Why "Medicare for all" isn't an answer

[Loren Pechtel]

I've pointed this out before but now I have a clear example of the issue: Medicare pays too little.

https://www.npr.org/sections/health...atv-crash-gets-56-603-bill-for-air-ambulance-

Yes, this is about a huge bill, but buried in it:

AAMS commissioned a study to determine the actual cost of a medevac ride. The report found it takes about $2.9 million a year to run a single helicopter base. Each base handles about 300 transports a year, and the rides cost about $11,000 each, according to the report.
...
The Centers for Medicare & Medicaid Services said it pays an average of $4,624 per ride, plus $31.67 a mile, which works out to an average Medicare reimbursement of $6,556 for helicopter ambulance rides for seniors. Medicaid in most states pays less.

Medicare for all would remove this hidden subsidy and the money would have to come from somewhere.

 

[bilby]

Oh well.

Clearly UHC can never work, and the current system in the US is the very best you can ever hope for.

The systems in every other developed nation on earth are clearly a figment of our imaginations, as they have been proven to be impossible by a simplistic assessment of the cost of helicopter medical evacuation, which plays (as we all know) a central and critical role in 99.998% of all medical care.

I could never have afforded that flu shot if I had had to pay the full cost of the helicopter transport to my local clinic. I expect a few hedge fund managers had to sleep on park benches after footing the tax bill for that one.

 

[untermensche]

We invaded Iraq for no reason.

It cost trillions.

It is amazing how there is no limit to the money for terrorism and war but so little money for health care.

It is all about priorities.

As long as we have a government more interested in aggressive war than healthcare we will have problems.

 

[Tom Sawyer]

Well, this is why us countries with UHC never have patients medivaced to hospitals but make accident victims get up and walk to the emergency rooms like they’re not pussies.

 

[phands]

I've pointed this out before but now I have a clear example of the issue: Medicare pays too little.

https://www.npr.org/sections/health...atv-crash-gets-56-603-bill-for-air-ambulance-

Yes, this is about a huge bill, but buried in it:

AAMS commissioned a study to determine the actual cost of a medevac ride. The report found it takes about $2.9 million a year to run a single helicopter base. Each base handles about 300 transports a year, and the rides cost about $11,000 each, according to the report.
...
The Centers for Medicare & Medicaid Services said it pays an average of $4,624 per ride, plus $31.67 a mile, which works out to an average Medicare reimbursement of $6,556 for helicopter ambulance rides for seniors. Medicaid in most states pays less.

Medicare for all would remove this hidden subsidy and the money would have to come from somewhere.

The UK NHS was working just fine until the republican-equivalent Tory party started sabotaging it to make it more like the awful US system. People don't need health insurance, they need health care. Imagine if all the money used to keep health insurers afloat went directly to treating people.

And then there's the question of how the government uses tax revenue. I'd be much happier knowing my tax money was going toward health care for all, as opposed to making billionaires even richer, pr buying ruinously expensive weapons systems or subsidizing tobacco or sugar barons.

 

[Axulus]

We invaded Iraq for no reason.

It cost trillions.

It is amazing how there is no limit to the money for terrorism and war but so little money for health care.

It is all about priorities.

As long as we have a government more interested in aggressive war than healthcare we will have problems.

Is California, New York and Vermont more interested in aggressive war than healthcare? Why haven't the most liberal states been able to pass any sort of universal healthcare? If the most liberal state in the country can't manage a universal healthcare system, it is insanity to believe the federal government can manage it.

 

[Axulus]

I've pointed this out before but now I have a clear example of the issue: Medicare pays too little.

https://www.npr.org/sections/health...atv-crash-gets-56-603-bill-for-air-ambulance-

Yes, this is about a huge bill, but buried in it:

AAMS commissioned a study to determine the actual cost of a medevac ride. The report found it takes about $2.9 million a year to run a single helicopter base. Each base handles about 300 transports a year, and the rides cost about $11,000 each, according to the report.
...
The Centers for Medicare & Medicaid Services said it pays an average of $4,624 per ride, plus $31.67 a mile, which works out to an average Medicare reimbursement of $6,556 for helicopter ambulance rides for seniors. Medicaid in most states pays less.

Medicare for all would remove this hidden subsidy and the money would have to come from somewhere.

The UK NHS was working just fine until the republican-equivalent Tory party started sabotaging it to make it more like the awful US system. People don't need health insurance, they need health care. Imagine if all the money used to keep health insurers afloat went directly to treating people.

And then there's the question of how the government uses tax revenue. I'd be much happier knowing my tax money was going toward health care for all, as opposed to making billionaires even richer, pr buying ruinously expensive weapons systems or subsidizing tobacco or sugar barons.

Health insurers take up about 3% of all healthcare spending in profits and administration. They also play some role in containing costs (they negotiate with healthcare providers to reduce payment amounts for healthcare services, because lower payments mean lower costs for the health insurance companies). Additionally, there is a significant market share from non-profit health insurance companies.

In other words, health insurance companies play almost zero role in sucking up dollars from healthcare spending.

 

[untermensche]

We invaded Iraq for no reason.

It cost trillions.

It is amazing how there is no limit to the money for terrorism and war but so little money for health care.

It is all about priorities.

As long as we have a government more interested in aggressive war than healthcare we will have problems.

Is California, New York and Vermont more interested in aggressive war than healthcare? Why haven't the most liberal states been able to pass any sort of universal healthcare? If the most liberal state in the country can't manage a universal healthcare system, it is insanity to believe the federal government can manage it.

States are arbitrary areas of land.

They have no interests.

The liberals are being fought against by corporate interests.

The corporate interests are masters at lying and manipulation and they have huge wealth and no morality. And they control politicians on both sides of the isle.

Presently the lying corporate interests are winning.

The level of widespread ignorance in the US is amazing.

Trump talked about a totally unneeded useless wall and millions cheered.

The ignorance level is drowning us all.

 

[ZiprHead]

To fight high drug prices, Utah will pay for public employees to go fill prescriptions in Mexico

 

[Toni]

I've pointed this out before but now I have a clear example of the issue: Medicare pays too little.

https://www.npr.org/sections/health...atv-crash-gets-56-603-bill-for-air-ambulance-

Yes, this is about a huge bill, but buried in it:

AAMS commissioned a study to determine the actual cost of a medevac ride. The report found it takes about $2.9 million a year to run a single helicopter base. Each base handles about 300 transports a year, and the rides cost about $11,000 each, according to the report.
...
The Centers for Medicare & Medicaid Services said it pays an average of $4,624 per ride, plus $31.67 a mile, which works out to an average Medicare reimbursement of $6,556 for helicopter ambulance rides for seniors. Medicaid in most states pays less.

Medicare for all would remove this hidden subsidy and the money would have to come from somewhere.

Medicare--and Medicaid do pay too little. That's a problem with the US system of publicly funded health coverage that I've talked about for YEARS. YEARS. For at least the past 20 years and probably much longer than that, Medicaid and many major health insurance providers do not cover the cost of providing basic treatment. Twenty years ago, I worked in the business office of my local medical clinic and I quickly learned how little insurance companies will pay for basic services and how far they will go to avoid paying a relatively modest fee, such as covering an office visit for an infant whose mother suspected s/he had an ear infection but was instead just teething. Two things: It is impossible to know which is causing the crying and low grade fever without a trained medical provider's exam--and sometimes they miss early ear infections. Ear infections and teething both can cause low grade fever, distress and tugging at the ear by the child. This is pretty routine for young babies. The insurance company certainly spent more effort and more resources for itself and for the provider denying the claim, which was re-submitted and denial challenged, than it would have if it simply paid the claim. Many insurers would routinely deny all claims the first time they were submitted because avoiding paying a claim for another billing cycle or two made their books look better plus a lot of patients will give up and pay the bill themselves, especially elderly people who cannot bear to have a bill unpaid for a few days, much less months. Medicaid has long paid so little for basic services that many providers seek to limit the number of medicaid patients they care for--and creating health care ghettos in the process. 20 years ago, Medicare was on the same trajectory, with ever changing rules which the physicians needed to be aware of in order to avoid providing a non-covered service that had previously been covered and which they could no longer charge either Medicare or the patient for.

THIS is the biggest reason I have ever argued against 'Medicare for all' in the US. I am very much aware that other countries manage to provide universal health coverage apparently without the parsimony or political blowhards expounding on things like covering the cost of birth control, pregnancy, preventative care for women and so on.

The truth is that there is zero reason--ZERO reason that one payer should pay more or less for the same service at the same provider. There is some rationale about paying different amounts depending on region or location based upon cost of living, etc. There is zero good reason for there to be more than one payer if that payer is rational and pays based upon the needs of the patient and not the political whims of a party.

 

[Elixir]

I've pointed this out before but now I have a clear example of the issue: Medicare pays too little.

https://www.npr.org/sections/health...atv-crash-gets-56-603-bill-for-air-ambulance-

Yes, this is about a huge bill, but buried in it:

AAMS commissioned a study to determine the actual cost of a medevac ride. The report found it takes about $2.9 million a year to run a single helicopter base. Each base handles about 300 transports a year, and the rides cost about $11,000 each, according to the report.
...
The Centers for Medicare & Medicaid Services said it pays an average of $4,624 per ride, plus $31.67 a mile, which works out to an average Medicare reimbursement of $6,556 for helicopter ambulance rides for seniors. Medicaid in most states pays less.

Medicare for all would remove this hidden subsidy and the money would have to come from somewhere.

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.)

 

[GenesisNemesis]

Oh well.

Clearly UHC can never work, and the current system in the US is the very best you can ever hope for.

The systems in every other developed nation on earth are clearly a figment of our imaginations, as they have been proven to be impossible by a simplistic assessment of the cost of helicopter medical evacuation, which plays (as we all know) a central and critical role in 99.998% of all medical care.

I could never have afforded that flu shot if I had had to pay the full cost of the helicopter transport to my local clinic. I expect a few hedge fund managers had to sleep on park benches after footing the tax bill for that one.

I've never seen anyone against universal healthcare give a reasonable reply to this point.

 

[bilby]

Oh well.

Clearly UHC can never work, and the current system in the US is the very best you can ever hope for.

The systems in every other developed nation on earth are clearly a figment of our imaginations, as they have been proven to be impossible by a simplistic assessment of the cost of helicopter medical evacuation, which plays (as we all know) a central and critical role in 99.998% of all medical care.

I could never have afforded that flu shot if I had had to pay the full cost of the helicopter transport to my local clinic. I expect a few hedge fund managers had to sleep on park benches after footing the tax bill for that one.

I've never seen anyone against universal healthcare give a reasonable reply to this point.

Whenever I see Americans explaining how UHC is impossible, I am reminded of Frederick Lindemann's insistence, during WWII, that a liquid fuelled rocket was impossible (because the British had been unable to develop one), and that the V2 must therefore be a hoax.

When shown reconnaissance photos of the German rocket factory, in which several V2s could be seen in a railway siding, and asked what these objects were, if not large rockets, he declared that they could be barrage balloons.

Dr R V Jones recalls that the question was immediately asked "Why then are the Germans transporting them on railway flatcars? Are they perhaps 'heavier-than-air' balloons?".

If your theory says it's impossible, but you observe someone doing it, it's not reality that has got it wrong.

 

[Toni]

Oh well.

Clearly UHC can never work, and the current system in the US is the very best you can ever hope for.

The systems in every other developed nation on earth are clearly a figment of our imaginations, as they have been proven to be impossible by a simplistic assessment of the cost of helicopter medical evacuation, which plays (as we all know) a central and critical role in 99.998% of all medical care.

I could never have afforded that flu shot if I had had to pay the full cost of the helicopter transport to my local clinic. I expect a few hedge fund managers had to sleep on park benches after footing the tax bill for that one.

I've never seen anyone against universal healthcare give a reasonable reply to this point.

Whenever I see Americans explaining how UHC is impossible, I am reminded of Frederick Lindemann's insistence, during WWII, that a liquid fuelled rocket was impossible (because the British had been unable to develop one), and that the V2 must therefore be a hoax.

When shown reconnaissance photos of the German rocket factory, in which several V2s could be seen in a railway siding, and asked what these objects were, if not large rockets, he declared that they could be barrage balloons.

Dr R V Jones recalls that the question was immediately asked "Why then are the Germans transporting them on railway flatcars? Are they perhaps 'heavier-than-air' balloons?".

If your theory says it's impossible, but you observe someone doing it, it's not reality that has got it wrong.

In our current political climate: I don't see Medicare for all happening. To make matters worse, people running for office are CALLING it Medicare for all. Which is making major providers like the Mayo Clinic come out against Medicare For All because currently Medicare DOES NOT PAY ADEQUATELY FOR TREATMENT. Not here in the US.

I agree that it is one of the stupidest things in the world but there you have it. We are currently fucking up our medical care system by underfunding Medicare and Medicaid which has the ripple effect of not paying enough to cover the cost for procedures and services and we have lots of providers, including major providers who work hard to contain costs struggling to stay open. Yes, a huge part is the cost we pay for medications but that's not the whole thing.

The one and only way to fix that is to ensure that legislators and their families must be covered ONLY by the insurance that the poorest people in their states have.

 

[Alcoholic Actuary]

Medicare for all isn't an answer because democrats do not now, nor will they in the near future hold filibuster-proof control of all three branches of government. Until they do, 'expensive helicopter rides' is the least of anyone's concern.

aa

 

[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.

 

[Harry Bosch]

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.

Well, it wouldn't happen until after the dems take the Presidency and hold on to the house (if able). It would take 5 years minimum to fully implement. During that time, the republicans would hammer the dems and blame all the short term problems on the dems. Democrats don't turn out well in off years when their party is in control. And then bam, the republicans would sweep in again and end it. Dems would be crazy to put their necks out again. They would be wiser to seek to expand the existing program and get more people covered, increase the safety net...

 

[Elixir]

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.

Well, it wouldn't happen until after the dems take the Presidency and hold on to the house (if able). It would take 5 years minimum to fully implement. During that time, the republicans would hammer the dems and blame all the short term problems on the dems. Democrats don't turn out well in off years when their party is in control. And then bam, the republicans would sweep in again and end it. Dems would be crazy to put their necks out again. They would be wiser to seek to expand the existing program and get more people covered, increase the safety net...

Yknow... I been thinking about that some lately. Maybe Trump will become a blessing in disguise. The biggest motivators for voters to turn out for midterms are anger and fear. Dem anger fueled this year's election, and the R'thugs failed to generate enough fear to counter it, despite the invention of scare-a-vans etc.. If Dems can take over the Senate and White House in 2020, the anger factor will go to the other side; Billy Joe Jim Bob is gonna be pissed that he can't wave his nazi flag so freely any more. This will imperil the Dems for 2022. But the fear factor will also flip side, and the Dems will have an ace in the hole - Donald J Trump. A real life example of what will REALLY fuck up your life, this country, the economy, get your daughter raped and your son condemned to menial work (or shot if he's the wrong color). If Dems can learn to work that angle effectively. maybe they can get some of their supporters out of the house.

 

[Loren Pechtel]

I've pointed this out before but now I have a clear example of the issue: Medicare pays too little.

https://www.npr.org/sections/health...atv-crash-gets-56-603-bill-for-air-ambulance-

Yes, this is about a huge bill, but buried in it:

AAMS commissioned a study to determine the actual cost of a medevac ride. The report found it takes about $2.9 million a year to run a single helicopter base. Each base handles about 300 transports a year, and the rides cost about $11,000 each, according to the report.
...
The Centers for Medicare & Medicaid Services said it pays an average of $4,624 per ride, plus $31.67 a mile, which works out to an average Medicare reimbursement of $6,556 for helicopter ambulance rides for seniors. Medicaid in most states pays less.

Medicare for all would remove this hidden subsidy and the money would have to come from somewhere.

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.

- - - 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.

 

[bilby]

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.

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.

A system of care is only as good as the care provided to the least cared for.

Fuck 'scoring them higher because they are UHC' - we are scoring the USA lower because it completely fails a large proportion of the people. That's not an unreasonable position to take. If 20% of surgical patients died from hospital acquired infections, you wouldn't get to say "But if we ignore those people, the outcomes are excellent". Likewise, you cannot get away with ignoring the uninsured, and saying "For the insured, the outcomes are excellent, so we shouldn't be marked down for what happens to the rest".