Medicare for All

[jclay]

John Oliver on Medicare for All

He hits it out of the park...and is hysterical.

[Jimbolina]

I watched that segment this morning. Fantastic and well put together! I felt he did an excellent job of explaining the pros and cons and dispelling some of the myths.

[ericpmoss]

Much less funny, but straight from the author of the Yale study in Lancet:

[progetto]

Our system in Australia works well.

[jclay]

Our system in Australia works well.

Most every other First World country has a health care systems that provides cradle to grave coverage far more cost effectively than our astonishingly Byzantine, flawed and very expensive system.

[theflashunc]

Germany's managed to do it since the 1870s for Pete's sake.

[Scott G.]

Most every other First World country has a health care systems that provides cradle to grave coverage far more cost effectively than our astonishingly Byzantine, flawed and very expensive system.

Australia has universal care, not single payer.
Did you read TR Reid back in the day on how health care systems
with one exception evolved from existing bits, rather than fiat lux, let there be Medicare for all ?

[jclay]

Australia has universal care, not single payer.
Did you read TR Reid back in the day on how health care systems
with one exception evolved from existing bits, rather than fiat lux, let there be Medicare for all ?

A fully nationalized universal system like the UK has would be fine with me but it would be politically impossible here for the foreseeable future. If I had to guess I'd think it preferable (haven't done serious homework on it) but it's a political non-starter.

I don't see any economic advantage to utilization of a multiplicity of insurers even where vigorously regulated in the pubic interest as in Germany and some other countries.

Yes, I'm aware of TR.

Since HC is always going to be expensive it's best to figure out the most cost effective way to provide it. Ours isn't. It would be difficult to create such an insane, expensive and flaw ridden agglomeration of underwriting systems as ours if you tried; and you certainly wouldn't if given a clean sheet of paper with the mission of finding the most cost effective way to provide cradle to grave health care for our entire population.

[Mark Kelly]

Australia has universal care, not single payer.

In reality, the Australian system is a single payer system with an increasingly less viable private opt-out clause. If you opt out you still have to pay 2/3 of the appropriate levy.

[SteveP]

I am on medicare.
I think it is fantastic... small cost... around 140/ month
every doctor takes it ( as far as I know ).
No hyper inflated costs...
They should gradually reduce the age of qualification...
it's 65 now
make it start at 60 for 2-3 years
then reduce to 55
as they build staff, etc

they are adding essentially a younger, relatively healthier population to the covered group.
The residual balance not covered could be picked up by a private policy which is what happens with many company or union plans.
It would greatly diminish the number of unfortunate people who currently go broke trying to pay for an ill family member.

[mbrtool]

I also think Medicare is great. The part F is creeping up we're at $460/month for my wife and myself 73, 70 I know it goes up as you age...still not bad considering.

Ray

[jclay]

I also think Medicare is great. The part F is creeping up we're at $460/month for my wife and myself 73, 70 I know it goes up as you age...still not bad considering.

Ray

I am on medicare.
I think it is fantastic... small cost... around 140/ month
every doctor takes it ( as far as I know ).
No hyper inflated costs...
They should gradually reduce the age of qualification...
it's 65 now
make it start at 60 for 2-3 years
then reduce to 55
as they build staff, etc

they are adding essentially a younger, relatively healthier population to the covered group.
The residual balance not covered could be picked up by a private policy which is what happens with many company or union plans.
It would greatly diminish the number of unfortunate people who currently go broke trying to pay for an ill family member.

The idea isn't to provide Medicare exactly as it exists now. The idea is to modify it and improve it's coverage and funding so that it covers everything from cradle to grave. No copays, co-isurance, deductables or any of those games.

The nuts and bolts of how to structure taxes to pay for it, bring it on line and everything else associated with it would of course need to be carefully determined but being one of the folks who think that billionaires shouldn't exist, that corporate welfare shouldn't exist (at least for long term, financially stable corporations and industry sectors) and that the military should be drastically reduced, it's clear that we have the $$.

A couple of the glaring flaws with our current underwriting system:

Sketch out how you, and your employer's health care insurance contributions made on your behalf will look over your career. Just rough, paper/pencil. Most will have numerous employers over their career. You'll end up with a series of disconnected, upward curves (years on X axis and accumulated contributions on Y) which will likely have spaces between them (periods of unemployment, between jobs, back to school, etc.). You and your different employers will contribute to numerous insurance policies, each of which ceases to provide coverage when you lose/change jobs. You could have been working and contributing with Employer A for, say, 5 years. At termination, all of the contributions will cease to provide benefit:
1) there is no storage component for riding through a period of unemployment or retraining even though you will have made significant contributions.
2) the sum of your career contributions, constituting the vast majority of your lifetime HC contributions and made during your healthiest (least medically costly) and most financially productive years, is not going into a vehicle that will provide benefit in old age.

Those characteristics are sub-optimal, to say the least.

It makes far more economic and operational sense to have a cradle to grave system into which we pay and which is designed to eliminate those rather glaring defects (not to mention all the others that can create financial disaster even for insured peeps). Our Balkanized system of financially disconnected public and private underwriting systems cannot possibly do that. Only a national, tax based system expressly designed for that mission, can. Canada's system is a good example and based on too much reading on my part, it has a per capita cost of about 2/3 of our “system�.

There's obviously a hell of a lot more to creating this sort of thing but it should be pretty obvious from this extremely abridged, 40,000 foot view that we've come up with what is, intrinsically, financially, about the most expensive and flaw ridden underwriting method imaginable. I mean, if someone gave you a clean sheet of paper and the mission of coming up with the most expensive, opaque, flaw ridden health care underwriting system possible it would be difficult to match ours; it would be a truly comical exercise.

More information here:
Single-Payer Reform | Annals of Internal Medicine | American College of Physicians
What Is Single Payer Healthcare? – Healthcare-NOW!
Single-Payer National Health Insurance - PNHP

[jclay]

Costs less, makes more $ available for increased wages, more cost efficient, covers everybody, improves public health, helps level the business playing field and attenuates the race to the bottom....how terrible.

Here is the Economic Policy Institute's take on M4A. Unless you enjoy paying more, having no coverage when in between jobs, co-pays and co-insurance, assisting the race to the bottom, and knowing that the six figure contributions made during your productive years will not provide any benefit during your retirement years it's worth reading:

Fundamental health reform like ‘Medicare for All’ would help the labor market: Job loss claims are misleading, and substantial boosts to job quality are often overlooked | Economic Policy Institute

Canada is next door and Western Europe isn't really that distant. We could actually talk to those folks (gasp!), learn from their experiences and create one of the best systems on the planet; or we could maintain our moronic funding system.

How is that not a wise and important endeavour?

[stackie]

As a physician on the front lines of this whole issue, I would wholeheartedly agree that we should be on a single payor system. Currently, our system is based on entirely perverse incentives. The medical industrial complex has Washington bought. Big insurance, big pharmacy, big device manufacturers. They want their products sold, so they hire lobbyists no Washington to make it happen.

As a realist, or perhaps conspiracy theorist, the current system is so lucrative to certain interests that they will fight so doggedly to maintain the status quo, that achieving single payor healthcare is going to be a very difficult task to accomplish. Any attempt to move toward single payor will be attached with ridiculous grenades being thrown, such as “you’ll lose your ability to choose your doctor” or “ there will be death panels”. Well, the later is not so ridiculous. We will have to have ethics panels who will be tasked to decide when to stop using society’s financial resources to save a case with low likelihood of meaningful recovery. So, if that’s what one means by death panels, yes, we need them.

All current single payor systems have limitations to what care will be covered. In Canada, there is a private system that allows individuals with the means to bypass the state system. I completely support that. We are not completely socialist. Almost everyone should be entitled to basic healthcare, e.g., appendectomy for appendicitis, immunizations, medications for diabetes, hypertension, etc. But not everyone gets dialysis, liver transplants, etc unless you have the means to finance. Otherwise the the country will truly be crippled by the costs. Well, actually not, there’s not enough physicians and staff to accomplish this level of care for everyone. So, really, we will just ration like Canada and the UK. By limitation of resources.

Once Americans embrace this concept, then we can move forward. But just watch those grenades that the medical industrial complex will throw.

Just my ignorant opinions, take with a grain of salt.

Jon

[ericpmoss]

Newsweek: M4A Likely to Improve Wages and Create New Jobs

It's telling (to me) that after Joe Biden won big on Super Tuesday, health insurance and pharma stocks surged some 14%.

[summilux]

In Canada, there is a private system that allows individuals with the means to bypass the state system.

Ummm, not really. For all practical purposes, the provincial governments have a monopoly on providing nearly all medical services. It is illegal for a physician to charge patients for services covered by the province. Things like cosmetic surgery that are not covered by the government system are private and you pay for everything yourself. There are a few libertarian-minded organizations and physicians that sporadically test these laws, but so far none of them have been very successful. Perhaps you are thinking of UK or the Republic of Ireland, where a state and a private system function together.

For the wealthy in Canada, the typical way to bypass the Canadian system is to go to the US. I have a friend who is high up in a Canadian bank and when he became an executive, they sent him to Manhattan where he a got a day of MRI and other tests to make sure he was healthy. People who want experimental therapy that is unapproved in Canada often turn to charities or other fundraising efforts to help pay for treatment in the US. Some Canadians also resort to medical tourism in the Carribean, Mexico or India for things like stomach stapling if they are deemed in ineligible in Canada.

Another way to do a system work around is to use social or business networks. When we moved to Ottawa, we could not find a family physician ourselves but someone in the Faculty of Medicine, where I work, helped us find one. And just recently, my wife developed a skin rash that stumpted our family doc. The wait time to see a dermatologist was 6 months but one of my wife's friends had a friend who is a dermatologist and this person saw my wife a week later.

The Canadian system is not perfect. If your life is in danger, you will get world class health care immediately and your outcome will be amongst the best in the world. For other things, i.e. hip replacement or ACL surgery or skin rashes, you wait. Maybe a year or more.

[theflashunc]

It's a great election slogan and I'm all for it, but there's going to be a lot of work to go into whatever the single payer plan ends up being. Medicare is pretty great, but lots of gaps in it's design just given who it covers that would need to be addressed in a comprehensive system.

[ericpmoss]

It's a great election slogan and I'm all for it, but there's going to be a lot of work to go into whatever the single payer plan ends up being. Medicare is pretty great, but lots of gaps in it's design just given who it covers that would need to be addressed in a comprehensive system.

There are indeed lots of gaps in the current Medicare. The first step in the legislation is to fill all the gaps and simplify it for the end-user. So, all medically necessary things are covered -- eyeglasses, hearing aids, home health care, pharmaceuticals. No patchwork of coverage and year-long lock-ins.

Just the coverage of home health care would have saved my Mom a horror-show end of life in a nursing home. End of life is never good, but I'll pay someone to kill me to avoid a nursing home.

[theflashunc]

There are indeed lots of gaps in the current Medicare. The first step in the legislation is to fill all the gaps and simplify it for the end-user. So, all medically necessary things are covered -- eyeglasses, hearing aids, home health care, pharmaceuticals. No patchwork of coverage and year-long lock-ins.

Just the coverage of home health care would have saved my Mom a horror-show end of life in a nursing home. End of life is never good, but I'll pay someone to kill me to avoid a nursing home.

I meant more the bigger stuff that Medicare was never designed to cover things like pregnancy, neonatal care, or pediatric health issues. But those are also valid.

Whatever results would be more a Medicare/Medicaid chimera single payer system.

[vvv321]

I meant more the bigger stuff that Medicare was never designed to cover things like pregnancy, neonatal care, or pediatric health issues. But those are also valid.

Whatever results would be more a Medicare/Medicaid chimera single payer system.

I don't care what they call it, as long as it's single payer.