I'm coming around to the idea of a universal "Copper" healthcare plan

[Recursion]

It's basically what Norway does. Everybody is enrolled in it automatically, and it's paid for by a dedicated payroll levy.

It doesn't pay for care, as such, but it limits annual out of pocket expenses to... whatever (people with graphing calculators and spreadsheets can figure out what the annual out of pocket cap needs to be and what the payroll levy to pay for it needs to be). Call it $6000 for now. You or your insurer pay up to that amount, after which the Copper Plan picks up the tab.

All providers must accept it, and must provide a single charge master (that's the list of how much different treatments cost) that they charge to everyone. (That step, not the particulars of financing, is the real difference in the US and other countries' healthcare -- there's no other country I know of where a doctor can simply "decide" what to charge for a treatment.)

This would let people who have insurance they like keep it, limit individuals' exposure to medical debt, and limit providers' exposure to unpaid medical bills. I don't know how high the payroll levy would have to be, but glancing at other countries' systems suggests something like 5 or 6%. That's not the easiest sell in the world but I think it's doable.

[MontanaMama]

1. This is an interesting take on the problem.

It might be especially attractive in states where there is little or no competition between insurance companies. I live in MT and am self employed and thus self insured. There are only two companies that offer health insurance plans to those in the individual market. One of the two companies doesn’t actually want to be competitive so they price their plans so high that most people can’t or won’t choose them.

I buy a silver plan from the other company for my family of three that costs $18,000 a year in premiums with a $4500 individual deductible with a max out of pocket of $9000. That’s a Silver plan! The Gold plan is absolutely unaffordable for me. The Bronze plan would be less expensive in premium but not by very much and the deductibles are in the neighborhood of $6000-$7000 per person. A plan like you describe would cost my family much less. Something’s gotta give.

[Recursion]

2. That's what I like: it drastically changes the incentives of the insurance market

The cap also means that a given insurer won't be on the hook for more than $6000 for a single person for a single year. If the insurance market is about competing for that particular band of reimbursement, it starts looking a lot more like the European insurance market.

[Lonestarblue]

3. Interesting ideas. Would this plan replace Medicare?

And employer-sponsored plans, which often trap employees into staying in jobs they don’t like simply because of the health insurance and pre-existing conditions?

I support Medicare for All because I’ve been on original Medicare for a few years and find it better than employer-sponsored plans (except for endless paperwork they send me!).

[CTyankee]

4. lowering the age for Medicare would be great. At what age, I don't know, but everyone likes

Medicare.

[pnwmom]

17. But not everyone realizes that you need to pay for Part B, if you want outpatient hospital

coverage (which is ESSENTIAL). And if you want copays and deductible to be (mostly) covered, you need to pay for a Supplemental Part C policy.

Also, not all doctors take Medicare, especially some specialists.

[CTyankee]

20. It is what seniors do now and of course it takes a bite out of our income.

It seems to me that we have a "best of two bad alternatives" here. We won't get to perfect no matter how hard we Dems want the very best health care we can get. That doesn't mean we shouldn't try, but we have to look at reality and what is possible.

[luvtheGWN]

7. I assume Norway's hospitals are not privately owned?

I see the biggest problem in the US healthcare (non)system is that healthcare costs (docs, hospitals, drugs etc.) are corporate for-profit driven enterprises, with basically no controls on costs. It's easy to lay all the blame on the insurance companies but they are only one part of it.

[Recursion]

10. Most of the hospitals are not, but the doctors' practices are private (nt)

[Bettie]

5. A whole lot of people

around here don't even go to the doctor, because the copays and out of pocket amounts are not in their budget.

$6000 out of pocket per person in a family is an awful lot of money to those on the lower end of the income spectrum. Heck, it is an awful lot of money for people in the middle of the income spectrum.

And with this plan, you'd still need basic insurance AND to pay a tax to cover your 6K (x # of family members) annually. OH, and I'm guessing you'd still need to find cash for eye exams and dentistry.

[Nature Man]

6. $6000 is two shitty cars

or money to spend on things like groceries, bills, car repairs, childcare, etc.

The good news is, if you're dying in the ER or ICU, they'll still do everything they can, regardless of insurance status.

[Bettie]

8. And that 30-50 dollar copay

just to walk into the doctor's office is the difference between making it to the next payday or not.

Yep, wait until you're really, really sick and then you can get care...and a note to tell your employer why you are gone, though you'll still probably lose your job, because "at will employment" laws.

[Recursion]

9. So expand Medicaid. That's what it's for

Norway does that too; people making less than X get a card that gets them health care for free.

[Bettie]

11. A single payer plan would

absorb Medicaid and Medicare. It would give everyone coverage.

People would no longer have to avoid treatment for fear of bankruptcy or go bankrupt because they got cancer or had an auto accident. These things happen, far more often than you'd probably like to think.

But, I get it. We'll always be yoked to profit-driven "care" that is really about ensuring that those of means get top notch care and the rest get the bare minimum to keep them breathing and at work.

[Recursion]

12. Yeah, the idea that those are the two options is just stupid (nt)

[tinrobot]

14. The dedictible and copays could be income-adjusted

Those below the poverty line only have a small co-pay (or none)

As you get towards middle income, the deductible starts to take effect.

[fpublic]

13. Why pay for insurance profits?

If your risk is limited to $X, why do you need insurance?
If your actual care costs < X, why give any of the difference to a for-profit corporation when Medicare could insure you at lower administrative cost?
If the insurance company's risk was limited to $X, they would need to pay for less care for you in order to maximized profit for shareholders <cough, cough> just as they do now.

[Bettie]

15. Yep, but we're somehow supposed to think that

maximizing shareholder value is the MOST important thing, human lives? Dead last in importance.

Executives need more compensation!

Stockholders, new buildings for the insurance companies, better perks for those highly compensated execs: all much more important than health care!

We need single payer, but some really like a multi tiered system as long as they are in the upper tiers.

[Recursion]

18. There's something to be said for Mitch McConnell not controlling health care

God knows what kind of goon the next GOP President would appoint to HHS

[volstork]

16. I don't disagree with your post.

I am a physician, and I also support single-payer universal healthcare.

One error, though: "a doctor can simply 'decide' what to charge for a treatment."
DOCTORS do not decide what to charge-- INSURANCE COMPANIES do, and that is a vast difference. I took a 60-100% loss on everything I did, from a simple yearly exam to a complex surgery, all while paying ever-increasing malpractice insurance premiums and fighting additional overhead increases. Per my contractual agreements with some large insurers, I could not even have access to the fee schedules, which is essentially those companies saying, "You'll take what we give you."

Only physicians who do not accept insurance (e.g.-- plastic surgeons, "concierge" physicians) are allowed to set their own fee schedules, and can charge what the market will bear.

[oldsoftie]

19. Pay for much of it with a VAT, like Norway does.

I've long supported a plan that would take large bills off of people. WOuld put a stop to medical bankruptcies. And would stop medical poverty.
Maybe even a sliding scale as to how much you'd pay; otherwise many procedures would miraculously be far above 6k.
Phase it in slowly, with a slowly dropping number of where it begins.
And a slowly rising VAT. EVERYONE pays. You'll get less pushback when people think everyone is paying

[avlbeerfan]

21. Agree

I totally agree anything universal has to be paid by VAT it’s truly the only fair way. That’s also how other countries with universal health care pay for it.

[oldsoftie]

22. You're one of the few. nt

[bhikkhu]

23. Given that plan, then suddenly every damn thing you need costs at least $6000

...which I can say, having watched how the health care industry has steadily optimized profits here over the last couple of decades. People get so used to it it's hard to even see anymore.

Example: I dislocated a shoulder a couple years ago, had insurance. Didn't know jack about it so I went to the hospital and did what they told me, got a $9000 bill to pop it back in, which just maxed out my out-of-pocket, and was right at the top level of what the insurance company allowed as "normal".

The kicker though was that after the procedure I went home and, like an idiot, popped the thing right back out. Nothing had really been explained to me so I wasn't careful enough. I rushed back to the hospital and the doctor who'd treated me saw me, asked what happened and I told him. He said "will you be ok if I just fix it?", I was fine, and he extended my arm am pressed his thumb against the bone, popped right back in. Less than a minute and it was done. And then he told me what to avoid to not pop it back out while it was healing. Why didn't they just do that in the first place?

Anyway...four hours and $9000 for the first dislocation, no charge and about 5 minutes for the second. And probably anywhere in the world but a US hospital would have just done something pretty close to the second procedure there, and charged a fair rate. As it was, the whole thing went through insurance and I had zero say in anything.

[luvtheGWN]

24. $9,000 to fix a dislocated shoulder?

That's OUTRAGEOUS.

[bhikkhu]

25. Agreed

But the way they do things, I never even had any idea of what they were charging until 6 months later, when the insurance paid their share of the charges and the hospital sent me the bill for the balance. And I looked up online what a general "fair price" for a shoulder dislocation was in the US; $3,000-$9,000 was the answer.

Looking at that prices, however, there was an option that chiropractors were typically competent to reset a shoulder, and their price was about $100. I asked a local chiropractor and he said "sure, no problem" if it happens again. Would have been good to know.

[luvtheGWN]

27. Considering that 31% of that amount,

according to recent studies, was for administration, it's no damn wonder that healthcare costs in the US are twice and sometimes triple what they are in other countries with universal healthcare.

And a "fair price" of $3,000 to $9,000 for relocating a dislocated shoulder is highway robbery. I fell down the stairs when I was about 3 yrs old and ended up with a dislocated shoulder. Mom rushed me to the family doc to reset it. Bet he didn't even charge for it. (But it must have hurt like holy hell because I blocked it from my mind but was deathly afraid of poor Dr. Smith every time I saw him after that.....)

[cbdo2007]

26. The "plan" isn't the problem in your example, it is the billed amounts.

No fixes to our health care system will ever work without the govt setting standard rates for everything.

[bhikkhu]

29. That's exactly what would fix it

In other things normal price-shopping provides all the pressures needed to keep prices reasonable. But that doesn't work at all in health care. Most people have no idea what they need, no idea what things cost, and then no way to shop around. Even if they did have the time.

In my example I didn't have any idea what it cost until 6 months later, and I don't think there was a single person I interacted with at the hospital who was in any position to tell me if I did ask. I'm not sure why the insurance companies don't set rates and standards, but lacking that a government standard would really help.

[IronLionZion]

28. The universal charge master is the key to controlling costs

having some transparency and standardization for how much a treatment would cost should get more attention on the campaign trail. It could even be standardized by state or county if the argument could be made for different prices for whatever reason. There's no reason that every provider in a city charges different amounts for the exact same procedure using the same equipment, drugs, and amount of labor.

[Recursion]

30. Or that the same provider charges wildly different amounts

Depending on who is billing him. Honestly I think the UCM is the missing key here that makes the rest of the reforms we want much much easier.