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When I read posts on social media, the word “free” pops up all too frequently.
Free health care, free education, free flu shots, free birth control, freedom from taxes is popular too. Is this wishful thinking or a reflection of a serious lack of understanding about how things work?
I look for offers including free shipping, but what if I must spend $200 to receive it? Buy two get one free, but I only need one. Now I have three and still paid for two.
I don’t know if I should laugh or cry when I read people asking why our health care can’t be free like Canada or England or a Scandinavian country. In some countries college is “free” as well. Of course in those countries taxes are higher, especially payroll taxes and also the 20% + value added tax (VAT).
While we are vocal about taxes, it appears Americans would prefer the cost of many essential services and benefits to be buried in taxes and thus naively claimed to be free.
I liken this to what I call the highway syndrome. I drive happily down the road using the express lanes going through one toll area after another and it’s free to me. I don’t slow down, no coins in the booth – just free. That is until EZ Pass charges my credit card.
Some of my fellow seniors believe they should not pay property taxes toward the cost of schools. They did their bit when younger with their children they say. Imagine property taxes necessary if schools were only funded by young families.
Our new president says Social Security benefits should be tax free and yet those income taxes are used to fund both Social Security ($50 billion a year) and Medicare ($35 billion a year) trusts.
Many retirees look for strategies to avoid IRMAA Medicare premiums, but in their absence, premiums for all on Medicare would be higher – or the national deficit would be as Part B is 69% funded from general revenue. Medicare Advantage plans are sometimes free, but there is a price to pay – limited access to care, not so publicized deductibles and, of course draining more funds than necessary from traditional Medicare. It’s all connected.
Many Americans embrace the idea of lower taxes, it’s almost traditional. Who favors higher taxes? I’d like lower taxes, but who will foot the bill we are accumulating? Even the national debt is not free – nearly $1 trillion a year in interest payments.
In reality the US is among the lowest taxed countries in the world.
I’m pretty sure free does not exist and yet we seem to want more of it.🤑
When things are ‘free’ and consumers don’t have some skin in the game it tends to make them less responsible. If all my care is free then heck yes I will go ahead and get all the expensive tests and care that I can. But if I know that I am responsible for part of the cost then I will be more discerning about what care I really need. This (along with personal well being) also provides incentive to try and live a healthier lifestyle. This is a common sense principle that makes perfect sense in many areas of life, but many would still call it unfair. I am in agreement that ‘free’ is not a good solution. If consumers think Medicare for All means ‘free’ they will be surprised, plus imagine how much more health care demand there will be if everything was free.
It may be common sense, but when it comes to health care it is a fallacy.
The concept has been tried for decades. That is the reasoning Medigap F is no longer around. The idea of making patients consumers, shoppers with skin in the game is simply not applicable to health care. It may motivate to use a generic drug, but not much more.
I doubt many people, sensible people, will get all the tests they can because they are “free” Who in their right mind wants any tests that are not absolutely necessary? Many are uncomfortable, unpleasant and often with a measure of risk.
‘’The patient does not determine the care needed, the physician does and very, very few patients are going to say, “that’s too much, I think I’ll skip that MRI, nor are they going to shop for the cheapest deal.
I never once thought about the cost of my or my wife’s or my children’s care. If someone is sick, especially seriously, price is and should be the last thing on your mind.
All the things that make sense for motivating consumers to buy or not do not apply in the same way to health care. We have tried FSAs, HSAs, HRAs, high deductible health plans, no Plan F. No scheme has had any significant positive impact.
Clearly, we can’t have a blank check either which gets us back to insurance using dollar limits, various forms of reviews for medical necessity, utilization limits such as with chiropractors, etc.
I’ve been splurging lately since we’ve met our high deductible: CT scan, cardiac stress test, blood tests for Alzheimer’s, MRI. Much nicer paying 20% than 100%.
Sounds like asking for trouble. What if one of those tests turns up a false positive? Do you know what you will do if one turns up positive? At 77 I’m looking to reduce the number of diagnostic tests I take.
I’ll rely on my doctors to help interpret the results. Already my neurologist has a quite different opinion than the radiologist. At 60 I’m not at the point yet where I want to reduce testing.
But none of it is fun or enjoyable or things you would like to do is it. I hope all those tests are negative and turn out a waste of time.
Thanks!
Your viewpoint may make sense when deciding whether to use Cologuard or have a colonoscopy. It makes no sense when you are unconscious after an accident or heart attack. It is impossible to be a careful consumer in such circumstances. Health care in general is something people want less of, not more. The fewer visits to the doctor I need and the fewer medications I take the happier I am. Meanwhile, some people put off care because they can’t afford it, leading to more expensive care at an emergency room later.
You’re right of course, but did you ever consider we view spending on health quite differently? What we can afford.
To but it simply a $50 co-pay is not affordable, but spending the same for two at the movies is okay. The same $50 or $100 is viewed very differently when it comes to spending on health care – guaranteed.
The cinema is discretionary, you can chose to go, or not. The co-pay often is not discretionary, or not in the same way. OK, you could skip your annual physical, although it’s a bad idea, but if you’re in pain, or you broke your arm, or you’re having dizzy spells, you need to see a doctor (or a PA these days).
Yes, but my point is people complain loudly about a $50 Rx co-pay, but voluntarily will spend the $50 on something enjoyable. It’s still $50. It’s human nature when it comes to health care. I saw that in action for many years managing health plans.
I get a kick when I hear people say we should have Medicare-For-All thinking it is free. I tell them wait until you turn 65 and see how free it is.
Medicare for all certainly would not be free. It would have some different benefits because of the ages covered – pediatrics for example. Rx would have to be handled differently.
Keep in mind, it is not adding trillions in new costs, it is moving existing costs into a single system while eliminating incredible duplication and admin costs. And yes it creates a large bureaucracy, but we already have that just spread about among employee, insurers, etc.
Yes, a lot of issues to resolve, questions to answer, but given what we have now as a non system, there is no way, no basis to simply dismiss Medicare for all from serious consideration.
We need to think outside the box, fix what is wrong, build on the last decades of experience that works.
Given current Medicare concentrates costs for the most expensive population – 65 plus – including the entire population would like lower current Medicare rates per person. There would be some cost savings, mostly administrative and in provider payments.
However, given what providers go through dealing with many different insurance, government plans, simplicity would be welcomed.
Employers would contribute, but at lower rates than they now spend on health benefits. They would come the change
All citizens would have the same deductibles, same OOP cost maximums and most important no uninsured, no bankruptcies.
Everyone in the pool.
I agree with alot of that, but the point I was making was if you talk to many “people on the street,” they believe Medicare-For-All means FREE health care for all.
You are right and they also believe it will create massive new costs and will be socialized medicine which are all wrong but reasons we cannot make any progress on health care in this country.
The US is too far gone to have anything like an affordable universal health care system. Too many vested interests in forms of the status quo from medical professionals themselves through corporate healthcare providers, pharmas, and the vast insurance industry ( which let’s not forget on a macroeconomic basis cannot create overall value).
I know people who will defend to the death the superiority of care in the US system while at the same time paying vastly more for basic meds available almost anywhere else in the world for less.
If that is the case we have no right to complain about anything related to paying for healthcare and we can ignore the millions with no coverage.
I have been involved with health benefits since 1962 from paying claims to being Chairman of the Board of an HMO. I used to be opposed to Medicare as were most employers, but after trying everything and looking at the broad picture for the US, if there is a solution applicable to the entire country, covering everyone and not shifting costs arounds, i like to know what it is.
If there is a solution for all it would necessitate shifting costs around whether through general taxation (the wealthy paying for the poor) or the healthy subsidising the sick. That’s how pooling of risks works. And it would have to be mandatory or there would be too many opt outs among the young and working ( why pay for all those old folk when you can start paying when you’re 40 or 50).
All insurance is a risk taking, but Medicare and Medicaid shift costs differently by paying fees at much lower than the market price thus driving costs to private coverage.
Actually, compared to what I pay for my coverage from The Marketplace / ACA / Obamacare, it is pretty close to free – I’m age 62. For 2024 my annual premium for a Silver plan is $12,000, and for 2025 it will be about $ 14,400, for rhe same plan. And thats before I get one iota of actual medical care. I can’t wait to turn 65 !
IMO Medicare is the best insurance I’ve had since the good old days of the $100 deductible. Today I’m all in with Medicare, sup, and part d for less than $400/month.
Of course I may have to edit this post after my 12/2 rendezvous with my insurance agent. Yikes.
August, you are so right. When you add in the premium, which rises steadily if your income is more than $206.00 for 2024…along with the deductible, and the expense of a medigap policy, we are talking real money, for. Those who choose original Medicare.
Important to note—I don’t think Medicare-For-All
would look anything like the traditional Medicare insurance we currently have.
Correction. if income is more than $206,000.
Do you mean IRMAA? That starts at $103,000 for singles this year ($106,000 next year). There are a lot of singles on Medicare. The deductible is $257 next year, which hardly seems enough to get upset about.
There is no income-based difference in premiums for Medicare Advantage or Medigap, but I agree that Medigap policies aren’t cheap.
Kathy, I should have made myself clearer…$206,000. Is the threshold for married couples.
About medigap…the premium you pay can vary according to the area and state you live in and the condition of your health.
Agreed. There can be a significant difference in the cost of Medigap plans based on where you live, but not based on income. If you buy during Guaranteed Issue periods your health is not a factor.
My old man would always say …
“I can’t afford any more free offers!”.
After mom died, my sister criticized me for returning an unopened bag of prescription drugs. “Why are you sending those back? They were free”.
“But who will foot the bill we are accumulating?”
While I realize your piece is about taxes, they exist to pay for government spending. I don’t object to paying IRMAA — I object to paying IRMAA because our government does a rotten job of eliminating waste and fraud.
As for property taxes, they are fine, too. But if you look at education in this country, there has been virtually no correlation between additional spending on public schools and increased educational achievement. Where’s the accountability for applying the tax revenue in an effective manner?
Actually research shows school funding is directly related to better results.
https://www.chalkbeat.org/2019/8/13/21055545/4-new-studies-bolster-the-case-more-money-for-schools-helps-low-income-students/
Who is that waste and fraud caused by? Other Americans, that’s who.
When it comes to Medicare the waste and fraud is often the result of patient action or inaction and complicity because they benefit personally.
However, Medicare does a poor job uncovering fraud and takes too long doing so.
Medicare patients receive an EOB each quarter and could easily spot payments for services not provided. Not likely to happen though.
One of my favorite examples related to medical transportation in an ambulance. The coverage was finally denied when it was discovered the patient was riding in the front seat next to the driver for this medically necessary transportation.
After reviewing my EOB I reported that I had returned a CPAP machine the day it was delivered and the provider still charged for it. I was told that there was nothing to be done, they had delivered the machine. End of discussion. So much for being responsible and taking action.
Don’t know about this case, but some medical equipment can’t be returned even if not used. Same with drugs, You take it out of pharmacy even if you don’t open container, can’t be returned.
As a grizzly old guy once remarked “ain’t nothin’ free.
But things do change.
Social security benefits used to be tax-free.
Right now US corporate income tax at 21% is good, not the lowest, but Harris was in favor of raising it dramatically
keep in mind that Americans on average only fund about 15% of the SS benefit they collect. So it’s logical, just like a non-contributory pension, to pay taxes on a portion of the benefit. Equally important is the taxes paid go back to the SS trust so in their absence the trust is even worse shape or younger people pay higher taxes.
“Free” appears to be “a limited time offer”.
I have been thinking about how tax and planning complexity will increase if some of the current proposed modifications to our tax laws are enacted.
Tax systems are frequently used for more reasons than merely raising revenue for the government to enable it to function. Our tax systems are currently a means of redistribution of income, implementing tax expenditures, and facilitating political objectives and thus will always be complex.
I would be happy to pay higher taxes if we got universal, government-run health care in exchange, but that position seems to be unpopular in this country. Of course, I grew up in one of those “socialist” countries, with “free” health care and nearly “free” tertiary education. Demonizing the word “socialist” has warped the conversation.
You are absolutely correct. The misuse- intentionally- of socialism is disgraceful. But using government- run health care also needs to be avoided because Medicare is not the NHS which is a no, no in the US and is used to scare people.
Plus for most people even higher taxes for a universal insurance program would still leave a net gain when you consider costs today in terms of premiums and OOP costs.
Americans are their own worst enemy all too often.
Medicare is a form of government-run health care. There are a lot of different ways of delivering universal care.
No, it isn’t. It does not run health care. To say that triggers such reaction we will never get to meaningful changes. I have friends in England. The wife has been waiting over a year for hip surgery and recently she was told they wouldn’t do it if she didn’t lose weight. She has been in pain all that time. That’s is govt health care. It may be logically, but not to Americans many who don’t realize you wait for health care here too.
We have used Medicare extensively for 15 years going to who we want, where we want having surgery in a few days or weeks not months. Medicare is insurance, not health care.
Medicare is health care organized, managed and paid for by the government.
The problem in the UK is that the Conservative government starved the NHS of funds and Brexit starved it of workers. It will take a while to recover. Meanwhile France is held to have the best health system in the world, also “socialized”.
BTW, when a vascular surgeon in the US told me I needed to see a hematologist the wait was over a year…. When I didn’t die I decided not to bother. (And this was in an area with two big university-based health systems plus a lot of independents.)
Saying “Medicare is health care organized, managed and paid for by the government” is not only not true, it gives the false argument to those claiming socialized medicine, scaring people and helping to block solutions.
Medicare does not organize health care nor does it manage care. In fact, several government studies criticize the low oversight of claims and it is prevented from doing any pre certification at all.
Never in nearly 15 years has Medicare had anything to do with managing any care we have received.
As far as paid by government, that’s not even true because while taxes fund the majority of costs, those who enroll in Part B and D pay separate premiums plus an array of out-of-pocket costs just like employer or private coverage.
Between Part B, D and Medigap Connie and I pay over $1500 a month in premiums The day before I retired I paid $197.00 a month for full coverage for both, including dental and vision. I sure don’t feel like I have government paid health care.
On the other hand my friend in England who is retired says his care is free as he pays no taxes, no premium and no out of pocket costs because he is retired over 65.
“Medicare does not organize health care nor does it manage care.”
Does Medicare decide which treatments they will pay for? Does Medicare decide which drugs they will pay for? Or have limits on either? If the answer to any of these questions is yes, then yes, it is government managed.
That’s exactly what all insurance does, some forms more than others. That is exactly why Medicare is government run, citizen funded insurance.
It does not employ doctors, assign you to a doctor or facility, limit your choices or require pre approval of services. Medicare does not own facilities and determine their budget.
There is no type of coverage that does not attempt to manage the cost of care because left up to patent and provider alone insurance would not be affordable to anyone.
States regulate insurance, require certain coverage, approve premiums, etc.
Any argument that Medicare is government run health care is simply bogus.
You are, yet again, arguing about semantics.
Management: Medicare determines what services will, or will not, be covered. It determines how much will be paid for services and makes the payments. It determines premiums for Medicare A and B, and IRMAA. Etc. The system doesn’t manage itself.
Cost: you have said repeatedly that you and Connie have received hundreds of thousands of dollars worth of medical care. I doubt your premiums have come close to covering that.
If I took my ex-employer’s Medicare Advantage plan the premium would be zero. My Part D plan’s premium next year will be zero.
What you just described is insurance. Exactly what any insurance does. That is not management of health care.
That is why Medicare is an insurance and nothing like the NHS. No semantics, just facts.
MA plans, HMOs attempt to manage care by limiting access, by pre-certification of services, concurrent review of services, pre-authorization of referrals to specialists.
Of course our premiums don’t cover the services received.
On the other hand, some people may use minimal or no services in a year and pay the same as we do, thus losing money. That’s why it’s insurance and exactly what happens with any insurance. You pay and hope you don’t get your moneys worth. At least I do. I don’t fancy collecting a penny on any insurance policy I have.
Sigh. Insurance companies run Medicare Advantage plans. The government runs Medicare. Since I don’t see any port, end of my participation in this discussion.
You and Richard appear to be talking past each other. Perhaps I can help.
Yes, Medicare is a government run and managed insurance program. But that is not government run and managed health care.
England’s National Health Service (NHS) is an example of a government run health care. The NHS owns and operates all (or most) health care facilities. Hospitals, day surgery centers, doctor’s offices, medical labs and so on. NHS, not supply and demand, determines how many and where all health care faculties exist. All (or most) medical professionals are employees of the NHS with the existence of their job and their compensation set and paid by the NHS. NHS determines how many and where each medical professional works and gets paid. That’s a big difference from running an insurance program.
I grew up in England, I am well aware of how the NHS operates. I am willing to call the NHS “a government run health care system”, and Medicare “government run health care insurance”.
When Medicare tells me I can only have x number of PT sessions a year, as it did until recently, it is managing my health care.
When Medicare tells me it will only cover one specific chiropractic intervention, for a given number of sessions, it is managing my health care.
When Medicare tells me that if I am not making what it considers progress, I must leave rehab, it is managing my health care.
When Medicare refuses to cover treatment it classifies as experimental, it is managing my health care.
Maybe what we should be asking voters is whether they want their health care run by for-profit insurance companies, or by not-for-profit Medicare.
BTW, in my state health care facilities need a license from the state Department of Health and Human Services – i.e. the government.
Medicare doesn’t manage your health care. Medicare, like all insurances, tells you what it will pay for. Since you and your medical care provider are independent agents and not employees of Medicare you are free to make other arrangements to get any other care you want.
See the first two definitions of “manage” here. Insurance companies also manage care.
Every insurance does what you describe and always has. All insurance has some form of medical necessity provision, reasonable and customary requirement. no insurance can or should provide a blank check. They may even have a specific numerical limit on a service.
Medicare provisions and guidelines are the least restrictive of all. That’s the weak effort to control costs. Some of what you experience is also based on what is submitted by providers.
He will however have paid considerable income taxes over his lifetime more than the US and be subject to much lower capital gains and inheritance tax thresholds than in the US.
And much higher payroll taxes and a VAT at 20% standard.