Do you support universal health care? Why or why not?

[AeneasBK]

Privatization leads to price increases because of one simple word.

"Profit."

Sure but it can also be regulated, no?

"We know it costs X to make Y, so pull the other one if you try to charge Z for it" kind of thing.

[Edge-]

Sure but it can also be regulated, no?

It can be, but regulations are difficult and Republicans are "ideologically" (quotes because it's hardly a coherent ideology in the slightest) opposed to such regulations. Look at the ACA and the profit-caps put on insurance companies that have been ignored over the years, for example.

And regulating private businesses to limit profits is treading closer and closer to "socialism" in the eyes of many, to boot.

I'd love to go back to ye-olden days of flying where prices were the same (hell, you could even exchange tickets with other airlines) and airlines had to compete by offering better experiences and service. Instead of like, charging the same prices now, giving you less room, less storage, worse food, worse service, obnoxious passengers, no amenities, and shit that used to come for free is now a paid extra.

[Elegiac]

It can be, but regulations are difficult and Republicans are "ideologically" (quotes because it's hardly a coherent ideology in the slightest) opposed to such regulations. Look at the ACA and the profit-caps put on insurance companies that have been ignored over the years, for example.

And regulating private businesses to limit profits is treading closer and closer to "socialism" in the eyes of many, to boot.

I'd love to go back to ye-olden days of flying where prices were the same (hell, you could even exchange tickets with other airlines) and airlines had to compete by offering better experiences and service. Instead of like, charging the same prices now, giving you less room, less storage, worse food, worse service, obnoxious passengers, no amenities, and shit that used to come for free is now a paid extra.

Reminder that if companies like Apple were worker cooperatives each employee would have an annual income of nearly half a million dollars.

This idea that furnishing the profit motive with carte blanche enriches everyone is blatant nonsense; crony capitalism might as well be economic anarchy.

[omeomorfismo]

Where in there does it say "Takes action to help someone because you feel bad for them?" Nowhere. Again, I can understand and feel the way someone does without wanting to do anything about it.


Because insurance isn't (or shouldn't be) mandatory. Insurance should work like the personal coverage portion of comprehensive car insurance, like it did before the ACA.

wait, in US car's insurance isnt mandatory? you can actually do an incident and be too poor/scumbag to repay the victims?

[Elegiac]

wait, in US car's insurance isnt mandatory? you can actually do an incident and be too poor/scumbag to repay the victims?

Car insurance in some form is a legal requirement in pretty much every state except New Hampshire, which still requires drivers to be able to prove they can pay for liability out of pocket before they issue a license in most cases - so no.

The anarchist wet dream he's describing exists only in the heads of a few libertarians. Or eaten by bears because the political philosophy of personal responsibility is too lazy to pick up their garbage.

[Edge-]

Reminder that if companies like Apple were worker cooperatives each employee would have an annual income of nearly half a million dollars.

This idea that furnishing the profit motive with carte blanche enriches everyone is blatant nonsense; crony capitalism might as well be economic anarchy.

https://www.inc.com/jessica-stillman...doing-now.html

Yep, and the company that made headlines a while back by making $70K/year the minimum wage has not only managed to survive, despite the endless predictions of immediate closure, but it's thriving. And their employees are makin lots of babies, too.

WHICH IS A LONG WAY OF SAYING that the for-profit driven motivation of insurance companies is bullshit and drives up the costs pointlessly, and I don't know why anyone would argue otherwise. Especially when you look at the efficiency of the Medicare program, which has around a 2% administrative cost compared to the 12-17% for private insurance - https://www.politifact.com/factcheck...e-insurance-a/

[Zan15]

https://www.inc.com/jessica-stillman...doing-now.html

Yep, and the company that made headlines a while back by making $70K/year the minimum wage has not only managed to survive, despite the endless predictions of immediate closure, but it's thriving. And their employees are makin lots of babies, too.

WHICH IS A LONG WAY OF SAYING that the for-profit driven motivation of insurance companies is bullshit and drives up the costs pointlessly, and I don't know why anyone would argue otherwise. Especially when you look at the efficiency of the Medicare program, which has around a 2% administrative cost compared to the 12-17% for private insurance - https://www.politifact.com/factcheck...e-insurance-a/

Well the 2% is a gamed number, its more than triple that number in reality.

Also the administrative cost % is skewed in favor of Medicare because their cost per claim is substantially higher than private insurance because of the population that Medicare covers (elderly). i.e they get a lot less claims per member but the claims are huge in relative terms then the average for the private sector, which equates to much lower administrative cost.


Of course a lot of this growth in administrative cost is because of the growth in Medicare Advantage and the Medicare Drug plans.



https://www.nytimes.com/2018/10/15/u...ive-costs.html
https://www.heritage.org/medicare/co...-or-efficiency

the actual cost is higher because of services performed for Medicare by other parts of the government that aren’t accounted for:
The Social Security Administration collects premiums
the Internal Revenue Service collects taxes for the program
the F.B.I. provides fraud prevention services
and at least seven other federal agencies and departments also do work that benefits Medicare.

National Health Expenditure data shows both the government’s administrative costs for Medicare and those of Medicare’s private plans. Putting them together for the most recent year available (2016), they reach $47 billion, or 7 percent of total Medicare spending — well above the administrative costs borne directly by the Medicare program.

Medicare’s private drug benefit plans incur administrative costs that are about 11 percent of their spending. All of this additional, private administrative cost is paid for by taxpayers and, through their premiums, people who use Medicare



Still way better than the 12-17% born by private insurance but you ain't going to save that much going to a medicare for all system as you would going to a universal system like Canada

[Edge-]

Still way better than the 12-17% born by private insurance but you ain't going to save that much going to a medicare for all system as you would going to a universal system like Canada

Erm...M4A is a universal system though...or have progressive been misleading us all this time and I've been wrong too?

And your links are...not entirely backing you. The Heritage Foundation ain't a great one to begin with given the hardcore conservative skew, and the NYT article includes this gem -

The claim that these administrative costs are overlooked is false. As annual reporting of Medicare’s finances plainly states, they are accounted for.

Which links to this - https://theincidentaleconomist.com/w...tive-cost-ctd/

A look at Table III.B1 on page 51 of the 2012 Trustees report (PDF) shows the amounts Medicare does reimburse the Treasury (IRS), SSA, and HHS for administrative expenses pertaining to Part A. Other tables later in the report do the same for other parts of the program (see comments to this post). I suppose the charge could be that there are still other administrative costs that are provided by one or several of these agencies for which Medicare does not reimburse. If so, I’d l like to know exactly what the Trustees are missing in their report. Right now, my best hypothesis is “nothing.” Solid evidence would be necessary to convince me otherwise.

What would happen to those private Medicare/Drug plans though is an unknown. Whether the government would continue to offer them or whether they would leave additional private insurance to the realm of...well, the private insurance companies if there are any left, is an open question.

Though it's worth noting with those programs like Part C, those are Medicare-administered private insurance plans so that's already more than a bit of a grey area.

So Medicare proper still has incredibly low costs, well below even the 7% combined administrative costs when you include the Medicare-administered private insurance plans.

[Ripster42]

Erm...M4A is a universal system though...or have progressive been misleading us all this time and I've been wrong too?

And your links are...not entirely backing you. The Heritage Foundation ain't a great one to begin with given the hardcore conservative skew, and the NYT article includes this gem -

Pretty sure they work in insurance. He just wants to make money bankrupting people who need healthcare.

[BeepBoo]

wait, in US car's insurance isnt mandatory? you can actually do an incident and be too poor/scumbag to repay the victims?

I was specifically talking about the comprehensive (meaning the part where the insurance company reimburses you if you wreck your own shit). Incidental insurance is mandatory basically everywhere. There isn't really a healthcare equivalent of incidental insurance, because that's usually covered in something else (like your auto insurance policy, where it covers medical bills others incur due to your mistakes).

[Antiganon]

Okay, but is it absolutely certain that privatising some aspects of healthcare would lead to a 1000% increase in costs or is that a uniquely American issue? Could reforms in the states lead to insulin being available to diabetics at the cost it is to citizens elsewhere in the world, or is it going to be 6 grand a year and only ever increase?


EDIT: The topic of the thread seems to be only to discuss this as it regards to USA, and I'm sorry for being so off topic, my original post was answering the thread title more than the first post.

So long as healthcare is a for-profit enterprise in the US, Americans will continue to pay through the nose for services that cost pennies on the dollar in EU and Canada.

The healthcare industry lobby is incredibly powerful and we'll funded and piecemeal attempts at regulation are not likely to go anywhere.

The only real solution is to kill their golden goose. M4A does it quick, a public option does it slowly, but either way we need the profit motive eliminated from prescription drugs and medically necessary health services, or it's all for naught, just a different group of fatcats cashing a different percentage of the same checks.

[Zan15]

So long as healthcare is a for-profit enterprise in the US, Americans will continue to pay through the nose for services that cost pennies on the dollar in EU and Canada.

The healthcare industry lobby is incredibly powerful and we'll funded and piecemeal attempts at regulation are not likely to go anywhere.

The only real solution is to kill their golden goose. M4A does it quick, a public option does it slowly, but either way we need the profit motive eliminated from prescription drugs and medically necessary health services, or it's all for naught, just a different group of fatcats cashing a different percentage of the same checks.

well healthcare is also for profit in Canada and other countries.
but those things are limited by price controls and regulations.

Some specialist are making 600k+ in canada so there is still substancial profit to be had. They are also required to publicly release how much they made each year in their "blue book" releases.



As far as the lobby is concerned, you could rally the other 90% of the non healthcare/insurance related companies out there and show them how much money they will save under a universal system. then you would completly crush them with lobby support from every other industry.

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Erm...M4A is a universal system though...or have progressive been misleading us all this time and I've been wrong too?

And your links are...not entirely backing you. The Heritage Foundation ain't a great one to begin with given the hardcore conservative skew, and the NYT article includes this gem -



Which links to this - https://theincidentaleconomist.com/w...tive-cost-ctd/



What would happen to those private Medicare/Drug plans though is an unknown. Whether the government would continue to offer them or whether they would leave additional private insurance to the realm of...well, the private insurance companies if there are any left, is an open question.

Though it's worth noting with those programs like Part C, those are Medicare-administered private insurance plans so that's already more than a bit of a grey area.

So Medicare proper still has incredibly low costs, well below even the 7% combined administrative costs when you include the Medicare-administered private insurance plans.

Heritage was just the easiest to link and easiest to understand. They are not always evil when adding up numbers. Their anaylsis was quite simple and straight forward using all of Medicare's numbers. If its not administrative expense then someone needs to explain where those billions went becuause its a lot of money that is being spent without a clear reason why.


there are a dozen more from KKF to non partisan groups.

Again if you adjust for the population that you are covering and the difference in cost for those patients the administrative cost are very misleading when it comes to Medicare.

A Medicare for all would have 5x the number of claims at 1/3 the average charge of just the current medicare plan/population. Thus increasing cost substancially.

Of course you don't need this at all with a canadian type system

[Antiganon]

well healthcare is also for profit in Canada and other countries.
but those things are limited by price controls and regulations.

Some specialist are making 600k+ in canada so there is still substancial profit to be had. They are also required to publicly release how much they made each year in their "blue book" releases.



As far as the lobby is concerned, you could rally the other 90% of the non healthcare/insurance related companies out there and show them how much money they will save under a universal system. then you would completly crush them with lobby support from every other industry.

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Heritage was just the easiest to link and easiest to understand. They are not always evil when adding up numbers. Their anaylsis was quite simple and straight forward using all of Medicare's numbers. If its not administrative expense then someone needs to explain where those billions went becuause its a lot of money that is being spent without a clear reason why.


there are a dozen more from KKF to non partisan groups.

Again if you adjust for the population that you are covering and the difference in cost for those patients the administrative cost are very misleading when it comes to Medicare.

A Medicare for all would have 5x the number of claims at 1/3 the average charge of just the current medicare plan/population. Thus increasing cost substancially.

Of course you don't need this at all with a canadian type system

Pretty sure @Endus will correct you, but from a quick Google 95% of Canadian healthcare is nonprofit, with the remaining 5% being mostly non covered services.

Regarding Medicare costs, you would be eliminating the costs to process those same claims by private insurers, as well as eliminating any sort of in network/out of network cost differentials that make billing more complicated. You'd also standardize the billing system across everyone, rather than having a bunch of different companies all doing their own thing in their own way.

There is no reasonable argument to be made that administering M4A would cost more than the current system.

[Endus]

well healthcare is also for profit in Canada and other countries.
but those things are limited by price controls and regulations.

Some specialist are making 600k+ in canada so there is still substancial profit to be had. They are also required to publicly release how much they made each year in their "blue book" releases.

Pretty sure @Endus will correct you, but from a quick Google 95% of Canadian healthcare is nonprofit, with the remaining 5% being mostly non covered services.

Yep. Specialists still make high incomes, but their income is predicated on their work, not on a profit percentage. Salaries and such are not "profit".

Hospitals are all non-profits here (at least, that I'm aware of, barring some weird niche case somewhere), and doctors clinics as well. The standard way billing is handled for clinics is that a patient visit has a set billing cost, as do services; the doctor doesn't set the price, they bill the provincial government according to the government's price lists. Those doctors can work longer hours and see more patients and thus make more money, but that's still not "profit". Plus, patients are perfectly entitled to change doctors whenever, so there's still competition, it's just competition based on quality of service rather than price.

You get a few speciality clinics providing secondary services like physiotherapy or MRIs, who do both health services and for-profit services, but not in the core health services. If your doctor recommends an MRI or massage, you'll get it covered and you'll get an appointment time based on triage; if your doctor doesn't think physio is necessary but might help, you can pay for it yourself. And you're getting basically similar price points as the government would; prices for these things are way lower in Canada than the USA.

There is no reasonable argument to be made that administering M4A would cost more than the current system.

What people need to realize is that the cost impacts are going to be felt mostly by hospital administrations (not doctors and nurses), pharmacorps (not pharmacists), and particularly health insurance providers.

Not taxpayers.

The health insurance industry will be ravaged, but it's an industry that creates profit off human suffering, so seriously, fuck that industry in the ear.

[Zan15]

Yep. Specialists still make high incomes, but their income is predicated on their work, not on a profit percentage. Salaries and such are not "profit".

Hospitals are all non-profits here (at least, that I'm aware of, barring some weird niche case somewhere), and doctors clinics as well. The standard way billing is handled for clinics is that a patient visit has a set billing cost, as do services; the doctor doesn't set the price, they bill the provincial government according to the government's price lists. Those doctors can work longer hours and see more patients and thus make more money, but that's still not "profit". Plus, patients are perfectly entitled to change doctors whenever, so there's still competition, it's just competition based on quality of service rather than price.

You get a few speciality clinics providing secondary services like physiotherapy or MRIs, who do both health services and for-profit services, but not in the core health services. If your doctor recommends an MRI or massage, you'll get it covered and you'll get an appointment time based on triage; if your doctor doesn't think physio is necessary but might help, you can pay for it yourself. And you're getting basically similar price points as the government would; prices for these things are way lower in Canada than the USA.

.

I'd argue that its all semantics.

Sure if you are an employee of a corporation/business you get a salary. You have expenses. What do you call what is left over after your income - expenses??.
If you are a company its a "profit" but as an individual its not a "profit"? Semantics if you ask me. Either way its excess reimbursement above cost.
They are also not employed by the Canadian "system". That right there would exclude you from being called Salaried. You are reimbursed for services rendered by the system. Akin to an independent contractor/business in the US. Its reimbursement not salary.


Who pays for that specialist expenses in his office? Who pays the electricity? Who pays the Gas? Who pays the staff receptionist? etc etc
So if they get 600,000k as a specialist in Canada and he has to pay for all the office expenses then what do you call the 200k that is left over?
At the end of the day they would have excess revenue from the reimbursement for which they can pay themselves from. You could pay yourself a salary as a business but then you would be double taxed. Normally you would pay yourself as a "pass through" on the remaining revenue.


I know you don't have LLC's up there, but are not most doctor offices set up as LLPs, Sole Proprietorship or corporations up there?

Also they are still paid based on procedures in Canada so its hard to call it a salary since it can vary based on what services are performed. Again semantics.




If they are run as non profit they don't technically have "profits" because they call that "excess revenue" that they reinvest into the hospital or into charity care here in the US. The majority of hospitals in the US are also "non profit" (3,000 are nonprofits, 1,300 for-profit, and 1,000 operated by state and local governments--rounded #'s of course)



Drugs are still for profit in Canada they are just price regulated to limit the profits the pharma industry can make. Same with supplies and things like implants.
As compared to the US where its all about maximizing profits with no limits. They just balance the profit with the countries ability to pay. They won't jack it too high because they will make more per patient but lose out on overall profits with the massive drop in # of people buying their shit.


The system itself in Canada is non profit on the administration side, which in the US the private insurance sector is not (for the most part there are some).

[Zan15]

Pretty sure @Endus will correct you, but from a quick Google 95% of Canadian healthcare is nonprofit, with the remaining 5% being mostly non covered services.

Regarding Medicare costs, you would be eliminating the costs to process those same claims by private insurers, as well as eliminating any sort of in network/out of network cost differentials that make billing more complicated. You'd also standardize the billing system across everyone, rather than having a bunch of different companies all doing their own thing in their own way.

There is no reasonable argument to be made that administering M4A would cost more than the current system.

Not true. Medicare has those same problems.

They have out of network claims.
They have doctors who refuse Medicare rates.
They have to pay those doctors 125% of Medicare. Those doctors can appeal for higher rates if they can prove complexity.


Also as far as billing you have 8 companies that do Medicare processing of standard Medicare. You have another half dozen that do DME processing. You have 4 that do Dialysis. Etc Etc Etc.
On top of that now you have 200+ that do Medicare Advantage processing.
On top of that you now have a separate process for Medicare Drug plans.


Also billing is currently standardized because of regulations put in place by the ACA. I think you mean Benefits being different for every patient which then correlates to you having to deal with a lot of different ways and problems to get benefits paid if a problem occurs.

Still does not cut down on expenses in dealing with 200+ entities a day if not more for some large healthcare entities.

Pretty sure [MENTION=614243]

There is no reasonable argument to be made that administering M4A would cost more than the current system.

As long as they put price controls in place, which Medicare does not have in a lot of big buckets of services including Drugs and the Govt does not try to takeover administration of the plan from the private sector. The second you have a huge M4A govt agency doing ALL the work then kiss efficiency and cost good bye.

Medicare already proved the private sector can do it 10x better and there are private companies willing to do it for WAAAAAAAY less than what the big private insurance carrier charge private companies.

Of course this is all moot if you just forgot M4A and went to a Nationalized health plan like Canada.
This interim step of M4A is a waste of time.

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Erm...M4A is a universal system though...or have progressive been misleading us all this time and I've been wrong too?

.

Well its a problem in what M4A means, which seems to be different for everyone.

If it means expanding Medicare to everyone then sure its a universal system but its not a good one. Its basically the private insurance industry with less profits. Same problems same bullshit.


If its a catch all to move everyone to a nationalized healthcare plan then yah.

[Edge-]

Well its a problem in what M4A means, which seems to be different for everyone.

Yep, that's part of the issue I have with the M4A advocates. They don't seem to understand that the general understanding of M4A in the abstract is very vague, and people filling in the gaps with what they want to be there drives its huge support as an abstract concept.

But practically in terms of reality, that's very much what M4A means. It means everyone is covered by Medicare, a single universal insurance/payment system. Whether there's private option in addition to that etc. is a separate matter, but at its core it's universal coverage.

If it means expanding Medicare to everyone then sure its a universal system but its not a good one. Its basically the private insurance industry with less profits. Same problems same bullshit.

Not really, because a lot of the problems (additional administration costs in handling Medicare-private plans, out of network coverage etc.) are considerably reduced when you either entirely remove private insurance or you leave private insurance as "Cadillac" supplementary plans for people who want even more coverage or want coverage for specific things.

[Zan15]

And your links are...not entirely backing you. The Heritage Foundation ain't a great one to begin with given the hardcore conservative skew, and the NYT article includes this gem -

Which links to this - https://theincidentaleconomist.com/w...tive-cost-ctd/



What would happen to those private Medicare/Drug plans though is an unknown. Whether the government would continue to offer them or whether they would leave additional private insurance to the realm of...well, the private insurance companies if there are any left, is an open question.

Though it's worth noting with those programs like Part C, those are Medicare-administered private insurance plans so that's already more than a bit of a grey area.

So Medicare proper still has incredibly low costs, well below even the 7% combined administrative costs when you include the Medicare-administered private insurance plans.

You seem very caught up in the Heritage Foundation when this very topic has been studied by many other "foundations/institutes"

You can even take the raw numbers from Medicare of which there are TWO measurements (how coinvent huh?)

https://www.cms.gov/Research-Statist...untsHistorical

NHE Tables (ZIP)
Table 23
Government Administration 48.9b

https://www.cms.gov/files/document/2...ees-report.pdf
Medicare Trustee report Administrative expenses 10.6


Two separate reports published by the Centers for Medicare and Medicaid Services quantify Medicare’s administrative costs: the report of the Medicare Board of Trustees and the report of the National Health Expenditure Accounts (NHEA).

The trustees’ report measures only the administrative costs incurred by the federal government, while the NHEA report includes the administrative costs incurred not only by the federal government but also by Medicare Advantage plans and Part D plans, both of which are provided through private insurers. The trustees’ report depicts 2% administrative costs (or lower), whereas the NHEA’s report outlines costs closer to 7%.



The report they list Part D as having a "9.4% Plan administrative expenses and profits"

[Edge-]

You seem very caught up in the Heritage Foundation when this very topic has been studied by many other "foundations/institutes"

Because my dislike has nothing to do with it being a "foundation/institute". It has to do with it being a garbage, bottom-tier conservative think-tank. You know, the kind that were created in reaction to actual think-tanks because they were proposing progressive policy positions, so conservatives made their own think tanks that started with a conclusion and searched for "evidence" to support it, rather than looking at the evidence and coming to conclusions.

The trustees’ report measures only the administrative costs incurred by the federal government, while the NHEA report includes the administrative costs incurred not only by the federal government but also by Medicare Advantage plans and Part D plans, both of which are provided through private insurers. The trustees’ report depicts 2% administrative costs (or lower), whereas the NHEA’s report outlines costs closer to 7%.

Red bit is the rub. Those are still provided through private insurers, which would no longer be the case with a proper M4A rollout. Again, the point is getting private insurance out of Medicare, as it's those aspects of the program where administrative costs see big increases.

[Zan15]

Yep, that's part of the issue I have with the M4A advocates. They don't seem to understand that the general understanding of M4A in the abstract is very vague, and people filling in the gaps with what they want to be there drives its huge support as an abstract concept.

But practically in terms of reality, that's very much what M4A means. It means everyone is covered by Medicare, a single universal insurance/payment system. Whether there's private option in addition to that etc. is a separate matter, but at its core it's universal coverage.



Not really, because a lot of the problems (additional administration costs in handling Medicare-private plans, out of network coverage etc.) are considerably reduced when you either entirely remove private insurance or you leave private insurance as "Cadillac" supplementary plans for people who want even more coverage or want coverage for specific things.

Unfortunately that is the problem Medicare is no where near a single universal insurance/payment system.
Its actually at least 5 maybe 4.5 since D and Advantage kind of go hand and hand.

Part A, B, C, D, Advantage.

Not to mention the dozen or so entities that manage each piece in each region on top of 200+ advantage companies.


Bottom line Medicare for all, meaning moving everyone to Medicare might be a good second step from ACA but its a horrific end game vs a system like Canada or other nationalized plans.