US Medical Insurance: How Much Choice?

[Jolly_Penguin]

I believe that everybody should have the same level of medical coverage and that it should be excellent--although I am not opposed to co-pays for those who can afford them or do not have seriously or chronically ill or disabled or elderly members in which case those individuals/families should have zero co-pay. Medications should be easily affordable and there should be a sliding scale for lower income or high need patients. Elective cosmetic surgery shouldn't be covered but pretty much anything else should be.

Yes, and when you talk about it lacking political support, or your politicians, such as congress getting in the way of it, that's up to you to change. Your country claims to be a democracy, where voting matters and the people have a voice, so it should be relatively easy compared to some countries where that is less so, and many of those countries already have this.

 

[Jolly_Penguin]

No country as large as the US has single payer. In fact, only 20 countries have single payer and most of them are small. It's unreasonable for politicians to simply promise M4A, when that actually happening is close to impossible.

Why would that be some kind of consideration? Yes, you have ten times the population of Canada, but you also have ten times the population of Canada so there's that many more people paying into the system. The concept behind it scales up easily.

Yes. I don't get this argument either. You've got even more collective bargaining power with a larger population. That also would go for pharmacare. The only barrier you are facing is political will, and that's something you can change.

 

[Worldtraveller]

No country as large as the US has single payer. In fact, only 20 countries have single payer and most of them are small. It's unreasonable for politicians to simply promise M4A, when that actually happening is close to impossible.

Why would that be some kind of consideration? Yes, you have ten times the population of Canada, but you also have ten times the population of Canada so there's that many more people paying into the system. The concept behind it scales up easily.

Yeah. In theory, the bigger the better is how something like this should work.

I leave it to the US to demonstrate how badly greed and rampant capitalism will fuck it up, though.

 

[lpetrich]

If AOC can't even understand her own healthcare plan, why should she design ours? with bullshit like

Cutting healthcare costs for providers and consumers alike requires more variety, not less. Someone young and healthy such as Ocasio-Cortez can bank on a high deductible in exchange for low premiums, whereas older or chronically sicker consumers will want lower deductibles and higher premiums. Ocasio-Cortez, who wears glasses, might want vision insurance included in her plan, but consumers with perfect eyesight probably wouldn't opt to pay for that.

Without ever criticizing employer-dependence or having limited choices of doctors or not being able to get insurance because of pre-existing conditions.

 

[SimpleDon]

Coming from outside the American system(s), it's hard to understand what various health care schemes in the US are trying to accomplish. Portions of it seem like it's just leveraging health care as an employment benefit rather than an attempt to make health care more broadly accessible to people without incurring unmanageable debt burdens.

We are running health care as a profit-making business because of the bizarre belief (hope?) that every other country in the world is wrong that running health care as a profit-making business is crazy. It is Econ 101 and the faith in the fantasy of the free market running us off of a cliff in order to provide new investment opportunities for the already rich to invest the excess profits produced by suppressing the middle-class wage in the US. It is neoliberalism.

 

[KeepTalking]

I know a single woman, breast cancer survivor. Her premium is just over $2000 with a $6000 deductible. Silver level plan.

And subsidies are based on income. Debt has nothing to do with it.

Look at the screenshots. Family plan. And if you're not getting subsidies you're making enough you can afford those premiums.

Yeah, what the hell is wrong with that guy, thinking he should be able to insure his wife and kids as well? His wife needs to get out of the house and get a job, so she can pay for her own insurance, and the kids, well fuck them, if it's to expensive to put them on the insurance plan, imagine daycare plus insurance. Those little rugrats can go get jobs as well. Problem solved, and now the insurance premium will only be about $1,000!

 

[Loren Pechtel]

I know a single woman, breast cancer survivor. Her premium is just over $2000 with a $6000 deductible. Silver level plan.

And subsidies are based on income. Debt has nothing to do with it.

Look at the screenshots. Family plan. And if you're not getting subsidies you're making enough you can afford those premiums.

Yeah, what the hell is wrong with that guy, thinking he should be able to insure his wife and kids as well? His wife needs to get out of the house and get a job, so she can pay for her own insurance, and the kids, well fuck them, if it's to expensive to put them on the insurance plan, imagine daycare plus insurance. Those little rugrats can go get jobs as well. Problem solved, and now the insurance premium will only be about $1,000!

The point is the deductible being shown is the family deductible but it's one sick person--the relevant number is the individual deductible.

 

[southernhybrid]

No country as large as the US has single payer. In fact, only 20 countries have single payer and most of them are small. It's unreasonable for politicians to simply promise M4A, when that actually happening is close to impossible.

Why would that be some kind of consideration? Yes, you have ten times the population of Canada, but you also have ten times the population of Canada so there's that many more people paying into the system. The concept behind it scales up easily.

I see comments like yours quite frequently. To me, it makes no sense to say that it's just as easy to come up with a plan in a country that has around 320 million people, living in 50 unique states, with a wide variety of ideologies as it is in a country that is one tenth or less the size. Sorry, I just don't see how we can transition from what we have now to a single payer system without causing chaos. Perhaps if we were able to pass a public option, we could head in that direction, assuming enough people were drawn to that option over time.

The US is more divided than it has been in my lifetime. How do we bridge the divides? How do we get so many different states to agree on the same thing? How do we prevent court challenges from destroying an attempt to. have single payer? Our courts did a lot of damage to the ACA. SCOTUS rejected the plan to have all states have the expanded version of Medicaid. Just this week, one court rejected the individual mandate. Our country is very different from smaller countries. It makes things much more complicated, imo. What do we do when private hospitals, which most are these days, start closing down because they no longer receive the more generous reimbursement rates that private insurance pays?

As someone who worked in healthcare for 42 years, I see a lot of potential problems with trying to radically change our current healthcare mess to something very different. It's true that we need big changes, but why not start small, like controlling the insane prices of drugs? Why not offer more preventative care to all? Our public health system has been drastically cut back. That started in the 80s. Why not bring back good effective public health programs that serve all based on income? We have totally failed our citizens who suffer from serious mental health diseases! Why not do something about that! There are so many things we could do to improve what we have now, without going to single payer. Plus, there is no way single payer would ever pass in our Congress. Why promote a scheme that has no chance of happening?

Of course there are many other issues that I mentioned that nobody seems to be able to address. Is there a problem with fraud and abuse in the Canadian health care system. If not, how does Canada prevent that?

 

[krypton iodine sulfur]

Of course there are many other issues that I mentioned that nobody seems to be able to address. Is there a problem with fraud and abuse in the Canadian health care system. If not, how does Canada prevent that?

The concern is too vague. Every system is susceptible to fraud and abuse to some degree. What sort of fraud?

Fraudulent insurance claims from the end user? In most cases, public insurers work directly with health care providers so I, as the end user, never file an actual claim which I could alter. There are limited scenarios with reimbursements and tax deductions which one might be able to try to claim fraudulently. Also, some health insurance coverage in Canada is private. I could try to file fraudulent claims with the insurer in cases where they don't work directly with the health care provider. I suppose I could also work in concert with the health care provider to try to defraud the insurer.

 

[Jimmy Higgins]

No country as large as the US has single payer. In fact, only 20 countries have single payer and most of them are small. It's unreasonable for politicians to simply promise M4A, when that actually happening is close to impossible.

Why would that be some kind of consideration? Yes, you have ten times the population of Canada, but you also have ten times the population of Canada so there's that many more people paying into the system. The concept behind it scales up easily.

I see comments like yours quite frequently. To me, it makes no sense to say that it's just as easy to come up with a plan in a country that has around 320 million people, living in 50 unique states, with a wide variety of ideologies as it is in a country that is one tenth or less the size. Sorry, I just don't see how we can transition from what we have now to a single payer system without causing chaos. Perhaps if we were able to pass a public option, we could head in that direction, assuming enough people were drawn to that option over time.

The US is more divided than it has been in my lifetime. How do we bridge the divides? How do we get so many different states to agree on the same thing? How do we prevent court challenges from destroying an attempt to. have single payer? Our courts did a lot of damage to the ACA. SCOTUS rejected the plan to have all states have the expanded version of Medicaid. Just this week, one court rejected the individual mandate. Our country is very different from smaller countries. It makes things much more complicated, imo. What do we do when private hospitals, which most are these days, start closing down because they no longer receive the more generous reimbursement rates that private insurance pays?

As someone who worked in healthcare for 42 years, I see a lot of potential problems with trying to radically change our current healthcare mess to something very different. It's true that we need big changes, but why not start small, like controlling the insane prices of drugs? Why not offer more preventative care to all? Our public health system has been drastically cut back. That started in the 80s. Why not bring back good effective public health programs that serve all based on income? We have totally failed our citizens who suffer from serious mental health diseases! Why not do something about that! There are so many things we could do to improve what we have now, without going to single payer. Plus, there is no way single payer would ever pass in our Congress. Why promote a scheme that has no chance of happening?

Of course there are many other issues that I mentioned that nobody seems to be able to address. Is there a problem with fraud and abuse in the Canadian health care system. If not, how does Canada prevent that?

Your original post came off as indicating 'Health Care system for 325 million isn't possible'. So that led to some questions about the claim. Your follow up post indeed brings up the unfortunate truths that is the place America finds itself and how health care for all in a nation that brags itself Christian... is virtually impossible. But if it wasn't for that issue, UHC, should be very possible.

 

[Jolly_Penguin]

It isn't nearly as complicated or difficult as you make it sound. And yes, you can get it through Congress. You need only convince the populace, by showing how well it works both within your own nation (Medicare) and in other countries. You already have huge numbers supporting it when it's polled.

Your last barrier is your politicians, yes, primarily because they are influenced by the big money from the insurance and drug companies. But at the end of the day, these politicians are voted in or out by the people. If it becomes clear to them that they will lose their seats of they oppose single payer health care, they will turn around on the issue.

As for a two tiered "Medicare for all who want it" system, that will fail badly. You need universality and you need to take the for profit insurance companies out of the picture. If you don't, then they will see to it with their money that doctors and hospitals gravitate away from the public system, and it will fail before it can get going.

 

[Toni]

It isn't nearly as complicated or difficult as you make it sound. And yes, you can get it through Congress. You need only convince the populace, by showing how well it works both within your own nation (Medicare) and in other countries. You already have huge numbers supporting it when it's polled.

Your last barrier is your politicians, yes, primarily because they are influenced by the big money from the insurance and drug companies. But at the end of the day, these politicians are voted in or out by the people. If it becomes clear to them that they will lose their seats of they oppose single payer health care, they will turn around on the issue.

As for a two tiered "Medicare for all who want it" system, that will fail badly. You need universality and you need to take the for profit insurance companies out of the picture. If you don't, then they will see to it with their money that doctors and hospitals gravitate away from the public system, and it will fail before it can get going.

Yes the big barrier is the politicians. Full stop. Not just in enacting legislation establishing a national health service but also funding it, maintaining funding it and also keeping their products litical and religious beliefs out of medical care altogether. See the debate over abortion, gynecological care in general, birth control, child birth and end of life decisions. I would also anticipate budget concerns or ‘budget concerns’ being put into play with regards to treatment for HIV infections, addictions, transplants. My opinion is that care decisions should be made by medical providers and patients, keeping in mind that medical providers are advised and governed by professional associations which determine best practices and so on.

Those are the things that concern me.

 

[Jimmy Higgins]

It isn't nearly as complicated or difficult as you make it sound. And yes, you can get it through Congress. You need only convince the populace, by showing how well it works both within your own nation (Medicare) and in other countries. You already have huge numbers supporting it when it's polled.

Middle East peace is easy, you just need to get the Arabs and Israelis to sign off on it.

Your last barrier is your politicians, yes, primarily because they are influenced by the big money from the insurance and drug companies. But at the end of the day, these politicians are voted in or out by the people. If it becomes clear to them that they will lose their seats of they oppose single payer health care, they will turn around on the issue.

Well, inertia, insurance companies, the Republicans, Democrats to point, unions, big corporations, little corporations, grandma, the Tea Party... just a few dozen hurdles. SCOTUS barely ruled ACA was legal! Had the case been ruled on with the current court, ACA would have been likely found unconstitutional. And insanely enough, it could still be.

But thanks for playing "Do You Have A Clue About America?"

 

[southernhybrid]

I would like to see UHC, but there are many ways to accomplish it other than single payer. Why not look into the many European countries that don't have single payer, but have successful UHC?

I saw a poll earlier this week that mentioned that there are only 25% of Americans who want single payer. Shouldn't they have a say in what type of coverage we offer all Americans?

Based on some of the posts here, I don't think people who don't live in the US, have a good understanding of how difficult it will be to go to a single payer system. Plus we already have coverage for poorest among us, Medicaid. We already have CHIP, the plan for children who live in homes where the income is too high for Medicaid, but still quite low. We already have Medicare for those who have been on disability for two years, and those who are 65 and older and have paid into the system for at least ten years. We already have VA care for veterans, especially disabled veterans. The VA sometimes gives excellent care, but in recent years, this hasn't always been the case, so more funding needs to be put into the VA program. It's hard to get good doctors to work for the VA, at least partly because the pay is low for a physician.

How do you explain that one third of all Medicare recipients have chosen Advantage Plans, which are actually private insurance plans, subsidized by the federal government?

Skip the next paragraph if you already have an excellent understanding of the cost of Medicare premiums and the various parts of Medicare coverage.

The majority of American want a lot of choices. The current Medicare system does allow choices because Part D, Advantage Plans and supplements that pay the 20% of outpatient care that isn't covered by Medicare are all offered by private insurance companies. Part A is the only free part of Medicare, which of course, we all pay into during the course of our working life. Part A only covers hospitalizations after a deducible of about 1300 dollars or so, which most of us rarely if ever need, home health, which is mostly short term skilled nursing or therapy visits to the homes of homebound people, and hospice, the benefit that provides skilled nursing and aide services in the home to those deemed to have a life expectancy of 6 months of less. Part B will be 144 per month next year. It only covers 80% of outpatient services, and it pays out at a much lower rate than what private insurance companies do. Part D is our fucked up drug plan, again provided by private insurance companies. It's far from perfect, but prior to 2003, there was no drug coverage in Medicare. Drugs are usually the most expensive thing that we pay for once we become older adults. Part D often has large copays for many drugs. Part C is the cheapest option. These are the so called Advantage Plans, which usually only cost what Part B costs. They include some coverage for vision, dental and hearing aides, all things not normally covered by traditional Medicare. Please explain how we magically go from this to some free for all plan! ( I'm sure I've explained all this before, but some posters don't seem to have a clue as to how Medicare works in the US, so I'm going over it again for them. )

While paying 4 or 500 per month for Part B, D and a supplement might sound cheap, it's not cheap if a couple each pays that and their income is primarily SS. Most pensions, other than governmental ones, have been discontinued. No politician has explained how it will be possible to get rid of all of these premiums and copays without raising taxes significantly. Nobody has explained how they will magically get rid of our mostly profit based health care system for one that is all non profit. But, it makes more sense to me, to gradually have non profit insurance companies that are subsidized by the government, then to go to M4A, which has many problems itself. To me, the German or French system might be more reasonable than a single payer system. I don't even understand the obsession with single payer. I want all Americans to have access to health care. I'm just not convinced that M4A is feasible or the best option for. us.

It's not the insurance companies that are the real problem. It's the profit making corporations that have taken over most of our health care system that are killing us. What can we do to change that? Stagnant wages are also a huge problem. Can we do anything other than increasing the minimum wage which hasn't been increased since 2009 to change that? Can we even get enough support for that? Price controls would be difficult to get passed, but maybe price controls are needed to keep the price of medical care under control. Why should a mammogram be billed at 1000 dollars, when Medicare reimburses it at less than 100 dollars? How crazy is that? In 2006, I didn't have anything but catastrophic insurance coverage and I had to pay over 300 dollars for a simple mammogram. That's before the local hospital was owned by a private corporation. Now a mammogram is billed at over 1000 dollars! It's crazy.

It's a lot more complicated than some of you seem to think.

 

[T.G.G. Moogly]

It's not complicated when you think of it in terms of cost. It's really the old economics tale about guns or butter. Americans like guns in the form of a huge military. They don't particularly like butter in the form of healthcare. There is indeed a need for transparency, I mean, would you walk into a grocery store if nothing had prices? Would you walk into a clothing store or dealership or any store and start to shop with no prices on anything and NO ONE able to tell you what the item or service will cost?

If we had to pay for food the way we pay for medical care we would have the same problem. The problem is economics and a huge helping of for profit corruption. The thing that is needed is transparency and simplicity. It's so refreshing receiving correspondence from the SSA because it is written at about a 5th grade level and is entirely absent any legalese. Everything is stated in the most unambiguous terms, unlike health insurance with is more complicated than the catholic catechism.

 

[laughing dog]

JP is right. It really is so simple to change society in the wave of a hand. It is just a mystery why UHC has not happened with all the handwaved support for it.

 

[Horatio Parker]

I think JP has a point(yes I really said that).

Anything we have the real resources to do, can be done. We have enough medical infrastructure to care for everybody, so why aren't we? Our restraints are self imposed. A generation or more of propaganda has had its effect.

 

[Jolly_Penguin]

I think JP has a point(yes I really said that).

Anything we have the real resources to do, can be done. We have enough medical infrastructure to care for everybody, so why aren't we? Our restraints are self imposed. A generation or more of propaganda has had its effect.

Exactly. There is absolutely zero reason why one of the richest nations on earth can't have universal health care as a right for all citizens, without the need for money grabbing for profit insurance companies in the mix. Just look at your military budget. How often do your politicians and media ask how you gonna pay for that?

Get some backbone already people. You CAN make this happen. All you are missing is the confidence and self respect to try. You've let the corporate profiteers beat you down so much that you can't see that the power is still yours. They only have it because you let them.

 

[laughing dog]

I think JP has a point(yes I really said that).

Anything we have the real resources to do, can be done. We have enough medical infrastructure to care for everybody, so why aren't we? Our restraints are self imposed. A generation or more of propaganda has had its effect.

Exactly. There is absolutely zero reason why one of the richest nations on earth can't have universal health care as a right for all citizens, without the need for money grabbing for profit insurance companies in the mix. Just look at your military budget. How often do your politicians and media ask how you gonna pay for that?

Get some backbone already people. You CAN make this happen. All you are missing is the confidence and self respect to try. You've let the corporate profiteers beat you down so much that you can't see that the power is still yours. They only have it because you let them.

Oh, the problem all along here has been a lack of backbone. Thank you, prophet JP for opening our eyes.

 

[Jolly_Penguin]

You're welcome. Now get up from your couch and put down the chips, and make it happen. And if you can't bring your sorry self to do that, then get out of the way.