4 ms·

Let's just say people could agree that a public system or option was actually the right course of action. I think the most interesting / challenging part would

Let's just say people could agree that a public system or option was actually the right course of action. I think the most interesting / challenging part would be the transition into that system from what we currently have. To me, that would be more interesting to read about than arguments about how to change peoples minds.

nugget 7y ago
I support Medicare for all but I’m also realistic that it will result in a two-tiered public/private system, similar to what the UK has with the NHS and separate cash pay services and private insurance. The key is to disconnect the private system from employment where the costs and purchase decisions are obfuscated from the end consumer. When a critical mass of consumers pay out of pocket for services, the market will drive down prices and increase transparency. At least that’s the best shot at it, based on what I’ve seen.
- sharemywin 7y ago
  Here's a couple list of top healthcare systems in the world: https://fr.april-international.com/en/healthcare-expatriates/which-countries-have-best-healthcare-systems https://fr.april-international.com/en/healthcare-expatriates...
- ameister14 7y ago
  I would be careful likening that system to the NHS - the NHS is much more fully nationalized than a medicare for all system would be
  - nugget 7y ago
    It would be at first. But if almost all of a hospital’s revenue comes from CMS, why wouldn’t CMS simply run the hospital? If it can run provider networks more efficiently, why not hospitals? At least that’s how I predict the political discussion will evolve.
    - colinmhayes 7y ago
      Government programs will never be as efficient as private ones unless they utilize market power to make themselves price setters. Nationalized health insurance is a great idea, but nationalized health care would be much more difficult to implement, and would likely not be as good as the system we currently have.
cogman10 7y ago
In a medicare for all situation, the biggest problem would be pumping up the system to handle a huge influx of new claims. I imagine roll out would be "in 1 or 2 years, everyone will be enrolled in medicare". Which would give the federal government time to hire enough claims processing agents. Hospitals are already setup to bill medicare so that isn't an issue. After that, it will just be businesses making the necessary arrangements to cancel current insurance plans. What is going to be weird is "How do we handle HSAs" and "What does supplemental insurance look like?" The industries I see negatively impacted by this are the healthcare industry (harder to charge huge prices for medical treatments in a single payer system), the insurance industry (I doubt many individuals or employers will opt for supplemental plans), and the pharmaceutical industry (government has more negotiating power over price when it isn't a single patient paying for it). An optional medicare plan would be, IMO, a disaster. It is basically the worst of all worlds. Everyone pays more for medicare, not everyone can afford it, and we are still in a weird mishmash of payment that will depend entirely on who your employer is, if you opted in for medicare, etc. If it goes down like Obama care did, I can also see some red states deciding "We aren't going to allow medicare opt in!" which would, frankly, defeat the purpose of making the opt in happen. Further, it sets itself up for easy repeal later on. Medicare for all, once given, will be near impossible to take away.

nugget 7y ago

I support Medicare for all but I’m also realistic that it will result in a two-tiered public/private system, similar to what the UK has with the NHS and separate cash pay services and private insurance. The key is to disconnect the private system from employment where the costs and purchase decisions are obfuscated from the end consumer. When a critical mass of consumers pay out of pocket for services, the market will drive down prices and increase transparency. At least that’s the best shot at it, based on what I’ve seen.

sharemywin 7y ago
Here's a couple list of top healthcare systems in the world: https://fr.april-international.com/en/healthcare-expatriates/which-countries-have-best-healthcare-systems https://fr.april-international.com/en/healthcare-expatriates...
ameister14 7y ago
I would be careful likening that system to the NHS - the NHS is much more fully nationalized than a medicare for all system would be
- nugget 7y ago
  It would be at first. But if almost all of a hospital’s revenue comes from CMS, why wouldn’t CMS simply run the hospital? If it can run provider networks more efficiently, why not hospitals? At least that’s how I predict the political discussion will evolve.
  - colinmhayes 7y ago
    Government programs will never be as efficient as private ones unless they utilize market power to make themselves price setters. Nationalized health insurance is a great idea, but nationalized health care would be much more difficult to implement, and would likely not be as good as the system we currently have.

cogman10 7y ago

In a medicare for all situation, the biggest problem would be pumping up the system to handle a huge influx of new claims. I imagine roll out would be "in 1 or 2 years, everyone will be enrolled in medicare". Which would give the federal government time to hire enough claims processing agents. Hospitals are already setup to bill medicare so that isn't an issue. After that, it will just be businesses making the necessary arrangements to cancel current insurance plans. What is going to be weird is "How do we handle HSAs" and "What does supplemental insurance look like?" The industries I see negatively impacted by this are the healthcare industry (harder to charge huge prices for medical treatments in a single payer system), the insurance industry (I doubt many individuals or employers will opt for supplemental plans), and the pharmaceutical industry (government has more negotiating power over price when it isn't a single patient paying for it). An optional medicare plan would be, IMO, a disaster. It is basically the worst of all worlds. Everyone pays more for medicare, not everyone can afford it, and we are still in a weird mishmash of payment that will depend entirely on who your employer is, if you opted in for medicare, etc. If it goes down like Obama care did, I can also see some red states deciding "We aren't going to allow medicare opt in!" which would, frankly, defeat the purpose of making the opt in happen. Further, it sets itself up for easy repeal later on. Medicare for all, once given, will be near impossible to take away.