M4A vs Public Option

[Rhea]

Compare and contrast “Medicare for All” and “Public Option”
I’d like to assume for the sake of the discussion that there is legislative will to fix Medicare/Public Option to make each optimized (not perfect, optimized).

I am interested in hearing opinions on why one is better than the other or ow one might flow into the other, and what changes are necessary to get your support.

 

[Rhea]

My initial opinion that sparks this query:

I feel like a well defined “Public Option” would quickly become very popular and provide everything we hoped for, possibly including what is hoped for from M4A - true humane minimum access to healthcare for all. I don’t look for Caddillac, just a humane baseline.

 

[Metaphor]

An Australian perspective here. Australia has had universal health cover from 1984 under Medicare.

I don't know if there are Constitutional issues to an Australian or British style national health service/insurance, but a 'public option' seems like a very strange option, if you had the choice between M4A and a public option.

A public option still requires payment, on a yearly basis, from private citizens. It puts the onus on individuals to navigate their health insurance, and face fines if they don't buy any. It doesn't do anything to save the interests of private health insurers, because as soon as you have a government offering, the government's offering chips away at the competitiveness of other health insurers because the government option does not have to be profitable to the government. Alternatively, if the government option takes away all the 'difficult' customers from the private insurance market, then it's simply a large, permanent gift to the private insurance market.

A public option still ties health care coverage to employment, because most people won't be on 'the public option'. Universal health care coverage is never universal, but it's even further from universal if you have to change your affairs every time you change jobs or fall in or out of employment.

A medicare for all option does not have to ban private health insurance. Australia has private health insurance providers.

A very large problem with Medicare is that since the government sets the prices, it can freeze them at an arbitrary and unsustainable level (for providers of medical services), and either quality has to fall, or co-pays have to be introduced or increased. It's possible to see a GP in Australia without getting charged (the session is 'bulk billed' to the government), but you have zero chance of seeing a specialist of any kind without a significant co-pay, or without waiting months and possibly years, to see a specialist as an outpatient in a public hospital setting.

 

[Angry Floof]

Compare and contrast “Medicare for All” and “Public Option”
I’d like to assume for the sake of the discussion that there is legislative will to fix Medicare/Public Option to make each optimized (not perfect, optimized).

I am interested in hearing opinions on why one is better than the other or ow one might flow into the other, and what changes are necessary to get your support.

At this point, I'd be happy with either being implemented. But I favor M4A. I want to live in a society where we take care of everyone. Yes, let the billionaires have Medicare. Why not? They're citizens, too. And health care is an area where inequality is most painful. M4A would remove any separation in people's minds between the rich and the poor. Want to unify our country for real? UBI and M4A with no exceptions on eligibility would cultivate the idea (realization) that we're all in this together and no one is unworthy of basic necessities. Republicans will get over it eventually.

 

[laughing dog]

A public option does not need to require payment by individuals - that is a myth.

If Medicare for all means the current medicare for all and no private health insurance, then I would be against it because current Medicare is not that good compared to plans available to current workers.

 

[T.G.G. Moogly]

I use a Medicare advantage plan, which is basically Medicare with a private option. So far it's worked out great. Yes, it's essentially M4A but it seems to me that the dollars spent toward my health are better managed than if I purchased a standard supplement which would cost thousands more dollars a year. Time will tell whether I made the right choice but so far so good.

I could certainly be wrong but doesn't it make more sense to have government subsidized medical providers compete with each other? Isn't that the purpose of advantage plans? Isn't that what they do?

If we're assuming that M4A would do away with any and all financial concerns on my part related to medical treatment then it's a no brainer, M4A is the deal. Just so M4A doesn't end up like LA public transportation.

 

[Swammerdami]

Private health insurance has three huge financial disadvantages:
(1) Insurers are motivated to deny care whenever they can, regardless of medical advice or risk/benefit assessments.
(2) Although eager to reduce the price paid for healthcare in the specific, insurers benefit from higher prices in general, since their "cut" is generally a percentage of the total pie. This is the antithesis of free-market price discovery, since both buyer and seller of medical services want higher prices!
(3) Insurance claims adjusters and the hospital clerks whose full-time job is to interact with insurers are an unproductive drain on society. Imagine if these many hundreds of thousands of insurance workers had instead trained to be nurses!

in my version of a "public option" the government would provide, or pay for, medical services directly for those who chose the option. The government would be in competition with private insurers, thus mitigating some of the disadvantages listed above. Medicare doesn't accomplish this.

That the government can provide quality healthcare itself is demonstrated by Veterans' healthcare. Veterans typically rave about their healthcare; surveys show it is at least as good as that provided by most private insurers. Well-advertised reports to the contrary are — as usual in post-rational America — due to Republican exaggerations and lies.

Subsidizing insurance, whether public or private, for low-income people is a separate topic. I support taxpayer-funded healthcare for everyone.

 

[TV and credit cards]

I like a public option as a toe in the water approach toward M4A. Should you choose this option, your’s and your employer’s contributions would go to gov. My public option would be a military style service: you get what you need when you need it. Crybabies get a packet of Motrin.
I would consider disincentives for unhealthy lifestyles. That is, if you have the means to eat healthy and choose not to, you should pay no small share of the cost for any related health issues. Further, employers would pay into employee healthcare coverage based on total hours worked with penalties for hours over forty. People should have the opportunity to not only eat healthy but the time to exercise.
To subsidize costs, I would tax dairy. This crap should be taxed like tobacco. And to a lesser extent, meat.

 

[J842P]

A public option does not need to require payment by individuals - that is a myth.

If Medicare for all means the current medicare for all and no private health insurance, then I would be against it because current Medicare is not that good compared to plans available to current workers.

Well, it does not mean that. It is much more expansive.

Regardless, I think both options aren't the best, but M4A is much better. I suspect a public option will simply become a dumping ground for the sickest and poorest members of society. It will likely fail because of this, and it will set back healthcare in America for decades.

Ideally, I think a national health service like the NHS is the best system.

Regardless, the ultimate arbiter of these things is the will of the electorate and polity. Any system can become corrupt and inadequate if it is allowed to deteriorate without democratic pressure to keep it working. The problem is the American polity - it has been brainwashed for the last 50 years by an extremist right-wing ideology, which is present in both the Democratic and Republican parties, which says that government can never do anything, and that laissez-faire capitalism is the optimal solution to all of societies problems.

Except for the military, which should be funded like an open spigot.

 

[Jason Harvestdancer]

Health Insurance exists at the intersection between two of the most highly regulated sectors of the economy - healthcare and finance. There are many problems with it as a result.

I would prefer a dual system - one entirely public, one entirely private. Before you say "wait that is what we already have" re-read my first two sentences and realize that isn't what we already have.

Let people choose which one of the two systems they want to be in.

 

[T.G.G. Moogly]

I like a public option as a toe in the water approach toward M4A. Should you choose this option, your’s and your employer’s contributions would go to gov. My public option would be a military style service: you get what you need when you need it. Crybabies get a packet of Motrin.
I would consider disincentives for unhealthy lifestyles. That is, if you have the means to eat healthy and choose not to, you should pay no small share of the cost for any related health issues. Further, employers would pay into employee healthcare coverage based on total hours worked with penalties for hours over forty. People should have the opportunity to not only eat healthy but the time to exercise.
To subsidize costs, I would tax dairy. This crap should be taxed like tobacco. And to a lesser extent, meat.

Advantage Plans head in this direction because they are less expensive. They still cost money and people are still getting filthy rich on your dime but what else is new, really. Over my lifetime I've paid tens of thousands if not hundreds of thousands of dollars for car, home and life insurance and have never recouped a dime. It sucks but that's life.

Hoping that the population generally will realize healthy diet and lifestyle is simply never going to happen, not even with disincentives.

Health Insurance exists at the intersection between two of the most highly regulated sectors of the economy - healthcare and finance. There are many problems with it as a result.

I would prefer a dual system - one entirely public, one entirely private. Before you say "wait that is what we already have" re-read my first two sentences and realize that isn't what we already have.

Let people choose which one of the two systems they want to be in.

Societies decide what they want. Private vs public is really a moot distinction, particularly in the long term.

 

[laughing dog]

A public option does not need to require payment by individuals - that is a myth.

If Medicare for all means the current medicare for all and no private health insurance, then I would be against it because current Medicare is not that good compared to plans available to current workers.

Well, it does not mean that. It is much more expansive.

That depends on who is doing the talking. Medicare for All is a real misleading term if it is more expansive.

 

[southernhybrid]

I have mixed feelings, but I am a strong supporter of UHC. I was on traditional Medicare for about five years. I never bought a supplement because if my husband and I both had a supplement plus Part D ( the part that covers drugs ) our total coverage would have cost us about 700 per month minimum. The supplements, which only cover the 20% of Part B ( out patient coverage ) increase in price as one ages. I worked with a lady who was in her 80s. Her supplement was 350 per month and the only reason she needed to keep working was because she wanted that supplement.

The drug plans are all provided by private insurance companies, and all drugs have copays. Some copays are tiny. For example, this year I only paid 10 dollars for a. 3 month supply of my most important drug. There are many drugs that aren't covered at all by Medicare, unless you beg and can get your provider to beg for you. That way, you can sometimes get a price reduction on the drug.

Supplements are also provided by private insurance companies and they only cover the 20% of outpatient things that M'care covers. They don't cover anything that M'care doesn't cover. Traditional M'care doesn't cover the drugs that we take at home. It does cover some out patient injections. Most older adults will need to take at least a couple of Rx. drugs as they age. Supplements also cover the hospitalization deductible that M'care demands.

I love my Advantage Plan. It only costs the two of us about 300 dollars per month. There are some deductions for hospitalization, but unless you pay for a supplement ( also private insurance plans ) you will have that same deductible My copay for a providers visit in network is only 5 dollars, while an in network specialist is about 35 dollars copay. Out of network providers cost a little bit more. My AP also covers dental, vision and hearing at no extra cost to me. Traditional Medicare doesn't cover those things at all. So, imo, private insurance plans, which are subsidized by the federal government are much better for me compared to traditional M'care.

If you are very poor, you will qualify for M'caid as your M'care supplement. Some doctors won't take M'caid since it tends to pay less than traditional M'care. Some doctors don't even take M'care, since it usually pays less than most private health insurance. If you are not poor enough to get M'caid, but fairly low income, you can sometimes get your Part B covered by M'caid. That was passed in the 1980s.

The problem that I have with M4A, is that people are under the false impression that it's all free. Bernie Sanders means well, but when he said that M4A would be free and that it would cover dental, vision, drugs, long term care etc. he never explained how the country would be able to afford such coverage. I've read numerous articles explaining the over all cost and none of them seemed to find a reasonable way to pay for all of those things. We already have M'caid for those who are poor and have never paid into Medicare for at least 10 years, the minimum number of years to qualify. I've had many patients on M'caid when I was still working. While it was sometimes difficult to find a provider who accepted M'caid, all of my patients were able to get the care they needed. They were just limited to the smaller number of providers who accept that payment.

There is also a huge amount of fraud and abuse in Medicare. When I started working in home health back in the late 70s, every single bill we sent was reviewed and approved or denied by M'care. That stopped a long time ago due to the overwhelming number of people who received home health. We would need to hire an army of Medicare reviewers to check every bill. Private insurance companies are usually stricter about reviewing bills and making sure that the charge was warranted. I've seen Medicare abused by companies I've worked for and by providers who gave me care. For example, I had a tele visit with my NP earlier this year. The group billed M'care over 200 dollars, although M'care paid about 100. The worst abuse I've read about lately, is providers charging for an extensive visit when a person has a COVID test. Patients usually don't even spend time with the provider when they get a COVID test, but some providers are billing for a 400 dollar visit, in addition to the test. M'care pays about half of that. By receiving less money, the provider or agency is able to write off the rest as a tax loss. It's crazy. Providers don't work for M'care. They just provide care and bill M'care, but in my experience, the majority of them, including so called non profits, have a tendency to over bill.

I'm giving all these details because I don't think most Americans have a clue about how M'care works or bills. At least not until they are on it. I worked in several agencies that provided care to M'care recipients. I worked for about ten years as a QA/UR nurse so I am very familiar with hiow these companies over bill or over utilized.

So, how do we change this without causing total chaos? Certainly, more people could be hired to review M'care bills, but I'm not sure how many would be needed if the entire country received M'care. Why is my Advantage Plan so much better than traditional M'care? One of you said that these companies are getting wealthy off of the care we receive. But, what about all the doctors, home health and hospice agencies, hospitals, etc. that are getting wealthy from M'care? Actually, a lot of hospitals claim they would have to shut down if all of their patients were on M'care because it pays less than private insurance. I'm just trying to explain how complicated it would be to change from what we have now, to M4A.

Finally, there's the fact that a large percentage of Americans like the private insurance that they have now, regardless if it's from their employers or if it's from a Medicare Advantage Plan. How do we convince most everyone that we need to dramatically change our system? Why not just find a way to provide decent. health care for all Americans. The poorest already get M'caid. The disabled and older adults already have M'care. It's those who work but either aren't offered insurance or find that the insurance is unaffordable who need help. A public option might be the best thing, but have we even been given any details regarding how it would work, and how much it would cost. M'care might sound very cheap to those who are still working, but if you're living on SS with a limited amount of savings, even 300 dollars a month for a couple can be very expensive. My husband and I are lucky to have a lot of savings and no debt, otherwise, that 300 per month would be expensive. We are healthy so we don't need much care, but some people need lots of care. It's complicated.

And, btw, Part B cost me 105 dollars a month six years ago, when I started on M'care. In 2021 it will cost me a little over 148 per month. It keeps going up. The only free part of Medicare is Part A, which covers hospitalization with a fairly large deductible, home health ( short term skilled nursing visits, usually post hospitalization or for a skilled nursing procedure ) and hospice ( end of life care )

Is anyone else here as familiar with all of these things as I am? If so, I would love to see your opnion on this, as well as any ideas from anyone as to how we could solve all of these potential problems. I don't want to lose my Advantage Plan after being on traditional M'care, but a public option, assuming the cost would be affordable, sounds like it might be a good idea. Something drastic needs to be done. That's for sure.

 

[T.G.G. Moogly]

There is also a huge amount of fraud and abuse in Medicare.

I see that as the biggest problem. If another provider is able to clean up the fraud or incentivize the care then that provider should get the business because they are providing a better product. Within medicare there are no incentives to do a better job than the next person. Quite the contrary, there is plenty of incentive to cheat the system, at least that's my observation. Perhaps reforming medicare is to treat it as a provider of last resort. That way everyone is covered but there are incentives to control costs and improve quality, concerns medicare lacks.

 

[ZiprHead]

The problem that I have with M4A, is that people are under the false impression that it's all free. Bernie Sanders means well, but when he said that M4A would be free and that it would cover dental, vision, drugs, long term care etc. he never explained how the country would be able to afford such coverage. I've read numerous articles explaining the over all cost and none of them seemed to find a reasonable way to pay for all of those things. We already have M'caid for those who are poor and have never paid into Medicare for at least 10 years, the minimum number of years to qualify. I've had many patients on M'caid when I was still working. While it was sometimes difficult to find a provider who accepted M'caid, all of my patients were able to get the care they needed. They were just limited to the smaller number of providers who accept that payment.

Sorry, but Bernie's plan is still cheaper than what we pay now. The Koch brothers funded a study to prove M4A would be more expensive. Too bad for them the study proved just the opposite.

'Medicare-for-All' program could cost $32 trillion but may also save $2 trillion

The PDF of the study.

 

[Tharmas]

Is anyone else here as familiar with all of these things as I am? If so, I would love to see your opnion on this, as well as any ideas from anyone as to how we could solve all of these potential problems. I don't want to lose my Advantage Plan after being on traditional M'care, but a public option, assuming the cost would be affordable, sounds like it might be a good idea. Something drastic needs to be done. That's for sure.

I have been on traditional Medicare for seven years. I agree, it is NOT free, regardless of what people think.

My part B payments, deducted from my Social Security, are $148.50/mo. My supplemental, which is a Cadillac plan, costs me $230/mo. It does go up every year, by a few dollars. All told it’s about 30% of what I was paying when I had to pay for private insurance without an employer kicking in. Of course, without the employer benefit of health care, I got paid somewhat more.

I have no “in network” or “out of network” to worry about, no co-pays, and it’s fully portable from state to state and in foreign countries (which is good because we like to travel). I’ve looked into Advantage plans and they have real benefits, but so far I’ve stuck with traditional.

Part D, prescription drugs, is a rip-off program designed by George Bush, with support from Congressional neo liberals, to benefit insurance companies. Co-pays can be extremely high, depending on the drug (yes some are quite cheap) as are premiums.

I suffer from a fairly rare, generally lethal, genetic disability which is treatable to a degree (they can’t cure it but they can keep it from progressing). Treatments, which have only been developed in the last two to three years, cost in the neighborhood of $500,000 - $750,000 per year. So far I have been able to take advantage of these programs, and haven’t had to pay a cent. Mostly that’s do to the various parts of Medicare and my supplemental, although the last final amount is provided by a charity set up by the bio-tech firm that created the treatment.

I will add that when I lived in Canada I loved their health system. I wonder if they suffer from fraud?

 

[ZiprHead]

There is also a huge amount of fraud and abuse in Medicare. When I started working in home health back in the late 70s, every single bill we sent was reviewed and approved or denied by M'care. That stopped a long time ago due to the overwhelming number of people who received home health. We would need to hire an army of Medicare reviewers to check every bill. Private insurance companies are usually stricter about reviewing bills and making sure that the charge was warranted. I've seen Medicare abused by companies I've worked for and by providers who gave me care. For example, I had a tele visit with my NP earlier this year. The group billed M'care over 200 dollars, although M'care paid about 100. The worst abuse I've read about lately, is providers charging for an extensive visit when a person has a COVID test. Patients usually don't even spend time with the provider when they get a COVID test, but some providers are billing for a 400 dollar visit, in addition to the test. M'care pays about half of that. By receiving less money, the provider or agency is able to write off the rest as a tax loss. It's crazy. Providers don't work for M'care. They just provide care and bill M'care, but in my experience, the majority of them, including so called non profits, have a tendency to over bill.

That (bolded) is not fraud. That's typical medical insurance billing. The provider bills their standard rate. When the provider agrees to accept medicare it agrees to the medicare reimbursement. The bill would also include the portion you are required to pay, if any (deductible and/or copay). The provider gets the same information as you, then bills you for what medicare tells them they can bill you. The same as commercial insurance plans. I worked for well over ten years in insurance reimbursement for a major hospital system, sometimes working directly with Medicare personnel themselves during audits.

BTW, here's a list of major fraud and abuse enforcement cases that have been settled.

Here's another list

 

[ZiprHead]

An interesting article I just ran across.:

We Asked Prosecutors if Health Insurance Companies Care About Fraud. They Laughed at Us.
To protect their networks and bottom lines, health insurers don’t aggressively pursue widespread fraud, making it easy for scammers. Then they pass the costs off to you.

It seems counterintuitive. Escalating health care costs are one of the greatest financial concerns in the United States. And an estimated 10% of those costs are likely eaten up by fraud, experts say. Yet private health insurers, who preside over some $1.2 trillion in spending each year, exhibit a puzzling lack of ambition when it comes to bringing fraudsters to justice.

Like much of what happens behind the scenes in the health insurance industry, the insurers’ tepid response to fraud typically goes unexamined. But this year, I dove into the crazy tale of a Texas personal trainer who didn’t have a medical license but was easily able to claim he was a doctor and bill some of the nation’s most prominent health insurers for four years — walking away with $4 million. David Williams, who was also a convicted felon, discovered stunning weaknesses in the system: that when he applied for a National Provider Identifier, the number required to bill health insurance plans, no one would verify whether he was a doctor; and that when he billed insurers as an out-of-network “doctor,” they wouldn’t check either and would keep paying him even long after they learned of his fraud. He was later convicted of health care fraud and is now in federal prison.

Williams’ scam raised the eyebrows of even my most jaded health care sources. It prompted a half-dozen Democratic senators to write to the federal agency that administers the NPIs and ask what it was doing to plug the “loopholes.”

But it also got me thinking: As journalists, we are peppered with press releases touting the fraud enforcement successes in Medicare and Medicaid, the government health plans. The federal Department of Justice and state Medicaid Fraud Control Units file thousands of criminal and civil cases a year (and still are accused of not being as aggressive as they could be). Clearly, their goal is to let folks know they will be prosecuted.

But we rarely hear about the fraud enforcement efforts of private health insurers. These companies manage the plans of about 150 million Americans who get their health benefits through their employers. They’re sitting on a massive trove of claims data that can help identify scammers, and problems are routinely flagged by their members. And experts, including investigators who once worked for the insurers, tell me there’s rampant fraud against the private plans.

The bottom line is significant: If a con artist, or a corrupt medical professional, makes off with health care dollars, those losses are not necessarily the insurers’. They will be passed on to people covered by the plans in the form of higher monthly premiums and out-of-pocket costs as well as reduced benefits.

 

[southernhybrid]

There is also a huge amount of fraud and abuse in Medicare. When I started working in home health back in the late 70s, every single bill we sent was reviewed and approved or denied by M'care. That stopped a long time ago due to the overwhelming number of people who received home health. We would need to hire an army of Medicare reviewers to check every bill. Private insurance companies are usually stricter about reviewing bills and making sure that the charge was warranted. I've seen Medicare abused by companies I've worked for and by providers who gave me care. For example, I had a tele visit with my NP earlier this year. The group billed M'care over 200 dollars, although M'care paid about 100. The worst abuse I've read about lately, is providers charging for an extensive visit when a person has a COVID test. Patients usually don't even spend time with the provider when they get a COVID test, but some providers are billing for a 400 dollar visit, in addition to the test. M'care pays about half of that. By receiving less money, the provider or agency is able to write off the rest as a tax loss. It's crazy. Providers don't work for M'care. They just provide care and bill M'care, but in my experience, the majority of them, including so called non profits, have a tendency to over bill.

That (bolded) is not fraud. That's typical medical insurance billing. The provider bills their standard rate. When the provider agrees to accept medicare it agrees to the medicare reimbursement. The bill would also include the portion you are required to pay, if any (deductible and/or copay). The provider gets the same information as you, then bills you for what medicare tells them they can bill you. The same as commercial insurance plans. I worked for well over ten years in insurance reimbursement for a major hospital system, sometimes working directly with Medicare personnel themselves during audits.

BTW, here's a list of major fraud and abuse enforcement cases that have been settled.

Here's another list

Again, I must not have been clear. I never said that was fraud. I was only making the point that medical providers bill a lot more than they receive in order to get the tax break. No. It's not fraud or illegal. That isn't what I was talking about when I mentioned fraud. Fraud is billing for something that was never provided and that happens a lot with Medicare billing. Abuse is when you make it look as if someone needs a certain type of care or procedure etc. when in fact, they really don't. For example, when I worked in home health, one company where I worked always pushed the nurses to make more visits than were medically necessary. This because such a huge problem that M'care changed the way it paid. Instead of paying for each visit, they paid a lump sum based on the very long assessment completed by the nurse on her initial visit. So, what did these companies do? They gave the patients fewer visits than they needed so they could make a higher profit. M'care can't keep up with all of this abuse. Abuse of the guidelines is more common than fraud. But the last time I read about fraud and abuse in M'care, it was estimated to be over 400 billion dollars a year. That's what I'm talking about. How do we make it affordable while getting rid of the fraud and abuse.

 

[crazyfingers]

Compare and contrast “Medicare for All” and “Public Option”
I’d like to assume for the sake of the discussion that there is legislative will to fix Medicare/Public Option to make each optimized (not perfect, optimized).

I am interested in hearing opinions on why one is better than the other or ow one might flow into the other, and what changes are necessary to get your support.

I looked at the title M4A vs Public Option and was momentarily confused. M4A is a file format for audio files akin to MP3, AAC and Wav. I've been converting audio files today to put on my USB stick for the car.

Never mind. I think that M4A would be best for the country as a whole. Those who want some premium extras can buy them as they do in other countries.