5 ms·

3) Medicare for all, starting today. Stroke of a pen I just fixed everything. > existing hospital infrastructure Hospitals already deal with medicare. > ins

by luma 2y ago

3) Medicare for all, starting today. Stroke of a pen I just fixed everything. > existing hospital infrastructure Hospitals already deal with medicare. > insurance companies Oh no the vultures in the system will go hungry whatever shall we do > citizens who don't want a single-payer system Buy premium insurance above and beyond the public option, same as every other modern industrialized country. If you don't like the offering for free, the market can cover whatever gap exists.

bumby 2y ago
Ignoring that a “stroke of the pen” is a dictatorial solution almost by definition… Considering Medicare/Medicaid are currently approaching $1T annually to serve less than 20% of the population how dues your stroke of the pen plan pay for the increase when everyone is enrolled? Hospitals are forced to accept Medicare, but in many cases this is at a loss, subsidized by private charges elsewhere. So you’ll need to find out how to shore up that cost, too. These types of naive solutions assume everyone else is very very stupid or very very corrupt (or else why didn’t such a simple solution get implemented already?)
- ryandrake 2y ago
  Come on--obviously OP meant a "stroke of the pen, held by duly elected representatives". Nothing dictatorial about that. We currently can almost get enough of those representatives in office to do it (and a president to sign it), if it weren't for things like the electoral college, gerrymandering, and grossly unequal representation in the Senate, things that currently give disproportionate power to the "team" that happens to oppose single-payer.
  - bumby 2y ago
    I meant it as an executive order, which is really the only stroke of a pen that would work. Otherwise you’d have to build the political capital to get enough representatives to sign on, and that’s exactly the non-simple task I was alluding to. Those are the same reps who make the rules you’re complaining about, and the same ones who can’t agree on a budget when we don’t have a massive increase in Medicare entitlements. Maybe I’m too cynical, but pretending like there’s the political capital to do it just in the horizon feels like a pipe dream to me. I’m old enough to remember politicians talking about a single payer system in the 1990s and yet here we are.
- ceejayoz 2y ago
  Medicare covers the most expensive part of the population. The US spends 2-3x what the rest of the OECD spends per-capita, with about the same outcomes. Our system is the least cost efficient system in the entire developed world. It’s hard to see how Medicare-for-all could manage to do worse.
  - bumby 2y ago
    I agree with the population part. But more nuance is that a huge part is the last few weeks of life because of cultural aspects regarding protecting life by all means necessary. However, they’re a saying in healthcare that you can optimize for quality, access, or cost but you only get two. The US system is largely focused on optimizing for quality and access (although I admit the latter isn’t necessarily done well and generally relies on reactive care). So to open up access further, you’d probably need to address the other two levers, and I’m not seeing anyone discuss that. There’s also the disproportionate amount of R&D done by the US which effectively subsidizes the rest of the world to help keep their costs down. All that to say, none of the simple solutions bandied about really talk about those effects, let alone how to manage them.
- pjmorris 2y ago
  > Considering Medicare/Medicaid are currently approaching $1T annually to serve less than 20% of the population how dues your stroke of the pen plan pay for the increase when everyone is enrolled? Most countries manage on ~12% or less of GDP, the US takes ~17% of GDP to pay for healthcare [0]. For example, the UK manages to cover everyone for about 12% of GDP. If the US adopted a plan as ubiquitous as the UK, in the same manner as the UK, it'd be cheaper than the current system. Expense seems to be correlated more with the presence of insurance than with the ubiquity of healthcare. [0] https://ourworldindata.org/financing-healthcare https://ourworldindata.org/financing-healthcare
  - bumby 2y ago
    This is the frustrating part of these conversations because people act like you can just swap one country for another like they are interchangeable. They aren’t. For example, other countries get to keep drug costs low because the companies that make them get huge profits in the US. If the US charges the same, the profits and R&D also dry up unless you set up another system. Also, the US tends to rely on extreme measures more often very late in life. I’ve heard (but can’t confirm) this drives a huge proportion of costs. This is rooted in cultural ideas of the sanctity of life. You can’t just pull the rug out unless you’re prepared for backlash about “death panels” and such. There’s a lot of nuance and the “just do what other countries do” misses it completely.
    - 8note 2y ago
      New drug funding tends to come from the US government already. Drug company R&D looks more like "what patents can we buy out and jack the prices in?"
      - nradov 2y ago
        That's simply misinformation. The US government funds some of the basic research that produces candidate molecules. But the vast majority of the cost in drug development comes in phase 3 human clinical trials. Almost all of that is paid for by pharmaceutical companies, and many trials fail.

by luma 2y ago

bumby 2y ago

Ignoring that a “stroke of the pen” is a dictatorial solution almost by definition… Considering Medicare/Medicaid are currently approaching $1T annually to serve less than 20% of the population how dues your stroke of the pen plan pay for the increase when everyone is enrolled? Hospitals are forced to accept Medicare, but in many cases this is at a loss, subsidized by private charges elsewhere. So you’ll need to find out how to shore up that cost, too. These types of naive solutions assume everyone else is very very stupid or very very corrupt (or else why didn’t such a simple solution get implemented already?)

ryandrake 2y ago
Come on--obviously OP meant a "stroke of the pen, held by duly elected representatives". Nothing dictatorial about that. We currently can almost get enough of those representatives in office to do it (and a president to sign it), if it weren't for things like the electoral college, gerrymandering, and grossly unequal representation in the Senate, things that currently give disproportionate power to the "team" that happens to oppose single-payer.
- bumby 2y ago
  I meant it as an executive order, which is really the only stroke of a pen that would work. Otherwise you’d have to build the political capital to get enough representatives to sign on, and that’s exactly the non-simple task I was alluding to. Those are the same reps who make the rules you’re complaining about, and the same ones who can’t agree on a budget when we don’t have a massive increase in Medicare entitlements. Maybe I’m too cynical, but pretending like there’s the political capital to do it just in the horizon feels like a pipe dream to me. I’m old enough to remember politicians talking about a single payer system in the 1990s and yet here we are.
ceejayoz 2y ago
Medicare covers the most expensive part of the population. The US spends 2-3x what the rest of the OECD spends per-capita, with about the same outcomes. Our system is the least cost efficient system in the entire developed world. It’s hard to see how Medicare-for-all could manage to do worse.
- bumby 2y ago
  I agree with the population part. But more nuance is that a huge part is the last few weeks of life because of cultural aspects regarding protecting life by all means necessary. However, they’re a saying in healthcare that you can optimize for quality, access, or cost but you only get two. The US system is largely focused on optimizing for quality and access (although I admit the latter isn’t necessarily done well and generally relies on reactive care). So to open up access further, you’d probably need to address the other two levers, and I’m not seeing anyone discuss that. There’s also the disproportionate amount of R&D done by the US which effectively subsidizes the rest of the world to help keep their costs down. All that to say, none of the simple solutions bandied about really talk about those effects, let alone how to manage them.
pjmorris 2y ago
> Considering Medicare/Medicaid are currently approaching $1T annually to serve less than 20% of the population how dues your stroke of the pen plan pay for the increase when everyone is enrolled? Most countries manage on ~12% or less of GDP, the US takes ~17% of GDP to pay for healthcare [0]. For example, the UK manages to cover everyone for about 12% of GDP. If the US adopted a plan as ubiquitous as the UK, in the same manner as the UK, it'd be cheaper than the current system. Expense seems to be correlated more with the presence of insurance than with the ubiquity of healthcare. [0] https://ourworldindata.org/financing-healthcare https://ourworldindata.org/financing-healthcare
- bumby 2y ago
  This is the frustrating part of these conversations because people act like you can just swap one country for another like they are interchangeable. They aren’t. For example, other countries get to keep drug costs low because the companies that make them get huge profits in the US. If the US charges the same, the profits and R&D also dry up unless you set up another system. Also, the US tends to rely on extreme measures more often very late in life. I’ve heard (but can’t confirm) this drives a huge proportion of costs. This is rooted in cultural ideas of the sanctity of life. You can’t just pull the rug out unless you’re prepared for backlash about “death panels” and such. There’s a lot of nuance and the “just do what other countries do” misses it completely.
  - 8note 2y ago
    New drug funding tends to come from the US government already. Drug company R&D looks more like "what patents can we buy out and jack the prices in?"
    - nradov 2y ago
      That's simply misinformation. The US government funds some of the basic research that produces candidate molecules. But the vast majority of the cost in drug development comes in phase 3 human clinical trials. Almost all of that is paid for by pharmaceutical companies, and many trials fail.