Although it’s been proposed for years by some health care reform advocates, Medicare For All is gaining new steam as the race for 2020 heats up. While various Democrats are currently introducing different versions of the idea, the central idea remains: a new, single-payer health care system with a wide range of coverage and zero out-of-pocket costs except for prescription drugs, and different forms of taxpayer funding replacing premiums. Is such an ambitious overhaul feasible, either technically or politically? To discuss, Jim Braude was joined by Dr. Don Berwick, former head of Medicare and Medicaid under President Obama; and Jonathan Gruber, one of the architects of the Affordable Care Act and Romney-Care.
Medicare For All: What’s It Mean, And Is It Possible?
“It helps if they’re vague.” What a load of tosh. So as long as you don’t say the truth about what the plans really mean, people will support it? You only want power, and will lie and cheat to get it.
You explain the disadvantages of the “public option” (Medicare buy in, Medicare for some) to the voters: 1) losing a lost of cost savings potential for a very streamlined admin 2) loss of a unified electorate = loss of political leverage 3) the insurance companies get an even MORE cherry picked pool. (Medicare covers already the most costly patients group, plus 65 years).
A system TO DELIVER CARE can either be good for the patients OR have a lot of for private players extracting profits (starting with private for-profit insurance companies). The private insurance companies BRING NOTHING TO THE TABLE, if a public non profit insurance agency (dealing with non-profit or for profit players) is reasonably set up (it is not rocket science ALL single payer nation are capable of doing it much better than the U.S.)
And of course the agency must be reasonably funded (read HALF THE SPENDING of the U.S.) – so they can pay well negotiated but adequate compensations to doctors and hospitals. Then there will be very little room for private insurance companies, and no one is going to miss them.
In countries with single payer the patients / insured have little to do with the public insurance agency and they do not miss that. At. All. – when there are contacts they are usually well organized and polite – and that’s it. Patients may be attached to the doctors, or appreciative of a hospital (more likely a department where they got care for non-trivial health problems) –
the rich and wealthy (if they are healthy !) will OPT out and will not see any reason to help fund the public option. They (or their employers) will pay too much into the overpriced contracts (considering how much the pool has been purged) – but their CARE is at least good and they can afford it. Except of course when they have pre-existing conditions – then they will land with the public option.
Another effect is that the private insurance packages can _appear_ to be reasonably prices (while being too costly considering that they keep only the good insured). On the other hand the public coverage will appear to be expensive (they miss out on the higher contributions of good earners and they have all the costly patients).
The Republican party can then howl about the “inefficiency” of the “socialist” system (and don’t expect the Corporate donation chasing Democrats to hold strongly against it).
They can sneakily and openly defund it – they did that btw: Medicare and Medicaid will get less funding over the course of the next 10 years – if the Trump admin cuts remain effective. The taxcuts for the rich and super rich have increased debt and deficit and someone has to pay for it.
And WHAT would be the rational to have Medicare and then offer _another_ public non-profit package but it is NOT Medicare ??? More complicated admin ?
The problem with Medicare for All – it would be almost impossible to get rid of it and much harder to defund it.
When the wealthy cannot opt out from paying and they get the full coverage like everybody else – most of them will USE it. So they have a STAKE in the system. And there will be not political divide between the voters of the Republican party. They TOO have skin in the game and want the system to be GOOD and COST-EFFICIENT.
+Xyz Same Notice how you fail to list every actual negative in your lies to promote your bullcrap.
1) The system will have no competition, which means it will be more costly, not less. The “streamlined and less costly” lie was used when Obama kicked the banks out of student lending. Then the costs multiplied by more than five in less than a decade. Or how about the California rail system? Government projects always go smoothly and under budget right? Oh, no, in fact, it’s always the exact opposite.
2) We already have the system, and can see just how bad it is: The VA is broken and corrupt beyond belief. Massive waste, massive waiting lines. Veterans cycled through lists being treated as numbers, not people. Veterans DYING because service is denied, delayed, or rationed.
And your “the rich will pay for it” nonsense is nothing but your own envy speaking. Hell, you can’t even get the people who VOTE for the stupid system to use it.
+Skyblade12 If your assertion is true, then why is our system in the UK delivering better results for a lot less money!? If competition in the medical industry results in guaranteed streamlining and cheaper prices, why do you in the USA pay so much more for your healthcare, medicines, hospitals and GPs etc than any country with socialised healthcare?
A system where you have a number of middle-men skimming profits from various areas before a person even receives any treatment or sees a physician is always going to result in inferior and inefficient outcome.
I would much prefer the NHS system in the UK than what you have in the USA
+Sanj Chowdhary Well, first, I disagree with your assertion that the UK delivers better results for less money. Second, there are far more problems with the US system than just the insurance companies. The entire government run big pharma monopolies are a huge problem with our costs. The restriction of certain drugs and lack of alternative sources means that prices are frequently cheaper for such things in other countries. Third, you have far more middle men skimming profits in a government run system, especially a system like the US’s, which is far larger than the UK’s. Because your tiny little island is roughly the equivalent of a single state over here, missing entire layers of grift and corruption. And yet, even in a single state over here, even those most in favor of a system like yours aren’t stupid enough to try to implement it on a local level, because they know it would fail. Which is why, despite being presented multiple times, even the most liberal states have rejected local versions of the plan.
Looking at countries with socialized healthcare along with the Veterans Administration is all you need to know. Be ‘vague’ is the new speak for ‘lie’.
WRONG. The VA has done poorly because Republicans keep on cutting funding to the program. It has nothing to do with the fact that it is publicly-funded. Medicare is publicly-funded and it’s the most popular healthcare program in the country.
This arguments comes down to preventing needless suffering by providing healthcare to all Americans. As of now you cannot be turned away for major health conditions. You will end up bankrupt if you don’t have good expensive insurance or loads of money. You don’t have to go to a doctor! The only reason the quality of healthcare in the US is at this level is because it is expensive. The only reason we are able to treat many conditions is because there is a market to make money. Take away that incentive and the quality of healthcare goes down so much that you no longer have to option for treatment, you sit on a waiting list for longer or don’t get treated at all. You don’t have the right to expensive high level healthcare. Someone has to pay for the research, someone has to pay the college tuition of the doctors. Just think about it.
L DeGrave You’re talking utter, uninformed nonsense, said with all the confidence of utter ignorance. Instead of pulling facts out if your arse try looking at how universal health insurance/care works in every other civilized, first world country. I enjoyed free NHS health care in England and I can tell you it was first class care. I was fully treated for prostate cancer, discovered during a free well man check up. I’m still alive to tell you about it. If I was on expensive insurance I would never have had the check up, if I had no insurance I would not have had a check up. Either way I would be dead now. Of course you get treated for all conditions. As for research, it is private insurance that doesn’t want to spend money on research because there is no money in it. They want to sell opiates not antibiotics. There hasn’t been any real research into new antibiotics for twenty years by private companies because it is expensive and there isn’t the profits they want.
There’s no debate on Medicare For All. No negotiations. We’re way behind on this. American people shouldn’t take no for an answer.
When it comes to healthcare, people have to have skin in it. Americans just don’t take good care of themselves. Just go to any mall and watch what they eat. The only good idea is to have a single payer CATASTROPHIC health care system paid by LARGE EXCISE TAXES on tobacco, alcohol, sugar, snacks, soda, and perhaps dairy products which have been proven in studies to cause heart disease and type 2 diabetes. Cancer is also affected by these products. These products cause a lot of the major health problems people have that take up a lot of our financial health care resources. A small pool of people who don’t take good care of themselves make up the largest costs in our health care system. This is the most equitable way to finance our health care system. We need to also address the demand for health care. Making these products more expensive will reduce the demand for them and thus decrease the need for big cost health care for heart disease, type 2 diabetes, cancer, and prescription drug problems. The rest of the health care system should be private. I am an economist and I am 66 years old. I eat a plant based diet and I never get sick. If everyone were like me, doctors would be in dire need of patients and medical costs would plummet.
Main Stream Media and politicians have NO solution, not because they are obtuse, but because they are OWNED.
I do:
Replace Obamacare with self insurance- a progressive employer/employee payroll tax for ALL hospital stays, nationwide. No copay, no deductible. Primary Care and Drugs out of pocket, BUT WITH a calendar cap. SAVES billions, and still keeps hospitals in the private marketplace. We will call it the Self Insured Care Act-SICA because we’re sick a what we got now.
Hospital single payer for the Left, and for the Right-for profit hospitals. Win-Win. The public pays! But so does Hollywood, Congress, and all those blessed illegals.
BTW, ask yourself why solutions are not being debated.
BECAUSE powerful, multi-billion dollar special interests are steering the conversation, and Medicare for All is considered a straw man proposal easily defeated, just like Bernie’s first run. What they don’t want is some kind of single payer plan that kicks the insurance industry to the curb. Neither does Bernie. . . .
ACA was a “solution” that made sure that the overpriced U.S. system could continue (else the pitchforks would have been on the streets long ago). ACA was an insurance-friendly set-up (that is why the Corporate Dems defend it and are “sceptical” about the solution that functions everywhere else in the world and for decdades and at much, much lower costs).
ACA made sure that the profiteers could continute to extract profits. And since the costs are outrageous (double spending of what would be necessary, and that is no hype) – there need to be a lot of subsidies – but these fund the dysfunction and the profits – not a good and cost-efficient hassle-free system like in the single payer nations.
It is true that the single payer systems also need plenty of subsidies – but NOT as much as the U.S. already susidizes per person. In a single payere system the government pays LESS and patients/workers and companies pay much, much less.
It is true that the single payer systems also need plenty of subsidies – but NOT as much as the U.S. if you compare the subsidies per person * In a single payer system the government pays LESS per person and patients/workers and companies pay much, much less.
* Only that comparsion makes sense if you have countries in all sizes from a few millions – like 3, 30, 60, 85, 127 or 238 ** (Denmark, Netherlands, Italy/France/UK, Germany, Japan, the U.S.)
** estimate for the U.S. in 2017/2018 (those numbers include the undocomented immigrants; roughly 3 – 3,5 % of the population = 10,5 – 11 million people. Now I have seen claims that their number is higher – more like 20 millions. Well that would account for another 3 %.
That segment is younger on average, so either children, teenagers, or adults that are working – less retired persons (which are a costy group, healthcare wise). So they CONTRIBUTE to the economy – and should get healthcare coverage for that – whoever may benefit from their often lower wages, should be made to pay for their they are younger than the average U.S. citizens (so they cause much less costs in the system).
The argument is often that they are “leeching off the system” or that they would if they would get a path to legal status.
Well if the U.S. is spending 90 – 100 % more than other wealthy nations the official 3 % – or worst case scenario 6 % of the population – are NOT the problem that needs the most attention. Moreover they may avoid using medical services – but when a condition / illness gets severe they will need to (and in some cases that might attribute to higher costs in the end, because they do not get care until there is considerable damage).
So they WILL cause costs then – which may be hard to recuperate by the hospital / doctor. If they are broke, they are broke (even if you deport them – you are not going to let them die on the steps of the hospital, let alone their children).
So if they have insurance and coverage it would not add to the overall spending but DETRACT from the administrative costs for EVERYONE.
A lot of out of pocket spending is already included ! in the total spending in the country. There are rumours that they use forged SS cards, or maybe charities pay for them or they have a GoFundMe. Either way, their numbers are factored into the population numbera and the numbers for their healthcare expenditures is factored in as well in the “per capita healthcare expenditures” of the U.S.
The “free market” can impossibly work for healthcare. – _There is no need to reinvent the wheel._ If so many countries (small, medium and large) did their individual version of Single Payer, usually since the late 1940s, and they ALL end up with AVERAGE spending per person between 4,900 USD and 5,700 USD (we are talking about rich nations like France,Belgium, Japan, Canada …… Germany)
As opposed to the spending per person of USD 10,240 in the U.S. (Keiser Family Foundation, numbers for 2017 based on OECD data).
Then you can draw conclusions:
1) a first world nations will need to send approx. 5,000 USD per person per year if they want to have a good hassle free system for everyone. (which is still a lot of money, a healthy family of four will have a “share” of 20,000 and more year, after year. of course the spending that does not occur for them goes to the rare cases when people end up with high treatment costs for severe illnesses. And a lot goes into care for old people. Modern medicine can add more life time – but that comes at a cost.
2) The more _public non-profit_ a country has in their system – the _more cost efficient_ they can have their GOOD services. So it is better to have non-profit public hospitals than have contracts with for-profit hospital chains. The for-profit hospitals even if well regulated WILL try to sneak in something and medicine is so complex that there are countless ways to do so.
That is why most nations removed the profit motive from the situations with COMPLEX decisions (or at least they restrict the power of the for-profit players – like that no chains are allowed for hospitals).
STILL: the NHS leans the most towards public non-profit and has the U.K. has the lowest spending per person. Likewise if a nation allows _some_ room for the for profit insurance companies and “privately insured only doctors” they end up with higher costs for everyone.
That is usually when the public coverage is underfunded so quality will suffer OR the public coverage is not comprehensive and unified. Unified means: everyone gets the same treatment in the same places – provided a doctor decides it is medically warranted. and that doctor is not influenced by a profit motive, nor does he or she have to consult anyone – like the insurance agency.
The insurance agency only negoatiates the framework, like drug prices, costs for ambulance transports, what a day in the hospital costs, etc.) – the doctors use the tools as they see fit and MAKE THE COMPLEX DECISIONS.
There are incentives for doctors to game the system, to “milk” good insurance packages (not better outcomes, but unnecessary procedures, keeping the “good” patients longer in the hospital, unnecessary tests, etc.). Even if they would not do that (they inevitably will, the complexitiy allows for that) – they system is not nearly as streamlined as it could be. so they miss out on the cost savings of a simple administration.
The NHS even runs the doctor practices and hospitals (so they donot have a contract with the hospital or the doctor practice that may be private or public – they doctors and hospitals are part of the structure).
Most of the spending in the UK happens via the NHS (and spending on private insurance and out of pocket for “private only” doctors makes things only more expensive). They have a _record low level of spending per person._
For a wealthy country with the typical age structure of a mature economy: that is important. Sandard of living influences wage levels and that is important for costs in healthcare. Another factor is that everyone gets all that modern medicine has to offer. And AGE is a huge cost factor because with old age the most costs manifest.
So you cannot compare Hungary (look at their wage levels and minimum wages), and you cannot compare Israel and Taiwan with Germany, Denmark, France or Japan. They might offer modern medicine for everyone but their population is much, much younger on average.
The U.S. btw has also a much younger population on average (immigration !) – and only for that reason should beat the Europeans or Japan cost-wise.
Next time you hear that there are waiting times in Canada (they have systems and provisions per province) or that the NHS in the U.K. is struggling ….. True – and Canada spends ONLY USD 4,800 (in that range, numbers 2017) per person and the U.K. spends only 4,250 USD per person.
You _increase the budgets_ (which would come from gov. funding to avoid the problems with persons that cannot afford the higher spending on the individual level) to _only HALF of the U.S. spending_ and the healthcare systems in Canada and in the U.K. would run like a charm. (and beat the crap out of the U.S. system).
Currently Canada spends 47 – 48 % of the U.S. and the U.K. spends only 41,5 %. Getting HALF = 50 % would be a considerable improvement. It speaks to the efficiency of the very “public, non-profit” oriented NHS that they pull it off at that level of underfunding.
but with the yearly flu wave in winter they are hanging in the ropes – the “winter crisis”. Of when social services for the elderly are cut and they have to KEEP seniors after treatment has been finished because they defunded the public care centers and they cannot afford the private for-profit care homes for the elderly.
Tory insanity (but it becomes understandable if you realize that they want to run the system into the ground to “justify” a privatization through the backdoor).
Is it Possible? I don’t think so. Of course I’m Canadian and I have it. Maybe I shouldn’t talk?
The “public” are not stupid. Centrists need to get their heads around that fact. Yes 1/3 of the populace will oppose anything, and everything that the government does, because they don’t trust a government that forces their kids to go to desegregated schools, whether they have kids or not. The rest of the country is open to government programs that will work. The centrist on the panel rightly points out that drug, hospital, and health insurance corporations will oppose Medicare for All. That need not stop us if we can create enough public support for real change. We don’t need to be “vague” about the process, we need to LEAD and show them that MFA will work and will save money.
While this won’t apply during the transition period, we can ultimately pay for Medicare for all with a tax CUT, given that the Feds, States and Local governments together pay more per capita for Medicare/Medicaid plus employee health premiums than any other country in the world pays for ALL of their health care costs.
“Government programs that work”. Like the VA, right? That’s exactly what you want to put us all on.
How about the mass rail system. Look at how well that worked. Supposed to replace all our evil cars, and yet all that’s happened when California tried to put in ONE rail line was the cost more than doubled while literally none of it got built.
Or how about student loans? All taken under the government during Obama’s admin, under the promise of streamlining and reducing costs. And costs jumped more than five times what they had been.
The government is never efficient, and eliminating all competition NEVER results in a better product.
+Skyblade12 So the anti-government screed. Student loans were fine until the Republicans told the banks that instead of the government making the loans, that the banks could make the loans at extortionate interest rates and that the Republicans would be sure that no one could pull a Trump and declare bankruptcy on their debts.
Mass transit was working great in CA until the private sector got them to tear up all the rail lines so that people would have to buy cars. And if you are saying that we should not have “government” roads, just see how CA does.
The problem with the VA is a lack of resources, mostly because the Republican health care system is so so so so expensive that the VA can’t manage to keep up. I know that you must think America is the “land of the stupid” because if the bloody French can have the BEST health care system in the world for about $0.60 on the dollar against our WORST in the developed world system, then you must think that the French are geniuses.
Government does many things better than the private sector. Police, Fire Protection, Education, Roads, Social Security, Medicare, Medicaid, The Armed Forces. Would you fly if the government did not regulate airlines? Maybe you would, but you probably would not have lived long enough to write your post. Do you think that the private sector would make the food supply safe? How about privatizing the Center for Disease Control, good idea?
Now, should the government control the Copper Market, no. But the Copper Market would collapse if governments, primarily ours, did not regulate it.
Pull your nose out of your Ayn Rand and look at the real world.
You will notice you didnt hear the word ‘Constitution’, once.
WHAT polls are you citing?? I don’t know any THINKING American who wants Medicare for all! It’s plain old socialized medicine, and you’d better do a little more studying into how it affects other countries….and their tax rates as well as waiting periods! Another government control. We are not a socialist country, and the majority if American do NOT want that! We see what it’s done to Venezuela, Cuba, etc. It just SOUNDS good to say everyone will be taken care of, but many people want their own insurance, and want jobs where they can choose and buy their own. “New steam”, nothing! Dem bias!
I pay 1000 dollars a month for full coverage me and kid. I would rather keep the 1000 dollars a month and pay more in taxes. It would have saved me so much struggling.
But wouldn’t the tax be less than current premiums?
Disingenuous representation about employer provided health insurance. Most people like their DOCTORS not their plans..Under Medicare for all you would be able to Keep your doctor and also not have to worry about who’s in or out of network.
As of right now, we pay three times the average per person than we would be, and most don’t get the care quality or technology that’s available to very few. You can pay hundreds of thousands into your insurance over years , then if you get something they deem too expensive, they’ll drop you. What we have now is disgusting. We’re overpayment billions unnecessarily for everything because we allow legal bribery and corporate welfare, corporate control over government and people. Sick…