Petition to expand Medicare to be the Single Payer Healthcare System for the USA

[jclay]

Title pretty much says it all. If you want single payer healthcare-now.org is a key organization to support.

https://www.healthcare-now.org/blog/...edicares-50th/

[Too Tall]

Title pretty much says it all. If you want single payer healthcare-now.org is a key organization to support.

https://www.healthcare-now.org/blog/...edicares-50th/

J. You knda dropped a bomb. Are you wanting an informed discussion or is this a sore point?

[Jonathan]

I think he wants single payer health care.

[ron l edmiston]

-- happy birthday & thank you meicare for your half century life/service..

ronnie with medicare primary and bcbs secondary..

[jclay]

I think he wants single payer health care.

Right. No bombshell, just an FYI for thems that might be so inclined.

[jclay]

Single Payer is a far more cost effective healthcare financial structure than private insurance. Roughly 1/3 of our population is already on it via Medicare, Tricare (military retirees) and some others. The cost benefits and service delivery are proven, here and abroad. Healthcare-now, Physicans For A National Health Program, the New York State Assembly and the long stalled HR676 are attempting to improve and expand Medicare to become the national healthcare program for the entire country. That would be a wonderful improvement and substantially lower costs but certain ideological camps oppose it in general and even want to dismantle Medicare. Since healthcare costs are such a large portion of an individual's lifetime budget and earnings, and critical to quality of life, it's worthwhile to become informed as to what Single Payer is, how other countries use it to provide world class, cradle to grave, healthcare for their entire populations, and what can be done to move our country in that direction. The links in the lead post are excellent resources for that and for applying your support. It's worth your effort to become informed.

[monadnocky]

True story that, I think, encapsulates the American experience of single-payer benefits.

Back in 2008 I was doing my internship at a VA here in the Northeast. Most of the guys (and 99% of them were guys) I worked with were Vietnam era or later (into the 70's and early 80's, a few Desert Storm guys in the mix) and there was a smattering a Korea vets and even a few WWI guys (one of whom was in his late 80's but looked, amazingly, like he was 55- I was floored when someone told me he was WWII). Amazing guys, all of them, and while their political views were more diverse than you might think, most of them were, perhaps predictably, fairly conservative in their views of what was likely on the horizon (Obama was taking office, lots of talk of changes to healthcare, "socialist" healthcare systems, what have you). They were military after all, combat vets (although they would be quick to point out that asking someone if they "saw combat" is poor form - "what do you think we were doing over there, making cookies?" - even support/supply guys might get caught up in the mix.)

One of these guys had a wife who underwent a very expensive and as invasive-as-you-can-get procedure at the VA (trying to maintain confidentiality here as much as possible) but it was 100% paid for by the Veterans Administration. I'm not sure of the figure, and stuff like this is hard to monetize I know, but he stated that it cost well over half a million dollars and his cost was exactly zero (well, actually, not true, he would laugh as he talked about how it would cost him a few bucks every time he visited his wife because he would go to the cafeteria to get some chow). And literally not a few minutes after talking about this he would rail against the thought of any upcoming changes to healthcare, of any "socialist" changes to medicine. Strange.

Now, don't get me wrong, I'm extremely grateful that this guy's wife could get a heart transplant. And he was a great guy who I greatly admired. I think he was just frightened that there might be some boat-rocking in the healthcare system that could only serve to threaten what was, for him, a superb single-payer system. I think a lot of folks in the Medicare and Tricare system feel the same - not really aware of the reality of how their healthcare is paid for, perhaps aware on some level that the quality of their care might be threatened if everyone was able to reap the same benefits. Perhaps this is why the most vocal opponents of such changes appear to be those who are benefiting most from it?

I just don't know.

[roseyscot]

I work in the healthcare revenue cycle side of things. Medicare does not keep the lights on for the doctors and hospitals. Unless the single payer system brings with it higher reimbursement rates than Medicare currently provides, you are going to see a continued decrease in medical professionals willing to undertake the massive time and financial sacrifices required to be licensed providers. That means a decrease in the quality of care too.

I'm not saying it can't be done or that it wouldn't be beneficial overall. I am cautioning that the change needs to be just as focused on improvements for the providers as it is for the recipients.

[monadnocky]

I work in the healthcare revenue cycle side of things. Medicare does not keep the lights on for the doctors and hospitals. Unless the single payer system brings with it higher reimbursement rates than Medicare currently provides, you are going to see a continued decrease in medical professionals willing to undertake the massive time and financial sacrifices required to be licensed providers. That means a decrease in the quality of care too.

I'm not saying it can't be done or that it wouldn't be beneficial overall. I am cautioning that the change needs to be just as focused on improvements for the providers as it is for the recipients.

Hallelujah.

Rosey... to your point, my practice simply does not take Medicare. Or, rather, as we like to frame it, Medicare does not reimburse enough for us to cover our expenses. Neither do most group psychology practices around here.
So yes, that is a problem. In terms of being accessible to people who otherwise can't afford services, social justice, all sorts of stuff. But we can't see patients for what amounts to negative billing.

[christian]

I grew up in a country with single-layer healthcare. It's true that most of the doctors drove Volvos, not Mercedes, but I'm not convinced that the quality of care necessarily is in line with physicians' practices profitability.

[Matthew J]

I grew up in a country with single-layer healthcare. It's true that most of the doctors drove Volvos, not Mercedes, but I'm not convinced that the quality of care necessarily is in line with physicians' practices profitability.

Stats would seem to back you up. U.S. doctors may be on the higher end internationally when it comes to compensation. U.S. health figures tend to be more in the middle among first world countries. Even countries with far higher % of smokers.

[roseyscot]

Stats would seem to back you up. U.S. doctors may be on the higher end internationally when it comes to compensation. U.S. health figures tend to be more in the middle among first world countries. Even countries with far higher % of smokers.

I'm less concerned about the health of the smokers. It's the fat, junk food eating, never exercising American population that has the highest costs of care and our country is overflowing with that portion of the population. Good thing modern medicine can keep even the most unhealthy among us alive many years beyond our expiration dates.

[vertical_doug]

I work in the healthcare revenue cycle side of things. Medicare does not keep the lights on for the doctors and hospitals. Unless the single payer system brings with it higher reimbursement rates than Medicare currently provides, you are going to see a continued decrease in medical professionals willing to undertake the massive time and financial sacrifices required to be licensed providers. That means a decrease in the quality of care too.

I'm not saying it can't be done or that it wouldn't be beneficial overall. I am cautioning that the change needs to be just as focused on improvements for the providers as it is for the recipients.

A big part of the issue is the system is just become so complex it is hard to understand where the money goes. 'Where does it hurt?' by Jon Bush might be an interesting read for the summer as it tries to explain the system.

I recently had a dinner with many of my aunts and uncles where I was the only non-senior at the table. My relatives have health issues and 3 have been hospitalized in the past 2 years. Each bill was larger than 4 years college tuition and board at any private school in the United States. The younger generation will be left with a bill for their college and a bill for their parents medical care which they can never pay of

Obviously, the insurer will not reimburse the hospital for the full amount, and settle for a fraction. This corrupts the whole system as you begin a cat and mouse game of inflating bills and no one will know what something should costs.

and I have no idea what the solution is....

[roseyscot]

A big part of the issue is the system is just become so complex it is hard to understand where the money goes. 'Where does it hurt?' by Jon Bush might be an interesting read for the summer as it tries to explain the system.

I recently had a dinner with many of my aunts and uncles where I was the only non-senior at the table. My relatives have health issues and 3 have been hospitalized in the past 2 years. Each bill was larger than 4 years college tuition and board at any private school in the United States. The younger generation will be left with a bill for their college and a bill for their parents medical care which they can never pay of

Obviously, the insurer will not reimburse the hospital for the full amount, and settle for a fraction. This corrupts the whole system as you begin a cat and mouse game of inflating bills and no one will know what something should costs.

and I have no idea what the solution is....

Funny you mention my former boss's book. I got my start at athena. I haven't read it yet, but Jonathan Bush is the only Bush (yes, he's related to the former presidents and Billy Bush) I can imagine getting advice from. Yes, it's a very complicated system, but reducing it to a single payer who acts with the kind of consistency and fairness normally reserved for the UCI is a risky proposition too.

[vertical_doug]

Funny you mention my former boss's book. I got my start at athena. I haven't read it yet, but Jonathan Bush is the only Bush (yes, he's related to the former presidents and Billy Bush) I can imagine getting advice from. Yes, it's a very complicated system, but reducing it to a single payer who acts with the kind of consistency and fairness normally reserved for the UCI is a risky proposition too.

I want to see the money going to the people providing care for the patient. My fear is the system as it is now being operated, rewards the aggregator who aggressively games the system. This is a long term problem.

[monadnocky]

I don't know very much about medicaid reimbursement, but I have heard enough stories about providers (both medical and psychological) who play really fast and loose with coding, etc. and I understand that this is hardly uncommon.

[bigbill]

The single payer systems mentioned, medicare, medicade, and tricare and not equivalent. I'm retired Navy and working a second career as an engineer. I have BCBS, Tricare, and VA. Tricare is equivalent reimbursement-wise to Medicare, it's relatively easy to find a doctor that will accept it. Medicaid is not widely accepted due to a low reimbursement. VA is VA, it's a self contained and very inefficient system, but it's nothing out of pocket. I use BCBS for my primary with Tricare paying the copay and covering the gap. For Veterans in the VA system, I'd like to see a program where VA pays the gap and copay for Medicare when we reach 65 so we can move out of the VA system and free up resources. I don't see single payer anytime in the near future as long as insurance companies can make a profit and influence politicians.

[jclay]

I work in the healthcare revenue cycle side of things. Medicare does not keep the lights on for the doctors and hospitals. Unless the single payer system brings with it higher reimbursement rates than Medicare currently provides, you are going to see a continued decrease in medical professionals willing to undertake the massive time and financial sacrifices required to be licensed providers. That means a decrease in the quality of care too.

I'm not saying it can't be done or that it wouldn't be beneficial overall. I am cautioning that the change needs to be just as focused on improvements for the providers as it is for the recipients.

It is under funded but far more efficient than private insurance. Imagine if 60% the 200k that I've contributed to private insurance over my working life, and which will evaporate in the near term upon my separation, had instead been put into a well run national HC system; imagine scaling that over the population.

Our Balkanized, patchwork quilt of funding mechanisms is a poor, inefficient way to finance HC. It also causes other difficulties like creating a uniform digital medical record keeping/management system. If other countries can figure that out one would hope we could.

I don't subscribe to FUD and aside from vested financial interests that's the main hurdle. Technically and financially it's a slam dunk.

[vertical_doug]

It is under funded but far more efficient than private insurance. Imagine if 60% the 200k that I've contributed to private insurance over my working life, and which will evaporate in the near term upon my separation, had instead been put into a well run national HC system; imagine scaling that over the population.

Our Balkanized, patchwork quilt of funding mechanisms is a poor, inefficient way to finance HC. It also causes other difficulties like creating a uniform digital medical record keeping/management system. If other countries can figure that out one would hope we could.

I don't subscribe to FUD and aside from vested financial interests that's the main hurdle. Technically and financially it's a slam dunk.

Although I agree with you on the single-payer as being part of the solution, your 200k is just a deck chair on the Titanic. There is a segment of the population of about 5% which is so unhealthy and such heavy consumers of healthcare that your 200k, my 200k, everyone's 200k doesn't go very far. The financial challenge is very large. We have to address end-of-life spend and other sensitive issues to find answers.

[bigbill]

It is under funded but far more efficient than private insurance. Imagine if 60% the 200k that I've contributed to private insurance over my working life, and which will evaporate in the near term upon my separation, had instead been put into a well run national HC system; imagine scaling that over the population.

Our Balkanized, patchwork quilt of funding mechanisms is a poor, inefficient way to finance HC. It also causes other difficulties like creating a uniform digital medical record keeping/management system. If other countries can figure that out one would hope we could.

I don't subscribe to FUD and aside from vested financial interests that's the main hurdle. Technically and financially it's a slam dunk.

We have a government run health care system, VA. As a person in the VA system (I only see VA once a year for wellness check), I can tell you it's a terrible system staffed by people who for the vast majority, want to do the right thing. They're hindered by levels of administration, outdated record keeping (because the gov is always several generations behind), and about 1% of the career civil service workers who believe that VA exists to give them a job. A single payer system would have to be run by a private entity that is required to show transparency and accountability.