside and let Vermont do what it wanted. The Clinton administration and Donna Shalala had allowed Wisconsin to try out a new welfare program to see how it worked out. It seems like the Obama administration could have done the same with Vermont's single payer program.

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Originally Posted by bust

]Thanks for your account of the Canadian system [[follow the link above to see it). But your estimates of how much a similar system in the US would cost don't paint the full picture. They make it seem much more costly than it would be in reality.

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I totally get what you are saying.

But the pragmatic distinction is one of shifting the cost from a mix of employer-paid [[partial to full), employee paid [[typically partial) plus out of pocket costs [[deductibles/copays, non-covered items) to the government [[ie. taxes).

While it is certainly possible, indeed likely, if one didn't screw things up beyond recognition that savings would be banked over the current model, your still go to shift who pays and how much.

For ease, let's take someone who currently gets a plan through their employer, where the employer pays 2/3, and the employee 1/3.

Let's say that employee loses $4,000 off their cheque each year for their 1/3.

Assuming bi-weekly pay, that's $153 per cheque.

If that is swapped for payroll or income tax that takes the same amount or less, I don't imagine any great controversy.

But that's not going to cover the new program.

You have to recover the employer contribution, at $8,000.

If you did this through income tax, I suspect many would scream.

Presumably you go for a form of employer-paid payroll tax; and/or corporate income tax, and if you can get that passed, that's great.

But that cost recovery still leaves you with the costs of covering the uninsured [[today) and with the costs of wiping out deductibles and copays.

Absolutely do-able, probably can be fully covered by savings.

But wait for it.....where are those savings coming from?

Upfront, you would more or less have to mandate that all hospitals be non-profits. It really doesn't matter if you put everyone on public insurance and say 'x' is what we are going to pay for 'y'; except that you can't lower the price without taking out costs.

The costs taken out to match the Canadian system are outlined in Oladub's post.

- Direct savings of a single-insurer, single plan, the vast majority of hospital sales/accounting/insurance relations folks go away [[some remain to deal with non-U.S. patients without the new insurance scheme).

- To be clear, the above means layoffs, in the direct healthcare sector and in the private insurance sector in the tens of thousands minimum. Arguably overdue, but I expect to see some serious opposition both from those whose jobs would vanish and their unions, plus States where health insurers are large employers.

-Next, you have to rollback the cost of drugs. Doing that with new drugs isn't that hard, you adopt the way drugs are priced internationally on newly approved drugs. But in order to drop US healthcare costs, you'd have to revisit the price of already approved drugs, particularly those still on-patent, expect a messy fight on that.

-Then you have to tackle malpractice-insurance. Doing so in the US means massive tort reform. Capping pain and suffering awards and possibly getting rid of civil juries. The lawyers might object....

- Once you've done that, you have to lower the fees that doctors are paid, now, lowering the cost of their malpractice insurance, and their billing costs should help towards that. But to get to Canadian levels, never mind European ones, your talking steep rollbacks, particularly for specialists.

Ready for a doctor's strike? It happened when the first province here adopted Universal Care.

https://en.wikipedia.org/wiki/Saskat...tors%27_strike

It also requires rationalizing the number of facilities. One reason US care can be quick, when you're insured, is that you have the second highest number of MRIs/PETS/CTS per person [[after Japan). You are similarly over-weight in variety of other areas such as the number of certain medical specialists.

If you move to contain costs, some of that will have to give. Some doctors will move to practice elsewhere, some will no longer get trained in the future with the prospect of lesser income.

All of which should not be construed to suggest I oppose Universal Health Insurance in the U.S. I'm very much in favour of it.

Rather, I recognize the massive political challenge in getting there.

Canuck on the size does not matter aspect,are you thinking that the size the US does not matter?

If you have for all then you have to be able to service the population by haveing X amount of facilities.You will be paying for facilities that cost the same to build,staff,operate no matter where they are.

Then what will happen if the budget drops back like in a recession,the first thing that will happen would be the trimming of facilities in low population eras which is exactly what the failed model of the VA did.

Look how the VA operates or did in the past,they were limited in number of facilities so some had to drive hours just to visit.

At this time what percentage of full service hospitals in Canada service what percentage of the population in a given radius.

Last winter in the UK a flu outbreak overwhelmed the system to the point where there was no beds,incoming ambulances were lined up outside,patients were stored in the hallways.

Because they had to reduce the level of facilities in order to try and keep up with funding,as a result it increased wait times for all other services.

On the free healthcare on a individual state implemented aspect,Fla already pays $6 billon out towards illegal immigration,in theory we could direct those funds towards a healthcare for all and maybe see a small increase in an added tax.But there are only about 5 states carrying that burden.

But what happens to one state that increases taxes in order to pay for healthcare for all,do the ones with private insurance then flee that high tax state for another state,while those with no insurance move to that state?

It is no secret that people flee high tax states,how would that work anyways when there is a stark difference in one states revenue base verses another,if the lower income based state cannot afford the costs do they then shut it down?

The only way it would work is on the federal level where the cost is born by everybody.

Even at that it would take 20 years to implement,no way you can immediately change the existing system an retain it at its current level.

It still goes down to it does not matter how many support healthcare care for all or what side of the fence one is on,I support free beer for everybody but until I can figure out how to pay for it,sorry for the tease.

So yay free healthcare for all,excuse me but how much is this going to cost me,do not worry the government will figure it out later,just pass it and trust us to do things in your best interests.

We can debate free healthcare and it’s good sides and bad sides all day long,the bottom line in every American is going to be how much more is coming out of my weekly check,then they can decide to support it or not.

Everybody already understands the concept of it.

I see I posted at the same time as CV so a lot of this is addressed with senaios

I guess one of the biggest questions I would have would be,If people under the current Canadian system are coming to the United States for care related to deficiency’s in thier system,where do we go if we implement a similar program?

And lets post those deficiencies and the reason for care outside of the Canadian system,like the cancer aspect,without claiming hatred towards Canadians as a focus point,if the need for the services did not exist it would not be happening.

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Originally Posted by jcole

As has been proven time and again during this administration, it doesn't matter what the vast majority of Americans WANT, it's getting it voted on by the senate. And passed.

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Exactly! Best of luck to Bernie getting elected, and best of luck getting all the career politicians on board and getting this passed. [[sincerely and hopefully)

^^^ Well there's always the professor [[Warren), or the self-loather [[Biden) to come up with a sterling plan!

I don't weigh into these often. Has anybody really looked at Medicare? It ain't all that great. Too many gotchas, exceptions and added costs. Lots of loopholes. Optional premiums can be hundreds of dollars. And still, not all providers accept it nor do all insurance companies offer policies.

Medicaid is better for the client, all costs are covered, very little, if any out of pocket.

But again, not all providers accept it.


My proposal is more along the lines of Medicaid than Medicare. ALL costs covered, few if any optional programs. Elective/cosmetic surgery would be one, except when needed as a result of accident/injury/burns leading to visible disfiguration or deformity.

Premiums would be income based, not risk or prior condition based. Some adjustment could be made for 'bad habit' risk such as smokers or drug users, but that could get touchy also.

ALL providers would be required to accept the program. No opt out. If you're a licensed medical practitioner, you're in.

ALL medical insurance companies would be required to participate.

Those two points would help to spread/balance the risk more widely across the board so that no practices would be overloaded with lower income patients as is the case now. Care would be better balanced also. Everyone could have access to equal care, not just those that can afford elitist providers.


And for any of this to work, medical billing practices need to be worked on. No more $10 aspirin, $3 'gelatinous dietary supplement' [[Jello), $50 'doctor consultations' when they wave at you from the hallway or $100 charge for a drug that costs under $10 to make.

In short, a fundamental change of the process.


Vote for me. Vote often.

At this point in time, Bernie would have no better luck getting it passed than would Warren, Biden, Beto or Buttegeig. If Mitch is still in office, do you honestly think things will get BETTER? Shee-it!

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Originally Posted by Zacha341

^^^ Well there's always the professor [[Warren), or the self-loather [[Biden) to come up with a sterling plan!

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^^^ I don't. At least not for the rank and file and poor. What a mess!

The best proposal I've seen is one where you pay your doctor directly a nominal monthly fee that covers any minor procedure or preventative visit you need. Things like resetting simple broken bones, sprains, illnesses, physicals, screenings, stuff like that.

Then, you pay insurance for anything catastrophic that might happen - cancer, severe injuries - anything needing an extended hospital visit or long-term care.

The cost savings of not having to deal with insurance makes the general practitioners doctor's prices fall pretty dramatically. You also have pressure taken off of hospitals to focus on severe illness and injuries.

A few doctors and insurance systems were trying this out in Texas and Oregon, but the ACA made it more or less impossible to implement.

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Originally Posted by Meddle

I don't weigh into these often. Has anybody really looked at Medicare? It ain't all that great. Too many gotchas, exceptions and added costs. Lots of loopholes. Optional premiums can be hundreds of dollars. And still, not all providers accept it nor do all insurance companies offer policies.

Medicaid is better for the client, all costs are covered, very little, if any out of pocket.

But again, not all providers accept it.


My proposal is more along the lines of Medicaid than Medicare. ALL costs covered, few if any optional programs. Elective/cosmetic surgery would be one, except when needed as a result of accident/injury/burns leading to visible disfiguration or deformity.

Premiums would be income based, not risk or prior condition based. Some adjustment could be made for 'bad habit' risk such as smokers or drug users, but that could get touchy also.

ALL providers would be required to accept the program. No opt out. If you're a licensed medical practitioner, you're in.

ALL medical insurance companies would be required to participate.

Those two points would help to spread/balance the risk more widely across the board so that no practices would be overloaded with lower income patients as is the case now. Care would be better balanced also. Everyone could have access to equal care, not just those that can afford elitist providers.


And for any of this to work, medical billing practices need to be worked on. No more $10 aspirin, $3 'gelatinous dietary supplement' [[Jello), $50 'doctor consultations' when they wave at you from the hallway or $100 charge for a drug that costs under $10 to make.

In short, a fundamental change of the process.


Vote for me. Vote often.

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This...

https://www.commondreams.org/news/2019/09/08/progressives-explode-after-abc-panel-featuring-chris-christie-and-rahm-Emanuel

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The ABC political show "This Week" on Sunday devoted a chunk of time to attacking Medicare for All, drawing fire for the segment's panel makeup and language.Of particular gall to critics was the fact that the panel's nominal liberal was former Chicago Mayor Rahm Emanuel, a fiercely right-wing Democrat whose decades-long career in Washington, as Intercept editor Ryan Grim recently detailed in his book "We've Got People," has been devoted to stifling the party's progressive wing.Sunday was no different as Emanuel, now an investment banker with the firm Center View Partners, took aim at Medicare for All by framing the broadly popular policy proposal as a danger to Democratic electoral hopes in 2020. During the discussion, Emanuel attacked progressive calls for Medicare for All. Both men claimed that voters would viscerally reject any attempt to change the nation's healthcare system, both by getting rid of private
insurance and ofering care to non-citizens.

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Anybody else sick of those ads that are running over and over claiming Sen. Peters wants to close hospitals? Article about who is running them:


https://www.opensecrets.org/news/201...l-bills-fight/

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A secretive “dark money” group, which claims to represent doctors and patients, engaged in a TV advertising blitz totaling at least $2.3 million from late July through mid-August. Its ads urge vulnerable senators to reject a proposal meant to cut down on expensive surprise medical bills.

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This just happened:

Florida man returns from China, develops flu-like symptoms, does the responsible thing and gets tested to make sure he's not carrying coronavirus and putting others at risk. Requests the cheaper blood test instead of the CT scan the hospital recommends. Fortunately all he has is the flu. Then he gets billed $3,270, and more bills are coming. His insurance refuses to cover anything unless he can provide 3 years of medical records to prove his flu is not related to a pre-existing condition. Trump rolled back Affordable Health Care Act regulations that would have prevented this his first year in office.

How many Americans are going to skip getting tested in order to avoid situations like this because they're poorly insured or uninsured, and our medical care is outrageously expensive?

Even with what passes for decent insurance these days the deductibles are often so high people may choose not to.

Providing good affordable health care to all keeps us all safer. Lacking it puts us all at much greater risk.

A Miami man who flew to China worried he might have coronavirus. He may owe thousands.
https://www.miamiherald.com/news/hea...240476806.html

^ if he cannot cover the $3,270 the hospital will apply to the county of his residence as a charity case.

The hospital will accept a lower rate as a cash payment basis paid by the county.

Both the county and the hospital receive federal funds every year to cover indigent care.

If he cannot get insurance because of pre existing conditions and qualifies as lower income he can get state Medicaid,which is also reimbursed by the federal government and the other state taxpayers .

There are options,the headline could apply to many unforeseen financial circumstances that could arise in anybody’s daily life.

If he can afford to fly to China he can afford the $3500 or insurance or not he should have just paid the $150 travelers insurance that is available when traveling international.

If one is sick and poor they can walk into any state funded clinic,show proof of residency and receive care.

The article refers to Florida so I am presenting a set of Florida options,it may be different elsewhere.

It is tough to get any insurance with pre existing issues,even life insurance.

The claim that the poor do not have excess to healthcare is bs,in Florida anyways if you are poor and do not have healthcare,it is because you did not take the time to sign up.

Some that are married and a spouse has severe health problems,get divorced so the spouse can qualify.

I do not know the exact details but most of the people that I know that have insurance through their employer and had pre existing conditions have told me anyways,under the Obama care their premiums would have doubled at the least had they signed up which would have put them in a grey zone of sorts.

Making to much to qualify and if they switched to ACA the added costs would have dropped them into an income bracket of having to pay the double rate.

To me anyways all ACA really did was increase the shift of funds from those already paying in order to cover those not paying,but in the process the increase in premiums would create more in need and increase the level of those not paying into.

I think they are doing what they need to do already,because until you can lower the fixed costs and cost of medicines there is really no point in asking for more money.

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Originally Posted by Canadian Visitor

As I've noted, there are variation of universal coverage which can provide some measure of 'choice' in insurance.

Though, I would suggest that choice is typically overrated.

I've had the same insurer my whole life, the Government of Ontario.

I've never had an item that is intrinsically covered [[hospital care, family physician, specialist etc etc.) not covered.

Never had to fight for it.

There are things covered privately here, in whole or in part. Medical devices, dental, out-of-hospital prescriptions, and out-of-hospital physiotherapy are mostly 'private' services.

Though there are programs to support seniors and/or low-income earners in most cases.

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I have a good friend from the US who married a Canadian and they live in Ontario. After they moved there she was diagnosed with cancer and she's going through her third round of chemotherapy. She is incredibly grateful for the great care she has received. She has never had to fight for it. Nor has she ever had to pay a dime beyond her very well-used taxes.

And of course I have lots of other friends and family who have been diagnosed with cancer in the US. And NONE of them say the same things. Struggling with insurance and hospitals here were extra burdens. Some had to make hard choices about the treatments they can afford. One was bankrupted.

There is no reason whatsoever why Canadians can accomplish such a better system and we can't. We can do it too.

But to do so we will need to take on the terrible greed that extracts so much wealth from the current American system. Yes, it's a huge part of our economy. It's far too much, at the cost of far too much suffering.

I'd like a system like Canada's, with robust universal healthcare, and the opportunity to supplement it with private insurance if wanted.

A very important part of that is the universal healthcare system must be good enough that those who cannot afford to supplement it receive the same quality of care my friend in Ontario is receiving.

It's long past time: we should no longer suffer from a system so corrupted by greed!

If we mimic the Canadian form of healthcare without retaining the private options then where would the Canadians go for timely healthcare?

https://www.usnews.com/news/best-cou...or-health-care

The UK also has free healthcare for all but is in serious condition with up to 3 hour wait times in the ambulance parking lot once you arrive and are over 40 hospitals behind on keeping up with the demand.

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Originally Posted by bust

I have a good friend from the US who married a Canadian and they live in Ontario. After they moved there she was diagnosed with cancer and is currently going through her third round of chemotherapy. She is incredibly grateful for the great care she has received. She has never had to fight for it. Nor has she ever had to pay a dime beyond her very well-used taxes.

And of course I have lots of other friends and family who have been diagnosed with cancer in the US. And NONE of them say the same things. Struggling with insurance and hospitals here put significant extra burdens on them. Some had to make hard choices about the treatments they can afford. One was bankrupted.

There is no reason whatsoever why Canadians can accomplish such a better system and we can't. We can do it too.

But it does mean we will need to take on the terrible greed that extracts so much wealth from the current American system. Yes, it's a huge part of our economy. It's far too much, and at the cost of too much suffering.

I'd like a system like Canada's, with robust universal healthcare, and the opportunity for some to supplement it with private insurance if they want.

A very important part of that is the universal healthcare system is good enough that those who cannot afford to supplement it receive the same quality of care my friend in Ontario is receiving.

It's long past time we should no longer suffer from a system so corrupted by greed!

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+5 .....

I think the main issue is the layers of beauracy involved with the private health insurance system.

Before the passage of the AHCA, some doctors in Oregon were experimenting with a system where you pay your doctor directly a monthly coverage fee that includes any visit you need for basic health care - sickness, checkups, broken bones, etc... Then you pay a regular health insurance company for only catastrophic coverage. The benefit to the doctor is the reduction in costs for billing, which is substantial, letting them charge significantly less for, essentially, unlimited regular health care.

The rules of the AHCA meant this system wouldn't work anymore and it was abandoned, but I would like to see it tried out again. This is basically how health care used to work before private insurance, minus the catastrophic coverage.