This is what I'm talking about. "Medicare for all" is a nice slogan but it doesn't tell me what someone is actually for. How would you modify a single payer regime to work for our larger population?

6% for those who purchase Medicare Advantage. That is opposed to a cap of 20% for the healthcare administration (no longer insurance) companies selling on the exchanges. That's a lot of money just for paper shuffling.

Exactly what modifications would be needed are beyond me. I assume there would be literally thousands. However, shifting all those wasted premium dollars into paying for, say, a 6% system would pay for a bunch of them. And that's the end of this one for me.

which is doing the actual insurance provisioning (and it's even worse for Medicaid). Medicare has huge contracts with these big insurance companies to do the actual check-cutting and benefit-reimbursing; they never have to say what their overhead is.

of Medicare have long asserted that this figure is wrong and does not include all kinds of extra expenses that are not counted. This has been debunked a number of times. It does include, for instance, IRS costs related to Medicare.

Some question why the cost for the "privatized" portion of Medicare, (Advantage, which my husband has) is as high as 6%. I'm not worrying about whether that should be lower, however, and just pointing out that if we can provide an elderly population with a LOT of chronic health problems with Advantage-level coverage for 6% admin cost (instead of 20%!), we probably can provide similarly adequate or better levels of coverage for the far healthier portions of our population.

You're just pretending that the provisioning insurer doesn't exist.

It doesn't go Trust Fund -> Doctor, it goes Trust Fund -> Aetna -> Doctor.

incur well over a third of all our national healthcare costs. Almost all are on a national single-payer plan.

Just imagine if we were paying billing administrators an extra 14-19% per head. Now, just imagine if we were paying those administrators an extra 14-19% per head for the 87% of the rest of us. Of course, we ARE! Correction: For rest of us who have do coverage now.

Moving to Medicare For All just for people currently getting medical treatment would shift us from $1.5T public + $1.5T private to $2.7T public.

Now add in the 12% of Americans without insurance. If they use medical services at the same rate as the rest of the population, we're back right at $3T which is what we're paying now (though at least it's all public at that point). Add in the underinsured who are avoiding treatments because of money and it goes higher.

This would be something like a 20% across the board payroll levy or a 40% across the board corporate tax.

because, natch, most people need less health care than retirees.

add reduced overhead rates since each additional Medicare transaction does not need an equal marginal percentage of current overhead

add negotiating power with HCPs for non-elderly procedures.

add employer subsidies (they pay Aetna, why would they refuse to pay Medicare?)

Then come back with the new numbers.

I was born and bred on it and worked in it. Couldn't complain. I used to contribute an amount out of my salary - free at the point of use.

We could move towards it by further expanding the FQHC system

Oh, zero, huh?

coverage, because it's part of the Medicare system that contracts with carriers using the power of its giant size over the market: As very strongly evidenced by that 6% overhead that is allowed versus the 20% max now allowed under the ACA. My husband has it.

Cost for completely private coverage on the open market would be far higher. I'm significantly younger and my coverage is far more expensive. We could never afford to just go to BCBS or any other private "insurer" for his healthcare coverage.

I didn't find a figure for expenditure on private free-market coverage by those elderly who need not consider cost in a quick search. Probably not many of them relatively speaking.

Whether that's "public" or not is a matter of debate.

Cost for completely private coverage on the open market would be far higher.

Sure, the coverage and rate mandate does keep costs down. But it's basically like a mini-ACA in that sense.

Medicare part A premiums are 0 if you paid into medicare. Expanding medicare to everyone would continue that. Yes the horrible drug 'benefit' badly needs reform. Yes nursing home care doesn't exist. It should. Are you aware of the deductibles that most private insurance plans before and after ACA come with? They are far worse than medicare.

Oops?

I sure as hell never have. Also if you think employers are going to give that money they were spending on insurance to employees, I've got a bridge to sell you.

That's Medicare's monthly premium per beneficiary

I think you don't get that. The Trust Fund currently spends that money and will continue to.

perhaps you missed that sentence in the OP?

The Trust Fund covers the $407 for people who paid into it.

The Trust Fund cannot pay it for current workers if we expand Medicare. Do you get that?

It's ridiculously dishonest to imply that Medicare would stay exactly the same if it was expanded to universal coverage.

We could all pay much higher Medicare levies into a larger trust fund that pays everybody's premiums.

We could all directly pay Medicare premiums, with or without a mandate to do so.

We could do some combination of the two.

But those aren't neutral decisions, and it's kind of silly to talk about being "for" Medicare For All without saying which one of those paths you want to go down, because they're very very different.

to work just like the current system that doesn't cover everyone?

As I said, a totally dishonest op.

Like, around $800 per person per month.

In your plan to expand Medicare, what do you do with someone who doesn't pay the premiums? Or are there premiums at all? (And if not, how are you paying for it?)

Please take a little time to educate yourself. Our current system is ridiculously expensive. We have the most expensive healthcare system on the planet and we deliver remarkably mediocre healthcare from that system. Every other modern industrial democracy that has implemented a universal public system has far lower per capita costs and they deliver better healthcare. I guess we are just too stupid to do that here. Or something.

Even than what other countries pay for their elderly care.

We have the most expensive healthcare system on the planet and we deliver remarkably mediocre healthcare from that system

Yep. And that includes Medicare. It's a ridiculously expensive way to deliver medicine. Our doctors make three times what German doctors do. Drug companies charge 100 times what they charge for other countries (even to Medicare). So do device manufacturers.

If providers here were cheap enough for Medicare for All to be affordable, we wouldn't need Medicare for All. We could just do the French thing where people pay 30% of healthcare costs and the government pays the rest.

I guess they cannot take the time to actually read up on what they are fauxraged about, daily. Goodluck, but I am afraid you are wasting your time with someone that does not understand their own topic.

"Medicare for all" is a good start IMO.

It's got high deductibles for Part A and only offers 80% coinsurance for Part B.

Unless, of course, you're deliberately sowing FUD.

The bill is called The Expanded & Improved Medicare For All Act

I think it can be reasonably stated that anyone who supports this bill wants Medicare For All.

It's not that hard to tweek the system we already have.... no need to remake the wheel.

Require everyone to pay into medicare. A 1.5% tax on ALL earnings - corporate and private - straight off the top - will easily get the job done. Demand more from the people at the top to shore up the trust fund. Demand responsible charges from providers and quality BASIC care.

I have no problem with giving all people the exact same choice seniors get now. I can choose "traditional" 80/20 insurance where I can see any doctor that takes medicare without any referrals OR I can choose a medicare HMO that limits my costs and my choices. If I want more choice I can minimize my risk for high costs by buying a supplemental policy.

I'd kill off medicaid and put the dollars into national medicare. Give people who gross under 400% of the poverty level coverage in a medicare HMO plan with no copays, deductables, or coinsurance.

Cover long term care. Cover home care. Offer a stipend to a family member who quits works to full time caregive and therefore save money out of the system.

The system works pretty damn good now for seniors. Generally we old farts are much healthier and living longer than our counterparts of the past. It works.

Expand it.

Healthcare spending is about 18% of the US GDP, and that's with millions of people going without the treatment they need. Roughly half of that is already paid for by the Government (Medicare, Medicaid, VA, tribal health services, FQHCs, etc.).

That leaves 9% of the GDP as private medical expenses. Let's run with the common figure that Medicare can cut costs by 20% from private health care spending. That leaves the current equivalent of 7.2% of the GDP that it would cost for Medicare to simply replace the current health care being provided without adding the people currently uninsured or with insurance they can't afford to use.

The percentages may be confusing, so let's use numbers:

The US GDP is $17 trillion, give or take. So we are currently spending about $3 trillion on healthcare; about $1.5 trillion of it comes from the government. If we moved everyone who's currently using private coverage to Medicare, we could cut that figure to $2.7 trillion, all of which would now be government spending. Immediately, without even addressing currently uninsured people, we need to find $1.2 trillion in revenue for the first year alone, and that's with people still contributing to the Medicare trust fund through their payroll levies.

The total wage income in the US is $6 trillion, so that would be a 20% across the board tax if we just did wages.

Total corporate profits in the US are $3 trillion, so that would be a 40% across the board tax if we just taxed profits.

If we taxed wages and profits equally, that would be a 13% across the board payroll tax and a 13% across the board corporate profit tax and that is just to cover the people currently receiving medical care; it doesn't count actually getting medical care to people who need it but aren't getting it now.

If we just look at the currently uninsured population (that's about 12% of the country, Kaiser says), then if they use medical services at the same rate as everybody else we're going to wind up paying $3 trillion again just like we are now. And if we add the people who have insurance but are avoiding treatments because they can't afford the copays, it's going to go even higher.

You are assuming we'll keep paying $750 a pill and maintain the current level of tax loopholes for businesses and investment income.

I'm assuming we'll finally start demanding fairer billing from providers, negotiate better pricing and open the spread for where the money comes from.

The truth of how it would be funded is likely somewhere in between.


Now all that said, I'd jump for joy if we could end up with a healthcare system that works are is totally public run and funded with no profit but that's a bit Utopian IMHO.

BTW - I'm an accountant.... for the affluent and for businesses. Despite what they want you to think, the vast majority of wealth created in this country is never taxed...... at all. Capture all of it and it will increase the spread........ lower the percentages.

Obamacare. That money could be diverted to Medicare but at a lower cost.

We wouldn't be paying for private jets for insurance company presidents, advertisements and such.

Private insurance is allowed 15% overheard. Medicare overhead is 3%.

If we run with the notion that Medicare cuts costs by 20%, we would be spending $2.7 trillion on health care without getting people who currently can't afford treatment treated.

Kaiser estimates 12% of the population is uninsured. If they start using medical services at the rate most people do (which is probably optimistic; they will probably need more care than people who have had insurance), then immediately we are adding 13.6% to the costs (that's 12 divided by 88), meaning the total cost is just over $3 trillion... which is exactly where we are now. And that's not counting the people who have insurance but can't afford the copays and so are skipping treatments...

I think it's irresponsible to say that extending health care to the entire country is going to save money. We have so many people currently going without health care that the costs are going to go up.

AND so do your employers unless you are on social welfare or make a substantial yearly salary. I think it's like $150,000 or the like.

The insurance "companies" are member-owned co-operatives.

It's not as simple as profit motive, or the non-profit I sure rs in the US would be much cheaper. The cooperative nature makes a difference, I think.

More insuring agencies are non-profit, they just tend to underwrite fewer people.

Though even in the large-scale commercial space, about two thirds of the BCBS groups are still not-for-profit. They aren't noticeably better as far as I can tell, which is why I'm skeptical of the idea that insurance company profits are the problem here.

One area in which your analysis is faulty is that the GENPOP will cost as much to insure as the elderly. I am 76 now and my usage of health care is much higher than its was in my 20s, 30s, 40s, and 50s.

While it would be a "regressive tax" I would like to see us go, like most other first world countries, with a Value Added Tax (VAT) which would provide an "off budget" medicare for all system where people could readily understand what it costs.

Medicare Part A = a% VAT
Medicare Part A (no deductibles) = b% VAT
Medicare Part B (government subsidy) = c% VAT
Medicare Part B (fully paid for all) = d% VAT
Medicare Part B (no deductibles or co-pays) = e% VAT
Medicare Part D (as we currently have it) = f% VAT
Medicare Part D (fully paid) =g% VAT
Long Term Care = h% VAT
Dental Care = i% VAT
Full Mental Health Care = j% VAT
Elective Cosmetic Surgery Care = k% VAT

The voters would then have a clear choice on benefits versus cost directly to them.

On the one hand, the insurance pool is getting younger than Medicare. On the other hand, it's also getting poorer and sicker than the private insurance pool currently is (because it's including all the currently uninsured and under-insured people and actually treating them). Which one of those forces "wins" is not clear: premiums might be lower or higher.

I'm a fan of a VAT. I know it's regressive, and I know the problems that causes, but it's how Europe pays for its health care systems and it seems to work.

a national health care system that delivers high quality, easily accessible health care to any human being in the U.S. who seeks it, at no cost at all at the door, paid for entirely by taxes.

Medicare for all is a compromise, because I'm pragmatic.

What you describe above? It's less than my current insurance costs me. The premium is less, the deductible is less, and the copay is less.

I'd be glad to move to medicare for all on the way to a truly universal health care system.

And my situation is not unusual for those in the "above median wage" pay area.

Look, I've got a excellent services provided employer PPO plan with a nasty deductible, and an HSA plan that doesn't cover that deductible, so we're always running out of pocket at the end of the year due to a disabled dependent.
Even though their negotiated rates are typically the best in the business, we still end up paying near 1/3 of my paycheck in medical - usually around $24000 a year. $18140 of that is "before taxes" so I don't "see" it, but still; if Single Payer or Universal Medicare kicks in, and I have to pay even 5% more in taxes to pay for it (and not see the money), it's a lot more money I have to take home, even if I have to pay for supplemental coverage for the things Medicare doesn't pay.

I'd be looking at almost an extra $400 a month in my pocket, even running numbers for the loss of the "tax benefit" in paying the premium, and doubling the amount that is taken out for SSI every paycheck to match a "Universal Health Care" tax. If I need a supplemental plan after that, I could fairly easily pay for it - so long, of course, as those plans retain their current premium listings and don't jack up the premium just because they can.
Health Care must be de-linked from employment. Identifying health care as a "business" or a "benefit" ensures there's too many hidden bullshit costs embedded in health care to appeal to accountants and give shareholders and funds an attractive "healthy profit". Which means, no matter what type of job or how hard you work, if you don't have the money to afford to pay for good health care, you're only an outlier (at best) and a burden to the health care system.

Haele

that people need to be mindful of.

It's very hard to take single-payer advocacy seriously unless it accounts not only for "how do we pay for it" but also contemplates how that funding mechanism will be sold to the general public.

Free from deductibles, co-pays are $0-10, prescription drug costs are 100% covered (for generic drugs, and also for brand name drugs IF they are medically necessary and there's no generic alternative). Preventative care is free--stuff like immunizations, mammograms, prostate exams, etc. And all pregnancy and minor child medical care is free. I am able to choose my own doctors and specialists within the enormous Medicaid network, and I can self-refer for second opinions if I need to. All covered by federal and state tax dollars.

Medicaid is truly a single payer plan. The small co-pays for certain services were forced into the program by Republicans, just to add a little hardship for the poor. It would (and does) function just fine without them, although they are pretty low and easy for a typical middle-class family to afford.

I'm about to have gastric bypass surgery, and the whole process has been 100% covered by Medicaid. I haven't had to pay a dime for any of my pre-surgery visits, specialist consultations, tests, and lab work. I won't owe a dime for the surgery and aftercare, either. Thank goodness, Medicaid recognizes that the expense of the bariatric surgery now is a lot less than the expense of a coronary artery bypass, spine surgery, and decades of diabetes care and supplies would be later.

If you want to fight for a truly single payer program that has been proven to provide quality healthcare for decades, and already has all of the underlying structure in place, NOTHING beats Medicaid.

Because it's at the State level (again, even Canada doesn't try to run their plan nationally). States can, and may, raise the Medicaid level until essentially everybody gets it.

The downside: Medicaid has no dedicated revenue stream and so can be held hostage by Congress.

point.

In reality a plan with no out of pocket max and a jacked up drug plan all but completely geared for treatment isn't the best model to work from.

At this stage it doesn't matter so much but eventually the brand will have to be separated from the plan design because in truth no Medicare as it exists for all isn't super attractive. The only reason about any plans are liked is about 90% or better explained by the fact the most people barely use it. A couple doctors visits and two or three common prescriptions and that is about it, those in a position to really need it are generally less enthralled happy as they are to have coverage.

younger healthier people enrolling will drive down costs. Taking the burden of the backs of small businesses will create more employment opportunities.

Tweak it? Of course. But as a basic model it's solid.

Not the individual. Part B has a cost of $105 monthly which is normally deducted from Social Security. Without a supplement insurance there are still costs to the patient. If you have an Advantage Plan then you are not allowed a medigap so your specialists is with 80% and Dr visits costs also. The donut hole on the drug plan is not good, and should be honest Ng away by 2017. Person on Social Security averages $1300 a month and if medications are needed there isn't enough money left over for basic necessities.

I would love to see a national health plan but even say in France there is a monthly premium and much higher taxes. Their medical cost per person is much higher in the US. Lots of work to perfect the system.

for my part B and my prescriptions. The plan costs me nothing extra. They take the $104.50 for my Medicare part B, and in return I have no copay at all for regular office visits, and the three medications I'm on I get by mail, three months supply at a time, and again no copay.

So in my experience so far, Medicare is more than affordable.

I keep on being very puzzled by the occasional threads here ranting about how awful and expensive Medicare is.

Part B just covers 80% of your costs.

The advantage plans are helpful there, but it seems troubling that private insurers have to ride in and save the day like that.

is an idiot.

Humana, the company I have for my Advantage Plan, offers several options, including at least one that costs more out of pocket, but allows the user to use whatever doctors she wants. I good friend of mine, several years older than I am, has that and is very happy with it. She has some health issues that require her to see a couple of specialists. In her case she has a copay for doctor visits.

approx. I paid the bills for 6 yrs. when she had Alzheimer's so I know. She did have copays, though, but it was all pretty affordable.

… which is the part that will enable the boot to how pharmaceutical's have trashed the care of human beings and run up costs. Cost savings comes from pharma and the measures to stop re-visits to the expensive end by managing care at the lowest cost end.

These reforms have been long pointed out and they are ALL part of what can save us money with delivered services and increasing the quality of life under single payer.

This will never be enacted nationally, but it could be on a state by state basis. That's hwo it happened in Canada.

Those making $50 to 100k pay a little ($100 a month or so for full prime coverage), then those making over 100k pay significantly more. If you make a mill, you pay a ton. How's that sound?

And which I think is a much better idea than single payer.

and shows how much we need to know about US health care and the complexities of the many systems around the world if we really want to have universal health care that works for all. I highly recommend T R Reid's book The Healing of America, A Global Quest for Better Cheaper and Fairer Health Care. He makes clear that every developed country, no matter what financial system they have decided to use, provides better quality of health care and outcomes for ALL their citizens at lower costs than we do in the US.

We need to start by making sure our elected representatives have correct information about the quality free health care they receive any place, any time UNTIL THEY DIE, and how it compares with what most of the rest of Americans have.