Why "Medicare for all" isn't an answer

[Loren Pechtel]

Look all you want at minor sub-sets of Medicare costs. The undeniable fact remains - people in the US pay FAR more and have WORSE outcomes than people in countries with UHC. Yes, there are higher taxes, but taxes paid are only higher vs the average cost of medical care if you're knocking down hundreds of thousands or millions per year. But since that's exactly what the right wing scaremongers are themselves afraid of, I guess it makes sense for them to argue against Medicare for all, no matter how specious the argument.

(ETA: If you want to take a look at the particular case you bring up, please let us know what the total cost of all helevac systems in the US amounts to, and compare it to the profits of all for-profit health insurance companies, and the administrative waste that occurs before those profits.)

It appears you utterly missed my point.

The issue is that Medicare manages to look good by mandating prices that are too low--something that can't continue in a Medicare-for-all environment.

As for UHC systems getting better outcomes--only if you score them as having a better outcome because they are UHC.

Universality is a vital component of a healthcare system.

That everyone gets healthcare is important. The report that scored the UHC systems above ours made 20% of the score based on whether they were UHC systems, though, not anything to do with the delivery. They wouldn't have included a fudge factor like that unless the results didn't support their point of view otherwise.

Having great outcomes for the 80% of people who get care, and no care at all for the other 20% is NOT an acceptable outcome for a civilized society, any more than you can call a household successful because dad has plenty of cash to spend if his kids are starving and have no shoes.

Except that's not what happens in the US. Yes, there are people who don't get care they need and that hurts our health outcomes and that's included in the report.

- - - Updated - - -

So LP picks one of the most expensive, and rare, cases of medical transport as an argument against medicare for all? Color me surprised.

Medicare for all, as it is now probably wouldn't work. However, implementing it universally with more up to date and realistic pricing is eminently do-able.

What I'm saying is putting in realistic pricing will probably get rid of the cost advantage.

I get what you're saying. I'm saying you're wrong.

You're suggesting an unrealistically low pricing and saying that would make it fail. Duh. Also, some rare procedures/policies might be underpriced, knowing that they are a loss, but they won't affect the overall cost or business because they are rare.

Let me know if that's confusing to you, and I'll try to explain it again with crayons.

I presented that as an example of the problem, I don't believe we have good data on just how big the problem is.

- - - Updated - - -

This argument strikes me like many of the arguments against gun safety measures. Any one of them presented singly will only have a limited effect, but taken together in a multi-pronged approach will have a greater desired effect. The same is true of health care. Personally, I don't understand this. We're supposed to be the greatest country in the world, yet we're the only Western nation without this. How did all these other countries do something we are unable to do? I guess we're just so special - in a stupid way.

Because an awful lot of us don't trust the government not to cut corners. All we need to do is look at how shoddy the three existing government healthcare systems are. Fix them first!

 

[Elixir]

Look all you want at minor sub-sets of Medicare costs. The undeniable fact remains - people in the US pay FAR more and have WORSE outcomes than people in countries with UHC. Yes, there are higher taxes, but taxes paid are only higher vs the average cost of medical care if you're knocking down hundreds of thousands or millions per year. But since that's exactly what the right wing scaremongers are themselves afraid of, I guess it makes sense for them to argue against Medicare for all, no matter how specious the argument.

(ETA: If you want to take a look at the particular case you bring up, please let us know what the total cost of all helevac systems in the US amounts to, and compare it to the profits of all for-profit health insurance companies, and the administrative waste that occurs before those profits.)

It appears you utterly missed my point.

The simple facts are still there, Loren.

* People in countries with UHC generally approve of UHC
* People in the USA do NOT approve of the current system and generally want UHC.
* UHC delivers better outcomes at lower costs than the USA system.

You say Medicares costs (to the end user I assume) that are "too low". If you're right, they'd go up. So what? It's still a better system according to the end users.

All we need to do is look at how shoddy the three existing government healthcare systems are.

Pick three of these to look at, rather than subsets of subsidized healthcare within a for-profit system:


Countries with universal health care include Austria, Belarus, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, Moldova, the Netherlands, Norway, Portugal, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Turkey, Ukraine, and the United Kingdom.

ETA: four years in, I am very happy - nay, ecstatic - with Medicare.

 

[Jimmy Higgins]

Because an awful lot of us don't trust the government not to cut corners.

Wait... you mean keep down costs?

All we need to do is look at how shoddy the three existing government healthcare systems are. Fix them first!

Well, you fix Medicare by insuring all people and increasing the money pool that provides health care services. Medicare already covers the most expensive people, and does so well enough that the Elderly will vote your ass out of office if you threaten it.

 

[bilby]

Medivacs aren't uncommon in the UK. My local (NHS) hospital has a chopper and helipad. My nephew was knocked unconscious by his surfboard on a remote beach a few years ago. His g/f phoned 999 and he was airlifted under an hour later.

The service might have been cut lately, but all public services have been cut by the Tories for no good reason.

Apparently most of the choppers are Coastguard or Royal Air Force (also public services), but quite a few of the big hospitals have helipads. Crucially, patients are not charged for airlifts.

Nope; most UK air ambulance services are charitably funded; The NHS provides paramedic and other medical staff, while the aircraft and pilots are funded by public donations. As the NHS has to provide both the medical staff and the vehicles for ground ambulances, it is actually less of an impost on the NHS budget to use a helicopter than a traditional ambulance.

https://aaac.org.uk/

The RAF and coastguard used to provide helicopter rescue (as distinct from medical evacuation/air ambulance) services to coastal shipping and for mountain rescue, but this service was taken over by a private contractor (Bristow) in 2013; The RAF ceased Air Sea Rescue operations in 2015.

On 26 March 2013 Bristow was awarded a 10-year contract to operate the search and rescue operations in the United Kingdom, at the time being provided by CHC Helicopter (on behalf of Her Majesty's Coastguard), the Royal Air Force and the Royal Navy. Bristow is currently operating AgustaWestland AW139 and Sikorsky S-92 helicopters in support of this contract. They were originally planning on using AgustaWestland AW189 helicopters but the procurement programme has been delayed, resulting in AAR AIrlift Group claiming the first civilian registered SAR AW189, based in the Falkland Islands, in support of the UK Government

(Wikipedia)

 

[bilby]

Universality is a vital component of a healthcare system.

That everyone gets healthcare is important. The report that scored the UHC systems above ours made 20% of the score based on whether they were UHC systems, though, not anything to do with the delivery. They wouldn't have included a fudge factor like that unless the results didn't support their point of view otherwise.

Having great outcomes for the 80% of people who get care, and no care at all for the other 20% is NOT an acceptable outcome for a civilized society, any more than you can call a household successful because dad has plenty of cash to spend if his kids are starving and have no shoes.

Except that's not what happens in the US. Yes, there are people who don't get care they need and that hurts our health outcomes and that's included in the report.

If you are basing your position on a specific report, then you need to present that report for us to consider.

I am NOT responding to a specific report - and I cannot be expected to respond to a report that you have in mind, but have not told me about.

I am discussing this topic with you, and with the other posters in this thread - not with some report of unknown provenance that you have in the back of your mind but have not presented to the rest of us for consideration. I don't care what your pet report says; I care about what is actually happening in the real world. I certainly cannot be assumed to be basing my position on a report that you haven't shown me.

The hypothetical existence of a report that has (allegedly) poor methodology or a biased approach does NOT in any way render all arguments that agree with that report's broad conclusions false - and your pretense that it might is really rather pathetic.

 

[laughing dog]

Because an awful lot of us don't trust the government not to cut corners.

But you trust private insurance companies, even for profit ones?

This past election, my area was awash with Republican dog whistling about "socialist health care". One of the ads was an elderly woman who did not a gov't bureaucrat telling her which doctor to use - but she was ok with a clerk from her health insurance telling which doctor she could use. LOL.

 

[Jimmy Higgins]

Because an awful lot of us don't trust the government not to cut corners.

But you trust private insurance companies, even for profit ones?

This past election, my area was awash with Republican dog whistling about "socialist health care". One of the ads was an elderly woman who did not a gov't bureaucrat telling her which doctor to use - but she was ok with a clerk from her health insurance telling which doctor she could use. LOL.

We don't want the Government telling us who we can see or making our medical decisions. We do want them to be involved in the financing via pooling the largest quantity of money to make health care as accessible to as many people as possible. Right now, Medicare for All would be the latter and I'm so tired of hearing fallacies defending our "If you get lucky" health care system.

Families shouldn't have to sacrifice everything for health care of a seriously sick family member. No American should have to rely on a GoFundMe site to pay the health care bills.

 

[Elixir]

Because an awful lot of us don't trust the government not to cut corners.

But you trust private insurance companies, even for profit ones?

This past election, my area was awash with Republican dog whistling about "socialist health care". One of the ads was an elderly woman who did not a gov't bureaucrat telling her which doctor to use - but she was ok with a clerk from her health insurance telling which doctor she could use. LOL.

She deserves a which doctor.

 

[ZiprHead]

Hmm.. ok *devil's advocate switch activated*

There are problems with universal health care. It means longer waiting times for basic care, especially if not vital care, and it can also mean less optimal care for those who could otherwise afford better.

When one of the tendons in my right bicep snapped a few years ago, had I had lots of money and lived in the USA, I could have had an expensive operation to repair it and get it back to 100%. Instead I was told it isn't covered by OHIP and I can't get it done here in Ontario. I now have one bicep tendon on that side, and it is back to 85% total strength I used to have in the arm. This is not atypical.

With the USA right there so close, I could have flown there and had the operation done had I wanted to pay for it. That's a convenience Canadians have that would be taken away if the USA went full on UHC. I would then have to fly further away to get it done.

Doctors get paid significantly less under UHC. A lot of Canadian doctors trained in government subsidized medical schools cross into the USA to practice. Its called the "brain drain".

Drug companies make less profit, which slows incentive to innovate new drugs.

It usually takes me 2 to 3 days to see my GP for routine checkup or random non-emergency health issue. In the USA given enough money I could see a doctor an hour from now, right?

It also means there is nothing stopping people from going to the emergency room for stuff that turns out to be nothing. The ER gets far more hypochondriacs.

*devil's advocate deactivated*

But all in all, I would much prefer UHC to what you've got in the USA. I've worked in personal injury law years back, and it was like pulling teeth getting insurance companies to pay. I can hardly imagine the nightmare of doing that for basic routine care that isn't the result of a dramatic car crash. The poor are covered. And nobody has to worry about going to the hospital. That more people go for nothing that they think is something, is better than the alternative of people who should be going in getting put off from going in due to cost, and costing themselves or the system more later on.

[YOUTUBE]https://youtu.be/CVX3vm7elHI[/YOUTUBE]

Over 500 Canadian doctors protest raises, say they're being paid too much (yes, too much)

 

[ZiprHead]

In the Canadian model, there are no private clinics. It isn't a two tiered system with a public option. Its full on public option only. I personally support that, because the alternative would be lesser care for the majority who can't afford the better care. My sister faced this issue head on when she was in medical school. There was a big debate over bringing a 2 tiered system to Canada. I haven't heard of it since so maybe we won that fight.

 Two-tier healthcare

In Canada, there are private and public healthcare providers with complete patient freedom of choice between which doctors and facilities to use.

The public financing system, unofficially known as Medicare, consists of several different systems managed by each province or territory. The federal government distributes funds to the provinces for healthcare providing the provinces design their systems to meet certain criteria which they all do. Most people receiving care in Canada do not pay for their care. The medical provider gets paid a fixed fee for the care provided. The law bans the medical provider from charging patients to supplement their income from Medicare. Medical care providers can set their own fees that are higher than the Medicare reimbursement fee, but the patient must pay all the cost of care, not just the excess.

About 70% of Canada's healthcare funding is via the public system. Another 30% comes from private funding, divided approximately equally between out-of-pocket funding and private insurance, which may be complementary (meeting costs not covered by the public system such as the cost of prescription medicines, dental treatments and copayments) or supplementary (adding more choice of provider or providing faster access to care)[1] There are, however, financial disincentives that make private medicine for services that are covered by Medicare less economic.

Six of Canada's ten provinces used to ban private insurance for publicly insured services to inhibit queue jumping and so preserve fairness in the health care system. In 2005, the Supreme Court of Canada ruled that in Quebec, such bans are unconstitutional if the waiting period for care is excessively long. However, this ruling only applies within the Province of Quebec. A second court challenge is currently underway to determine whether the prohibition of private parallel health care violates the patients' right to life, liberty, and security under Section 7 of the Canadian Charter of Rights and Freedoms.

Some private hospitals operating while the national healthcare plan was instituted (for example, the Shouldice Hernia Centre in Thornhill, Ontario) continue to operate, but they may not bill additional charges for medical procedures. (The Shouldice Hospital, however, has mandatory additional room charges not covered by public health insurance. That effectively places it in the "upper tier" of a two-tier system. Welfare recipients, for example, cannot be referred there.)

Clinics are usually private operations but may not bill additional charges. Private healthcare may also be supplied, both in uncovered fields and to foreigners.

Yup, you won. At least in part of Canada anyway.

 

[ZiprHead]

I happened to catch a part of the Thom Hartmann program yesterday talking about this very subject. He compared two hospitals, one in Canada and one in the US, both similar in size and bed numbers. The US hospital had a billing staff of about a hundred people. The Canadian hospital's billing staff was three people.

The hospital I used to work at had about 45 people in the billing department. The department was subdivided by insurance providers, i.e. Medicare, BCBS, Healthplus, etc.

 

[bilby]

 Two-tier healthcare

... Private healthcare may also be supplied, both in uncovered fields and to foreigners.

...

Wait, Canadian patients are treated in uncovered fields?? What if it rains? Or snows? I know things are often surprisingly bad under private health systems, but I thought at least they provided buildings for the patients to be treated in.

 

[Tom Sawyer]

Pfft. Buildings for sick people.

Americans are such fucking pussies. Whaa!!! It’s raining and I got mud into my gaping chest wound. I need to send out a snarky tweet to let everyone know what a snowflake I am

 

[Jolly_Penguin]

[YOUTUBE]https://youtu.be/CVX3vm7elHI[/YOUTUBE]

Did you realize that you replied to my post by posting a video I had already posted?

 

[ZiprHead]

[YOUTUBE]https://youtu.be/CVX3vm7elHI[/YOUTUBE]

Did you realize that you replied to my post by posting a video I had already posted?

Yup, I posted it before reading further down.

I posted it because you said this: "Doctors get paid significantly less under UHC. A lot of Canadian doctors trained in government subsidized medical schools cross into the USA to practice. Its called the "brain drain"." and the witness in the video says it's not happening.

I also posted this link:

Over 500 Canadian doctors protest raises, say they're being paid too much (yes, too much)

Which I note you didn't comment on.

 

[Worldtraveller]

So LP picks one of the most expensive, and rare, cases of medical transport as an argument against medicare for all? Color me surprised.

Medicare for all, as it is now probably wouldn't work. However, implementing it universally with more up to date and realistic pricing is eminently do-able.

What I'm saying is putting in realistic pricing will probably get rid of the cost advantage.

I get what you're saying. I'm saying you're wrong.

You're suggesting an unrealistically low pricing and saying that would make it fail. Duh. Also, some rare procedures/policies might be underpriced, knowing that they are a loss, but they won't affect the overall cost or business because they are rare.

Let me know if that's confusing to you, and I'll try to explain it again with crayons.

I presented that as an example of the problem, I don't believe we have good data on just how big the problem is.

If you don't think we have enough data, why are you presenting your case as if that's conclusive. You explicitly say it isn't a solution, yet when called on your duplicitous claim, you now claim there's not enough information? Which is it?

 

[Canard DuJour]

Nope; most UK air ambulance services are charitably funded; The NHS provides paramedic and other medical staff, while the aircraft and pilots are funded by public donations. As the NHS has to provide both the medical staff and the vehicles for ground ambulances, it is actually less of an impost on the NHS budget to use a helicopter than a traditional ambulance.

https://aaac.org.uk/

The RAF and coastguard used to provide helicopter rescue (as distinct from medical evacuation/air ambulance) services to coastal shipping and for mountain rescue, but this service was taken over by a private contractor (Bristow) in 2013; The RAF ceased Air Sea Rescue operations in 2015.

On 26 March 2013 Bristow was awarded a 10-year contract to operate the search and rescue operations in the United Kingdom, at the time being provided by CHC Helicopter (on behalf of Her Majesty's Coastguard), the Royal Air Force and the Royal Navy. Bristow is currently operating AgustaWestland AW139 and Sikorsky S-92 helicopters in support of this contract. They were originally planning on using AgustaWestland AW189 helicopters but the procurement programme has been delayed, resulting in AAR AIrlift Group claiming the first civilian registered SAR AW189, based in the Falkland Islands, in support of the UK Government

(Wikipedia)

I stand corrected and updated.

One way or another, though, Brits get airlifted to hospital free at the point of need and have done for yonks (not that it was really doubt..)

 

[Worldtraveller]

Did LP just run away from this thread?

 

[Loren Pechtel]

The simple facts are still there, Loren.

* People in countries with UHC generally approve of UHC
* People in the USA do NOT approve of the current system and generally want UHC.
* UHC delivers better outcomes at lower costs than the USA system.

You say Medicares costs (to the end user I assume) that are "too low". If you're right, they'd go up. So what? It's still a better system according to the end users.

1) UHC does a decent job of the emergency situations and of the routine situations. That's enough to make most people happy. It doesn't do a good job for the problems that fall into neither of these categories--but these are a small enough number that the approval numbers will still be good.

XKCD: https://xkcd.com/937/

2) I agree that people have a problem with our system. That doesn't mean they want UHC, though.

3) UHC doesn't deliver better outcomes. They had to rig the scoring to make it look better.

And my point about costs is that Medicare for all would end the cost shifting and thus very well might end up removing the cost savings that Medicare supposedly provides.

All we need to do is look at how shoddy the three existing government healthcare systems are.

Pick three of these to look at, rather than subsets of subsidized healthcare within a for-profit system:


Countries with universal health care include Austria, Belarus, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, Moldova, the Netherlands, Norway, Portugal, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Turkey, Ukraine, and the United Kingdom.

ETA: four years in, I am very happy - nay, ecstatic - with Medicare.

I'm looking at how it works here. That's the best comparison point. Want Americans to support UHC, fix the UHC systems we have to show it will work! The idea of expanding the system when the existing ones are all bad makes no sense.

 

[Worldtraveller]

1) UHC does a decent job of the emergency situations and of the routine situations. That's enough to make most people happy. It doesn't do a good job for the problems that fall into neither of these categories--but these are a small enough number that the approval numbers will still be good.

XKCD: https://xkcd.com/937/

2) I agree that people have a problem with our system. That doesn't mean they want UHC, though.

3) UHC doesn't deliver better outcomes. They had to rig the scoring to make it look better.

And my point about costs is that Medicare for all would end the cost shifting and thus very well might end up removing the cost savings that Medicare supposedly provides.

Pick three of these to look at, rather than subsets of subsidized healthcare within a for-profit system:


Countries with universal health care include Austria, Belarus, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, Moldova, the Netherlands, Norway, Portugal, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Turkey, Ukraine, and the United Kingdom.

ETA: four years in, I am very happy - nay, ecstatic - with Medicare.

I'm looking at how it works here. That's the best comparison point. Want Americans to support UHC, fix the UHC systems we have to show it will work! The idea of expanding the system when the existing ones are all bad makes no sense.

You keep making blanket assertions like this when you've already said there isn't enough data.

Seems awfully convenient.

Also, UHC doesn't mean "UHC with no changes from the current system", as you seem to want to imply.