The lingering questions about Medicare-for-all

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With a landslide of Democratic 2020 candidates supporting Medicare-for-all and more than half the country backing some form of a national health plan, things get murkier when you dig into the details. Read more: . Subscribe to The Washington Post on YouTube:

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The lingering questions about Medicare-for-all

 

38 thoughts on “The lingering questions about Medicare-for-all

  1. Yoi pay medicare and they cover 80 %, you pay double for private insurance. Take half of you pay from private policy and medicare can cover 100%.

    • Part A….of traditional medicare covers 100% inpatient. Outpatient 80%. That’s why medicare supplement polices were and still are popular for medicare recipients. Now, medicare advantage is a 100% plan.

  2. The first step is to show a viable fiscal plan, show me the money and where is it going to come from. Every time they talk about Medicare for all they avoid telling you what their fiscal plan is. So far it is all smoke and mirrors because no viable fiscal plan that most people would support so far.

    • It costs LESS per person – the way the funding works is different. (I also know the systems of Germany and Austria from experience). Right now the U.S citizens (and partially also their employers) pay very high premiums into a completely overpriced private system with uncertain coverage (or unexpected costs when treatment is needed).

      I have World Bank Data from a few years ago. USD 9,200 per capita in the U.S., Germany 65 % and U.K. 41 % of that.
      (most wealthy countries have per capita expenditures of USD 5,000 – 6,000 in that report – Germany USD 5,600, Austria 5,400. Both countries have GOOD services, the private insurance scene is not important (there are historic reasons why they even have them).

      Affluent people use the public services as well, especially when it comes to the big stuff. And why would they pay extra ? the Public services are good – they are not the countries with the lowest costs (but population is older on average than in the U.S.) but the services are definitely good. The hassle and also the financial worries of paying for insurance or later for treatment are completely unknown in countries with single payer systems.

      Going broke over medical bills would be a weird concept. you would have to explain it to citizens of Europe or Australia or Japan who do not know the U.S. system how that is even possible.

      U.K. has even (most of) the doctors practices public, the high public non-profit share of providers may help them with their record setting low expenditures per person. (They have been defunded for 10 years – but with only 50 % of the U.S. expenditures per person the NHS would run like a charm).

      Even family doctors are employed with the NHS – in most countries they are small companies and have a contract with the non-profit public insurance company. The revenue pays for the costs of the practice and the few staff members – and the profit is the wage of the doctor so to speak. They make a good living – but in single payer systems the ONLY powerful and large for-profit player is Big Pharma. They have very standardized products, prices – or rather the discounts on list prices – are internationally comparable.

      That gives the public non-profit agencies some leverage to get a well negotiated price list for their insured. (the price list is relatively simple to negotiate. The complexity is regarding what patient will get what drugs – and that complex decision that cannot be monitored by regulators is outside the sphere of “profit”.

      The profit motive is completely irrelevant, the doctors ARE FREE to decide according to medical necessity. So whenever complexity is involved – when not even well intended regulators could protect the consumers from being taken advantage of – the profit motive is taken out of the equation and does not play a role in the system.

      Especially if the treatment would be costly (when you need insurance the most) the U.S. for-profit players have a huge incentive to NOT pay (or demand unexpected co-pays or do deny coverage for that treatment and wait if you will sue them).

      I read a story that someone was denied cancer treatment (well the payment for it) because they forgot to mention in the application the acne treatments as teenager.

      This was not just a mean employee doing overtime to screw an insurance client. That is a SYSTEM: when a person needs costly treatments the insurance company has a lot of employees dedicated to the task to go with a fine comb over the contracts to trick them out of coverage – and for that they need systems, procedures and software ! in place – and departments of office staff (and lawyers !).

      Likewise the hospitals and doctors need a lot of staff to handle the very complicted billing. And hospitals have to chase the money for unpaid bills. They are legally not allowed to deny help (although they do that as well) – but often the patients that receive emergeny treatment just can’t afford to pay out of pocket, not even with a payment plan. (And the ER does nothing for preventive care or chronic diseases).

      It is not only cruel – it is also counterproductive for the whole society (if you want a healthy workforce and people able to take care of themselves, family, in old age …)

      Plus it is costly and inefficient from an administrative point (only for the profiteers it pays off – the bureaucraZy is part of the cost of doing business for them, the just add the costs to the calculation).

    • The subsidies the private-for profits system gets – under ACA more than ever – have to compensate for the costs to administrate that insanity. Plus of course the profits for shareholders.
      To even keep the dysfunctional U.S. system afloat a lot of government funding must be added .

      Under Medicare For All citizens would pay more under the title: “taxes” or “wage deductions” or whatever you want to call it. But they would pay ZERO in healthcare ínsurance plans = NET a win per person.

      And there is so much waste going on that the extra subsidies should not be higher than they are now – at least after the mess is cleaned up – there might be some transition costs (backlog from too little care too late, or the costs of retraining the people that adminstrated all the red tape). For instance I hear time and again that people cannot afford their insuline.

      Do you have any idea about the financial consequences for the medical system when diabetes is not well taken care of ?? It is not only the preventable suffering and the too early deaths. It will also COST a lot until these patients meet their premature end – and society does not even get the positive outcomes for these expenditures. And the damage is already being done – so expect higher costs to show up when the U.S.finally gets a system that is worthy of a First World country.

       Single payer systems do have a very streamlined adminstration – a lot of cost savings come from that. Especially if one trap is avoided: still a lot of private for profit insurance coverage PLUS a public option (allegedly as solution for the transition phase) PLUS Medicare For All for certain age groups.

      10 % of the patients cause 90 % of the costs (age plays a huge role in that – age AND high risk patients).

      If the private insureres cannot comletely prevent MfA – the next best thing for them is to keep the pool of 25 – 55 years old. They would cleanse that pool of course of all high risk patients.

      Those will be shoved over to the public agency – under the “public option” that is now proposed for instance in the MfA plan of Booker and Harris, or if “many paths can lead to the goal of better healthcare”.

      No, no – all other nations have been doing single payer and most at least for 70 years. Golly gee if only we could do an experiment with hundreds of millions of people and for decades (and many nations doing their own version of it while following certain principles).

       If – IF – that sneaky undermining of MfA goes through – all the high cost patients will land with the public agencies, the privat for profit insurers will keep the good patients – always with the option to kick them out too if they turn out not to be so good (and they WILL find ways to do that whether it is legal or not).

      a) One beauty of that private-insurance-friendly version is that their package for the cherrypicked age group cannot be internationally compared. After all no other nation is so foolish to do it that way, so there is no way to benchmark

      b) that makes the public agency look costly, so it is easy to badmouth them. It also makes it easier to defund the system (try that when 95 % of the country get the same treatment in the same facilites).
      When the public services are not as good as they could be (see Europe where they ARE good in the wealthy countries) – the affluent people have no choice but to still buy private insurance.

      c) with a cherrypicked pool it is easy for the private insurers to offer rates that _look_ better (if you get rid of the small number of patients that cause a lot of the costs). And if “good” patients turn out to cause more costs they will find ways to annoy them so much that the patients will take refuge with the public option. So the insurers can sneak in profits and the (still) healthy insured will get the impression that private insurance is not so bad after all.
      It is helpful for the profiteers that only a smaller segment in the age group 25 – 55 will have the very bad healthcare events, most will stay relatively healthy, and as long they have no way of knowing what their insurance is worth. – that helps with the _divide and conquer strategy._ It dilutes the power and incentive of the voters to demand ONE good and streamlined solution for all.

      The public option (proposal of Booker and Harris) poses as MfA – but it is a covert gift to the insurance industry. And it will still need a lot of administration. so it does not leverage one of the major cost-saving potentials – a very streamlined admintration.

      The Real News had a numbers cruncher and a Harvard doctor on – speaker of a group of doctors for single payer. (Medicare for All would save the taxpayer 1,5 trillion USD). You should watch it

      The cost savings will ALSO take care of the currently uninsured or underinsured – the savings should be at least high enough to add them without extra costs to the system:

      the uninsured do get _some_ treatments in the U.S. . But often it is too little too late – and then in the most costly form imaginable: in the ER. Society gets the worst of both worlds so to speak – the bad healthcare outcomes and the high costs.
      Also consider the costs for the hospitals trying to get at least partial payments from the patients – again administrative costs that do nothing to make the DELIVERY OF CARE better.

      I read that 65 % of the healthcare expenditures of the U.S. come already from the government. That includes of course Medicare. The most costs for healthcare come in the last years of life and Medicare covers people from the age of 65 on – so it is not as bad as it sounds – and people paid into it so it is not a “handout” from the government.

      but those 65 % pay for overpriced services. Too costly drugs. And unnecessary red tape.

    • TheRealNews had a numbers cruncher (economist) and a Harvard doctor on – speaker of a group of doctors for single payer. (Medicare for All would save the taxpayer 1,5 trillion USD). You should watch it, it is not long and on the site of TRN they do not only have the embedded youtube video – they usually also have transcripts if you are pressed for time.

    • What was the fiscal plan for the war in Afghanistan, Iraq – or the recent tax cut for the rich and highly profitable businesses ?? What was the fiscal plan to bail out the banks or to compensate for the costs of the economic crisis caused by the banksters (read profit-chasing Capitalists).

      Every other nation can pull off single payer healthcare for less costs per person than the U.S. and with better outcomes.

      There are two major cost savers: drug prices and streamlined admin: the latter may not play out right away (in the transition phase hospitals and doctors STILL have to deal with the private insurers. And the increasingly unnecessary red-tape-administrators will have to be retrained (the MfA proposals have considerable budgets for that).

      But the private and public agencies could negotiate the drug prices RIGHT AWAY (and even together to make things at least transparent and streamlined there). – Big Pharma hates the idea – they would have the situation in the U.S. like in all other countries then.

      Now the public agencies are not even allowed to negotiate. The private insurers chose not to have a battle of giants with Big Pharma. They agree to peacefully co-exist – and rather take it out on the consumers/patients and they extract money from the government.

      That is typical when you have oligopolies on both sides. Sure, large corporations will usually squeeze their suppliers. But when the few large suppliers are equally powerful and the details are complex, so squeezing them could turn out to be a lot of work in the complex “market” – they will abstain from the hassle and will find other cozy arrangements.

      There might be some transition costs – considering the current dysfunction and the expertise of the big for-profit players to game the system (currently with the help of legal bribes for politicians). Or maybe the U.S. is simply incapable of doing it right …. as only wealthy nation on the globe.

      The MfA proposal of Sanders is a compromise already (only till age 25 and from 55 on in the first round). But that means there is a transition phase, and they can get the bugs out of the system before all the country is covered. And there is time to train more nurses and to start training more doctors.

    • half the people support this? Must be the same half that Romney talked about, the half that has been sponging off my half their entire lives. Or is could just be ignorant kids who have never had much expected of them. so they offer nothing

    • medicare for all will cost 5 times what the defense costs are.. and yeah, we do need to defend ourselves
      the last time we balanced a budget was when Next Gingrich was speaker of the House and Slick Willy was president…. who is gonna pay for it, when we cant even pay for obozocare?

    • +mugenjin205 It makes it seem like medicare for all may not be cheaper for every American due to taxes… but thats false,

      Also it makes it seem a lot more confusing than it is… basically if you cut out insurance companies.. this country saves trillions on healthcare. no hidden costs. taxes are minimal compared to what we currently pay private insurance.

  3. The only lingering question I have is: how long will the Washington Post continue to lie about Medicare-for-all? And follow-up question: who still trusts the Washington Post about anything?

    • It was not even too bad – compared to former attempts to muddy the water – Very quickly glossing over the graph with the healthcare costs. Yes technically Sanders is not right – not all countries pay 50 % of the U.S. expenditures per capita – some pay 56 % (Germany at the higher end of the average for a wealthy European country) – while others pay only 48 or 49 %. see my comment where I list the details shown in the slide at 2:44

      and then there is expensive Switzerland with also a private insurance system – and still ONLY 78 % of the U.S. per capita expenditures.

      WaPo would not even explain why it is that there is on principle no free market possible for healthcare, the various reasons why it is such a terrible fit for the free market and why the profit motive is toxic with a service like healthcare.
      And how every other developed nation realized that they cannot leave it to the private insurers between 1950 and 1970. (Well not the Swiss – they pay for it … at least their system is GOOD).

  4. The crux of the problem is that Americans want great benefits but are completely adverse to any kind of tax increase which could affect them. America revolted from Britain over taxes. They nearly started a civil war because of the whisky tax imposed during the Washington administration. I’m for Medicare-for-all, but the American aversion to taxes needs to be addressed for the system to work

    • It was a sneaky way to pose the question: “Would you accept a tax to fund healthcare, when you pay zero for private insurance and will have no (relevant) payments ever when getting treatment ?”

      WaPo and other mouthpieces (on TV for instance jack Tapper who also played dumb) have been called out – last time they announced the increased government costs (partially coming from new taxes) while conveniently “forgetting” that other costs (private insurance, co-pays) would fall sideways. And that even the Mercato study (that is very conservative regarding the savings potential) said there would be 2 trillion in savings possible over 10 years.
      Or in other words – if the system goes on like now it would cost 2 trillion more.

  5. 2:44 What countries spend the most money annually on health care per person in USD
    US 10,224 and Switzerland USD 8,009 = 78,34 % of the U.S. expenditures (both with private insurers * )
    56,03 % Germany 5,728
    53,90 % Sweden 5,511
    53,21 % Austria 5,440
    52,86 % Netherlands 5,386
    47,95 % France 4,902
    47,20 % Canada 4,826
    46,69 % Belgium 4,774
    46,14 % Japan 4717

    Source: 2017 Kaiser Family foundation analysis of Organisation for Economic Co-operation and Development data and 2017 U.s. National health Expenditure Data

    _I added the percentage_ to the graphic – how many percent comparged to the U.S. expenditures.

    * the only two countries where insurance is left to private for profit insurance companies. Switzerland has high cost of living, they pay good wages overall and have also the reputation of paying medical staff well (even considering the higher wages in general) They have everyone covered, and the system has a very good reputation.

    _Even expensive Switzerland beats the crap out of the U.S. when it comes to healthcare._
    The Swiss have the referendum system and they at least have some degree of control over the private insurers. That said – single payer is the way to go.

    It should be noted that it means: all that is spent in the country divided by number of people – now that means that the U.S. includes people that do not even have insurance and do not get healthcare or only insufficient care.

    Many wealthy countries of Europe are missing or Australia. But the picture is not that different from the World Bank 2014 data I know – Germany is at the higher end of the average – you can expect almost all wealthy !! nations to be in that range.

    It would be interesting where the U.K. is – they deliver most of the care in the country via the NHS which has been massively defunded over the last 10 years.

    in 2014 (data World Bank) they had only slightly higher expenditures than Japan.

  6. “…the idea [of supporters of single payer is] when the government – not _competing_ companies – run the system, government can do a better job …” – so WaPo staff has not yet realized that there is NO COMPETITION happening in the U.S. – Which is not surprising: a free market can only exist when the all actors in the game have about the same power. That is not at all the case with healthcare, not even close.
    Nor is it possible that even well meaning regulators could protect them.

    The for profit players will always be ahead 3 steps of patients and regulators.

    Most nations figured that out in the late 1940s, it took Canada and Australia a little longer ….

    If- IF – the profit motive plays are role when providing goods and services, there must be a free market and customers must have a choice – including the CHOICE NOT TO BUY at all. Else the desire of for-profit companies to make the highest possible profit will inevitably lead to exploitation of the consumers.

    What makes free market impossible with healthcare (insurance and delivery of services) ?

    The complexity of the system and the service, the impossibility to delay treatmentor to prepare for what you will need in the future (Will you need cancer treatment ? Which one ? hip replacement ? Emergency surgery because of an accident ? Asthma ? Diabetes ? ) – it will be leveraged against the consumers.

    _With healthcare not buying at all is not an option._

    You can do that with most other goods and services. Or work around even if it is inconvenient. Live with family if you cannot afford rent, have a simple phone, no smartphone, delay repairing the car, ride a bike, lend a car from a family member or take the bus. It will not cost your life.

    Treatment and administration (billing !) are very complex, it is often about life and death.  And to make matters worse those costs can be the highest expenditures a regular person will ever have. Higher than buying a home.

    • reimbursement rates?

      excess patients?… with 0 out of pocket to make them careful on prevention/consumption of care?

       the results from above…attracting or scaring off future/current doctors/medical innovation/invention?

    • We have tried free enterprise in health care and capitalism has produced monopolies that reduce access to care and high prices. Utter failure of capitalism. Doctors, hospitals and other providers are not for increase competition and free markets because it will reduce their income.

  7. I feel like some of those questions should have been asked better. Like the one on raising taxes should have mentioned that it would be a fraction of premiums and eliminate costs at the point of use.

  8. 1:33 resp. 2:30 2 studies: Urban Institute and Mercato Center (libertarian, Koch Brothers) estimate for single payer 32 / 32,6 trillion USD over the course of 10 year (let’s say an average of 3,3 trillion per year). WaPo also: the U.S. already spends NOW: 3,5 trillion USD (the people that are currently not or underinsured may still show up at the spending side – either out of pocket or paid on their behalf * )

    In other words – it would cost LESS than now even if one disregards that costs are going to rise disproportionally in the current system (and Mercato made very “conservative” assumptions when it comes to the potential of cost savings).

    * one can expect many of these cases to have HIGH costs because they might delay the more trivial treatments – but not when they get seriously ill – and then it tends to get costly).

  9. 2:29 The U.S. does spend DOUBLE compared to other rich countries – outlier Switzerland has a system that relies on private insurers like the U.S. – it shows in the expenditures per person of USD 8,000 as shown in 2:44 – the claim made in 2:48 is not correct – All other nations are between 4,700 and 5,700 USD * – versus 10,2040 of the U.S. – most wealthy nations are in that range (maybe up to 6,000)

    all numbers for 2017 – Keiser Foundation

     I know only the U.S., CH, Taiwan (costs not comparable, much younger population , lower standard of wages), maybe Singapore, that use mainly private insurers.

    All other countries (not only those shown with the costs) have AT LEAST a very strong (if not dominant) public non-profit insurance agency. That agency has contracts with for-profit and non-profit providers and companies. The more non-profit (escpecially when it comes to large providers like hospitals) the more cost-efficient.

    The Swiss insurance companies are at least better regulated than in the U.S., they cannot kick people off insurance, the premiums are the same for all people in the same age group (so no pre-existing conditions, I assume that means also no healthcare questions), denial of treatment would not fly.

    Lower income people get a subsidy (that is regulated per Kanton). And at least one Kanton offers a public option for insurance. With all these provisions – Switzerland still has costs of USD 8,000 per person per year.

    Difference: Everyone is covered, going broke over medical bills is unknown. the insurerers do not have a cherrypicked pool (in the U.S. plus 65 year old and people on disability are in the public system. 10 % of patients cause 90 % of costs, and old age is a major factor – so the private insurers already have a huge advantage because the most expensive group is covered by Medicare / Medicaid).

    Australia has a 2 tier system: Basics and the expensive treatments (hopsitals) are under the public coverage, but specialists, dental etc. is covered by “private” insurannce. That can be considered a gift to the insurance industry and high inomce people (their general tax helps fund the public system, which can be somewhat defunded if it does not cover ALL that is relevant for modern medicine. The private insurance will be somewhat overpriced but very wealthy people will still do better. It makes the _healthcare_system more expensive for everyone.

    And there is MORE CHANCE that doctors can only offer _private_ serivces. They will have enough patients, since the law makers carved out a niche for private. It is also possible to somewhat defund the public system which will cause wait times with the doctors and spcecialist that do accept public insurance coverage. – so people that want acceptable wait time will be fored to buy overpriced insurance.

    Plus there is the incentive to “milk” the contracts of patients with good insurance coverage (overtesting, keeping them longer in the hospital). In a system where all people get the same treatment that is not done – it would become too expensive and the public agency would stop treatments and tests that do not have value (in avoided costs, better diagnosis, preventive effect etc).

    In countries where the public insurance is comprehensive and reasonably funded wait times (for specialists, for elecitve surgery, in the ER) are acceptable. This is about funding and having the units spread out over the country. There a private doctor has to offer real value (a capacity in the field, offers a spceciality like accupuncture, really good with children, makes concessions regarding open times, ….). Acceptable waiting times, or being one of the few specialists in town will not suffice.

  10. The single largest problem is most people, from workplace plans that covered 100.percent, to Medicare, believe that health care has always been ” free “, or if at a cost, ” somebody else ” pays for it. Can’t move forward to anything else until that mindset changes.

    • What world do you live in? The vast, vast majority of Americans have employer based plans that are not covered 100%. Maybe 20 yrs ago but not now. We mostly live in an 80/20 world, with rising out of pocket maximums. The rest of us either have junk plans or no plans at all. You must live in a bubble

    • Michael Mills The same world we are all in, sir. It’s clearly obvious that health care now has everything to do with who pays for it. And the people 30 years ago who had 100 percent plans, and are now on Medicare, did have a mindset, shared by many, that ” somebody else pays for it.”, because nothing ever came out of their pocket. And you are correct, the costs keep rising. I thought the ” Affordable Care Act” and other plans were to address that.

    • Michael Mills Oh, by the way….Sanders, Warren. Harris and Booker already have 100 percent health care, paid by somebody else ( us, the taxpayers ) from being in the US Senate. So do they really care ?

  11. Wow this video makes medicare for all seem so confusing….
    Basically you SAVE lot of money by not giving it to private insurance… and you have to spend a little more in taxes to cover medicare for all.. But the total sum is cheaper for every American AND the country. Everyone wins with medicare for all (besides insurance companies).

  12. This is NOT “rocket science”. I have had FREE HEALTH-CARE in soon 65 Yrs. In my country. Ought to be clear, even for You, IT IS THE BEST WAY. …………..

  13. Eliminate those out of pocket expenses because your taxes are going to go through the roof…you won’t have anything in your pocket. Oddly enough, single payer was tried and failed in Bernie Sanders State of Vermont…the cost was unaffordable. Medicare for ALL is Medicare for No One! Your taxes are going to go through the roof, the government will determine if a procedure will be covered, it’s aged adjusted, so the older you are, the less care you will get, Canadian waiting times is huge and doctor shortages are inevitable. What sounds good on the surface is in a train wreck underneath. There is a reason people come to America to receive their healthcare, aka..Mick Jagger at the age of 75 was too old to have the procedure completed England, hence, he had it performed in NYC. Finland a few weeks ago collapsed and they sighted the cost of their Single Payer Healthcare Program. Without competition, you will not be able contain cost and you will lose innovation. Private markets are the solution, not more government.

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