Medicare For All - The Conservative Case For It

[jclay]

There are plenty of progressives and democrats who support it for fact based performance and rational economic reasons, but not so many who self identify as conservative. With that intro here is a link to an article, The Conservative Case For Universal Healthcare, that appeared in The American Conservative:

The Conservative Case for Universal Healthcare | The American Conservative

When those guys start to grok the economic rationale maybe it's time for the conservative base to reconsider.

[mzilliox]

You have to love a country that espouses the free market, then asks its government to "run" the free market. I've always thought government would better serve us if it actually served us, like with useful services. we are super rich, and get virtually nothing for it. Government only need touch the market when baddies need sorting.

Of course universal health care makes more sense, and of course its weird that the same place that would accuse the state of nannying, instead thinks for profit corporations should play nanny and provide us all with the health care we all think we deserve, but only if we find jobs.

Thanks for sharing this, it brings some optimism to my day

[ericpmoss]

I would be willing to try reversing the HMO Act that Nixon signed in 1973 that allowed health care to be for-profit. The moment Wall Street got involved, the situation for average people (as opposed to the investor class) started declining.

[jlyon]

The way the system currently exists will ensure even if we go to single payer system the costs will continue to be many times greater than the rest of the world.

The big health, hospital and drug companies will make sure that congress never cut their profits.

It seems to me that their should be a new level of medical care that is truly low cost(low quality) that people could choose with their own money.

Nobody ever seems to address the cost side just the payment side.
Could this country form some free medical schools-lower cost clinics for routine services (Dialysis, broken bones, child bearing, even some cancer fighting).

Now I may support single payer Medicare for all; but then some things I currently support would change.
I would insist on helmet laws for everyone on bikes and motorcycles. I would no longer support the legalization of some recreational drugs, I would want anyone hurt under the influence of these drugs to payback to the system in full any charges for medical care incurred in their accidents or impaired babies.
How about diet and exercise how can that be regulated?
And I am not a fan of regulations but when it is my money going to pay for this system I would want it to be very efficient.

Most people hate it when the government tells them to do anything, so I am not optimistic about either system.

It will never go back to the way when most people chose and paid for their own health care but it did work because the expectations for quality were in line with what people were willing to pay. Now everyone wants the best quality for everyone with bills that equal a small portion of their monthly budget with someone else picking up the difference.

[kytyree]

The big health, hospital and drug companies will make sure that congress never cut their profits.

I agree that I don't see this happening anytime soon.

From the article: "Getting rid of private insurers, which suck up a lot money without adding any value, would result in a huge savings

I don't see this happening either. Healthcare/health insurance is a cash cow for a lot of people and businesses in the US. I just do not see us "getting rid" of them quickly or easily. And that, to me, is the flaw in any plan to fix our healthcare system that doesn't address the health insurance side of the problem. So while the article may try to point out that socialized healthcare is cheaper it doesn't explain to me how we as a country are going to reach a point where the companies profiting from health insurance and healthcare step away from the table they're feasting at. Saying socialized healthcare is cheaper overall is another way of saying it's not as profitable for those involved...

I would insist on helmet laws for everyone on bikes and motorcycles. I would no longer support the legalization of some recreational drugs

I sat this morning and had my first cup of coffee listening to my 20 some year old neighbor cough his way through his first couple of menthols, as he does every morning, I don't feel that those types of decisions are costs that all of us should bare equally.

[summilux]

You might be interested in this piece on how the Canadian medical system got its start. The article is from a leftist website so beware. Nonetheless, they got the story right: activist farmers in an agricultural province elected a strong-willed government that faced down both the medical insurers and the physicians. 1968 is not now but the key ingredient remains a ballsy government.

The Birth of Medicare – Canadian Dimension

[vertical_doug]

Even when Margaret Thatcher became Prime Minister in 1979 which was essentially a rejection of the welfare state and heavy regulations, she promised the NHS would remain safe in her hands.

[jclay]

The big health, hospital and drug companies will make sure that congress never cut their profits.

That's still up to the public. We can change it, it's just a matter of supporting the right folks. Of course that would require folks to pay attention, make smart decisions get noisy about change and support progressive candidates.

Now I may support single payer Medicare for all; but then some things I currently support would change.
I would insist on helmet laws for everyone on bikes and motorcycles. I would no longer support the legalization of some recreational drugs, I would want anyone hurt under the influence of these drugs to payback to the system in full any charges for medical care incurred in their accidents or impaired babies.
How about diet and exercise how can that be regulated?
And I am not a fan of regulations but when it is my money going to pay for this system I would want it to be very efficient.

You're paying for it now, just by way of a system that costs about 50% more than nearly every other First World country. It seems supremely sensible to me, to move towards the most cost effective model regardless of other considerations. By virtue of being tax based, everybody who pays taxes has skin in the game.

[Jeffrey Lee]

By virtue of being tax based, everybody who pays taxes has skin in the game.

And when the people who do pay taxes can't stand to be taxed anymore?

[vertical_doug]

And when the people who do pay taxes can't stand to be taxed anymore?

This is the other large issue facing the nation- the concept of tax fairness. Currently if Federal Gov collects $1.9Tr in income tax, 1.6Tr comes from Individuals, and .3Tr comes from Corporations.

The US tax system has becoming more regressive since Reagan, and with Trump recent tax cuts, it moved even more.
Nominal Tax rates may look progressive, but in practice at the high end of the curve, the effective rates declines making it regressive at the top end

[sine]

Edit

By virtue of being tax based, everybody who pays taxes has skin in the game.

That's pretty funny. Only fifty four percent (currently) would have skin in the game.

The top 10% of income earners in the USA would be crushed by the tax burden needed to pay for Medicare for all........and potentially receive poorer healthcare.

As an example, according to the Fraser Institue research bulletin (8/17) the top 10% of income earners in Canada will pay an average of about cdn$39k for public healthcare in 2017.

Clay, I believe your "progressive" friends don't have a clue......or worse, keeping quiet about real costs.

[vertical_doug]

Edit



That's pretty funny. Only fifty four percent (currently) would have skin in the game.

The top 10% of income earners in the USA would be crushed by the tax burden needed to pay for Medicare for all........and potentially receive poorer healthcare.

As an example, according to the Fraser Institue research bulletin (8/17) the top 10% of income earners in Canada will pay an average of about cdn$39k for public healthcare in 2017.

Clay, I believe your "progressive" friends don't have a clue......or worse, keeping quiet about real costs.

It's not additional spend as much as changing the way the spend is paid for. Canada Healthcare is 11.1% of GDP, US is 18% of GDP, so anyway you look at it, more money is being spent in the US.
NHE Fact Sheet - Centers for Medicare & Medicaid Services

US Federal, State and Local gov already pay for 44% of this, so that tax is already collected. The reality is if our healthcare costs were on par with the rest of the OECD countries, we'd almost be fully funding our healthcare needs from current taxes paid. ACA was a good start, but failed miserably for any kind of cost containment as a concession for big business.

There is not one lever to pull to fix the problem, but many points needing to be addressed. For a large portion of our population in the US, health outcomes are probably worse than the developing world.

[fastupslowdown]

we're never going to get health care costs under control until we incentivize the insured to seek the lowest cost options. two items would help. bigger deductibles and insurance for all that covers basic care but leaves the private market to offer ala carte services. society needs to decide what coverage everyone should get and what should be left to the private market. its just a fact that plastic surgery and lasik two items typically not covered have shown the lowest inflation rates.

[ericpmoss]

It horrifies me that in the US, there is *always* money for bailing out the wealthy and for endless war, but only when we talk about not kicking people to the gutter do people ask "How ya gonna pay for that?" $4T for the Iraq War and we're still dealing with whole cities worth of disable vets, and not a peep. $21T of income held overseas in tax havens and not a peep. Jeff Bezos the richest man ever partly because taxpayers subsidize the workers who can't live on what he pays them, and "if you don't like it, get a better job". America the dream is great. America as implemented is bullshit.

[jclay]

we're never going to get health care costs under control until we incentivize the insured to seek the lowest cost options.

Bargaining with the hospital, surgeon etc. as they wheel you into the hospital? Right.

Our Balkanized system is incapable of providing the lowest costs. We have national examples that indicate the superior cost efficiency of single payer.

[fastupslowdown]

Bargaining with the hospital, surgeon etc. as they wheel you into the hospital? Right.

Our Balkanized system is incapable of providing the lowest costs. We have national examples that indicate the superior cost efficiency of single payer.

that's a straw-man argument -mike g

[vertical_doug]

Medicare prices a joint-replacement at $13k. 1 in 6 hospitals price the procedure >$90k. We all know private insurance pays between 30-40% on this price so reality is between $27k - $36k. Since one of the requirements for some hospitals to keep their non-profit is they need to provide a certain amount of free-care. By having an unrealistic high list price, they actually get away with providing less care. Just another scam in healthcare.

[jclay]

@fastupslowdown...Hogwash. First para is an accurate rep of what I've heard in person and encountered in media. I know people who espouse dickering with your MD as the way to lower costs. It's ludicrous. 2nd para is demonstrable fact.

[jclay]

we're never going to get health care costs under control until we incentivize the insured to seek the lowest cost options. two items would help. bigger deductibles and insurance for all that covers basic care but leaves the private market to offer ala carte services.

I wouldn't characterize what you've described as incentivization to seek lowest cost. High deductables incentivize people to go without treatment which I consider barbaric and beneath any country that can do better. It also negatively affects quality of life for ALL of us (think public health, mental care for folks with access to firearms, and go from there). A reasonable standard of living for the least of us improves the quality of life for all of us. National, tax funded insurance for all that covers basic (necessary to a reasonable life) care sounds like Medicare for All which I support. I don't support an individual, private insurance based system tasked with that mission simply because of the demonstrated flaws of private insurance here. Germany uses something like that but it's heavily regulated in favor of the insured. I don't know how they handle gaps in employment, inability to service premiums during hard economic circumstances and that sort of thing, which to me must be accomplished. I don't see how for profit companies can add a financial storage component to ride through such times. National (public) underwriting coupled with private service delivery (aka Medicare) can do so and is demonstrably far more cost effective than our private insurance based system.

Its just a fact that plastic surgery and lasik two items typically not covered have shown the lowest inflation rates.

Necessary medical care isn't a commodity item and so markets, which because of easy consumer choice do commodity items well (if you don't like your Keens it's no big deal...get the Merrils next time...medical is a little different), don't provide the population with the most cost efficient services....the system allows tremendous financial abuses. But it occurs to me that the types of items you described (plastic surgery and lasik), generally being very elective and rarely medically necessary, are much like commodity items. So it's no surprise that they might have the lowest inflation rates amongst the spectrum of medical services.

I don't think any serious person proposes that a national health care system should cover elective cosmetic surgery and the like. Reconstructive surgery after a mastectomy or other disfiguring event...I'm totally down with that being covered. Eye care? If glasses do the job for less $, then glasses it is. If lasik is less expensive then go with that.

[sine]

Bargaining with the hospital, surgeon etc. as they wheel you into the hospital? Right.

Our Balkanized system is incapable of providing the lowest costs. We have national examples that indicate the superior cost efficiency of single payer.

The Amish do it. WSJ reported years ago that elders negotiate prices (cash) with area hospitals.