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Let’s Look At Medicare For All

 
EN
 
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EN
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17 April 2019 09:12
 

CMS health spending data:  https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/NHE2017.zip

(If that doesn’t work, try https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html
and then go to link on spending from years up to 2017)

U.S. health care spending grew 3.9 percent in 2017, reaching $3.5 trillion.  As a share of the nation’s Gross Domestic Product, health spending accounted for 17.9 percent.  That’s all sources of spending.
Medicare’s portion of that was $705 million, or about 20% of all health care spending.
About $1.2 trillion came from private health insurance.
At the time, there were about 320,000,000 people in the USA. 
Just using those numbers (obviously, health care spending is going to grow as the population and inflation grow), in order to have Medicare for all that covered all health care spending, the USA would have had to collect $3.5 trillion to cover health care costs without bankrupting health care systems (who operate on fairly small margins).  Medicare would then replace all other forms of payment for health care costs.
So, current Medicare taxes would have to rise about 5 times to cover this.
There would, hopefully, be some efficiencies.  As the sole payer, Medicare could dictate prices and lower them.  This would force health care organizations to economize, and would probably force a lot of mergers and takeovers.  Furthermore, Medicare could change its payment structure from fee-per-service to simply allocating a certain amount that it would pay providers for the patients they have and anticipate gaining, and leaving it up to the provider how to manage those patients’ health needs and still make a profit.  Finally, since Medicare would not be a for-profit service, it could, theoretically, require less than a private insurance company to satisfy demand.
So, if the government could make Medicare efficient so that overall costs would be reduced, then the public would, theoretically, pay less in taxes than it currently pays in taxes, insurance premiums, and out-of-pocket costs. 

 

[ Edited: 17 April 2019 09:15 by EN]
 
icehorse
 
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icehorse
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17 April 2019 10:07
 

Largely agreed, but..

Just using those numbers (obviously, health care spending is going to grow as the population and inflation grow), in order to have Medicare for all that covered all health care spending, the USA would have had to collect $3.5 trillion to cover health care costs without bankrupting health care systems (who operate on fairly small margins).

Some players in health care systems operate on small margins, but sadly some players make outrageous profits. We should look at this on a case by case basis. For example, I’d say that most doctors are fairly compensated, not excessively so. But prescription drug mfgs. often make excessive profits. Look at the enormous lobbying efforts they use to keep us from getting our prescription drugs from Canada.

==

Two years ago we lived in Ca., and our monthly, bronze level ACA premium was $2600 for me and my wife. That’s with something like a $7,000 a year deductible - each. So if we stayed healthy we paid $30k / year and if we got sick that would jump to $45k / year. We moved to Wa., and it’s cheaper, but it’s still 20k to be healthy and 35k if we get sick.

 
 
EN
 
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EN
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17 April 2019 10:13
 
icehorse - 17 April 2019 10:07 AM

Largely agreed, but..

Just using those numbers (obviously, health care spending is going to grow as the population and inflation grow), in order to have Medicare for all that covered all health care spending, the USA would have had to collect $3.5 trillion to cover health care costs without bankrupting health care systems (who operate on fairly small margins).

Some players in health care systems operate on small margins, but sadly some players make outrageous profits. We should look at this on a case by case basis. For example, I’d say that most doctors are fairly compensated, not excessively so. But prescription drug mfgs. often make excessive profits. Look at the enormous lobbying efforts they use to keep us from getting our prescription drugs from Canada.

==

Two years ago we lived in Ca., and our monthly, bronze level ACA premium was $2600 for me and my wife. That’s with something like a $7,000 a year deductible - each. So if we stayed healthy we paid $30k / year and if we got sick that would jump to $45k / year. We moved to Wa., and it’s cheaper, but it’s still 20k to be healthy and 35k if we get sick.

Agree about drug manufacturers.  I was focusing mainly on hospital systems, but Medicare could certainly force Pharma to take less, if it is the only payer.  That would be an additional efficiency.

Of course, people don’t trust the government to be efficient, which is a fair position based on past experience.  Things would have to change in that regard.

 
icehorse
 
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icehorse
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17 April 2019 10:16
 

I seem to recall hearing that Medicare is actually fairly efficient?

 
 
EN
 
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EN
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17 April 2019 10:30
 
icehorse - 17 April 2019 10:16 AM

I seem to recall hearing that Medicare is actually fairly efficient?

It’s probably more efficient than the Defense Department.  But if we are going to go to Medicare for all, it’s going to have to be excellent.

 
unsmoked
 
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unsmoked
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17 April 2019 12:53
 
EN - 17 April 2019 10:30 AM
icehorse - 17 April 2019 10:16 AM

I seem to recall hearing that Medicare is actually fairly efficient?

It’s probably more efficient than the Defense Department.  But if we are going to go to Medicare for all, it’s going to have to be excellent.

https://en.wikipedia.org/wiki/Healthcare_in_Canada  Scroll down to public opinion.

More horrors of socialism:  https://money.cnn.com/2017/04/10/pf/college/free-college-tuition-new-york-europe/index.html

[ Edited: 17 April 2019 12:56 by unsmoked]
 
 
Jefe
 
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18 April 2019 07:58
 

Under a govt. mandated single payer program, patients would not be subjected to unnecessary and expensive diagnostics and treatments just for the sake of a profit margin.  Costs per patient would likely go way down.

 
 
Jan_CAN
 
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Jan_CAN
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18 April 2019 09:20
 
Jefe - 18 April 2019 07:58 AM

Under a govt. mandated single payer program, patients would not be subjected to unnecessary and expensive diagnostics and treatments just for the sake of a profit margin.  Costs per patient would likely go way down.

And those requiring tests, treatment and preventative care will receive it regardless of income, thereby lowering the infant mortality rate and increasing life expectancy.

The math is simple.  The U.S. spends a larger percentage of its GDP on health care than any other wealthy country, and yet fails to provide health care for all of its citizens and imposes an unacceptably high cost on the majority lower/middle classes.

 

[ Edited: 18 April 2019 10:10 by Jan_CAN]
 
 
Jan_CAN
 
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Jan_CAN
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19 April 2019 07:38
 

A four-step plan:


1.  Election 2020.  A healthcare-for-all POTUS and administration elected.

2.  In-depth governmental research into successful universal health care systems.  To assess which aspects of these systems would be most applicable to the U.S., their methods of implementation, and to determine specifics.

3.  Pass the United States of America Health Care Act.  This Act would guarantee affordable health care as a right for all citizens and would outline principles and procedures, including methods for payment of federal tax monies to states for allocation to hospitals/clinics/physicians.

4.  Stepped implementation.  Full coverage for every citizen made available ASAP, perhaps by expanding and enhancing the existing Medicaid/Medicare programs, funded by federal taxes and state taxes/modest monthly premiums.  For an interim period, private insurance could continue to be available for individuals who wish to opt out of Medicare.  Over time, the types of medical services that private insurance companies are permitted to provide for are reduced, the final target being that they provide for only extra (non-urgent) services for the wealthy.  Of course this will cost jobs in the private health insurance sector, but there will be additional jobs created in government health offices.  There will also be large costs to implement the changes – perhaps a few billion could be diverted from the $600 billion military budget?  Universal health care systems evolve over time and don’t begin in a perfect state, but they must have a start.  (In Canada it started in one province, led by one humanitarian man’s vision, and then spread over a country.)

As in the implementation of any big change, there will be confusion, uncertainty and probably all-out hostility.  It’ll be a fight, but it’ll be worth it.


“The greatest way to defend democracy is to make it work.”
— Tommy Douglas, ‘Father’ of Canadian medicare


The Birth of Medicare:  From Saskatchewan’s breakthrough to Canada?wide coverage
https://canadiandimension.com/articles/view/the-birth-of-medicare
(The last few closing sentences are out-of-date; Harper was voted out in 2015.)

 
 
EN
 
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EN
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19 April 2019 07:45
 
Jan_CAN - 19 April 2019 07:38 AM

A four-step plan:


1.  Election 2020.  A healthcare-for-all POTUS and administration elected.

2.  In-depth governmental research into successful universal health care systems.  To assess which aspects of these systems would be most applicable to the U.S., their methods of implementation, and to determine specifics.

3.  Pass the United States of America Health Care Act.  This Act would guarantee affordable health care as a right for all citizens and would outline principles and procedures, including methods for payment of federal tax monies to states for allocation to hospitals/clinics/physicians.

4.  Stepped implementation.  Full coverage for every citizen made available ASAP, perhaps by expanding and enhancing the existing Medicaid/Medicare programs, funded by federal taxes and state taxes/modest monthly premiums.  For an interim period, private insurance could continue to be available for individuals who wish to opt out of Medicare.  Over time, the types of medical services that private insurance companies are permitted to provide for are reduced, the final target being that they provide for only extra (non-urgent) services for the wealthy.  Of course this will cost jobs in the private health insurance sector, but there will be additional jobs created in government health offices.  There will also be large costs to implement the changes – perhaps a few billion could be diverted from the $600 billion military budget?  Universal health care systems evolve over time and don’t begin in a perfect state, but they must have a start.  (In Canada it started in one province, led by one humanitarian man’s vision, and then spread over a country.)

As in the implementation of any big change, there will be confusion, uncertainty and probably all-out hostility.  It’ll be a fight, but it’ll be worth it.


“The greatest way to defend democracy is to make it work.”
— Tommy Douglas, ‘Father’ of Canadian medicare


The Birth of Medicare:  From Saskatchewan’s breakthrough to Canada?wide coverage
https://canadiandimension.com/articles/view/the-birth-of-medicare
(The last few closing sentences are out-of-date; Harper was voted out in 2015.)

Opting out should not mean that they don’t pay taxes, right?  Like property taxes for schools, everyone pays, even if they don’t have kids going to school.

 
Jan_CAN
 
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Jan_CAN
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19 April 2019 07:59
 
EN - 19 April 2019 07:45 AM
Jan_CAN - 19 April 2019 07:38 AM

A four-step plan:


1.  Election 2020.  A healthcare-for-all POTUS and administration elected.

2.  In-depth governmental research into successful universal health care systems.  To assess which aspects of these systems would be most applicable to the U.S., their methods of implementation, and to determine specifics.

3.  Pass the United States of America Health Care Act.  This Act would guarantee affordable health care as a right for all citizens and would outline principles and procedures, including methods for payment of federal tax monies to states for allocation to hospitals/clinics/physicians.

4.  Stepped implementation.  Full coverage for every citizen made available ASAP, perhaps by expanding and enhancing the existing Medicaid/Medicare programs, funded by federal taxes and state taxes/modest monthly premiums.  For an interim period, private insurance could continue to be available for individuals who wish to opt out of Medicare.  Over time, the types of medical services that private insurance companies are permitted to provide for are reduced, the final target being that they provide for only extra (non-urgent) services for the wealthy.  Of course this will cost jobs in the private health insurance sector, but there will be additional jobs created in government health offices.  There will also be large costs to implement the changes – perhaps a few billion could be diverted from the $600 billion military budget?  Universal health care systems evolve over time and don’t begin in a perfect state, but they must have a start.  (In Canada it started in one province, led by one humanitarian man’s vision, and then spread over a country.)

As in the implementation of any big change, there will be confusion, uncertainty and probably all-out hostility.  It’ll be a fight, but it’ll be worth it.


“The greatest way to defend democracy is to make it work.”
— Tommy Douglas, ‘Father’ of Canadian medicare


The Birth of Medicare:  From Saskatchewan’s breakthrough to Canada?wide coverage
https://canadiandimension.com/articles/view/the-birth-of-medicare
(The last few closing sentences are out-of-date; Harper was voted out in 2015.)

Opting out should not mean that they don’t pay taxes, right?  Like property taxes for schools, everyone pays, even if they don’t have kids going to school.

Yes, opt-outers would still pay the taxes, but perhaps not monthly premiums.

When I started working, in my province those who were working and could afford it paid modest monthly premiums into our provincial health care plans.  (In the early 80’s, this was $48/month for single coverage.)  This changed some time ago and these funds are now obtained through our provincial income taxes.  However, some provinces still have monthly premiums (e.g. British Columbia).

[ Edited: 19 April 2019 08:05 by Jan_CAN]
 
 
Antisocialdarwinist
 
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19 April 2019 15:47
 

Since we can’t let people “die in the street,” Medicare for all seems like the least bad solution to me. Although I wouldn’t necessarily do away with private health insurance for those who wish to supplement their Medicare coverage. I would, however, do away with tax breaks for companies that provide health insurance for their employees: treat employer-subsidized health insurance as compensation and tax it accordingly.

I think the real underlying problem, though, is that health care is a for-profit business in the US. Yes, I understand that the profit motive spurs innovation. But it seems to me that we’ve reached a point where the innovation being spurred by profit is outweighed by the excessive costs of a for-profit system. Regardless of which way we eventually go in terms of universal coverage, costs will continue to be a problem as long as we stick with the profit model. In fact, I have a sneaking suspicion that once we take the profit out of healthcare, universal coverage will become a whole lot easier to achieve.

Underlying everything, however, is the fact that neither party wants to solve the healthcare problem. They’re more interested in keeping it alive for a campaign issue.

 
 
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19 April 2019 18:39
 

For-profit health care does not like competition, especially from the government.  America has the best “your money or your life healthcare” system in the world.

 
Twissel
 
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20 April 2019 03:14
 

The most important aspect of Medicare for all is tough negotiations by the state with hospitals and drug companies. There must be stringent guidelines on avoiding undue influences. And it must be clear that profitability is not a concern of the government, only coverage and quality.

 
 
Antisocialdarwinist
 
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20 April 2019 12:07
 
Skipshot - 19 April 2019 06:39 PM

For-profit health care does not like competition, especially from the government.  America has the best “your money or your life healthcare” system in the world.

The government isn’t competing with for-profit health care providers, it’s competing with for-profit health insurance providers. For the most part, purchasers of health insurance are employers. And the tax breaks associated with employer-provided health insurance (along with the Obamacare employer mandate) are a big reason why.

It’s true, health care providers prefer to deal with health insurance companies rather than Medicare, but that’s because Medicare isn’t willing to pay as much. And there are plenty enough customers with private health insurance that the health care providers can afford to pick and choose. But if employers largely stopped providing health insurance, that would change.

If the Democrats were smart (or actually, if they were interested in resolving the issue instead of keeping it alive as a wedge issue for the next election) they’d frame Medicare For All as “good for business.” Requiring American companies to provide health insurance puts them at a disadvantage compared to their competitors in countries with public health care, where companies aren’t burdened with the expense of providing health insurance for their employees.

 
 
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20 April 2019 12:37
 
Antisocialdarwinist - 20 April 2019 12:07 PM

If the Democrats were smart (or actually, if they were interested in resolving the issue instead of keeping it alive as a wedge issue for the next election) they’d frame Medicare For All as “good for business.” Requiring American companies to provide health insurance puts them at a disadvantage compared to their competitors in countries with public health care, where companies aren’t burdened with the expense of providing health insurance for their employees.

Yep.

Something is pretty clear when neither political party can agree that businesses would rather not have to provide health insurance for their employees, or that people would rather not have the quality of their health care dependent upon the kind of job they have.  We already pay taxes for other people’s health care, but why can’t those taxes pay for mine?

 
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