I would have retired sooner except for waiting until 65 and medicare. There were younger people waiting to take my job but I couldn't leave without health care.

Going from insuring 50 million Americans to 300 million would not be a trivial task.

For example:
How many customer service representatives would need to be hired and trained to answer questions from 300 million people instead of 50 million?
How long would it take for the government to procure office space for those customer service representatives?
How many servers would need to be purchased to process the increase in claim payments?
Does the software that runs on those servers need to be further optimized?

Setting the minimum enrollment age at 60 in 2018, then at 55 in 2019, then at 50 in 2020 and so on allows for an orderly growth in the administrative capabilities of Medicare. If you do it all in a year or twos time, the odds of failure are high.

Currently, 100% of workers pay into Medicare to help pay for a program used by 19% of the population (ie: people over 65). Add more people to the program and 100% of workers would need to pay even more.

It's not an impossible sell, but it's a reality that needs to be explained and addressed if such an increase is to be accepted by the working population.

a group typically developing significant to serious health problems. We'd have had the senate for sure, and at very least far more of the power in the house that pubs hold now.

A huge advance that would literally be in development right now, perhaps with ribbon-cutting for 2018 enrollments -- IF ONLY 70+ thousand more people had voted "us."

Next time.

The costs to provide health care for workers over the Medicare age or ones in an employer sponsored insurance plan beyond that age could move to the program and essentially the same dollars they spend now would be available. That's only the companies that provide benefits above the Medicare/SS levels, but it would also be possible to ramp up some sliding fees on smaller companies that aren't required to provide the benefits.

That could lessen the burden during the implementation while reining in the runaway costs. While the big bucks in health care might be trimmed, the lifetime benefits for the nurses/doctors would still be much more attractive than fast food work.

BTW, many people work past their Medicare (65) and SS (66) dates and continue to pay. Don't see why an earlier availability would keep able bodied folks out of the workforce.

And that is per person. I imagine that means that a family of four under a Medicare-for-all plan would need to pay a monthly premium of $400+ in addition to Medicare taxes still being deducted from their paychecks. That amount is currently 2.9%. And that covers the 19% of seniors currently on Medicare. So, if we truly went to Medicare for all, one would imagine that payroll tax would increase 5-fold to around 15%.

And what happens with a young family of four where the two kids are not of working age? They won't be paying into the Medicare payroll tax. Does their monthly premium rise as a result?

Now, that total amount - taxes + premiums - may well be less than what people currently pay for insurance through their employer. But that is still a hard sell to make to an American populace where the average person is a functioning moron...and that's before the anti-for-all forces start the campaigns of fear and lies to stop any "for all" initiative in its tracks.

cover Part B with a supplement. I am 70 and have the top Medicare coverage and that supplement is $210 per month for Part B.

In addition is the prescription drug coverage, with its famous doughnut hole. Its a crap shoot because it is the private system. Monthly payments can be 25 a month up to $70 but may pay less percentages of drugs per month and the the Doughnut hole that start after $3200 on "out of pocket" payments have been paid.

but unlikely to happen anytime soon.

but they would be limited on what they are able to charge..or what they are able to make. And that's not a bad thing.

Hospitals would fail.

should be reverted back to the non-profit sector, as they were before Nixon screwed things up.

it was Nixon who started the HMO trend and allowed profit into healthcare

but didn't remember it being that early. I gave birth in 1973, stayed in the hospital for three days and the bill was $287. That seems like a fairytale now.

Which isn't bad for a covered birth.

I think I was born under Medicaid, in 76. (I doubt my teenage dolt of a mother had insurance other than the Bank of Gramma and Grandpa, and I know it didn't cover my premature birth or extended stay.)

I find the numbers interesting -- costs have gone up, but I'm still collecting data on actual costs to patient. From the mental health care side -- my turf -- we've only had insurance parity guarantees for a few years. Before the parity law went into effect, on average, we'd get a $40-60 copay, a $50-70 visit payment, and be expected to discount for certain large insurers. They were also *INCREDIBLY* slow to pay. Going into private practice took independent wealth. We're making about the same, now, but the insurers are a) paying faster and b) there are fewer visit limits. There's also a ton of pent-up demand.

What's interesting is my much older colleagues who were in private practice in the 60s and 70s say that they were charging around $80-100 an hour, with very little insurance coverage. They were running 35-40 client hours a week, and in inflation adjusted dollars, were making about $400-450 (adjusted) an hour. Psychologists now still have 35-40 client hours a week. But are making $90-130, with much, much higher office costs. And we're seeing it, in burnout rates. We're losing a lot of therapists in their first 5 years of practice.

I had no insurance... actually a lot of people didn't have insurance in those days.

Cost us 3 local telephone calls.

are not in line with the rest of the western world. Also you are limited to having to only go to their facilities. HMOs are not the answer. It needs to be a free and open system.

not with the rest of the Western world. And the Federal government bans US providers from negotiating with drug companies for the lower prices drugs are sold at in the rest of the world.

I'm not saying HMO's are "the answer." I'm just saying that it's wrong to say they're "for-profit" and to imply they are at the root of our problems.

because they have taken the doctors making healthcare decisions out of the equation, and turned those decisions over to bean counters who are usually not doctors, and only look at the bottom line.

and services that may not be medically necessary or of questionable value.

I don't think we can have an affordable health care system if the decisions are made totally by those who profit from tests and services. Doctors should have a say, but without tough limits, docs and other providers will figure out how to line their pockets.

from the healthcare system. And that includes price controls of what can be charged by physicians as well as what can be charged for procedures and tests.

for an office visit. But they'll be lucky to get over $150 for a typical office visit for 98+% of patients. We've done the easy things.

We should have gone to single payer/Universal healthcare ages ago. THAT would have been the easy thing.

is what they pay, no matter how much the provider -- doctor, hospital, etc. -- charges. Under Medicare, that fee schedule hasn't increased much in the last 10 years. Medicaid is typically 20-30% lower than Medicare. Commercial insurance usually pays a little better than Medicare, but not always.

I live in a county with a massive Community Hospital system that's been buying up most of the facilities -- primary care practices, physical therapy, imaging, OBGYN, specialists. You name it, they've bought it in the last five years. They now control more than 80% of all medical services in my county. And it is not working, because their primary focus has shifted to cost cutting.

We're not happy with the changes -- we've gone from 10 minute same day urgent appointments and 3-4 day for scheduled appointments to "go to urgent care for a UTI" and 3 weeks out for a meds check and 6-10 weeks for an annual. 30 minutes on the phone to get to scheduling is not uncommon, and we cannot call "our" doctor's office at all anymore. Every call has to go through central scheduling. My spouse has hearing issues -- part of the reason we have the primary care we have is because he worked in the same building. He'd make his appointments as a walk-in because he uses a combination of his limited range of hearing and lip-reading. Phones don't work for him. (He texts and emails a lot.) He's not allowed to do that anymore, so we're looking for another provider who can deal with his hearing issues.

There's no alternative. Well, there's the much smaller, Catholic (Little Sisters of No Fucking Mercy) system. And there's a Kaiser system, which has contracts with all of the local hospitals for emergency and hospital services, but also has a 24/7 urgent facility within 5 miles. We're probably going to go with a small, "concierge" practice that will charge us an additional fee on top of our insurance so that he can get health care that works with his minor disability. (We can't use Kaiser, since our employer based doesn't offer it.)

I have been a member of Kaiser Permanente for over 48 years, had three of my four children born in Kaiser facilities, and, generally, been happy with my coverage.

But all is not rosy, with labor disputes, legal issues and suspect care as well. Also, one might see the huge salaries for the top management, as well as the enormous cash reserves they hold, as not exactly displaying the spirit of non profit corporations.

From Wiki:

As of December 31, 2015, Kaiser Permanente had 10.2 million health plan members, 186,497 employees, 18,652 physicians, 51,010 nurses, 38 medical centers, and 622 medical offices.[1] As of December 31, 2015, the non-profit Kaiser Foundation Health Plan and Kaiser Foundation Hospitals entities reported a combined $1.9 billion in net income on $60.7 billion in operating revenues.[1] Each Permanente Medical Group operates as a separate for-profit partnership or professional corporation in its individual territory, and while none publicly reports its financial results, each is primarily funded by reimbursements from its respective regional Kaiser Foundation Health Plan entity. KFHP is one of the largest not-for-profit organizations in the United States.

KP's quality of care has been highly rated and attributed to a strong emphasis on preventive care, its doctors being salaried rather than paid per service, and an attempt to minimize the time patients spend in high-cost hospitals by carefully planning their stay. However, Kaiser has had disputes with its employees' unions, repeatedly faced civil and criminal charges for falsification of records and patient dumping, faced action by regulators over the quality of care it provided, especially to patients with mental health issues, and has faced criticism from activists and action from regulators over the size of its cash reserves.

http://www.ontheissues.org/celeb/Richard_Nixon_Health_Care.htm

1970s: Supported national health insurance
The administration was open to domestic originality. It created a department--the Environmental Protection Agency--to police and try to eliminate the pollution of America's air and water; it supported the doomed Equal Rights Amendment (an extra push for that came from Julie Nixon Eisenhower); it supported national health insurance and increased spending for the arts, and it effectively moved to desegregate southern schools
Source: Ike and Dick, by Jeffrey Frank, p.342-3 , Nov 5, 2013

1970s: first proposed "employer mandate"
In 1965, Pres. Johnson's Great Society initiative led to the creation of Medicaid and Medicare, which provide federally funded health insurance for two under-served groups--the poor and the elderly.

Pres. Nixon recognized the draining effects of health costs on the economy and proposed a system of universal health care based on what's known as an "employer mandate": all employees would be required to pay for limited benefits for their employees. Although as many as 20 different health care proposals were introduced in Congress during the Nixon Administration, no proposal for universal coverage got a majority vote from a congressional committee until 1994.

Presidents Ford and Carter also pursued reform in the 1970s, but they ran into the same political obstacles that had blocked change for most of the 20th century. Over several decades, the health insurance industry had grown increasingly powerful. The historical odds were against Bill.
Source: Living History, by Hillary Rodham Clinton, p.146-147 , Nov 1, 2003

Do not tolerate 38 million Americans without medical care
We must seize the moment of freedom's triumph abroad to make America not just a rich society but a good society. The richest country in the world cannot tolerate the fact that we have the highest per capita health care costs in the world and yet 38 million of our people are unable to get adequate medical care because they cannot afford it.

To take a glaring example, we have made the mistake in addressing issues such as the exploding costs of health care in ways that removed market forces from the equation. We have erred by separating health care consumers from concern about the costs of the care being provided. We need to work out a system that includes a greater emphasis on preventative care, sufficient public funding for health insurance for those who cannot afford it in the private sector, competition among both health care providers and health insurance providers to keep down the costs of both, and decoupling the cost of health care from the cost of adding workers to the payroll.
Source: Seize the Moment, by Richard Nixon, p.291-293 , Jan 15, 1992

Federal assistance for catastrophic healthcare
While I oppose compulsory national health insurance, I have always supported federal assistance for catastrophic health care. My strong feelings in this respect are a direct result of losing two brothers to TB.

Because of the miracles of modern medicine, both my brothers would have recovered today. But the experience made an indelible impression on me. From the time I went to Congress in 1947, I was determined to support any proposal to help other families meet such extraordinary expenses without breaking the family budget.

In 1971, some observers were surprised when I included in my State of the Union message a request for the Congress to appropriate $100 million to launch a war on cancer. Why cancer? Why not some other worthwhile program? Again, the reason can be found in my background.

When Pat was 13 years old, her mother Kate Ryan died of cancer. I shall never forget the ordeal my mother's sister, Aunt Beth went through when she contracted breast cancer.
Source: In The Arena, by Richard Nixon, p.192 , Apr 1, 1991

Wrong to put health care system under heavy federal hand
It is time to bring comprehensive, high quality health care within the reach of every American. [We should] assure comprehensive health insurance protection to millions who cannot now obtain it or afford it, with improved protection against catastrophic illnesses. This will be a plan that maintains the high standards of quality in America's health care. And it will not require additional taxes.

Now, I recognize that other plans have been put forward that would put our whole health care system under the heavy hand of the Federal Government. This is the wrong approach. This has been tried abroad, and it has failed. It is not the way we do things here in America. This kind of plan would threaten the quality of care provided by our whole health care system. The right way is one that builds on the strengths of the present system. Government has a great role to play, but we must always make sure that our doctors will be working for their patients and not for the Federal Government.
Source: Pres. Nixon's 1974 State of the Union message to Congress , Jan 30, 1974

No American will miss basic medical care by inability to pay
I will offer a far-reaching set of proposals for improving America's health care and making it available more fairly to more people. I will propose:

A program to insure that no American family will be prevented from obtaining basic medical care by inability to pay.
I will propose a major increase in and redirection of aid to medical schools, to greatly increase the number of doctors and other health personnel.
Incentives to improve the delivery of health services, to get more medical care resources into those areas that have not been adequately served, to make greater use of medical assistants, and to slow the alarming rise in the costs of medical care.
New programs to encourage better preventive medicine, by attacking the causes of disease & injury, and by providing incentives to doctors to keep people well rather than just to treat them when they are sick.
I will also ask for an appropriation of $100 million to launch an intensive campaign to find a cure for cancer.

Source: Pres. Nixon's 1971 State of the Union message to Congress , Jan 22, 1971

Give people freedom to choose health insurance or not
But it compels nobody to have insurance who does not want it. His program under Social Security would require everybody who had Social Security to take government health insurance whether he wanted it or not. Senator Kennedy too often would rely too much on the federal government. Our health program provides for people over 65 the opportunity to have it if they want it. It provides a choice of having either government insurance or private insurance.
Source: The First Kennedy-Nixon Presidential Debate , Sep 26, 1960

Instead, expand Medicare down (age) and Medicaid up (income)

toward it. There will always be the dufuses who don't want the "government plan," so let them have what they think they want.

And brings the cost per patient down.

The thing with private insurance is that most practices have to employ one or more people just to haggle with insurance companies for payment. I had a friend who did this for about a year. She said the worst one was when a female patient had to have bladder surgery. She had some kind of junk insurance that didn't cover anything having to do with the female reproductive system. The insurance company wouldn't pay because the surgery was "down there". Of course, the bladder isn't a reproductive organ and men have bladders too. The insurance company said "Don't like it? Sue us."

So given the choice between Medicare/Medicaid paying less and insurance companies paying slow or sometimes not at all, lots of dictors would be happy to have more Medicaid and Medicare patients. It's less hassle. The same thing goes for hospitals.

Medicare is not an easy system from a billing perspective, either. As long as we continue to pay on a fee-for-service basis, no health system will be much of an improvement from that perspective.

Fortunately, the ACA eliminated a lot of those junk policies with "exclusions" designed to make the policy cheaper and easier to sell to those who don't read the coverage or think they are immune to getting sick.

It just drives up costs and doesn't result in better patient care.

is the easiest billing system in the country. No prior authorizations which are a cluster, and you KNOW what they will pay for and what they will pay without any issue -- its never a question. That said, its complex as hell, and it takes some effort to learn, but once its learned its much better than any other insurance -- which is often a black book of put claim in and hope for the best.

Its still very complex, but its the most standardized and the answer to your question -- almost all questions -- is available, if not easily accessible to a non-provider.

I agree, Medicare is easiest if you learn where to look -- LCDs, CCI, etc. But Medicare is also a pay and chase payer. You pretty much get paid on the initial claim, but if you used the -25 or -59 modifier too often, bill too many 99214 or 99215s, don't try other treatments before Hyalgan injections, etc., sooner or later you'll be identified as an outlier and audited. Then, the crap begins.

Truth is, fee-for-service billing is a waste and contributes to higher utilization of services.

That is what the dems should be pushing the public option as the Obamacare fix -- and pushing hard.

If we could just herd the damn cats and get leadership throughout the party to speak with one voice on this, we could actually get it done.

I know I'll be called nuts, but the public option solves the problem that is most salient to people. Namely, the fact that insurance companies are dropping out of some markets and prices are going up with lack of competition. The public option is the most feasible and fastest way to address this. All the frigging private companies can drop out and the public option is still there. The more who go the public option route, the bigger the negotiating pool, the better the prices. Sure, that is oversimplifying, but it is really not rocket science.

Do it gradually. Perhaps with an opt-in so we can avoid the death panel bullshit. Nobody can argue that it's forced if it's optional. Expand it to lower age groups and make the industry price competitive again.

Open it up. Medicare for all.

Actually I want to read it later.

Right now, the most lucrative fields are the ones where there's no patient information or choice -- anesthesiologist, radiologist, pathologist, to name a few. They're the loophole: the hospital doesn't require them to be in network, so even when the patient (when possible) does the homework and chooses an in-network hospital, doctor and other providers, the background specialists may be out of network, which lets them charge full freight. This is pretty clearly purely cynical and based on avarice; I've yet to see an argument for the loophole that doesn't equate to "I need a third sports car, a fourth alimony, and a beach house." I note that this doesn't happen with other minimal patient choice professionals -- otherwise, Emergency departments would be doing this with their trauma docs and surgeons. (And I know more than a few neurosurgeons who are somewhere on the sociopathic scale who would be all over this. It takes someone *special* to cut into a brain. It's a socially necessary skill, but I wouldn't want my niblings to marry one unless the kid was prepped for a future PTSD dx.)

That does a few things -- it may make those specialties less attractive (which could back up the system) because they'll come with similar specialist paychecks (say nephrologist or endocrinologist). But it will also keep costs down across the board. It may also force medical schools and teaching hospitals/university medical systems to do something like what dental schools had to do about 30 years ago -- bring down costs to their students and find more funding.

I admit I am a socialist when it comes to the rest of my profession: Nationalize us. Put us all on salary, in a union, and pay us based on a strict scale based on hours of direct patient care. But I am a dirty communitarian who believes we shouldn't be in the profession unless we want to give aid and comfort. And I don't like asshole specialists who think their bank balance makes them better.

want to pay the taxes needed. We already have a large tax burden...increasing it...I just don't think Americans in general will go for it.

Allow people to buy into Medicare just like they can buy into private plans.

Build up the public option and get all the bugs out.

There will always be strong opposition if we try to force everyone into a Medicare for All program, you'll never convince 30+ or so it is better by any means other than showing them while they have a choice to select what they think is best.

Medicare-for-those-smart-enough-to-choose-it, has a chance.

Do you charge everyone the same price regardless of pre-existing conditions or age? How do you prevent people from signing up only when they need medical care and dropping it immediately after?

That will bring younger, healthier people into the risk pool and bring the cost per patient down.

We also need to get away from "fee for service" billing and move to a condition management model, especially for chronic conditions.

The cost of drugs is quite simply out of control. There is absolutely NO reason for the cost gap between brand name and generic drugs. Some drug companies even offer identical drugs in other international markets for a fraction of the cost.

Furthermore, the cost of medical school and subsequent specialty training is outrageous... this cost of education (and subsequent artificially produced shortage of doctors) means compensation must be high. I'm confident MANY people that are not doctors could be doctors if medical school weren't literally hundreds of thousands of dollars.

wouldn't solve our problems, although it would help as long as innovation is not impeded. Drugs like recent Hepatitis meds are too expensive, but even at $100,000 for what almost amounts to a cure, we save on hospitalization and treatment long-term.

Anyone who wants to be a doc can have their loans paid off if they agree to serve for a period in rural areas. They don't because they are almost guaranteed $150,000 to $250,000 right out of training. That provides enough cash flow to pay off a $250K loan pretty fast while still living a very nice life-style.

There are plenty of people smart enough to be doctors. There aren't openings in medical schools to tech them.

IMO, the government should open more state/government medical schools and double/triple the number of doctors. Class tuition should be nearly free... students only having to pay for room/board/food/books/supplies. If you can pass the classes and make the necessary grades a competent doctor needs to have, then you can be a doctor. If not then then you don't graduate or become certified. Doctors with a wealth of knowledge and skills who don't have debt up to their eyebrows can afford to open medical practices in low income areas. Training more brains ensures that we ultimately end up with more brilliant minds innovating new cures and solutions (ie: the cream rises to top... so if you start with more milk you get more cream on top).

When insurance companies see that there are doctors, practices and medical groups out there willing to perform a procedure for $250 rather than $2500... they will stop covering the more expensive options. Then the medical industry as whole will have to follow the money and provide services at rates that insurance (or the single payer source) is willing to reimburse.


IMO, teachers' and doctors' education should be heavily state sponsored/subsidized so we can provide healthcare and education (two HUGE human rights) to any American who seek it for as little cost as possible. I know some programs exist that do this to a certain extent but they need drastically expanded for teachers, doctors, and climate scientists.

For example this:

Wtf does that have to do with anything? You know what else a "single-payer hospital", what ever that is, is not going to look like? It's not going to look like a grossly underfunded urban hospital today that is bearing the brunt of the turfing his wood paneled hospital performs daily to shed its low paying/uninsured "clients".

There is something like a 10-25% admin overhead savings in the current system that single payer can work with to smooth out the edges of a transition. Yes doctor fees might not be up to private insurance rates. Oh well. Hopefully Pharma is going to get a much deserved haircut, and some of those savings, along with the admin savings can be directed to the health care providers at all levels doing the actual work.

Speaking of the actual work, with universal access there will be more work for health care providers and more jobs doing that work.

The major complaint appears to be that huge savings will not materialize overnight. Gosh. Seeing as huge increases seem to be materializing under all the prior systems we've tried, I'd settle for a new system that slowly brought our costs into line with the rest of the developed world.

I'm getting tired of the pushback by lily-liveried so called liberals on this, or when it comes to lowering the cost of education.

Doctors in the U.K. make plenty of money. Maybe not enough for a fucking Lamborghini, but they sure as shit are not hurting. They have issues because of a push towards privatization by the Tories (and centrist pieces of shit like Blair).

Our single biggest problem is the fucking insurance companies. They are ripping all of us off, including Medicare patients. There are many ways to arrive at universal coverage. It doesn't have to be single payer, but it absolutely does have to include cost controls, using the power of the government to limit costs and guarantee coverage.

The Atlantic is a centrist rag. Fuck centrism, fuck this cowardly notion that we can't have what we absolutely MUST have, universal coverage, not this patchwork of different systems and schemes. It is costly in its inefficiency.

better job of coordination of care than the current Medicare system.

So, you get rid of insurance companies and the monthly premium goes from $700/month to $640. You think people are going to be happy with that. And, unless the single payer system picks up with tougher coordination of care and utilization efforts, utilization will increase. That is, I'm not sure you'll achieve that $640.

Note: I'm not for insurance companies. I'm just saying, we better make some changes before cutting them out. Like Medicare can't negotiate drug prices, but insurance companies do. No question the negotiations would be better if it were one or two payers, but those changes have to be made. Plus Medicare will have to invest billions for the infra-structure that is currently handled by insurance companies who administer Medicare. I've been for that since the 1980s, but Congress ain't going to invest the money to do it for a long time.

I don't think that people realize how dependent our economy is on the health care system.
Almost every single person that has a pension, or a 401K, or even a mutual fund has an investment in insurance companies.

Healthcare and Health Insurance is a multi TRILLION dollar part of our basic economy. What about when all of those people lose their jobs? What about when the teacher realizes that her pension just crashed because so much of it was tied up in the health economy.

There are no easy answers without blowing up our entire economy. We really need to think about everything involved.

Something must be done, I just don't know what the answer is.

to begin working on the long-term solutions.

It keeps going up, even in comparison to other kinds of insurance. In any case, my point was mostly that other countries more tightly regulate their health insurance companies than we do, which brings costs way down. To say nothing of CEO pay for those companies, which is typically outrageous.

http://cepr.net/blogs/cepr-blog/overhead-costs-for-private-health-insurance-keep-rising-even-as-costs-fall-for-other-types-of-insurance

collecting premiums, maintaining networks of qualified providers, utilization and quality review, announce to patients, coordination of care, billions of dollars to purchase, maintain and operate systems, etc., except on a more limited basis.

"The difference stems from whether Medicare essentially freeloads off other parts of the federal government for services that private insurers have to pay for on their own. Adjusted estimates for Medicare’s administrative costs cited by the Urban Institute, a think tank that does research on issues such as poverty and economics, range from 3.6 percent to 5 percent, rather than the 1.3 percent using the data in the trustees’ report."

http://www.politifact.com/truth-o-meter/statements/2011/may/30/barbara-boxer/barbara-boxer-says-medicare-overhead-far-lower-pri/


And if private insurers are getting savings by negotiating drugs, or utilization review, that needs to be factored in.

Finally, I'll ask you again -- So, you get rid of insurance companies and the monthly premium goes from $700/month to $640 with the supposed 8% savings. Do you think people are going to be happy with that? And, unless the single payer system picks up with tougher coordination of care and utilization efforts, utilization will increase. That is, I'm not sure you'll achieve that $640. Plus, the government is going to have to shell out the money upfront for systems that insurance companies have amortized over a number of years.

I'm all for single payer -- have been since 1980 or so -- although I don't think it will be enacted any time soon. In any event, the savings are nowhere near what people are anticipating. I think most people think we'll go from $700/month average premiums now to $300/month, not just $640 if we are lucky. Ain't going to happen unless there are some serious utilization controls and fees cut -- including what goes to nurses, etc. Most doctors I know aren't going to give their nurses a raise when their own pay just got cut 25%.

They are the most rapacious, most worthless corporations out there. They add nothing of value but an extra layer of confusion and bureaucracy. Anyone who comes from a country with a different system thinks we are completely insane.

What is the pay of nurses, doctors, etc in Canada or in the UK? Those people are not hurting, as I've said before. Now they can't buy a Ferrari, but so what? They should be in that business to help people, not to get rich.

If insurance companies are so fucking great, why in the fucking hell can't any one of them tell me what I have to pay out of pocket? Why are there even network and non-network providers? Why do we have to jump through hoops just to get a straight answer? Does anyone understand the "explanation of benefits"? A rhetorical question, because no one in fact does understand them, including the people who write. I cannot even tell if I am being double-billed or ripped off.

I think you are completely and utterly wrong. As a percentage of GDP, we spend more and have worse outcomes than countries with other systems. Some of that is because many people are still uninsured and costs are still too high for services. This is an old article but as of the writing, Duke Hospital (900 beds) had 1,300 billing clerks!!!! Single payer countries don't face this administrative overhead. Other things: drug costs are out of control (despite being developed often with federal money), and yes, some very high reimbursement rates (again, this is another place where rates can be set by the government, as they are for Medicare and Medicaid), and the fact that the price of a service depends on who pays.

http://www.investopedia.com/articles/personal-finance/080615/6-reasons-healthcare-so-expensive-us.asp

I agree we spend too much. That means providers are going to have to take a hit, those that work for them will have to take a hit, the government is going to have to come up with billions to design and maintain the systems that are currently maintained by insurance companies, people are going to have to reduce their expectation of the system, and we are going to have to say "No" to some things. Until we face that, we don't have a chance of making single payer or universal healthcare work (again, I could probably dig out papers I wrote about 1980 that shows that when I first supported that).

There are ceo's to consider here.

Stephen Hawking blames Tory politicians for damaging NHS

He thinks the Tories are trying to turn the NHS into “a US-style insurance system” and he's fighting back.

Except instead of paying premiums to a corporate middleman with ceos making billions off we the people. The people pay the Government the premium and cut out the greeey middle men that run up cost.

built into our health care system, to pay for the uninsured.

Getting rid of administrative costs and CEO compensation for health insurance companies would help.

Also, making payments to providers consistent (the same for every patient, not whatever insurance company X pays versus what insurance company B pays) would eliminate costs as well, settling at a middle range, most likely.

Finally, instead of hospitals having entire departments devoted solely to working with the byzantine rules of multiple insurance companies, that could all be streamlined as well. Every bill would be paid, which is not the case now.

Oh, one more, consistent and more reasonable prescription costs, negotiated on an economy of scale basis.

55, three to five years later drop it to 50 etc. It would depend on the number of applicants in a given age group. We can't shock the health care system by adding hundreds of millions to Medicare overnight. It might take 30 years to reach cradle to grave coverage, but stability is the goal. But as more older (and sicker) Americans are transitioned to Medicare, private insurance for younger Americans will become less expensive.

Reimbursement rates would need to be increased though. Currently, physicians cap the number of Medicare and Medicaid patients they see, because they need private pay insurance revenue to keep the doors open. Increasing reimbursement rates will go a long ways towards getting buy-in from physicians and other providers.

We definitely have to look into the effects of the transition to single payer. We can do it, but if there is too much short term pain, people could be turned off to a good idea forever.

Paying both for increased Medicare coverage AND their insurance?

Yes we do. And I want a second opinion on that analysis.

and the doctors are competent (they have to take exams and not all who pass are accepted into medical school), techniques developed in France are being used at UNM hospital for brain and spinal surgeries, doctors still make house calls, you call buy (at little cost, insurance to cover your full salary instead of the 2/3's if you are sick for a long time), etc.,etc., etc.

It's simple: The US invests a few billion dollars to set up the administration of a government-run health-insurance. A one-time payment.
And from then on, the system must run at zero costs to the government and zero profit.

ZERO PROFIT.

And there would be no CEOs with their obscene salaries and golden parachutes.



Without the need to generate a profit and without obscene wages, this government-run health-insurance could automatically offer the same service as private health-insurances but at lower costs.

when you say it's run at zero cost and profit to the government, who pays for the premiums??

Do you charge everyone the same price or do you charge differently based on age and pre-existing conditions? If it's the former, how do you prevent a situation where only sick people sign up while healthy people stay away? How do you prevent people from signing up only when they need it and dropping it once they no longer need it?

Who decides what treatments are covered and what's not?

Healthcare policy is a very complex issue and there's just no simple solution to the problems.

1. No insurance denied for pre-existing conditions. Young people get charged less than old people. Healthy people get charged less than people with pre-existing conditions.

2. People pay money to the insurance. The insurance pays out money to claims.

3. A provision similar to Obamacare that everybody MUST have health-insurance. Private or public, that's your choice. What plan? That's your choice. But you must have one. Any one.

4. If you cannot afford any health-insurance due to poverty, you get a bare-bones plan from the government-run health-insurance where the government pays the premiums.

5. The premiums are adjusted each year to correspond to the healthcare-costs of last year.

6. If you have an insurance, you must keep it for at least 1 year. You cannot drop out from health-insurance altogether: You can just move from one health-insurance to another. If you scam one health-insurance company and then move to another, the new one will find out, because they will be asking for your files from the old insurance-company: for how long you have been there, what you paid and what you got...



7. Private health-insurance companies don't have offices everywhere and don't offer plans everywhere. Government-offices already are in every single state, in every single county. No matter where you live, you will always have a choice between the public insurance and at least 1 private insurance.

1. Ok since you're charging people with pre-existing conditions more, you need to include many of the business activities of commercial insurance companies.

- underwriting to come up with a table of premiums for each type of pre-existing condition
- claims adjusting to make sure people who claimed they were healthy are not claiming for pre-existing conditions
- administrators to deal with healthcare service providers on proper billing whether something is a pre-existing condition or not. Negotiate with drug companies/distributors on formulary lists.

and you would need to pay these people competitively with the private sector. What really are you saving against the private insurance companies? I guess you don't need advertising and you'll probably cap the pay of senior management.

2 - 4.

premiums collected from paying customers = cost of medical claims + all these expenses listed above + cost of paying for people who can't afford healthcare insurance.

How much of the population would not be able to afford healthcare insurance? 10 - 20%? That means people who buy into the public insurance are paying an additional 10 - 20% for them.

If I buy a private healthcare insurance policy, I'm not paying for people who can't afford healthcare insurance. If I buy into the public healthcare insurance, I am paying for those people who can't afford insurance. So how is the public healthcare insurance going to be cheaper than the private healthcare insurance?

Wages are no problem. No pressure to run a profit and no wages in the range of dozens of millions of dollars means that money can be spent elsewhere.

Also, wages in upper echelons of the private sector are not based on what a person's work is worth. It's based on reputation, connections, charisma and negotiation-skills. You don't need somebody who works for $2 million a year. The same job can be done by somebody who does $100,000 a year.



As for the rest, I don't have the numbers/calculations but that's the system that Germany uses and it works.
(Sure, there's always complaints how doctors give preferential treatment to patients with expensive private health-insurance over patients with the cheaper bare-bones plans of public health-insurance. But apart from that, it works.)

If you are employed, you pay into single payer, just like SS and Medicare. Everyone gets charged the same amount based on a percentage of income. Government provided insurance provides for a basic level of care with some out of pocket expenses, while optional private insurance covers the gaps left over. Those who can't afford it don't pay.

A system like that could be scaled up or down based on what parts single payer covers and what is optional. At a minimum everyone would be protected from medical bankruptcy.

was that our employer-based healthcare system has its beginnings in the wage and price controls of WWII. Since employers couldn't give salary raises to their employees, they started to provide more benefits with health insurance being one of them. Health insurance premiums were, are still are, paid for by "pre-tax" dollars - that is the premiums don't count as part of your taxable income. There's some incentive for employers to control overall costs, but not so much for employees since their costs don't show up in their take home pay or count as taxable income.

I'd expect that to make single-payer/medicare-for-all work, there'd have to be a change to the tax code making health insurance premiums taxable, that is they are still deducted from employees total wages but counted as income subject to federal income tax. Then you would have employees/ers scrambling to find lower cost/more efficient healthcare that could be used to push for single payer. It would have to be "repeal" the tax breaks and "replace" it with cheaper, more efficient single-payer/national healthcare.

this country waged war against the world and won. still does. time to stop pretending single payer is something that couldn't be done.

The first 10 or 20 years after O'Care repeal would be even uglier. And the years after that.

Nurses and aides would probably get the same pay under single-payer. Doctors might get a little less, not much. Administrators, advertisers, insurers, much less. There would probably be limits on malpractice compensation. Single-payer would be worth the short-term "pain".

which is one of the things that drives US health care costs.

Plenty of places have to bring doctors in from other countries to take the primary care positions.

I'm not tyet comfortable with the idea of single payer. IMO, we need to start with a Public Option and see how that goes. If it works well, it migt naturally morph into a single payer plan.

Let's just never get rid of this sensibly sensible "Tethered-to-gainful-employment" Care and expect families who are befallen with an unexpected (and, of course, non-covered) illness to cover 5-6 digits of expenses through bake sales, charity events and other such fundraising ideas!

"Just because we're saying this isn't a good idea doesn't mean it should never be done" Well, sorry, that's exactly how the tone of this pro-PPO crap reads.

I guess ramping up multi trillion dollar initiatives is only workable when going to war.

Between "We just don't have the votes!!" and this article and "Well . . . . is such a drastic change doable right NOW? I mean, I LIKE my insurance. Of course, I'm not sick. Yet . . . GEEEEZ I just don't KNOW!" . . . is it any wonder why the average voter views the DNC as a bunch of wishy-washy marshmallow milquetoasts?

Why are we such COWARDS on what 31 countries and several dozen million people already view as a human right?

Because you're right . . . . if we keep kicking this can down the road, in 15 years it IS going to be too late to even discuss this and Big Pharma and Insurance are going to make things worse and more unaffordable.

It's one option of many, of course, but at least it reveals the true colors of centrists.

I am afraid the whole system will have to implode (even more than it has- the ACA only provides a short-term stopgap) before anyone will do anything.

In any case, we need to look to Canada. Their system started in one province, then spread throughout. I am unfamiliar with what they had before, but surely there are some lessons there.

I have had it with Democrats and their cowardice on this and many other issues.

I think it's more like... okay, if you want to do this, let's be creative and do it right.

Because not all of them do today. There will always be people willing to pay for supplemental insurance (or straight cash) to get the Doctor of their choice. I pay an extra $200 on top of my provided insurance to access a medical practice that guarantees me a same-day appointment and a non-rushed visit.

instead of just saying "single payer for all". great post.

Hillary and Obama knew health care was complicated. Let's not be like trump and think it will be easy. No matter what happens there will be a time of adjustment.

Tell THOSE families that Mercantile CullCare should be kept firmly in place while getting less accessible and less affordable each year we kick this can down the road.

and no one wants anyone to go without insurance... but let's face facts about how we try to fix this.

It's never going to be the right time. We don't have the votes. We don't have the state legislatures. We don't have the political will. We don't have this, we don't have that. Wealthy people need this first, and what about our military? What about all of the people who could lose their jobs?

Meanwhile, between the Big Pharma and Big Insurance lobbies and hospital Chargemasters, the meter is running, the fares are getting ever higher and the "personal responsibility" assholes' voices are getting even louder.

Go to a multi-payer system like the rest of the world does. What's all this bunk about throwing thousands in the for-profit industry out of work? If people want to pay through the nose for Cadillac care, let them. The bankrupting of working families has GOT to STOP.

To continue to defend and apologize for this criminal robbery we call "Health Care" now disgraces the unfortunate people who lose everything they worked so hard for.

is not defending the current system. ACA was a huge improvement for most people. Now we need to go the rest of the way to something that is more affordable and better coverage. This OP was not about doing nothing, it was about which type of health care we should promote. We can't look like leaders if we don't know the subject well enough to make strong arguments for what we supposedly champion as a fix.

Many of us here are unsure, even about the terminology. Medicare for all and single payer are not, as far as I know, interchangeable terms. What countries have single payer and how does it work?

Medicare for all isn't exactly a total fix. Medicare doesn't pay for everything. People will not get "free care." On the other hand, single payer isn't exactly free of fault either.

It needs to work better next time and it must be something that all states will sign onto, or it will fail again.

Many countries like Germany, Switzerland and the Netherlands provide it using private insurance companies but those companies are highly regulated.

Not starting one's career with a half million in debt would, at the very least, incentivize being a GP.

Many doctors use that very reasoning for charging such outrageous prices for things.

As you insure those people over their lifetimes, again they are unlikely to to need as much medical care as someone tha never had adequate care to begin with.

Yes, we need to pay doctors less.