8 ms·

Hoping someway, somehow, something like medicare for all comes to fruition at the national scale given that the economy will become even more of a gig economy

Hoping someway, somehow, something like medicare for all comes to fruition at the national scale given that the economy will become even more of a gig economy than pre-corona. Can't understand how this is not being talked about much since Bernie dropped out. A good family plan for a gig worker (without subsidies) is like 1500 a month in major markets.

vkou 6y ago
> Can't understand how this is not being talked about much since Bernie dropped out. It's not being talked about much because it is unpalatable to the pro-big-business arm of the Democrat establishment. And you cannot find a more pro-establishment candidate than Biden. We'll get a chance to try again in four years.
- wolco 6y ago
  You won't because the super delegates + plus press control over friendly outlets prevent candidates the public loves from winning and gives them candidates they are told they should like. And even though they look good on paper they never feel right. Then the general election happens and the other party wins because whoever their candidate is they generally have populist support. Once in a generation people do get the candidate they want but they give themselves a serious disadvantage each year.
  - blockmarker 6y ago
    Just because you don't like the candidate it doesn't mean that nobody else does.
  - drngdds 6y ago
    You what? Biden won because the public liked him more than Bernie, as you could see by the polls and the vote counts.
- bubbleRefuge 6y ago
  You mean Big Insurance Big Pharma ? Because I think most businesses , big and small, would benefit from a universal medicare type solution. One less thing to worry about for them and presumably government funded/single payer/ yada yada. It seems to me the whole theory that government programs need to be "paid for" is out the window as the Fed has 6T on their balances sheets and Congress has instructed the Treasury to spend 1.5 or 2T on C19 relief by printing treasury securities(that the Fed can buy if needbe). So its not about how can we fund universal health care ( and also a more dignified Social security retirement system [leave that for another thread]) its about the will to freaking do it and stand up to Big Pharma, Big Medicine, and Big Insurance lobbies.
whb07 6y ago
So if the healthcare and insurance markets are screwed up because of government, the solution then is more government? I always find this logic lacking. Maybe I could get an eli5 from someone ?
- pixelatedindex 6y ago
  I don't know about "more" government, but "less" government is also not the solution. The real solution is a "better" government, and that's a very layered problem. Either way, we pay a lot more for a very subpar health ecosystem compared to the rest of the world.
- deleted 6y ago
  [deleted]
- vangelis 6y ago
  What is government to you? Does government add complexity? If complexity is the issue, then folding multiple insurance companies with different reimbursements rates and interfaces into one entity should reduce complexity. Hospitals already deal with CMS, why not only deal with CMS?
- Eric_WVGG 6y ago
  The parent post said nothing about healthcare and the insurances markets being screwed up because of government. The argument for single-payer hinges on the theory that the profit motive is incompatible with the very idea of insurance (that is, as long as denying services is more profitable than providing them, an insurance market is an inefficient way to provide said services).
  - bhupy 6y ago
    It's complicated. 1) "Single payer" is not the only way to deliver universal healthcare. Germany, Switzerland, Netherlands, Singapore all have thriving multi-payer systems. In Switzerland and the Netherlands, ALL insurance is private. In Singapore, while the government covers catastrophic care, 70% of total health expenditures are private. 2) The biggest problem in the US is that healthcare is just more expensive, and American insurers end up having to pay more. An example: doctors in America earn more (PPP adjusted) than in any other country. MRI's in America cost more (even on the Medicare fee schedule) than almost any other country. A lot of this is actually caused by a series of well-intentioned policies passed over the last half century. 3) In the US, for-profit insurance profit margins are a pretty meagre 5%, which doesn't really make a dent in costs. Also, some of the biggest insurance providers are non-profits (Blue Cross Blue Shield, Kaiser) 4) Medicare fee schedules aren't that much better, in fact the part of Medicare that's actually working the best is Medicare Part C (Medicare Advantage), which relies on private payers. Source: I work at a claims adjuster
hinkley 6y ago
I don't know what the fee structure looks like, but there are at least a few tech organizations that offer insurance. https://www.washingtontechnology.org/ https://www.washingtontechnology.org/ Should probably be more of these, cooperatives, and foundations that work on software to support bootstrapping.
bhupy 6y ago
Doesn't have to be national — Canada's single payer healthcare system 1) is Provincial, 2) came about gradually from Province to Province. Saskatchewan was the first Province to offer single payer in 1947, followed by Alberta in 1951, etc. By 1961, all Provinces had some form of a single payer healthcare system. The US can do the same, this doesn't have to be all-or-nothing at the Federal level.
- sudosysgen 6y ago
  Not really, US States are much less powerful and represent a smaller fraction of the whole than Canadian provinces. A US state wouldn't have the power in practice to implement universal healthcare.
  - bhupy 6y ago
    What? US States are 1) far more powerful than Canadian Provinces, to the extent that anything not explicitly delegated to the Federal government by the Constitution is left to the States (10th Amendment) 2) nearly every single state in the US has a GDP per capita on par with whole European nation-states, which is more than enough to fund a single-payer system
    - sudosysgen 6y ago
      Canadian Provinces are more powerful than US States, because not only do they have jurisdiction on whatever isn't explicitly delegated to the Federal government, but there are many topics that the Federal government cannot ever touch. In practice, Canadian Provinces are much more powerful and have much more power than US States, because much of the funding that US states are reliant on comes from the Federal government, mainly because the US Federal government is allowed to do things that the states already do and thus to require the funding for it, which means that many state programs are in fact funded by the Federal government. This means that the Federal government, if it disagrees with a decision of a State, can cripple it by withdrawing funding. This is not the case for Canadian Provinces. Finally, in the US, there are (many) areas of dual authority, where both the Federal government and the State government has authority over an issue. This is very rare in Canada, where the Federal government only exerts dual authority in cases where either the Province fails to uphold a mandate (because Federal decisions, instead of being directly enforced, are often mandated then implemented by the Provinces, while this is much rarer in the US), or when it was originally an explicitly Federal prerogative that the Feds decided to share. Another huge difference is that US States have no authority on interstate matters such as commerce and travel, whereas Canadian provinces are allowed to tax goods from another province, or even to close borders between two provinces (although this is rarely used, it is a power exercised in times when it matters). So essentially, de jure States and Provinces are more or less equal in autonomy, but in practice Provinces have much more sovereignty. The economies of scale that make public healthcare work require you to either control the market or a significant portion of it in order to strong arm the suppliers, A few US states such as California might be able to, but the Federal government would very likely interfere.

vkou 6y ago

> Can't understand how this is not being talked about much since Bernie dropped out. It's not being talked about much because it is unpalatable to the pro-big-business arm of the Democrat establishment. And you cannot find a more pro-establishment candidate than Biden. We'll get a chance to try again in four years.

wolco 6y ago
You won't because the super delegates + plus press control over friendly outlets prevent candidates the public loves from winning and gives them candidates they are told they should like. And even though they look good on paper they never feel right. Then the general election happens and the other party wins because whoever their candidate is they generally have populist support. Once in a generation people do get the candidate they want but they give themselves a serious disadvantage each year.
- blockmarker 6y ago
  Just because you don't like the candidate it doesn't mean that nobody else does.
- drngdds 6y ago
  You what? Biden won because the public liked him more than Bernie, as you could see by the polls and the vote counts.
bubbleRefuge 6y ago
You mean Big Insurance Big Pharma ? Because I think most businesses , big and small, would benefit from a universal medicare type solution. One less thing to worry about for them and presumably government funded/single payer/ yada yada. It seems to me the whole theory that government programs need to be "paid for" is out the window as the Fed has 6T on their balances sheets and Congress has instructed the Treasury to spend 1.5 or 2T on C19 relief by printing treasury securities(that the Fed can buy if needbe). So its not about how can we fund universal health care ( and also a more dignified Social security retirement system [leave that for another thread]) its about the will to freaking do it and stand up to Big Pharma, Big Medicine, and Big Insurance lobbies.

whb07 6y ago

So if the healthcare and insurance markets are screwed up because of government, the solution then is more government? I always find this logic lacking. Maybe I could get an eli5 from someone ?

pixelatedindex 6y ago
I don't know about "more" government, but "less" government is also not the solution. The real solution is a "better" government, and that's a very layered problem. Either way, we pay a lot more for a very subpar health ecosystem compared to the rest of the world.
deleted 6y ago
[deleted]
vangelis 6y ago
What is government to you? Does government add complexity? If complexity is the issue, then folding multiple insurance companies with different reimbursements rates and interfaces into one entity should reduce complexity. Hospitals already deal with CMS, why not only deal with CMS?
Eric_WVGG 6y ago
The parent post said nothing about healthcare and the insurances markets being screwed up because of government. The argument for single-payer hinges on the theory that the profit motive is incompatible with the very idea of insurance (that is, as long as denying services is more profitable than providing them, an insurance market is an inefficient way to provide said services).
- bhupy 6y ago
  It's complicated. 1) "Single payer" is not the only way to deliver universal healthcare. Germany, Switzerland, Netherlands, Singapore all have thriving multi-payer systems. In Switzerland and the Netherlands, ALL insurance is private. In Singapore, while the government covers catastrophic care, 70% of total health expenditures are private. 2) The biggest problem in the US is that healthcare is just more expensive, and American insurers end up having to pay more. An example: doctors in America earn more (PPP adjusted) than in any other country. MRI's in America cost more (even on the Medicare fee schedule) than almost any other country. A lot of this is actually caused by a series of well-intentioned policies passed over the last half century. 3) In the US, for-profit insurance profit margins are a pretty meagre 5%, which doesn't really make a dent in costs. Also, some of the biggest insurance providers are non-profits (Blue Cross Blue Shield, Kaiser) 4) Medicare fee schedules aren't that much better, in fact the part of Medicare that's actually working the best is Medicare Part C (Medicare Advantage), which relies on private payers. Source: I work at a claims adjuster

hinkley 6y ago

I don't know what the fee structure looks like, but there are at least a few tech organizations that offer insurance. https://www.washingtontechnology.org/ https://www.washingtontechnology.org/ Should probably be more of these, cooperatives, and foundations that work on software to support bootstrapping.

bhupy 6y ago

Doesn't have to be national — Canada's single payer healthcare system 1) is Provincial, 2) came about gradually from Province to Province. Saskatchewan was the first Province to offer single payer in 1947, followed by Alberta in 1951, etc. By 1961, all Provinces had some form of a single payer healthcare system. The US can do the same, this doesn't have to be all-or-nothing at the Federal level.

sudosysgen 6y ago
Not really, US States are much less powerful and represent a smaller fraction of the whole than Canadian provinces. A US state wouldn't have the power in practice to implement universal healthcare.
- bhupy 6y ago
  What? US States are 1) far more powerful than Canadian Provinces, to the extent that anything not explicitly delegated to the Federal government by the Constitution is left to the States (10th Amendment) 2) nearly every single state in the US has a GDP per capita on par with whole European nation-states, which is more than enough to fund a single-payer system
  - sudosysgen 6y ago
    Canadian Provinces are more powerful than US States, because not only do they have jurisdiction on whatever isn't explicitly delegated to the Federal government, but there are many topics that the Federal government cannot ever touch. In practice, Canadian Provinces are much more powerful and have much more power than US States, because much of the funding that US states are reliant on comes from the Federal government, mainly because the US Federal government is allowed to do things that the states already do and thus to require the funding for it, which means that many state programs are in fact funded by the Federal government. This means that the Federal government, if it disagrees with a decision of a State, can cripple it by withdrawing funding. This is not the case for Canadian Provinces. Finally, in the US, there are (many) areas of dual authority, where both the Federal government and the State government has authority over an issue. This is very rare in Canada, where the Federal government only exerts dual authority in cases where either the Province fails to uphold a mandate (because Federal decisions, instead of being directly enforced, are often mandated then implemented by the Provinces, while this is much rarer in the US), or when it was originally an explicitly Federal prerogative that the Feds decided to share. Another huge difference is that US States have no authority on interstate matters such as commerce and travel, whereas Canadian provinces are allowed to tax goods from another province, or even to close borders between two provinces (although this is rarely used, it is a power exercised in times when it matters). So essentially, de jure States and Provinces are more or less equal in autonomy, but in practice Provinces have much more sovereignty. The economies of scale that make public healthcare work require you to either control the market or a significant portion of it in order to strong arm the suppliers, A few US states such as California might be able to, but the Federal government would very likely interfere.