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Before I say what it is, let’s consider all the things Americans don’t like about health care – cost, availability, insurance companies, third-party involvement, high deductibles, premiums, etc.
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NOW, the challenge.
Tell us why you will or will not support a form of Medicare for All replacing all the payment systems currently in place, public, employer and private plans to be funded by a combination of employer and individual taxes, income based premiums and cost sharing at the point of service.
Time to stick your neck out – Go‼️
Regarding the competitive marketplace: A funny line I heard at a conference: “Joe Namath doesn’t have a Medicare Advantage Plan”. And now I’m seeing Cal Ripken as a spokesman. Just the fact that these companies see the value in marketing such a basic need tells me there’s a problem here.
As long as it’s paid for I’m with you on this one.
I have never been without health insurance. As a child I was covered by my dad’s group policy, as an adult I was covered by my employer’s plan, as a proprietor I paid for my own insurance. For a couple years I received help from the Affordable Care Act, as did some of my clients; it was a Godsend.
There are many people who don’t believe in having health insurance. I know one such non-believer who went to the emergency room with chest pains; fortunately it was not a heart issue. Like many in his situation, he never paid the bill.
The cost of these healthcare deadbeats is passed on to paying patients in the form of higher fees. I don’t think that’s fair, but hey, healthcare providers ain’t charities.
My other issue relates to the employer/employee relationship. Future insurance premiums are a significant uncertainty, and employers don’t like that word. They try to transfer that uncertainty unto the worker bees, who also don’t like that word. M4A would help in this regard.
You’re right on all counts. Right now employers say they are planning more cost shifting to workers in 2026 and it is expected there will be significant premium increases top to bottom, the worst in ACA plans.
It seems I managed to acquire a record of red arrows on this post.
Sorry folks, but many comments here reflect the general misunderstandings associated with how we pay for health care, the role of insurers and government in paying the bills.
I started working in health benefits in 1962 processing claims, managed self-funded and insured coverage for 45 years, was on the boards of directors of four health plans and helped negotiate physician contracts. I also investigated and resolved more claim appeals than I can recall.
Little of the generally held perceptions about how we pay for health care, what it costs and how insurance works is accurate.
What most people want when it comes to receiving and paying for healthcare is impossible to achieve.
high cost does not automatically equal higher quality
more health care is not necessarily better health care
more competition in health care is more counterproductive than beneficial
insurance profits are not a significant part of premiums, but more to do with contract volume
a significant percentage of health care is unnecessary
American’s wait for care too
🔻
I will start you off with an up vote. Although I have some doubts about your views on the profits made in US health care I agree with your other points. The difficulty is seeing how to change the system. A new system doesn’t have to be Medicare for All. It doesn’t have to mimic the UK’s NHS. Other European countries have systems incorporating insurance that work well.
M4A could include insurance similar to how it does now, but on a level playing field. The essential element is 100% universal coverage and a single fee scheduled scheme possibly recognizing geographic differences in COL.
I have interviewed people in most European countries about their health care system. They are all different, but all universal. I never found one person with serious complaints. I suspect in part because they are not faced with out-of-pocket costs when services are required.
Even my friend in England likes their system despite his wife waiting for months for hip surgery. He still insists his health care is free. Not really, but when you don’t have to agonize over paying for a service, I guess it feels that way.
I believe there should be some form of Medicare for all. In a country as rich as ours, we should have basic healthcare available for all citizens. People would have the option for added services at a price to them. For example, concierge services are becoming popular, even among Medicare patients.
Expensive? Probably, but I believe we should do this. Realistic? Probably not given all the lobbyist for health care and Big Pharma.
I suspect your issue is that not enough of your fellow citizens share the same belief system. The US Healthcare complex is maintained by a highly successful network of for profit parties who have somehow convinced the populace that it is the best way of ensuring they get the best health treatment and the same populace believe sufficiently in exceptionalism/independence/self interest/every man for himself to want to keep government out of it and reject any collective solutions.
To the basic headline I don’t believe Medicare for All could ever happen, at least not until the US survives a serious external or indeed civil war.
Sadly I agree with your assessment that Medicare for all is not likely to happen, given the power of the insurance companies wield and how disruptive M-F-A would be to their bottom line.
Not necessarily, as someone still has to process all the claims. Especially since we would not start from scratch given all the Medicare experience.
What do you mean by “civil war?”
The traditional sense where divisions between groups in a country become such that they actually go to war with each other. Or perhaps other poltical and socio-economic differences being such that is active isolationism/resistance to contributing to the state as a whole.
The point is you’re not there yet. The precise definition is unimportant. My opinion is that it would take an event of that size and scale for the US to reconsider its aversion to a more collective healthcare solution perhaps as a healing mechanism after such a “war”.
Thank you for this post and, as always, for prompting reflection and conversation on a very complex topic. Most of my life the American system has worked for me including currently having Medicare. It has not for some others in my family, especially those who haven’t been able to work in traditional ways. ACA was a big help and Medicaid even more so. After reading all the perspectives, I’m left feeling a bit hopeless that we will never make things better in our country given the values we have. The easier solution seems to move overseas where they have other problems but most of figured out a way to have good medical coverage for everyone. I should make it to the finish line of life okay – depending on how far that line is and how I run, walk or stumble the last few yards – but I fear for my grandchildren and my children by the time they get to 65 and beyond.
I share your concerns, but it is not just when they reach age 65. The premiums our children pay, the deductibles and out of pocket costs are outrageous and it’s not the fault of the insurance company.
Every patientnt in the US for the most part is paying a different fee than anyone else. It is a bookkeeping nightmare. Go in to a pharmacy and you might pay a buck or 60 cents to fill a script as I did last week. KISS is the best system and pay our docs the fees they do deserve
Transparency is a big issue as far as I’m concerned … Try finding someone in a doc’s office / medical billing joint / insurance company who will give you a simple understandable answer to a question is often maddening
I have not encountered that. I ask until I get the answer. I accompany my wife and ask the more difficult questions for her as necessary. I suggest what to ask, but she doesn’t need much help.
if you are referring to transparency in terms of cost. I don’t care, because I am covered and can’t do anything about it anyway.
The one exception is for an Rx. That I question. Last year I went to fill an Rx and was quoted $650. I said that I was not paying that and the pharmacist said let me see if there are any coupons and then the price because $199.
You should also question and negotiate if you need to use an out of network doctor.
I use the pharmacy at my local Harris Teeter grocery store because they always check for the lowest price. If your pharmacy doesn’t it’s easy enough to check GoodRx before deciding where to fill a prescription.
What are the fees the docs deserve? Benchmarked against earnings in other developed countries or enough to buy boats, palatial second homes, aircraft……..
Incomes in that category are rare.
Primary care including pediatricians earn in the $200,000 range. Radiologists and anesthesiologists are among the highest paid.
I seem to remember reading that the supply of doctors is constrained by an artificial limit on residency programs. Lower supply means higher prices. Primary care salaries are not representative of the field as a whole.
Lower supply of some doctors means higher prices, but oversupply means higher costs. Add an extra specialist in an area and prices won’t go down but utilization will go up.
Health care does not respond to normal competitive forces.
As I said, some specialists are higher than primary care, more in the $400,000 range, but for some of them it means many more than 40 hours a week and 24 hour possible disruption.
I have a friend whose five year old daughter will undergo spinal surgery at Boston Children’s Hospital for the removal of a cancerous tumor. The result of this surgery could be recovery, paralysis or death. Do you think the parents would deny the doctor a place on Cape Cod with RDQ? I’m sure this surgeon— a woman doesn’t have a boat like Jeff Bezos or aircraft like Bill gates. But right now, do you believe they value her services any less?
I’m sure they don’t. But do you think that surgeons in Europe or Canada say wouldn’t be as good at such a surgery because they earn less?
That’s my point – it’s really hard to quantify a statement like
“pay our docs the fees they do deserve” because lifesaving and health restoring is such an emotive and unquantifiable activity.
Does a firefighter who risks their life to enter a burning building to rescue a child deserve $500k salary on the same basis?
The profit-takers in the whole US healthcare system do however exploit these emotive factors with the constant if unspoken threat of “do you want worse care?”
I suspect that many of those top doctors might be at places like the London Clinic. Why else would such places exist?
Spot on.
And there is the problem with healthcare.
None of us can look at it objectively in terms of cost/value. We want the best care and we don’t care what it costs, me included.
Those parents want the best for their daughter and rightly so, but the skill and caring of the doctor should have nothing to do with her income.
Americans tend to relate quality with cost for health care.
I once had a claim dispute to resolve. The wife of an employee was using a “top” obstetrician in NYC who charged thousand more than customary or allowed by our plan. She insisted she was going use the best, but she wanted the plan to pay.
As part of the claim appeal I investigated the physician and found he had numerous malpractice claims pending against him – likely contributing to his extraordinary fees.
This child’s scans were sent to the major cancer and pediatric hospitals in the US last May before her first surgery. None had more experience doing the operation than the doctor at Boston Children’s. The first surgery was highly successful, and the second will hopefully make chemo unnecessary. I think this doctor’s skill is worth high pay. If we can justify the extraordinary pay of some athletes, I’d also argue some medical practitioners are “worth it.”
That’s fine except we are not paying the bill we want to justify, nor could most people.
Athletes are paid outrageously in some cases because people are willing to pay ridiculous ticket prices with their money.
This is like people saying teachers are underpaid and deserve more while at the same time complaining about high property taxes.
i think the high athlete salaries have more to do with media contracts than fan ticket sales. In other words, a third party payer is involved.
i can’t think of any profession where someone with extraordinary skills isn’t paid more than the average. Even in single payer counties, isn’t that the reason why many people have private medical insurance? The case I mentioned of a doctor at Boston Children’s isn’t equivalent to the example you cited of some who just wanted to go to a pricey doctor. There are real reasons why BCH is one of the top children’s hospitals in the country.
No she wanted to go to that doctor because she was convinced he was the best doctor. People often equate price with quality.
i hardly think doctors are paid average.
The bottom line is if we think certain doctors should be paid more because of their skills, the we need to be able to measure their better outcomes and be willing to pay more.
buying private insurance has more to do with quicker access than quality.
my wife went to Wills Eye Hospital in Philadelphia and was operated on by one of the top retina surgeons in the country and both accepted Medicare as payment.
there is no direct relationship between fees and quality nor should there be unless you want to view physicians as simply business people which i don’t.
Your wife’s experience is a great example. The top retina specialist took Medicare, but isn’t that because he also operates on people with third party insurance? I imagine if you look at what Medicare paid, it was pennies on the dollar. So what happens if we go Medicare for all? How will that doctor’s pay get set? Don’t you want him to get anything for his specific skill and expertise? And if he gets the same pay as someone who does nothing more complex than some doing nothing more complicated than cataracts, is that fair? I’m not saying higher cost is the sign of better performance, but to be considered a leading eye doctor as you say, he does possess exceptional skills.
Yes, they accepted far less than private insurance would pay and that’s the very point. Costs are shifted from here to there and subsidized by different groups.
Don’t assume Medicare for All simply pays at current levels, that could not happen.
M4A is a concept for universal coverage not a literal use of existing Medicare. A lot would need to change to accommodate the entire population.
Latest projections see health care spending increasing at about 8% next year and surveys indicate employers are looking to shift more costs to employees.
Medicare premiums and deductible are going up next year a well.
The system cannot be sustained.
I wonder what the folks so opposed to Medicare for All will do when they turn 65? 😎
This simple question deserves red arrows? 😱
blue pill or red pill?
or
you’ve been rewarded with the red badge of courage 😉
Medicare for All creates a monopoly. And while monopolies might enjoy economy of scale, they are not too great when it comes to having incentives for being the best they can be. Being the only game in town routinely brings apathy for its customers, if not contempt. And little incentive for controlling costs.
Also, while I have issues with UHC, and Humana, and CVS Health and others, they have competition to keep them somewhat honest. And shareholders. And the gov’t.
My experiences with the IRS and Social Security and Medicare – with their complexity of rules, and their difficulty in reaching people who can solve my problems – leaves me with zero confidence that a Medicare for All bureaucracy would be any better. And because it would be bigger, I imagine it would be worse.
And finally, when you turn your healthcare over to the government, who provides oversight on how they’re doing? That’s right, it’s the government. Does that sound like an Rx for accountability?
“Medicare for All creates a monopoly. And while monopolies might enjoy economy of scale, they are not too great when it comes to having incentives for being the best they can be. Being the only game in town routinely brings apathy for its customers, if not contempt. And little incentive for controlling costs.
Also, while I have issues with UHC, and Humana, and CVS Health and others, they have competition to keep them somewhat honest. And shareholders. And the gov’t.”
Umm, and how is the “competition” working out in Medicare Advantage? If I recall some of these very companies have a DOJ initiated law suit claiming that they have been committing fraud. HHS spends more money per patient with MA than original Medicare and the patients have more constraints (between service limited to your zip code, to pre-authorizations).
That’s one of the points I made. If the private insurance companies color outside the lines, the DOJ looks into things. But if Medicare for All takes hold, who investigates? The federal government isn’t too fastidious or objective about investigating itself.
There would not be any monopoly as in both traditional and Advantage plans there is still competition. Although the Advantage plans’s manipulation, some might say as I do fraud when it comes to up disabilitizing up charges (I just created a new word), has got to end.
Nobody on Medicare today has turned their health care over to government. Medicare has proved its worth for over 60 years.
As to little incentive to control costs, when private coverage tries to control costs there is outrage, when Medicare talks about limited pre certification, there is outrage. When Medicare attempts lower fee payments there is outrage.
Exactly what type of cost control will Americans find acceptable? Answer, none. We want it all, we want it uncontrolled and we want to blame any one or anything other than ourselves for high costs.
I posed this question to Reps. Jackie Speier and Nancy Pelosi during town hall meetings promoting the Affordable Care Act. I told them it made no sense to me to put in a massive new infrastructure — and 50 separate state exchanges — instead of using the same funding to give 37 million uninsured Americans access to Medicare, which was already working well for 65 million recipients. Neither really had an answer to the question.
I still support Medicare for all. It fits the hybrid public/private model that I believe works best for national healthcare. I find it obscene that ours is the only leading nation in the world where people go bankrupt because of medical bills.
I once attended a small meeting at the White House during the Clinton years when they were trying to sell Hillary’s health care plan. I started asking questions and making observations and it wasn’t long before they didn’t call on me any longer.
thanks, now i know why Hillary’s plan stumbled out of the gate 😉
I support Medicare for all.
when there is a time that AI is truly working as intended we should let it come up with how it will work and let the politicians tear it apart and protect the special interests.
I chuckle a bit when I hear ‘Medicare for all’. I’m on Medicare and the premiums, deductibles and bills still add up to a sizable chunk of money. I think a lot of folks have the misconception that it’s ‘free care’. Also, as far as incentives, if all docs had to accept Medicare rates, we’d see the brightest tier of college students opting for engineering or business degrees, leaving us with the lower tiers as physicians. Nobody wants to spend 8 years of training, steep loans and little income during training to make blue collar wages. By 8 years I mean 4 in med school and 4 in residency training. It’s a very long haul. I have young doctors friends starting their career $400k in debt.
We also need to find a better way to fund medical training as they do in many European countries.
I would absolutely favor a Medicare for All approach. Our health system is a mess, and I say that as someone who’s been blessed to have excellent coverage throughout most of my adult life and am now on Medicare with a supplement from a previous employer.
I’d go further and say that this system also needs to cover assisted living options (including in-home care) for the final years. This is a huge problem with an enormous group of Baby Boomers in their golden years now.
Since 1990, CMS has offered assisted living and in-home care through PACE—the Program of All-Inclusive Care for the Elderly. It’s a comprehensive model that includes home support, clinic and hospital care, dental and vision services, prescription delivery, meals, transportation, housing help, caregiver respite—and even nursing home coverage when needed.
PACE is free for those on both Medicare and Medicaid; otherwise, costs vary and can reach up to $5,000/month.
While many older adults hope to age in place, PACE adoption has remained modest. By 2019, only 30 states had opted in, with one key obstacle: many seniors wish to keep their own doctors, while PACE organizations employ staffs – doctor, dentist, optometrist, physical and occupational therapists, pharmacist, nurses, nurse aides, drivers – for coordinated care.
I think you have the cart before the horse. Senior citizens are not, generally, in their reproductive years. So, Medicare isn’t paying for birth control, IVF, or abortion. Before you try to deal with the issue of doing single payor instead of the current mish-mash, you have to get an agreement on what would be covered by a single payor system. This, in my opinion, is not possible. With the current political divide in the US, we cannot achieve an agreement on anything.
Of course. We aren’t talking about just enrolling people in Medicare. That why I said a form of Medicare for all.
I am in favor of doing something, I just don’t think we have enough of a consensus on anything to get it done.
That has been the case since Medicare began in 1965. Back then I lobbied against Medicare, a stupid thing to do. Back then my employer provided good coverage into retirement even paying the Medicare premium.
Now there is no such retiree coverage. Even our employer Medicare supplemental coverage was taken away three years ago.
Until there is a consensus for a national, universal system, people are free to complain about insurance companies, premiums and out of pocket costs – but it’s our own fault.
Not one new idea has worked and none is working now or will. Will still have millions uninsured.
Medicare and MA work fine, some people will not be happy until the government controls every part of our lives. The fact that you are positive about Medicare for all is enough to make me negative about it. This blog is slowly becoming Quinn’s and his followers. I am not one of them.
Yikes, no need to be nasty. If you’re not a fan of someone’s posts, no one is forcing you to click on them. This is a voluntary site, and anyone can post, so if you think there are too many by Mr. Quinn, you can always post something yourself. Since the founder/editor of HD is battling a terminal illness, we’re all pitching in.
I don’t always agree with RDQ’s opinions, but I appreciate that he puts forth the effort of throwing out topics for discussion.
Well said Dana!
Well, MA does not work fine. It was supposed to save Medicare money, but it does the opposite. Just explain a better idea to assure every American has coverage to obtain care and costs are fairly distributed among all citizens.
what coverage do you have? What do you pay?
If Medicare works fine which I agree it does when adequately funded, why would not a similar system work for not just for 65 million, but 340 million?
It wouldn’t have to work for 340 million, just those who chose to use it, or needed it at some stage.
And how would you fund a government program that covers 340 million?
I haven’t the expertise to answer that question, but if Japan can do it for 123 million people, and Germany and France can do it for 84 and 69 million citizens respectively, the US should be able to figure it out.
There is little, if any additional cost, likely a savings.
As of 2023 the annual cost for employer family coverage was $23,968, higher now. Employees pay about 20% of that.
That is diverted to universal coverage. Employers pay about 8% of payroll for their employees.
The costs for Medicaid and ACA subsidies go away. Uncompensated care costs go away. Private premiums go away.
In other words, there is a more efficient better use of dollars now being spent.
The average worker pays over $6,000 in premiums each year and that is job based coverage.
In short it would be funded similarly to Medicare with a combination of employer and worker taxes, income based premiums and out of pocket costs when services are used.
But not additional costs beyond what we currently spend.
“The costs for Medicaid and ACA subsidies go away. Uncompensated care costs go away. Private premiums go away.”
Billions of dollars on administrative costs go away. Billions of dollars in profits for companies go away. This is all part of the exorbitant costs of premiums.
A study by McKinsey found that hospitals and health systems are conservatively spending an estimated $40 billion annually on costs associated with billing and collections.
Healthcare insurers made nearly 71 billions in profit in 2023.
There I just saved the country over 110 billion annually.
Except that profit thing is not what it is assumed to be.
Profits are not and never were a part of the problem. They make up a small percentage of premiums.
Sometimes those profit numbers are for the insurers business as a whole including non health lines of business.
About 69% of all workers are in self-insured plans where there is no profit motive as far as claims and premiums go.
However, profits don’t entirely go away. Medicare contracts with claim payers, often insurance companies and they still need a profit. It’s like self-insured employer who pay a flat fee for the claim service.
“Medicare for All,” one payer for all medical care in the United States, might make sense from an efficiency perspective, but fear that it would be unfair to health care providers (I’ve heard that Medicare rates don’t fairly compensate doctors, nurses, hospitals etc.) and also fear one entity making decisions about the healthcare I’m entitled to receive.
Medicare pays more than Medicaid, but less than commercial insurance. Premiums reflect the differences. In the other hand US doctors earn more than other doctors around the world – and patients pay for that. So, if it’s fairness in physician pay we want, no complaining about costs.
No entity will decide what healthcare you are entitled to receive, but may limit what someone else is willing to pay for. Medicare doesn’t do that. Today any such limits exist just interpreted differently depending on coverage.
Of course, no limits means higher costs.
Seems as if Medicare does limit what it will pay for.
This is NYT headline from today’s paper: Trump Administration Will Limit Medicare Spending on Pricey BandagesIn an about-face, the administration is cracking down on so-called skin substitutes, overused treatments that cost Medicare more than $10 billion last year. This may make sense and may be justifiable. But who is to say what is done to restrict coverage in the future will be justifiable.
This article— from The NY Times— recounts millions of dollars of fraud and abuse. Why should we see this curtailment of wasted money a harbinger of future cutbacks of legitimate Medicare spending? I don’t.
One reason doctors in the US deserve higher pay is because they have to do a four degree before they start training. They also have to pay for their education. Not that that necessarily justifies the actual salaries, especially of specialists compared to general practitioners.
My son is a doctor, so I admit some bias. But I’d argue higher pay shouldn’t be related solely to higher education expenses. Doctors have to complete years as interns and residents, and, for specialists, fellowship time. These are low pay and can be arduous — both physically and emotionally. Doctors deal with patients facing difficult issues every day. I believe their contribution to our wellbeing is every bit as important as that of high paid workers in finance, software development, management, etc. Their earnings should reflect that importance.
It is disingenuous to use Medicaid reimbursement as you have in comparison to what Medicare pays. Both of them are subsidized by what is paid by traditional commercial insurance, and government payments. When I see my Medicare statements showing what Medicare paid for a doctor visit, it is always a small fraction of what is billed. If you simply expand the current Medicare reimbursements to everyone, all the providers would quickly go broke.
Nobody said simply expand Medicare reimbursement. What we might look at is how medical education is funded and thus lower physician costs.
Universal Healthcare for all residents of the United States is the way to go. I prefer a risk+inflation adjusted voucher based system where residents can shop for private healh insurance and the wealthier residents get to buy supplemental insurance. What gets covered in the basic plan is recommended by a panel of medical experts with credentials.
Mark, the best healthcare systems in the world are the ones where government provides baseline care for everybody and those choosing to can add supplemental insurance — Germany, France, the Scandinavian nations.
However, the term “universal healthcare” has come to mean an all-government system like the NHS in Britain, which I do not support. I understand from my friends there that the waits for surgeries can be horrendous, and the NHS is slow to adopt new breakthroughs and therapies. The new cancer treatment that saved my life wasn’t even close to becoming available in the UK at the time it was approved here in the US.
I think Medicare and MA option have demonstrated that the choice, risk adjusted approach does not work. Everyone must be part of the same risk pool.
The current total payroll in the US is about $10 trillion. The government currently spends about $2 trillion on medical care, while everyone else spends $3 trillion. Therefore, in order to cover current spending, without any increase in usage, an additional tax of 30% on all salaries would be required.
This is why the government always chickens out – the costs are too high, and the voters would revolt.
No additional cost because Medicare for All would replace all existing spending by employers, individuals, government programs, even the VA for non-service connected care. Spending is redirected into one pool.
No 30% additional tax at all. Although unknown, substantial savings would occur through less administration costs, mostly benefiting the private sector.
Employers on average currently pay 7-12% of payroll for health insurance. That gets redirected. Workers pay thousands per month in their share of premiums and out of pocket costs. That is redirected.
All in all, starting cost neutral for basic health care coverage is quite feasible. Then we decide as a society on the generosity of added coverage we are willing to pay for.
I spent the first twenty seven years of my life with the UK’s NHS. I spent the next fifty years in the US, first with employer coverage and subsequently with Medicare. I vote for a national system, hands down. Even though I had good coverage, I knew many others did not. Also, the cost overheads are crazy. It doesn’t have to follow the NHS system – successive Tory governments have starved it of funds, and Brexit starved it of workers. The French system is usually considered the world’s best, and that’s good enough for me.
let’s aim—however recklessly—to please everyone with options. CMS would divide its $2 trillion annual budget among the population, sending a prorated share to each state. CMS retains its role in collecting FICA taxes and enforcing minimum federal standards for care, transparency, and data.
Instead of one-size-fits-all, each state could:
(editing the format)
Choice # 1: launch its own Medicare + medicaid-for-all
Choice #2: return the funds to CMS and stick with tradition (i.e. no change)
Choice #3: send citizens their share directly—to choose private plans or boldly wing it (i.e. no government program)
Of course, beware the siren call of choice: we might just find ourselves in a landscape where meccas of care sparkle beside deserts of neglect—proof that sometimes, getting what you wish for is the start of a whole new headache. 😉
“Americans will always do the right thing, after they have exhausted all other options” Winston Churchill.
“Choice #3: send citizens their share directly—to choose private plans or boldly wing it (i.e. no government program).”
The problem with this part of your plan is who pays for the cost of deadbeats that would just “take the money” and “boldly wing it”. I don’t think they would have the means to pay for the service themselves.
You really think 50 different systems are better than one? Why? The Brits had a version of that at one time: it was called the post code lottery because whether or not a procedure was covered depended on where you lived. Now they have NICE (National Institute for Health and Care Excellence), which determines coverage for the whole country.
“let’s aim—however recklessly—to please everyone with options“
Should’ve made it bold, really – formatting matters. But more seriously: I respect different opinions, preferences and freedom of choice. Seems fairer than cramming us all into one healthcare suit, whether it’s Medicare-for-all or the UK’s NHS. Consensus among state residents is far more achievable than national unanimity, and when federal, state, and private plans compete, innovation tends to thrive more than one-size-fits-all approach.
I know I know – we can’t please all the people all the time.
The worst thing to do with health care coverage is offering options for the level of coverage. Adverse selection must be avoided, simplicity a goal and certainly a persons coverage shouldn’t be based on where they live.
These are human systems. I’d expect state run Medicare type systems to be run as well as current Medicaid, which has problems. I can see the politicians coming up with a bill of several thousand pages to determine how to “equitably” divvy up the booty. There would be earmarks, exceptions and so on. I think of the U.S. federal tax code and shudder.
after editing the posting format, respectfully I choose all three choices, for peace’s sake, allowing them to coexist.
Imagine all the people living life in peace.
Let’s give peace – and freedom to choose – a chance.
Isn’t the problem with options is that they need to be paired with equivalent moral hazard?
For a cartoonish example let’s say Joey Sixpack could afford healthcare premiums but says “Hey for what I’d be spending there I can finance a speedboat for my day drinking” and then in said speedboat and with his beer buzz on he crashes badly.
Guess the expectation is that SAR, paramedics and ER care is still provided to him though he took the option of choosing to spend his money elsewhere.
The problem is insurance becomes conflated with health care. They are not one and the same. I’m only interested in serious conversations about how to improve U.S. health care. And, as we know, no one gets rich by promoting prevention. Instead, we get diversion and obfuscation. “People are dying!” Yes, pass me that Big Gulp and a couple of thousand empty calories, thank you!
One of our biggest problems is that each medical procedure in the US costs about 3 times as much as in any other country. Studies show that we don’t actually have more medical procedures per capita than other countries, despite the allegations of obesity and lack of exercise. So the root cause of our problems is not overuse of the medical system, but high costs.
Despite opposition to Medicare, including by the AMA, it was signed into law by LBJ nearly 60 years ago on 7/30/65. I am now 74 and it (Traditional, not an Advantage plan) has been greatly beneficial to me and my wife. If Medicare for All was in effect, it would likely lower healthcare costs and place the greedy private insurers in less of a dominant role, IMHO. I wholeheartedly support Medicare for All.
Yes, a system where everyone under 65 pays a 1.45% x 2 tax, or a 1.9% x 2 tax if you have a high income, raises a lot of money. If there are many workers, and few retirees, this can work. However, if you want to extend it to everyone, there is no ‘someone else’ to tax.
I agree Medicare works. However, greedy private insurers is not a fair representation. Their profit margins are about the same as regulated utilities. Plus they are required to pay in claims at least 80% of premiums. Premiums are driven by the unit cost of care, the intensity of care including where provided and the amount of care provided.
https://www.healthaffairs.org/content/forefront/addressing-greed-health-care-if-not-us-and
dwestenk –
70 here I agree with you 100%
Wait, I was told that the ACA was going to drastically lower medical costs for all of us?
As long as Americans demand health care like they have for decades, not likely the cost is going down, but there is hope for more equitable distribution of those costs and lower costs associated with administration at all levels.
The demands are escalating. Have you noticed the rise of “longevity clinics?”
We were lied to. We need to get government out of the health care business.
Making a blanket statement like you have here makes it sound like some sort of conspiracy theory.
In fairness you should explain in detail what the lie was so people have a chance to counter your arguments.
Ok, what is your solution that assures all Americans can pay for needed healthcare? All ideas welcome. How do you get your insurance?
How to assure that all Americans can pay for needed health care? That will never happen. For one thing, what we each define as “needed” is entirely subjective. For another, there are thousands of homeless on the streets, an estimated 187,000 in California alone. They can’t afford any health care. Then there are how many million living solely on some form of government largesse and that includes whatever social security benefit they have. So down the rabbit hole we go and in the utopia people would only pay what they can afford, or their fair share as the politicians are fond of telling us. And, they would get any medical treatment or drug that was “needed”. About 69 million are estimated to be receiving SS benefits. About 71.4 million are receiving Medicaid benefits. How to deal with personal income shortfalls? Why, universal income, of course! Let’s hand money to people to assure that they can pay all of their monthly bills and pay for their health care, too!
You know, other countries manage to provide healthcare to all their citizens at reasonable rates. It is not rocket science. It may require seeing all your fellow citizens AS your fellow citizens and not some amorphous “other”.
No, needed is not entirely subjective. The homeless and poor are wrapped into a M4A system. Given many other countries have universal systems that work in their own way and are generally supported by their citizens makes it difficult to argue against a single payer system.
Purchase through private sector insurance companies. Why are employers that we work for (and unions) in the providing health care business? Get them out (and government) and that will open the door for more competitive opportunities for suppliers and customers. As for Medicare, we are stuck with it for a few decades, but we have to start thinking about a cut off and the youth generations now.
The thing is competition does not work in health care as it does with other services and products.
Those who provide services also control demand plus more insurance companies in an area make it harder for them to negotiate fee payments because the process relies on delivering patients to the providers which made harder with more insurers.
when more services are available such a MRIs, scanners, labs, prices don’t decline, utilization increases.
what do you find objectionable about Medicare?
do you believe individuals can afford the full cost of insurance on their own and that will lead to universal coverage?
Competition does not work in health care in the U.S. because of structure and regulation. It is a “for-profit” system disguised as something else. It is dysfunctional, too. For decades insurance including Medicare negotiated rates but those without were/are in a different tier. The solution? Don’t fix the system, instead allow medical bankruptcy. Another example: Donor organs are in short supply. It is my understanding that the kidneys of smokers are rejected. Not so in parts of western Europe. Question: Would I accept a kidney from a smoker? Or do I prefer none at all? In France everyone is a donor but can opt out. The list of systemic failures is endless.