Not because I oppose it in principle, but because I find it very difficult to believe that the US would be able to provide decent care to all Americans if we adopted Medicare for All, I oppose it for practical reasons.
We currently provide good care for all but twenty million people under our combination of ...
- Government provided health care, primarily for the military and veterans, provided in government-run clinics and hospitals
- Government employee provided health care administrated by both government and private health insurance companies largely from private providers
- Medicaid, government-provided insurance for health care from the private health care providers for low-income families
- corporate self-insurance administered by the private health insurance companies
- employer provided group insurance purchased from private, primarily for-profit insurance companies
- Medicare, government-provided insurance for health care from the private health care providers for seniors
- individual health insurance purchased from private, primarily for-profit insurance companies with lower incomes receiving partial ObamaCare subsidies
... listed from the lowest to the highest cost per capita for those covered.
Medicare has a high cost per capita because it covers seniors who require a large amount of health care. Medicare has a small portion of the insurance component supplied by private, for-profit insurance companies. But these companies have always required a government subsidy to provide this part of Medicare.
Overall the government pays for a little more than 50% of the health care in the country.
Trump and the Republicans have promised health care much cheaper and better than ObamaCare. However, the bill that they almost passed, falling a single vote short in the Senate from John McCain, it is obvious that the secret plan was to return to the
status quo before ObamaCare.
Such a return would be untenable. Before ObamaCare, medical costs were increasing 7 to 10% a year. If you bought an American car the costs of health insurance was greater than all of the production costs except for the labor. Medical costs would have hit 25% of GDP in just twelve years if it continued to increase at the same rate that it was in 2008. The private insurance companies were over-paying the medical bills in order to increase their profits.
ObamaCare relied on the exchanges to lower the cost for small business to provide health care coverage to their workers, on Medicaid expansion, and on the subsidized individual policies to expand the number of people who were covered. Two of the three are the most expensive ways of covering the people in our country. These have been less than sterling in accomplishing the expansion of coverage. But ObamaCare did slow the inflation in medical costs. And more businesses have dropped coverage entirely or forced their employees to bear much more of the costs of their health care insurance as a method of increasing their profits, similar to how they got out from under their defined benefit pension plans in the 1980s.
The reasons that ObamaCare fell short are obvious. They failed to expand coverage to everyone and they relied on the private, for-profit insurance companies to provide the insurance, the most expensive way to provide health care in the world. Why did they do this?
The major reason was that Obama and the blue dog, conservative Democrats were beholden to Wall Street for their campaign contributions. The insurance companies are a part of the intangible range of the financial sector, selling only trust and promises.
The other major reason was to get it passed. The insurance companies and the drug companies lobby heavily in Congress and as the Democrats learned in the first Clinton administration the insurance companies could generate considerable opposition to changes in the health care system by lying to conservatives.
No candidate so far seems to even understand the complexity involved in going from where we are now to a single-payer system.
In the 1960s and into the 1970s the US had a health care system that was no more costly than the UHC systems in Europe on both a per capita and a percentage of GDP basis. It was based on hospitals owned mainly by governments and charities and insurance from non-profit, community rate based insurance companies, that is, the Blue Cross-Blue Shield companies who controlled the costs from the health care providers, no one could make a health care business succeed unless their charges were accepted by Blue Cross-Blue Shield. it was effectively a single-payer system because just about everyone had their insurance from one of the Blue Cross-Blue Shield companies. The few who had health insurance from for-profit companies were cherry-picked by the insurance companies because they were low risk. As late as the start of the 1990s the for-profits wrote only about 5% of the at-risk health care policies for small businesses and individuals.
That changed starting in the 1970s as the health care industry slowly changed into for-profit businesses, starting with hospitals. This trend accelerated in the 1980s as corporate profits and the incomes of the already rich increased due to the adoption of neoliberal policies meant to do those things and they needed new enterprises to "invest" in. Another boost in turning non-profit entities into profit-seeking ones was when the Republican Congress and Bill Clinton allowed the Blue Cross-Blue Shield companies to become for profits and "deregulated“them to allow them to refuse to sell to classes of individuals, that is to no longer be community rate based, like the for-profit insurance companies. The for-profit insurance companies slice and dice their offerings to try to get their ideal clients, healthy people who can afford to pay high rates. There is no reason to do this if you are running a UHC.
Basically, all Medicare for All is doing is to turn the providing of the insurance back into a single-payer, community rate based provider like it was in the 1970s, using the model of Medicare. Not hard to do but hard to pass through a Congress who is more beholden to Wall Street and the corporate interests than they are to the interests of the people who elected them.
Nobody has discussed how to deal with all of the fraud and abuse that exists in the current Medicare system.
Medicare can force health care providers to refund charges that Medicare finds to be excessive without a court order or other finding outside of their review process.
There is no reason to believe that fraud in Medicare is any greater than the fraud in private medical insurance. The only difference is that private insurance companies don't actively pursue fraud while Medicare does. The more it costs for health care, whether fair or fraud, the more profit the insurance companies make.
Nobody has discussed how hospitals will survive if they go from receiving the much higher payments that private insurance companies give them, to the much lower Medicare payments.
Are you discussing the annual shakedown by Congress of the health care providers called the "doc fix?" That Congress always eventually passes?
Nobody has discussed where all of the money will come from to support such a system. It's insane to think the wealthy Americans have enough money to pay for it, even if they were taxed at 100 percent.
There is no reason to think that Medicare for All will cost more than we pay now for health care for the people who have health care insurance now and every reason to believe that it will cost less. It depends on how many of the twenty million who still have no coverage in the US aren't covered by Medicare for All. There are always people who want to freeload on the system. They don't want to sign up for coverage because they don't want to pay for the health care of others. That is until they get sick. Then they want the hospitals and the doctors for free. We call these people libertarians.[/ha ha]
Nobody has said how much more taxes the middle class would have pay to support such a system, or what percentage of doctors would simply become concierge providers. If you're not familiar that means doctors that only take cash for their services and sometimes charge a monthly fee for access.
I had a similar program to that. My family doctor and another doctor turned his practice into a physician (something) practice, (I don't remember what they are called,) something like what you described. We paid like $300 a month and didn't have to pay for office visits or for vaccines or health maintenance medicine, ie vitamins. they would make house calls. They gave us their cell phone numbers and encouraged us to call them. It was like a small HMO. He had a lot of programs to live healthy, to lose weight, quit smoking, exercise coaching, etc. Our insurance provider paid the $300 and provided the major medical for hospitalization. I and my son did well on the program but my wife and daughter ignored it. Obviously, the healthier you were the better for them and us. I remember reading that the AMA doesn't like these kinds of practices but I don't remember why and since I can't remember what they are called I can't search for the answer. Perhaps, in the unlikely event that anyone reads this to here, they might know the answer.
There is no reason to believe that the middle class would have to pay more in taxes or premiums than they do now, even if they structure it as taxes the middle class shouldn't have to pay more.
And, nobody had even mentioned that many other countries are having problems supporting their own UHC systems.
This has very little to do with how the UHC is structured. Medical care is getting to be more expensive because the costs of technology are high. If you want to argue that we should ration health care, I don't think that you will get very far, ala death panels. There are some indications that some legislators around the world try to restrict UHC programs because these programs are unpopular with neoliberal ideology. These legislators are pretty much all conservatives, just another indication of why we shouldn't elect conservatives to run a government.
Plus, nobody has discussed how to manage the insane cost of aggressive end of life care that many people expect and many doctors prescribe. That's just for starters.
We will have this problem and many more like the medical error lawsuit abuse, the doctor shortage from too few medical schools, etc. no matter which health care delivery system we use. And we have to solve these problems no matter which system we use. No one in their right mind is saying that Medicare for All is going to solve all of the problems with health care. No one is even claiming that Medicare for All is even the least costly system we could go to, not even me. The British National Health Service is probably the least costly system operating in a highly developed country in the world.
It's far more complicated than most people think. I did audits for Medicare patients, helped with billing and Medicare reviews, etc. when I worked as a QA/UR nurse. It's very easy to abuse Medicare guidelines, by over or underutilizing based on how much profit would be made.
As it is for private, for-profit insurance companies. Once again, any health care system that you use is finally going to depend on the professionalism of the health care providers. This is what we are stuck with and the type of system that we use can only nibble around the edges of professionalism.
I'm against health care for profit,
I am too. It completely baffles me why anyone believes that we are better off assigning health care, education, national defense, etc. to corporations whose only obligation is to do whatever is required to make the highest profit possible instead of the one organization whose only obligation is to best serve the public welfare, the government.
... but how the fuck do we get it out, when almost everything from hospice to hospitals, from drugs to long term care are based on profit. And, btw, in case you don't know, Medicare doesn't pay for long term care. There must be a better way to help more people get adequate care without causing chaos.
Unfortunately, we can't do it the way that it happened over fifty years or so, by frog boiling, changing so slowly that nobody notices. We have to attack it openly, and Medicare for All is a good way to start.
The following is from an institution in Canada that describes itself as nonpartisan. Maybe our resident Canadian knows if it has any credibility. But, I have read many other articles about the problems with the British and the Canadian systems when it comes to financing. Considering the rabid increased costs of health care, I find these claims believable.
Perhaps, as patients, we expect too much. I know far too many people who run to their provider for every little sniffle, itch, or sore. I'm the extreme opposite, in that I put off medical exams until I'm sure I need one, and I refuse at least half of the tests and procedures ordered for me, at least in part because I don't want cause the system unnecessary expenses, but most people aren't like me. But, I digress.
The Japanese go to the doctor more often than in any other developed country. Yet they spend half of what we spend on a per capita basis.
https://www.fraserinstitute.org/article/canadas-health-care-crisis-is-an-economics-problem-not-a-management-problem
Government health spending is growing at unsustainable rates, while patients are facing shortages of medical resources and declining access to necessary medical care. The president of the Canadian Medical Association recently called on the federal government to become more involved in the management of provincial health systems in order to solve the serious problems plaguing Medicare. Unfortunately, the CMA president seriously misdiagnosed the cause of the health systems ills.
The Canadian health system has been run as a government monopoly since 1970. It doesnt really matter which level of government tries to manage the system, our experience shows that political planning doesnt work. Adding federal management would be as effective at averting disaster as rearranging the deck chairs on a sinking ship.
The current health system does not have a management problem; it has an economics problem. The looming crisis in our system has three identifiable causes: the governments monopoly over funding for medical care, the politically planned allocation of medical goods and services, and the lack of consumer exposure to the cost of using health care.
Politically managed, 100 percent redistributive financing produces a pay more, get less result: unsustainable cost growth and rationed access.
According to a recent Fraser Institute study using provincial government data, total government spending on health grew at an average annual rate of 7.5 percent across all provinces over the period from fiscal years 2000-2001 to 2009-2010. During the same period, total available provincial revenue from all sources, including federal transfers, grew at an average annual ratef only 5.7 percent. At the same time the economy, measured by gross domestic product (GDP) grew by only 5.2 percent.
Do some of your own DD. Read articles from many sources. Many countries are having problems financing their health care programs. We need to be very careful before we adopt something that doesn't work. I'm not a political conservative in any way, but I am a realist.
The most radical health care system we have ever had was the one we had before ObamaCare when we turned over the whole system to the profit motive. This was nuts supported by the believers in the free market, that the free market can do everything that the government does now and produce a better result because of the magic of the free market. I will tell you who doesn't believe in the magic of the free market, the executives of the corporations. They profess to do be believers but they fight every avoid market discipline and to avoid competition setting the prices that they get for their products.
I want to see a realistic plan as to how we can go from the mess we have now to a better, more cost-effective way of providing health care to all Americans. I haven't seen one yet from the candidates, although Biden's plan does sound a bit more rational than most of the others. Don't worry. I'm still going to vote for the Democratic nominee, regardless of who it is. Anybody else 2020!
Medicare for All will be very hard to pass through Congress, even one with the Democrats in charge in both houses of Congress and the presidency, as unlikely as that is. The entire Republican party and fully one half of the Democratic party are fully in the hands of Wall Street and the corporate interests. We are therefore stuck with the liberals and their ideas to try to start turning this nation around.
