Here’s EXACTLY How We Pay for Medicare for All

–Gerald Friedman, Professor of Economics at the University of Massachusetts Amherst, joins David to discuss the predicted costs associated with Bernie Sanders' Medicare-for-all proposal

–On the Bonus Show: White House wants to end Social Security numbers, ACLU sues to increase abortion pill access, cow farts are a major contributor to climate change, and much more…

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Broadcast on October 4, 2017

Here's EXACTLY How We Pay for Medicare for All

63 thoughts on “Here’s EXACTLY How We Pay for Medicare for All

    • A country should not be judged on how many golf courses it’s President owns, nor the nuclear warheads in it’s arsenal. The true measure of a nation’s worth is how it treats it’s minorities, poor and sick.

    • +winnywin   Yeah, let’s stop spotting blacks 100-150 points on civil service exams and college entrance exams. About time they started earning things by their own merit.

    • thomas jay
      As african-Americans usually get the worst schooling, less opportunities and suffers prejudice in many walks of life, a little bit of a hand up is surely the least a country can do!!

    • A little bit of a hand up? Blacks are kept in a perpetual state of childhood by all this welfare and affirmative action garbage. Today a black person could go get a race based loan from the Small Business Administration on nicer terms than I could as a white man. Unless you honestly think blacks are inferior, this racist favoritism really has to end.

    • Accelerationist
      That’s because of the relentless greed that has inserted itself into capitalism. If we put a cap on annual income and take any tax caps off of rich people such as the social security tax plus aggressively do away with this wide income gap among the rich and the working class, then and only then can capitalism work. No one should ever be a billionaire. What for? It is only self-serving and hoarding money by keeping stashed in offshore banks which puts that money out of circulation.

  1. Great episode. Has anyone written a plan for a crowd funded insurance company? How many people would need to be in the fund for the insurance mechanisms to work? Something I think about often….

  2. You can’t call yourself a fiscal conservative and oppose universal healthcare. You also can’t claim to be moral and oppose universal healthcare. So then why does the GOP and republican voters oppose universal healthcare? Because they are amoral proponents of economic systems that benefit a tiny number of people.

    • It is a stone cold fact single payer would save trillions, and lears you are the textbook example of the empathetic conservative that only cares about your bottom line and think Everyone can just pull themselves out of poverty magically…. It just simply isn’t the case we live in an oligarchy where wealth concentration is the worst its been in this country… but meanwhile just like in the 1920s and early 30s people like you supported these thinly supported ideas of laissez faire, they were against child labor laws, minimum wage maximum hours and the like and we all got fucked cause of it….

      Keep it up cause one day the populist left is gonna elect a real lefty the conservative economic position is untenable in a climate where taxes on the wealthy are historically low yet surprise, it hasnt trickled down to anyone but the 1%s kids.

    • Whyamimrpink78 the free market cannot produce cheap healthcare we have tried this for 80 years and it has led to our health care system being a giant hole for corporate greed. We spend more on healthcare than anyone else because the profit motive is counter to providing everyone healthcare…. if you were right the US healthcare system should be the best in the world because it is one of the most free market systems if not the most in the oecd… but it isn’t because the middle man is stealing from all of us to give to their shareholders.

    • Also please stop with homogeneity argument as if having minorities is an argument, it is a thinly veiled prejudice swipe at the fact that somehow blacks and latinos are not worth giving healthcare too. Nothing about the fact that the US is a pluralistic society means single payer wouldnt work.

  3. There are legitimate reasons to buy private health insurance, if you can afford it, within a single payer system. I have private health insurance here in Australia. If you need dental or some other specialist treatment you will be waiting a long time to get a spot in the public system, whereas I have instant access with my additional insurance. Its like a savings plan for the extras you dont want to wait for.

    • TD Queen, If Dental is added then the rates would have to be radically. Right now many of us have planes that are already out of control and unaffordable.

      Locally some of the casino workers have plans with Dental, and government and union jobs sometimes do too.

      The last company I worked at that had Dental Insurance the price they paid for a tooth filling was 8 dollars out of their “doctor system” and 24 for you own doctor.

      Thus if the filling was really 60 dollars at you local Dentist 4 miles away they paid 8 bucks.

      To get the 24 dollar reimbursement you had to go to their doctor far away in the bowels of Los Angeles and basically take a day off since the doctors office was like steerage on the Titanic. Giant lines, doctor barely speaks English, giant wait. Every new visit requires filling out all sorts of forms, they never had you last visits work on file.

      Thus the only folks who used the company dental system doctors were married, the wife took the kids and spent say 6 to 10 hours 50 miles away in the bowels of LA. The companies reasoning for pricing was it was there midwest Dental costs, not LA costs thus they paid little.

    • +The Dynast Queen, That question is one that I have asked myself in Sweden. We have free dental care for people younger than 20 or 22 (I don’t recall right now). Then it becomes not crazy expensive usually, but a hefty sum for the typical person.

      There is some additional governmental subsidies for people like me who have problems with dental hygiene due to my disability. I pay approximately half price for ordinary stuff and that price is fixed so it doesn’t get any higher even if I have to do more expensive work done.

      In Sweden you can see quite many people simply not be able to afford dental care, so they will get e.g. an infection in the jaw as a result, which is regarded as not dental care and thus is covered by our universal health care.

    • belt, I do not believe insurance companies should be allowed to sell across state lines (except possibly for states who’s area is less than 15,000 square miles), as that would mean a company could move to an area with very lax regulations and sell in states they wouldn’t otherwise be allowed to sell in.

    • Zeld, the state lines help the rich Democrats. ie Monopoly. My state has only one provider, Obamacare had them leave in droves. I hope California goes through gut wrenching 5X increases in premiums too. 🙂 Then the masses there might not kiss Nancy Pelosi’s rear end with so much gusto. ie pass a thousand page law to later read what is in it.

    • Elijah; the premiums here went up by 5x for many of us. That is why your comment of ” Make burst your little bubble but health insurance wasn’t affordable to use before Obamacare.” is rather clueless and totally ignorant, you ignore folks who had workable decent plans and now they cost 5x more and the coverage is worse and the deductibles are higher.

      Obamacare here has caused many to no longer be insured at all, thus it is a disaster.

      Democrats caused hard working folks to long longer afford insurance anymore, thus totally immoral. ie Democrats have blood on their hands for screwing over the working guy via 5X premium increases and no choice of providers anymore.

      Ie the Rich entitled Democrat Pelosi the old hag should be put in jail for ruining the coverage of the average Joe and Jane.

      ie rich, entitled Democrats that are rotten to the core and caused a giant mess with insurance, ie none available anymore at decent prices.

  4. If these prescription drugs are created with our tax dollars, by the NIH, NSF, DHHS, and public universities, then why should Medicare negotiate the price in the first place? If they’re “our” drugs, then the government should be like Canada and **set** the price.

    • The VA negotiates drug prices. They’re 45 percent lower than what everyone else pays. There is still a decent profit built in for pharma otherwise they wouldn’t do it. But they also benefit from smaller profits with higher volume of sales.

    • Matt Nice that’s quite sad really, because where i live i get to see a gp for free and also get to have anything done at a hospital for free. plus at the moment my medications are free as well. so all my medical needs are completely free, even with pre existing conditions and the kicker is i have no health insurance because of our medicare system

    • I AM ONLY ME, sounds like a lot of fascist jibber jabber to me. “Free this and free that and I didn’t have to pay anything,” I might be paraphrasing a little but you get the gist. I admit that some of it SOUNDS pretty ok but I don’t know… maybe if we gave it a better name like: America is the Greatest Healthcare Act or something. Or maybe I’ll just continue to vote against my own self interest because I don’t want the terrorists to win.

    • 3beltwesty even if you’re correct about the loss due to malpractice suits, that doesn’t negate the importance of increasing efficiency. If anything it supports reducing costs to physicians…about $84k on average for additional administration and loss of work time so they take one third less patients. All this to deal with the plethora of health insurance companies and plans.

    • I AM ONLY ME I don’t know why? I do know that a certain person pretending to be president likes Australia’s Healthcare. Even said they have great Healthcare unlike us. I can’t quite remember his name I believe it started with the t.

    • Hi Rose, The USA has its own different set of plans for each state, thus the billing is absurdly complex. Plus say if Sally a woman wants contraception help the 3 possible employers of Acme, Beta, or Gamma industries can dictate not to include some features due to religious grounds. In the 1992 VP debates this old chap Stockdale said ” I believe that a woman owns her body and what she does with it is her own business, period.” I almost fell out of my chair.

      See **** ” so when Stockdale fired off his view on abortion in five seconds flat—I believe that a woman owns her body and what she does with it is her own business, period.—he stunned everyone, even the moderator. Watching him, I got the sense that he was the type of person our Founding Fathers imagined when they penned the Constitution: a human being who could think for himself, and was willing to defend and explain his beliefs, despite the obvious fact that he wasn’t a glib talker.”

      https://www.huffingtonpost.com/entry/america-could-use-a-little-admiral-stockdale-right_us_58bf2a63e4b070e55af9e8bd

      This old eldery chaps instant answer actually hurt Perot who ran for President. But here today in the usa a womens employer can fine tune Obamacare to fit its wants for women. Does Canada do this stuff?

    • gbnz53 That’s amazing! I believe it’s mostly about who has influence in our government. Our government is for sale, 90% of the time the candidate with the most money wins the election. So our elected officials are beholden to their donors, if they don’t vote how their donors want them too their donors can get someone else in office who will. Our government is corrupt in that sense. The more money you donate the more influence you have, which obviously shouldn’t be the case.

    • Victor Torres In New Zealand an individual or a business can donate to a Political Party but not to an individual Politican. All donations of money or goods and services to a Political Party of greater than $1,500 has to be recorded and included in a Return made to the Electoral Commission each year. This also includes financial loans made to a Political Party. A separate more detailed disclosure is required for donations or loans over $30,000 made to any Political Party. The idea is to make all such donations and loans totally transparent as this information is published.
      In 2016 Transparency International ranked New Zealand and Denmark equal 1st as the least corrupt countries in the world. The USA was ranked 18th.

    • gbnz53 Is the donation caped at a certain limit? Or can you donate any amount you can afford? Here in the US a single person is capped at $2700 I believe. The real kicker is super pacs, super pacs are organizations who can donate unlimited amounts of money to any individual candidate. So you get a superpac of wealthy people who all have the same political policy goals and they can essentially buy the representation they want. In my opinion that’s why our country is so out of wack, people with money only care about their political gains everyone else be damned.

    • Victor Torres I don’t believe there is a cap but it would be uncommon to have donations to Political parties from any one individual or business that exceeds $30,000 in any year. Most people in NZ are not members of any Political Party. We have an MMP Electoral system (like Germany) and have two votes: One for the Party we want to be in power and one for who we want as our local Member of Parliament. Our elections are every 3 years and we have just had one. We will know this Thursday what coalition government we will have for the next 3 years . It could be Centre-Right or Centre-Left. To be honest, either way, it won’t effect me greatly and the core social policies we have never seem to change much with a change of government.

  5. Cost of a medicare for all system for the next 10 years approx 30Trillion, Cost of present for profit medical insurance and cash payment approx 46Trillion. Savings estimate is 16 Trillion over 10 years.

  6. Are Americans aware how much the rest of the industrialised world see’s America as this backward, archaic anomaly when it comes to healthcare? Like a country that hasn’t managed to organise public education and instead relies on private arrangements.

    • That is a culture issue. Other countries were raised with their system, we are raised with ours. When you break down the numbers the US system is on par with other nations

      https://www.aei.org/wp-content/uploads/2014/03/-the-business-of-health_110115929760.pdf

      With that how do you convince 320+ million people to drastically change they way they do healthcare? You can’t. It is similar to how in the US we love football and other countries love soccer. Or how other countries use the metric system and we don’t. Any talks of converting the US to metric is met with the legit barrier of how do you convince 300+ million people to change?

      So they may see us as backwards, I really don’t care. With that I just see them as ignorant.

    • Jose Delgado much of that innovation is done through research at universities often with government funding of which trump is cutting…..so, there’s that.

    • I don’t doubt that the USA has done great research and development – along with the other countries mentioned. And with large federal support as Beanie says. But that’s a separate issue to providing day to day healthcare for the non-rich. Which is something the USA does very inefficiently by global standards.

    • I’ve re-read my original post and it looks patronising to people in the US in general which it wasn’t meant to, so apologies for that. It was to try and understand whether the perception and experience of people outside the US has any impact on the dissatisfaction people in the US feel over healthcare. Are Americans angry that foreigners seem to pay less but get more? Or is that just not a factor for most?

  7. The Medicare system is in place already, it would absorb the Medicaid system also in place. Quickest & cheapest way to create universal healthcare. 1 payer system which eliminates the middleman aka healthcare insurance companies bring costs down.

  8. Friedman is correct about the UK – we have a bloody good system of government run healthcare. It’s currently under a lot of strain as our government is also trying to privatise the system a piece at a time as they’re trying to emulate your Republicans in their hatred of Joe and Jane Public. It works well enough though and doesn’t cost anything like you get screwed for in the USA. Our healthcare system has saved my life twice and my better-half’s once – total cost to us was nothing except for what we paid though our weekly national insurance contributions deducted straight from wages (as are our taxes), just as with anyone else in work. Those who don’t want to wait for various appointments and procedures (which vary with urgency) can always choose to pay extra for private health insurance but, again, it’s nothing like Americans get hammered for.

    • Gary Sinnott thanks for this. I was hoping an Englishman with first hand experience would chime in on this. Just sounds too good to be true!

    • Always happy to oblige… Maybe we could compare notes? My last experience was almost my _last_ experience , it was that serious. I’d been feeling rather off for a while and made an appointment to see my doctor. Various things happened including a delay in my appointment as, ironically, my doctor was himself ill for a week. On the day of the appt. my wife was only able to get one word out of me – “doctor” – before I passed out. I was out like the proverbial light, but hard, and my wife made a rather hurried call to the surgery and gave them my symptoms. Instead of me going to my doctor, he came hossing out and ran some tests. Shortly after, an ambulance took me to hospital and from there I started to die. It took some serious work by several staff to keep me from doing so (at one point they’d even had _that_ talk with my wife to prepare her for what they thought was going to happen) but between them and my sheer bloody-mindedness, I lived (obviously, or I wouldn’t be waffling on like this :). When I came out of the coma and was more lucid (which took a while), I was informed that I was now a diabetic. Lovely. _Not._

      I spent more than a week in hospital under the watchful care of some very dedicated staff and was eventually packed off home on hospital transport with medications and paperwork, a blood-glucose monitor and even more paperwork. It wasn’t the most fun I’ve ever had and I’m pretty sure I never want to repeat it either. For all of that, the total cost to me was £0.00 – and considering I’ve not been at work for more than 2 years due to a back injury you might think that incredible, but that’s just the way National Insurance works. I’ve paid into it for years and so have millions of others here. (We mostly also don’t do yearly tax forms as everything gets calculated by the government and deducted from pay too – Pay As You Earn, AKA PAYE, and it’s a great system.) From that funding pool comes the level and quality of healthcare we have here in the UK. It’s not perfect by any means as I said in the prior post, but it’s waaaaaay better than what America currently has. The government here has no incentive to screw people on their costs – essentially it’s a non-profit system and it’s for the good of the people. American politicians seem these days to only do anything for the good of themselves and their paymasters – if that’s supposed to be the American way…

      Now don’t get me started about my wife’s brain surgery for Cushing’s Disease over a decade ago, that was an absolute bastard of a time! There were so many tests run, from simple X-rays to MRIs to an inferior petrosal sinus sampling (and that’s a truly horrible test to endure which of itself carries a risk of death), as well as the surgery performed by about the best in the business anywhere on the planet and years of after-care – still came to £0.00 though. How much would _that_ cost in the USA under the current system?

    • Gary Sinnott literally. Fucking. Thousands. First of all, I’m glad you’re doing well. You and your wife. That’s good to hear and I hope the two of you are as happy and as healthy as can be.

      To answer your question: you would have to go bankrupt to pay for the kind of treatment you’re referring to. Let me give you a small example: I’m a paralegal (an attorney’s assistant, if you will) in the personal injury field. Car accidents, slip and falls, etc. An MRI alone could be anywhere from 1500 to 5000 dollars. Just. An. MRI. Never mind the treatment that is to alleviate whatever damages the MRI reveals. Gotta herniated lumbar disc? Here go maybe 4-8 sessions of PT that will CONSERVATIVELY cost about 5-10 grand.

      Of course, you’ll (presumably) have auto insurance to cover this (insurance which is tiered at anywhere from 15k to 250k), but once that coverage is exhausted (and booooy does it go exhausted quickly), your health insurance (provided you have it) kicks in…. IF the treatment you’re receiving is “pre approved and deemed medically necessary.”

      Friend. It’s a mess.

    • Search Youtube for Americans living in the UK. A number of them talk about their experiences with the UK NHS – I haven’t heard a bad word yet and all are amazed that the hospitals and GP’s don’t even have anywhere to pay…….

  9. Also wouldn’t this also mean employers won’t have to bare the cost of employees insurance. This would free up a lot of money in business to perhaps pay them fairer wages. This should also be a massive economic  stimulus

    • kiwibaldy it would be. It would mean more small business and workers free to work for them. Only companies with 50 or more employees have to offer insurance coverage. If I had a job that covered my health care costs I doubt I’d want to start my own business. ..that’s a big enough risk on its own.

      Plus clinics and hospitals in areas where the majority are working poor without health care would be profitable. This would help some rural areas a lot.

  10. The private insurance I have now costs $15, 000 a year for my wife and I, and that’s for a shitty HMO plan. A 2.2 percent tax increase sounds fucking awesome compared to that.

    • In the UK, your National Insurance “tax” (which pays for medical and pension among others) would cost you UK 87.76 a week if you earned UKP 1,000 a week. Other examples are on their website:

      https://www.gov.uk/national-insurance-rates-letters

      Thats for total medical costs including operations, ER, hospital stay, etc although you will pay a per prescription cost for any medicines at UK 8.60 an item, although if you need long-term medicines you can “subscribe” for UK 104 a year that would then cover all medicines. By the way, the type and actual cost of the medicine doesn’t change the charge – paracetamol costs the same as HIV medicine to the patient.

      http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptioncosts.aspx

      Thats for normal people, if you are one of the following, the medicines are free:
      You can get free NHS prescriptions if, at the time the prescription is dispensed, you:
      are 60 or over
      are under 16
      are 16-18 and in full-time education
      are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx)
      have a specified medical condition and have a valid medical exemption certificate (MedEx)
      have a continuing physical disability that prevents you going out without help from another person and have a valid MedEx
      hold a valid war pension exemption certificate and the prescription is for your accepted disability
      are an NHS inpatient
      You’re also entitled to free prescriptions if you or your partner – including civil partner – receive, or you’re under the age of 20 and the dependant of someone receiving:
      Income Support
      Income-based Jobseeker’s Allowance
      Income-related Employment and Support Allowance
      Pension Credit Guarantee Credit
      Universal Credit and meet the criteria

      Dental is slightly different, you’ll pay for that in most cases.

  11. “UK has the best healthcare in the world, BUT DON’T WORRY, we’re NOT going to do that socialist thing.”

    Crazy Americans.

    • We already have socialism. The problem is that most Americans are too uneducated to know it. I share this list quite often and have had several people deny that these are socialist programs. Sad, Socialist Programs in America

      1. The Military/Defense
      2. Highways/Roads
      3. Public Libraries
      4. Police
      5. Fire Dept.
      6. Postal Service
      7. Student Loans and Grants
      8. Bridges
      9. Garbage Collection
      10. Public Landfills
      11. War
      12. Farm Subsidies
      13. CIA
      14. FBI
      15. Congressional Health Care
      16. Polio Vaccine
      18. Social Security
      19. Museums
      20. Public Schools
      21. Jail/Prison System
      22. Corporate/Business Subsidies
      23. Veteran’s (VA) Health Care
      24. Public Parks
      25. All Elected Government Officials
      26. Food Stamps
      27. Sewer System
      28. Medicare
      29. Court System
      30. Bird Flu Vaccine
      31. G.I. Bill
      32. Hoover Dam
      33. State/City Zoos
      34. IRS
      35. Free Lunch Program
      37. Medicaid
      38. FDA
      39. Health Care for 9/11 Rescue Workers
      40. Swine Flu Vaccine
      41. Disability Insurance (SSDI)
      42. Town/State Run Beaches
      43. Corporate Bailouts/Welfare
      44. State Construction
      45. Unemployment Insurance
      46. City/Metro Buses
      47. WIC
      48. State Snow Removal
      49. PBS (Public Broadcasting Service)
      50. Centers for Disease Control and Prevention (CDC)
      51. Welfare
      52. Public Street Lighting
      53. FEMA
      54. Public Defenders
      55. S-CHIP (State Children’s Health Insurance Program)
      56. Amtrak
      57. NPR
      58. The Department of Homeland Security
      59. OSHA
      60. State and National Monuments
      61. The United States Department of Agriculture (USDA)
      62. Government Scholarships
      63. Department of Health and Human Service
      64. Census Bureau
      65. Department of Energy
      66. Customs and Border Protection
      67. Department of Education
      68. Secret Service
      69. Peace Corps
      70. Department of Justice
      71. National Weather Service
      72. The White House
      73. Government
      74. Law
      75. Civilization
      76. NASA

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