10 ms·

Medicare for All Could Eliminate the $600B Private Insurance Industry

31 points by qsymmachus 8y ago

verdverm 8y ago
Being a Trekie, I'm a fan of healthcare as a human right, free of costs to the patient. My main concern is that the current (recent) congresses have shown that they cannot create effective legislation. When was the last time the government made something better or more efficient?
- toomuchtodo 8y ago
  USDS/18F (I <3 you login.gov) is just one example I can provide. Just because you’re not aware of everyday progress due to government does not mean you should be so quick to write off such proposals. Perhaps a better path forward is, “How can we use government to help arrive at the end state of universal healthcare”. Remember, “we” are collectively government.
  - verdverm 8y ago
    Small legislation is different from major overhauls. We are seeing how well the first 3000+ page for healthcare is going
    - toomuchtodo 8y ago
      The ACA was a compromise championed by corporate Democrats with no spine, nothing as efficient or as comprehensive as Medicare For All. Incremental change is no longer tolerable in this domain.
      - verdverm 8y ago
        Depends on who you ask about small changes. I prefer the incremental to the monumental. So it is tolerable to some portion of the population
        toomuchtodo 8y ago
        I advocate for the have nots, not the haves, hence my stance.
        verdverm 8y ago
        How does preference for the average size of legislation have anything to do with that? Larger legislation sees more lobbying, and is thus more likely voicing the haves' voice
        toomuchtodo 8y ago
        Forget about the doc size of the legislation. The longer we wait to cover everyone with healthcare, the more citizens who suffer and die. Incremental change saves less people over a longer time period. This is why I advocate for radical change on a shorter time scale. More people get the healthcare they need sooner. Incremental change does not deliver this. If we can do Medicare For All in 100 pages of legislation, I’m all for it.
        verdverm 8y ago
        I'd imagine a small bill to deal with the opioid crisis would save a bunch of lives. Purchasing insurance across state borders would increase competition and statistical averaging of premium to payout ratio. Two simple things to save lives and reduce costs. ACA, big, radical, not what it was hyped to be Rarely does being radical end up well
        deleted 8y ago
        [deleted]
        ceejayoz 8y ago
        > Purchasing insurance across state borders would increase competition and statistical averaging of premium to payout ratio. No, it won't. They'll all move to the most corporate-friendly state. This already happened with credit cards - half the issued credit cards come out of Delaware.
- erikpukinskis 8y ago
  It's brilliant really, the Republican strategy: sabotage government from within until people stop believing it could have ever been effective. Win elections playing on people's fears, which are increased as society backslides into dysfunction. Meanwhile run a beautiful pristine operation serving the needs of corporations, protecting your donor base. It's a total perversion of democracy and even human decency, but I sure respect it as a strategic play.
  - objektif 8y ago
    This is pretty much the essence of crony capitalism. Unfortunately I have to say Democrats are catching up to republicans on that department led by Pelosi and friends.
deleted 8y ago
[deleted]
ineedasername 8y ago
The article talks about the current private insurance companies moving to a role of supplemental insurance. As an important note on this, that's how it works in both Canada and the UK, but in very different ways: In Canada, private insurance is not allowed to cover anything that is covered by the public insurance. So, no jumping the queue by paying out of pocket or through private insurance. Hopping over to the USA and paying out of pocket is an option for the well off though. In the UK, there is no such limit, and there is no cap on doctor earnings from private practice, but there are minimums on how much work must be performed for NHS, the public health system. Again, the well off have a way to jump the queue and receive faster/higher quality care. How these types of factors would play into a US private insurance and private doctor practice of course is unclear, and would be key sticking points in any Medicare for All plan. One thing for sure is that the insurance companies are unlikely to go willingly. Kicking and screaming is more like it, at least if they aren't just nationalized with massive golden parachutes for all of the top brass.
- malandrew 8y ago
  > but there are minimums on how much work must be performed for NHS So basically doctors are not free in the UK?
  - Something1234 8y ago
    I think the NHS actually pays for their training.
- tfehring 8y ago
  As context for this, it's worth mentioning the broader difference between the health care systems in Canada and the UK: - In the UK, the government works like a provider network that provides free* services. Doctors and other medical professionals are effectively government employees. - In Canada, the government works like a health insurer that provides free* insurance. Doctors and other medical professionals work for private organizations that are paid by the government for the services they provide. Discussion of socialized healthcare in the US, including Medicare for All, has exclusively or almost exclusively been based on the Canadian model. *"Free" meaning "approximately free at the margin for the individual, but ultimately funded by taxes."
tracker1 8y ago
And how many billion will that cost... Let's consider we have over 300 million people in the USA, and even $1K/person on average (it will be more) is $300 Billion (with a B)... added to the Federal Budget... it will be at least 2-3X that not even accounting for abuse.
- xs83 8y ago
  With the efficiency savings from a nationalised entity 2-3x is a stretch, yes people will probably pay more tax, that tax will be significantly lower than what they probably pay for private medical care. It removes the onus on Employers to provide medical care as a "requirement", it provides people who cant afford medical care a choice of treatment rather than just 'dying'.
  - malandrew 8y ago
    Since when does nationalizing anything make it more efficient? Even assuming the best case scenario where something is more efficient at the time it was created, you still end up with something that not only doesn't become more efficient with time, it often becomes less efficient with time when it's government-run.
    - toomuchtodo 8y ago
      It’s clear we can only go up from the dumpster fire that is privatized US healthcare, and other nations have proven nationalization to be effective. If you have a problem with the effectiveness of government, run for office or find a government job instead of complaining.
    - xs83 8y ago
      Efficiency maybe not - but at least it is not run for the benefit of shareholders - that only ever means increasing prices. Look at the UK rail system - it's a farce!
  - basementcat 8y ago
    For older people with more medical issues, the tax will be lower than paying for private medical care. For younger people it will be a tougher sell. Also, don't underestimate the political power of those who are accustomed to the "freedom" of not having insurance and just going to the emergency room when they get hurt. Nationalized health care will also have to grapple with freedom of religion. Does Medicare pay extra money for specialized operations so that Jehovah's Witnesses don't have to get blood transfusions? Does Medicare not cover certain medical treatments or procedures to ensure certain religious constituencies don't have their hard earned tax dollars paying for "sinful" activities?
xs83 8y ago
As someone who has lived in the UK with an amazing free healthcare system and now Australia who has a more complex model - but basically still universal free healthcare for the most part - I can safely say I took the NHS for granted in the UK. Australia is pretty good - most stuff will get fixed free, and they are at least transparent about where your tax goes (We have a Medicare Levy that is paid as a specific % of income, and a Medicare Levy Surcharge if you earn above a certain amount and don't take out private medical care). Private Healthcare is offered as a perk to employees, not as an expected part of the package. However - the article header sums this up - "Could Eliminate the 600B Private Insurance Industry" - Money talks and if you think for a second the super rich people running these companies give a shit over your welfare vs their money you are sorely mistaken. This would always fall at the first hurdle - and if by some magic measure something passed (Obamacare for example) - the next person would just repeal it.
- masonic 8y ago
  an amazing free healthcare system Well, sure -- you can't beat free.

31 points by qsymmachus 8y ago

Being a Trekie, I'm a fan of healthcare as a human right, free of costs to the patient. My main concern is that the current (recent) congresses have shown that they cannot create effective legislation. When was the last time the government made something better or more efficient?

toomuchtodo 8y ago
USDS/18F (I <3 you login.gov) is just one example I can provide. Just because you’re not aware of everyday progress due to government does not mean you should be so quick to write off such proposals. Perhaps a better path forward is, “How can we use government to help arrive at the end state of universal healthcare”. Remember, “we” are collectively government.
- verdverm 8y ago
  Small legislation is different from major overhauls. We are seeing how well the first 3000+ page for healthcare is going
  - toomuchtodo 8y ago
    The ACA was a compromise championed by corporate Democrats with no spine, nothing as efficient or as comprehensive as Medicare For All. Incremental change is no longer tolerable in this domain.
    - verdverm 8y ago
      Depends on who you ask about small changes. I prefer the incremental to the monumental. So it is tolerable to some portion of the population
      - toomuchtodo 8y ago
        I advocate for the have nots, not the haves, hence my stance.
        verdverm 8y ago
        How does preference for the average size of legislation have anything to do with that? Larger legislation sees more lobbying, and is thus more likely voicing the haves' voice
        toomuchtodo 8y ago
        Forget about the doc size of the legislation. The longer we wait to cover everyone with healthcare, the more citizens who suffer and die. Incremental change saves less people over a longer time period. This is why I advocate for radical change on a shorter time scale. More people get the healthcare they need sooner. Incremental change does not deliver this. If we can do Medicare For All in 100 pages of legislation, I’m all for it.
        verdverm 8y ago
        I'd imagine a small bill to deal with the opioid crisis would save a bunch of lives. Purchasing insurance across state borders would increase competition and statistical averaging of premium to payout ratio. Two simple things to save lives and reduce costs. ACA, big, radical, not what it was hyped to be Rarely does being radical end up well
        deleted 8y ago
        [deleted]
        ceejayoz 8y ago
        > Purchasing insurance across state borders would increase competition and statistical averaging of premium to payout ratio. No, it won't. They'll all move to the most corporate-friendly state. This already happened with credit cards - half the issued credit cards come out of Delaware.
erikpukinskis 8y ago
It's brilliant really, the Republican strategy: sabotage government from within until people stop believing it could have ever been effective. Win elections playing on people's fears, which are increased as society backslides into dysfunction. Meanwhile run a beautiful pristine operation serving the needs of corporations, protecting your donor base. It's a total perversion of democracy and even human decency, but I sure respect it as a strategic play.
- objektif 8y ago
  This is pretty much the essence of crony capitalism. Unfortunately I have to say Democrats are catching up to republicans on that department led by Pelosi and friends.

deleted 8y ago

[deleted]

ineedasername 8y ago

The article talks about the current private insurance companies moving to a role of supplemental insurance. As an important note on this, that's how it works in both Canada and the UK, but in very different ways: In Canada, private insurance is not allowed to cover anything that is covered by the public insurance. So, no jumping the queue by paying out of pocket or through private insurance. Hopping over to the USA and paying out of pocket is an option for the well off though. In the UK, there is no such limit, and there is no cap on doctor earnings from private practice, but there are minimums on how much work must be performed for NHS, the public health system. Again, the well off have a way to jump the queue and receive faster/higher quality care. How these types of factors would play into a US private insurance and private doctor practice of course is unclear, and would be key sticking points in any Medicare for All plan. One thing for sure is that the insurance companies are unlikely to go willingly. Kicking and screaming is more like it, at least if they aren't just nationalized with massive golden parachutes for all of the top brass.

malandrew 8y ago
> but there are minimums on how much work must be performed for NHS So basically doctors are not free in the UK?
- Something1234 8y ago
  I think the NHS actually pays for their training.
tfehring 8y ago
As context for this, it's worth mentioning the broader difference between the health care systems in Canada and the UK: - In the UK, the government works like a provider network that provides free* services. Doctors and other medical professionals are effectively government employees. - In Canada, the government works like a health insurer that provides free* insurance. Doctors and other medical professionals work for private organizations that are paid by the government for the services they provide. Discussion of socialized healthcare in the US, including Medicare for All, has exclusively or almost exclusively been based on the Canadian model. *"Free" meaning "approximately free at the margin for the individual, but ultimately funded by taxes."

tracker1 8y ago

And how many billion will that cost... Let's consider we have over 300 million people in the USA, and even $1K/person on average (it will be more) is $300 Billion (with a B)... added to the Federal Budget... it will be at least 2-3X that not even accounting for abuse.

xs83 8y ago
With the efficiency savings from a nationalised entity 2-3x is a stretch, yes people will probably pay more tax, that tax will be significantly lower than what they probably pay for private medical care. It removes the onus on Employers to provide medical care as a "requirement", it provides people who cant afford medical care a choice of treatment rather than just 'dying'.
- malandrew 8y ago
  Since when does nationalizing anything make it more efficient? Even assuming the best case scenario where something is more efficient at the time it was created, you still end up with something that not only doesn't become more efficient with time, it often becomes less efficient with time when it's government-run.
  - toomuchtodo 8y ago
    It’s clear we can only go up from the dumpster fire that is privatized US healthcare, and other nations have proven nationalization to be effective. If you have a problem with the effectiveness of government, run for office or find a government job instead of complaining.
  - xs83 8y ago
    Efficiency maybe not - but at least it is not run for the benefit of shareholders - that only ever means increasing prices. Look at the UK rail system - it's a farce!
- basementcat 8y ago
  For older people with more medical issues, the tax will be lower than paying for private medical care. For younger people it will be a tougher sell. Also, don't underestimate the political power of those who are accustomed to the "freedom" of not having insurance and just going to the emergency room when they get hurt. Nationalized health care will also have to grapple with freedom of religion. Does Medicare pay extra money for specialized operations so that Jehovah's Witnesses don't have to get blood transfusions? Does Medicare not cover certain medical treatments or procedures to ensure certain religious constituencies don't have their hard earned tax dollars paying for "sinful" activities?

xs83 8y ago

As someone who has lived in the UK with an amazing free healthcare system and now Australia who has a more complex model - but basically still universal free healthcare for the most part - I can safely say I took the NHS for granted in the UK. Australia is pretty good - most stuff will get fixed free, and they are at least transparent about where your tax goes (We have a Medicare Levy that is paid as a specific % of income, and a Medicare Levy Surcharge if you earn above a certain amount and don't take out private medical care). Private Healthcare is offered as a perk to employees, not as an expected part of the package. However - the article header sums this up - "Could Eliminate the 600B Private Insurance Industry" - Money talks and if you think for a second the super rich people running these companies give a shit over your welfare vs their money you are sorely mistaken. This would always fall at the first hurdle - and if by some magic measure something passed (Obamacare for example) - the next person would just repeal it.

masonic 8y ago
an amazing free healthcare system Well, sure -- you can't beat free.