4 ms·

Paying for Medicare for All

3 points by js2 7y ago

samstave 7y ago
I'm really curious about the following: We talk about Medicare, Healthcare (in general) constantly. I have built quite a few hospitals, healthcare software, and commissioned several hospitals as well. My brother is the head of the VA for the entire state of Alaska. Healthcare is a wedge issue every single election cycle. Yet here we are. Again talking about "medicare for all" (again) and ironically enough, we seem (IMO) to be addressing the symptom and never the cause. Costs are out of control across the board - and rather than addressing insurance and pharma (actually addressing, not lip service to injustice) - we try to apply a bandaid via medical subsidies. I find it really ironic that 'Healthcare' in the united states is a malignant tumor which keeps metastasizing as the decades progress. /rant
averros 7y ago
"And we make up the difference with targeted spending cuts, new taxes on giant corporations and the richest 1% of Americans, and by cracking down on tax evasion and fraud. Not one penny in middle-class tax increases." Yeah, sure. The increased tax on corporations will come out of paychecks. Just like Social Security does. And the "middle class" will be defined as "people not earning more than minimum wage". We saw these tax promises before. Never worked as advertised. (And as for the government-provided medicine, one would do well by heeding the old Soviet maxim: "You can have free treatment - if you don't care about the outcome.")
simonblack 7y ago
Americans will have to change the way the system gets paid, removing the billions paid to the 'leeches' on the system. Australia has a very good system, with everybody covered by a single-payer and also the choice available to pay 'extra' to gain things like a preferred doctor or surgeon when in hospital. Cost of triple-bypass cardiac surgery to me was zilch, nada, 'nuttin'. This cover for all works out to costing the Federal Government roughly $7400 per person per year. Extrapolating the Australian population size to the US population size, that would total a mere 2.6 trillion per year. Nowhere near the 20 to 30 trillion dollar figures that have been bandied about. On the other hand, if you accept the 30 trillion dollar figure, it just means that Americans are paying 10 times more for health care than they might be otherwise.
- js2 7y ago
  The 20-30T is over 10 years. The US currently spends 3.5T annually. About half of that is private spending (employer-sponsored, out-of-pocket, etc) and the other half is government spending (Medicare, Medicaid, VA, and government employees). The only way we can possibly contain costs is to legislate it via negotiation between shareholders. There's simply no free market to control cost of health care. I'm ambivalent if single-payer is the best option. On the one hand, the Federal government has shown it can supply it for those 65+ (Medicare). Satisfaction with Medicare is better than satisfaction with private insurance. And Medicare has 2% administration costs vs something like 14% for private insurance. OTOH, our existing system is much closer to a Bismarck-style multi-payer system like Germany, Japan, etc. I'm also ambivalent about trying to convert to single-payer in one fell swoop, vs a slower transition like making Medicare a public option with subsidies. Currently, 160M Americans are covered by employer sponsored coverage. I can imagine it's scary for many of them telling them they'll be put onto Medicare. Loss aversion and all that. Americans seem to like the illusion of choice and control. I say illusion because what choice, really, do I have over provider if it's employer-sponsored? In my career, I've only ever been offered 2-3 choices picked by the employer that are varying degrees of suck. Regardless, this will not be a simple transition: https://www.cbo.gov/publication/55150 https://www.cbo.gov/publication/55150
  - simonblack 7y ago
    The greatest drawback, as I see it, to the US system is this: Currently, 160M Americans are covered by employer sponsored coverage. The people most in need of 'single-payer' are the unfortunates who don't have employer-sponsored health cover (160M is less than half the US population); those out of work, whether 'retired' or 'not employed just right now'; those who are physically unable to work because of bad health or past injuries; etc. Single-payer covers everybody, and removes the cause of bankruptcies because of tens (or hundreds) of thousands of dollar hospital debts. There's no way I could have afforded my triple bypass surgery including 2 days in ICU on my 22-hours-a-week employment classified as 'casual work' if I was under the US health scheme. That surgery came with a mere two-week warning, I went to have an angiogram 'just to check things' and was told "We're not sure if we'll let you go home today!"

3 points by js2 7y ago

I'm really curious about the following: We talk about Medicare, Healthcare (in general) constantly. I have built quite a few hospitals, healthcare software, and commissioned several hospitals as well. My brother is the head of the VA for the entire state of Alaska. Healthcare is a wedge issue every single election cycle. Yet here we are. Again talking about "medicare for all" (again) and ironically enough, we seem (IMO) to be addressing the symptom and never the cause. Costs are out of control across the board - and rather than addressing insurance and pharma (actually addressing, not lip service to injustice) - we try to apply a bandaid via medical subsidies. I find it really ironic that 'Healthcare' in the united states is a malignant tumor which keeps metastasizing as the decades progress. /rant

averros 7y ago

"And we make up the difference with targeted spending cuts, new taxes on giant corporations and the richest 1% of Americans, and by cracking down on tax evasion and fraud. Not one penny in middle-class tax increases." Yeah, sure. The increased tax on corporations will come out of paychecks. Just like Social Security does. And the "middle class" will be defined as "people not earning more than minimum wage". We saw these tax promises before. Never worked as advertised. (And as for the government-provided medicine, one would do well by heeding the old Soviet maxim: "You can have free treatment - if you don't care about the outcome.")

simonblack 7y ago

Americans will have to change the way the system gets paid, removing the billions paid to the 'leeches' on the system. Australia has a very good system, with everybody covered by a single-payer and also the choice available to pay 'extra' to gain things like a preferred doctor or surgeon when in hospital. Cost of triple-bypass cardiac surgery to me was zilch, nada, 'nuttin'. This cover for all works out to costing the Federal Government roughly $7400 per person per year. Extrapolating the Australian population size to the US population size, that would total a mere 2.6 trillion per year. Nowhere near the 20 to 30 trillion dollar figures that have been bandied about. On the other hand, if you accept the 30 trillion dollar figure, it just means that Americans are paying 10 times more for health care than they might be otherwise.

js2 7y ago
The 20-30T is over 10 years. The US currently spends 3.5T annually. About half of that is private spending (employer-sponsored, out-of-pocket, etc) and the other half is government spending (Medicare, Medicaid, VA, and government employees). The only way we can possibly contain costs is to legislate it via negotiation between shareholders. There's simply no free market to control cost of health care. I'm ambivalent if single-payer is the best option. On the one hand, the Federal government has shown it can supply it for those 65+ (Medicare). Satisfaction with Medicare is better than satisfaction with private insurance. And Medicare has 2% administration costs vs something like 14% for private insurance. OTOH, our existing system is much closer to a Bismarck-style multi-payer system like Germany, Japan, etc. I'm also ambivalent about trying to convert to single-payer in one fell swoop, vs a slower transition like making Medicare a public option with subsidies. Currently, 160M Americans are covered by employer sponsored coverage. I can imagine it's scary for many of them telling them they'll be put onto Medicare. Loss aversion and all that. Americans seem to like the illusion of choice and control. I say illusion because what choice, really, do I have over provider if it's employer-sponsored? In my career, I've only ever been offered 2-3 choices picked by the employer that are varying degrees of suck. Regardless, this will not be a simple transition: https://www.cbo.gov/publication/55150 https://www.cbo.gov/publication/55150
- simonblack 7y ago
  The greatest drawback, as I see it, to the US system is this: Currently, 160M Americans are covered by employer sponsored coverage. The people most in need of 'single-payer' are the unfortunates who don't have employer-sponsored health cover (160M is less than half the US population); those out of work, whether 'retired' or 'not employed just right now'; those who are physically unable to work because of bad health or past injuries; etc. Single-payer covers everybody, and removes the cause of bankruptcies because of tens (or hundreds) of thousands of dollar hospital debts. There's no way I could have afforded my triple bypass surgery including 2 days in ICU on my 22-hours-a-week employment classified as 'casual work' if I was under the US health scheme. That surgery came with a mere two-week warning, I went to have an angiogram 'just to check things' and was told "We're not sure if we'll let you go home today!"