Medicare for all would cost more than what we are paying now. We need to stop avoiding this fact.

[Recursion]

Last edited Mon Nov 2, 2015, 02:27 AM - Edit history (1)

Looking at 2013 (the last year we have full data for), 168 million Americans have private health insurance of some form, while 47 million have Medicare and 41 million have no insurance (Kaiser, below). 50 million of the people with private insurance cannot actually get medical care because they cannot make their copays or deductibles (Commonwealth). The 168 million pay $916 billion in premiums to receive $801 billion in treatments for an overhead rate of 12.5% (CMS; the next two sentences too). Medicare, meanwhile, receives $585 billion in revenues to deliver $550 billion in treatments, for an overhead rate of 6%. So, a 6.5% savings off of $916 billion yields $60 billion dollars saved if we do nothing but migrate everyone on private insurance to the Medicare model.

Medicare has another advantage: it pays doctors, drug companies, etc. less than private insurance, on average 20% less (CNN). If that's a good guide, we would be saving an additional $160 billion, and the 168 million people currently with private insurance would be paying $680 billion for $640 billion in treatments, and we'll be saving $220 billion dollars. All well and good. But now let's look at the uninsured and underinsured. Remember: all we've done so far is take the exact same treatments people are getting today and find a cheaper way to pay for them. We haven't addressed the 50 million insured people skipping treatments, or the 40 million with no insurance. That's 90 million people who will now be getting health care under Medicare For All that aren't now.

The 118 million people who currently actually get treatment through private insurance would in this plan be costing on average $5700 per year (680 billion divided by 118 million). If the underinsured and uninsured start using medical care at the same rate as those 118 million, that will be an additional $513 billion in expenditures, meaning instead of paying $220 billion less, we'd be paying $293 billion more in total than we are now.

But what's worse is that we probably wouldn't spend that, because if we simply literally expand Medicare to everyone, they would have a $1200 deductible, a 20% copay for all treatments, no out of pocket maximum, and a $550 / month deductible, assuming the non-Senior Medicare enrollees would not get a premium subsidy from the Trust Fund like Seniors do. (And if we want the plan to be more generous than the current Medicare system then we have to increase the baseline cost we're talking about by that much more.) So it's not clear that that's actually going to help the underinsured at all (it sounds like exactly the sort of plan that isn't helping them now). But it really does to me illustrate the fact that if our actual goal is to make the $513 billion dollars in foregone health care actually happen, we're going to have to pay $513 billion dollars one way or another.

Single Payer may be a great idea (though very few countries actually do it; most achieve universal health care some other way), but the notion that it's going to cost less than our current "strategy" of simply not treating people is just a fantasy. It's going to cost a whole lot of money. And we really need to be up-front about that.

As an idea of the scale we're talking about here, $293 billion is about 50% of the entire defense budget, or a 12% payroll levy, or a 16% corporate tax (on top of our current levies and taxes), or a 20% VAT (depending one what we exclude).

https://www.cms.gov/Research-Statistics-Data-and-systems/Statistics-Trends-and-reports/NationalHealthExpendData/index.html

http://kff.org/other/state-indicator/total-population/

http://www.commonwealthfund.org/publications/press-releases/2015/may/underinsurance-brief-release

http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/

[elehhhhna]

1. Dgaf. Take it from the military budget.

Or vote for a war liking status quo 1%ers lady.

[Recursion]

8. That's $300 billion per year. That's 80% of the defense budget (nt)

[Igel]

18. That's the facile solution.

Do that and suddenly you have a lot of high-school graduate men with no additional training looking for jobs.

Suddenly a huge number of 22-year-olds no longer qualify for the GI bill.

Suddenly a large number of manufacturing jobs--munitions are built in the US, for the most part--vanish.

The military has a large civilian workforce. They'd be fired.

The innovation and engineering jobs that the military also provides for vanishes.

The pension funds and retirement funds that rely on stocks from defense-related contractors (and that can be toilet paper vendors) are weakened. When we hear about how much of the wealth in America is owned by the top 1% or 2% that's restricted (tacitly, because nobody wants all the details) to wealth held by households and individuals. Not pension funds, whether state or corporate.

Don't think of the DOD as "the war machine." Think of it as a $500 billion/year stimulus package that helps working class high-school graduates and the engineering/manufacturing sector.

[WinkyDink]

27. Oh, brother.

[Scuba]

32. And you have lots of new job openings for nurse, medical technicians, etc. Seems you ...

... folks who want us to think of DOD as something other than a "war machine" always overlook the alternative jobs that would be created with that money. And those new jobs would benefit humanity, unlike your war machine jobs.

[librechik]

40. foreign bases in Buttfuckistan?

We could cut the military to pay for healthcare. And do all the other sensible things grownups around the world do to care for their citizens. That we don't.

[Bigmack]

45. Actually.. when you add all the bells and whistles...

... the "defense" budget is over a $Trillion.

And "defense" spending is the worst way to stimulate the economy. A lot of defense spending goes toward those shiny new toys like the F-35 and Littoral Combat ship. (I wrote "shit" first, then corrected it, but... shit probably fits better.) http://www.truth-out.org/opinion/item/3166:defense-spending-the-worst-way-to-make-jobs

And unemployment..? The military has outsourced so many tasks...including combat.. that it's hard to tell what would happen. I do know that we have a lot of tasks to be done in this country... fires, hurricanes, infrastructure...
Our military could actually guard our borders.
Perhaps our "job creators" could actually do that.

Bottom line: We simply can't afford our Empire anymore. We need to take care of our own.

Isolationist..? Nope... a realistic view of what what we can and cannot do. After all, we haven't won a war.. or a peace out of that war... since WWII.

[Generic Other]

46. How about jobs building rather than destroying?

Crazy idea, I know. There isn't a bridge in my state that one can feel comfortable crossing, not a road anywhere without issues. Apparently, they didn't build 'em like the Romans. We need solar, wind farms, affordable housing, underground lines and fiber optic cables, clean water supplies, more efficient transportation systems. We need new ways to feed ourselves, affordable schools, better opportunities for our citizens than to earn college money by being shot at in foreign countries.

We live off the labors of workers who have been dead for a generation. Things are crumbling on the home front. Keep feeding the MIC and there will be nothing left to defend. We should do as the Christians have been taught: beat our swords into plowshares. NOT JUSTIFY OUR BARBARITY!

[Doubledee]

64. Not quite

Money spent on defense does not return to the economy anywhere near as much as does money spent on infrastructure and public assistance. Further, cost overruns, waste, corruption, black budgets, et al, all contribute to our economic woes not, as you suggest, to a thriving economy.

[Recursion]

98. Really? Because I'm pretty sure we're conversing on the Internet, funded originally by DARPA

The D in DARPA stands for "Defense".

[pangaia]

214. And what?

[mythology]

220. The internet is one of the backbones of the modern economy

Other things gained from military spending: GPS, epipens, microwaves and computers. Think what our world would be like without those.

[pangaia]

222. Well, I guess that is one way to look at the military.

[Recursion]

232. And the Internet is a very good example of money spent on defense returning to the economy

A million-fold, in this case.

[pangaia]

249. So we need a militray to... create technological innovation?

That's one of the silliest things I have ever heard.

[Recursion]

250. Well historically the military and religion have been the two biggest drivers of it

I urge you to watch an old BBC series by James Burke called "Connections" on this.

[Doubledee]

247. Your opinion is duly noted

As are those of many economists who oppose your views. Certainly without the private sector the internet would have remained a seldom used military toy unavailable to the general public. Further, every dollar spent on our bloated defense budget means money unavailable to important items that remain unaddressed. I recall that even such as Milton Friedman once noted that military spending does not return to the economy anywhere near the same productivity as does spending on infrastructure.

While you may enjoy seeing parades of uniforms and military hardware, you may thrill to the slaughter of innocents around the world, marvel at the wholesale destruction by our drones, others see a crumbling infrastructure, an educational system bankrupt and failing our children,. all because we are spending absurd amonts of money on the military, primarily because the lobbyist own our legislators, not because we need to spend that money in the interests of the people of this nation.

Here is a link, one among many, from an opposing opinion to your own:

http://www.context.org/iclib/ic20/chapman/

Here is a quote you might have seen before, from a certain five star general who knows whereof he speaks:

"Every gun that is made,every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed. This world in arms is not spending money alone, it is spending the sweat of its laborers, the genius of its scientists, the hopes of its children.
This is not a way of life at all in any true sense. Under clouds of war it is humanity hanging on a cross or iron."
Dwight David Eisenhower

[Recursion]

248. Sanctimony always wins hearts and minds...

Certainly without the private sector the internet would have remained a seldom used military toy unavailable to the general public.

Well, no, the private sector was the biggest obstacle the Internet faced. Every vendor had their own proprietary switching and routing models, and fought abandoning them tooth and nail. Anybody remember Banyan Vines?

While you may enjoy seeing parades of uniforms and military hardware, you may thrill to the slaughter of innocents around the world

Do you feel better, having said that?

[Doubledee]

261. Do I feel better?

Actually I find it difficult to speak to such an obnoxious oaf, but thanks ever so much for asking.

[pangaia]

265. That was pretty good. :>))))))))))))))))))

[SammyWinstonJack]

67. Really?

[1StrongBlackMan]

106. As someone that lives in a community where it's largest private ...

employer is a defense contractor, and there is a military base ... I've had this discussion a million times.

Idealist: "... and we can pay for it by ending military spending!"

Me: "Okay. But what do we do about the 5,500 unemployed missile designers/builders and the other 5,000 that support their work ... and what about the 34,000 civil workers that work on the base ... not to mention the Billions dollars the put into the economy?"

Idealist: "Well ... we just convert them to Green Tech and infrastructure repair."

Me: "You do know that building a missile is a different skill set than what is needed to fix a build. Right?"

[pangaia]

213. O M G !!

You have GOT to be kidding !!!

[CurtEastPoint]

2. What value do health insurers add? Zero. What do they do? Make profit.

Remove that from the equation, then let's talk.

[Recursion]

4. I did. Like I showed, it gives us a 6.5% savings off of $916 billion

It would save us about $60 billion dollars, and the cost restraints Medicare has would save us a further $160 billion dollars.

[JackInGreen]

3. I'm glad to see

That your trick'r'treat pale got special candy but don't eat it before you post.

[Recursion]

5. Was it the multiplication or the division you disagree with?

We have 90 million Americans not getting medical care right now. If we want them to get medical care that's going to cost a lot of money.

[JackInGreen]

7. Actually it's your framing

Which is skewed imo. Your maths good, but entirely within the box. There are no solutions there.

[Recursion]

9. You're right: there are no solutions without drastically lowering costs

Medicare pays 80% of what private insurance pays, but it pays something like double what the Canadian system pays. This is why it would be so expensive. We need to bring costs down first. I don't care if we just set explicit mandated price limits. We need to do it.

Doctors in Germany start out at about $50K per year and max out at about $80K per year. Drug companies get paid less by Germany, but drug prices aren't really a huge part of our price problem overall:



Drugs are only about half of that blue sliver labeled "stuff". The huge bulk of our spending is going to paying people to provide health care. Other countries pay those people a whole lot less than we do.

[Igel]

21. This is something that most overlook.

They hear "free" and assume "no cost." Many already vaguely assume that Medicare is self-funding, unaware that for decades it's been subsidized by general revenues.

They hear "lower costs" and when they'd save money it means one thing. When it's a manager saying that a company has to lower costs, they immediately hear, "They want to cut wages and benefits."

Ultimately, all the cost-lowering schemes for Medicare/Medicaid involve cutting wages and benefits to providers and managers. That can mean firing insurance company employees, whether actuaries, case managers, or secretaries. That can mean lowering wages to doctors and specialists, nurses and such.

While that's great, most such schemes also rely on more tax revenues. When most people say "tax increases" they really mean "tax somebody else, not me." Especially whoever has money. When it's a politician saying this, they often hear, "They want to tax me."

Then again, health care providers tend to be well represented in that upper quintile, those who have money. Lower their wages and suddenly who's taxed has to change. Revenues have to be sought from those making less money.

As for what insurance companies provide, they provide two things. First, it's a voluntary way of spreading out risk. They're often resented because they don't spread out risk the way that many would have government spread out risk--it's not as flat, nor as all-encompassing (because it's voluntary risk assumption, not mandatory, coerced risk assumption, and if it were flat risk distribution far fewer people would afford or buy it). Second, it's a way of limiting procedures and negotiating for lower prices from providers. Nobody likes that the limitation on procedures is seen as imposed (when it's something we agreed to as a condition of the insurance), and the negotiating with providers is from a position of limited power. Labor has a right to negotiate on an equal basis for pay; but when their rights are involved, then the result of the negotiations are to be dictated.

In a sense the call for single-payer amounts to a call for removing the possibility for doctors to reject Medicaid and Medicare. If they have no other alternative source of income, they'd be compelled to accept whatever deal they had to leave the field. Some love the idea of compulsion, especially in a Democracy.

[Recursion]

22. And, in fact, the compulsion in Canada isn't just economic but legally explicit

It is a crime to provide a medical service for someone covered by provincial Medicare outside of the Medicare system. And people do from time to time go to jail for it.

[Scuba]

36. You seem to know very little about how costs are managed in American health care settings.

Suggest you read up on how quality improvements lead to cost reductions in the delivery of healthcare.

[DirkGently]

132. Does this view take the cost of the uninsured into account?

It's always seemed to me that the big logic hole is pretending we don't all pay for everyone's healthcare anyway. And we pay more, and in more ways than simple dollars in and out.

When people are uninsured or underinsured, they skip things like checkups and non-emergency care. Things which, by the way, lower overall costs in many cases by avoiding more expensive emergency or life-saving care later.

In any case, we pay for this in all kinds of ways.

- Insurance premiums already cost everyone about $1,000 / year to cover the uninsured
http://abcnews.go.com/Business/story?id=7693848&page=1

- Local taxes often go for uncovered emergency room care -- the most expensive kind of care. But it's where fans of the current system tell the poor to go. They seem to think emergency rooms are a magical, free resource. Which is why when you go to one, it's full of people who should just be at a doctor's office, who simply have nowhere else to go. Wait times of several hours are commonplace.

This is not a working system.

- Lost wages and productivity because because people can't work, or get fired because they got sick, or a family member didn't receive adequate care, costing everyone by reducing spending and increasing the burden on other types of social safety nets.

These numbers, properly tallied, I would guess place in the tens or hundreds of billions per year.

And that's to say nothing of the harder to calculate costs of fear and uncertainty generated by the fact that many people don't know, month to month, how they are going to pay for medicine or other necessary care. Opportunities ignored, business ventures forgone, because people are afraid something will happen, and they will go bankrupt just trying to stay alive.

Other countries don't have massive bankruptcy filings based on healthcare costs. Here, it's one of the primary reasons people lose everything. We're special that way.

The big myth pushed by the sort of "we can't afford it" Libertarian view of national healthcare is that we can somehow compress healthcare costs by ignoring them.

The reality is that when we don't cover people, or don't cover things like preventative care, we pay anyway, and we pay more.


Then there's the fact that private health insurance "for all" remains flatly unworkable. I got another typical notice at work the other day that, as happens every year, costs are going up and benefits are going down. Why? Because we still have no real affordable choice.

One new cute twist was an announcement that prescriptions for certain brand-name drugs would be rejected immediately, subject to a determination as to whether a cheaper generic was available. If there's no generic, there is no coverage, period. The insurance company will tell us which drugs fall in this category, of course.

[Recursion]

148. Gah! No, we don't pay for everyone's medical care. You're sticking your head in the sand here

The uninsured don't actually use emergency rooms at the greater rate than the insured. EMTALA just let us put our heads in the sand and pretend that's happening.

[DirkGently]

150. Misleading. The uninsured use the Emergency Room

for everything, because we have mandated hospitals treat everyone regardless of ability to pay, and the uninsured do not have primary care physicians.

The "head in the sand" is the pretense that using the Emergency Room as a dumping ground for the uninsured is magically free. It is not.

[Recursion]

153. No, no, they don't. Read the Kaiser link

Or better yet, here's CDC on it:

http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf

The problem isn't that uninsured people are running to emergency rooms, adding to wait times and being paid for by the rest of us. The problem is that the uninsured simply aren't getting medical care.

[DirkGently]

157. It's both. And the conservative solution is magic "free" E-room care.

Pelley: Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?

Romney: Well, we do provide care for people who don’t have insurance, people – we – if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.

Pelley: That’s the most expensive way to do it.

Romney: Well the–

Pelley: In an emergency room.

When it comes to health care policy, this might be one of the more important moments of the presidential race. Romney doesn’t believe the United States has a responsibility to provide health care coverage to its own citizens – the Republican Party is the only major political party in any democracy on the planet to hold this position – but he does see emergency rooms as an avenue for caring for the uninsured.

And as a policy matter, that’s deeply absurd.

http://www.msnbc.com/rachel-maddow-show/the-gops-emergency-room-argument-never


It sounds like what you're arguing is that everything is fine because the uninsured simply don't get ordinary care. But that's not okay, and it's not "free" either. We all pay when people aren't covered -- in lost wages and opportunity costs, in bankruptcies for those who incur large medical bills they cannot pay. Meanwhile, when the uninsured absolutely must seek care, we pay for it in the most costly way possible -- by forcing hospital emergency rooms to admit everyone and tried to get paid where they can.

Health costs simply don't compress when you ignore them, any more than a broken road or rundown school fixes itself. We pay for them one way or the other. Government-run healthcare for everyone happens to be the most cost-efficient way to do it.

[Recursion]

159. Where the hell do you get the idea that I think this is "Fine"? (nt)

[Scuba]

34. Please cite your source for the claim that "Medicare pays 80% of what private insurance pays."

In my not small experience, private insurance companies were negotiating prices comparable to, sometimes lower than, what Medicare was paying.

[SickOfTheOnePct]

44. CNN link

http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/

[Scuba]

60. Doctors represent only a small part of healthcare reimbursement.

[Recursion]

65. No, it's a very large part

Here's "stuff" (drugs and devices) vs. "overhead" vs. "services". Notice how "services" is like Pac-Man there.

Here's the breakdown of "services":



Note that "hospitals" will include a lot of payments to physicians also.

[Scuba]

79. Yep, just over a quarter of services, which is about 3/4 of everything.

And 30% of 75% is less than a quarter of all healthcare costs. Not a big part of the overall cost picture.

[Recursion]

80. Much bigger than, say, "profits", which is the usual boogeyman here (nt)

[Scuba]

87. Still disproves the claim that Medicare only pays 80% of healthcare costs.

BTW, this thread hasn't even ventured into the esoteric world of healthcare costs vs. charges. As we used to say in the business, healthcare information management isn't rocket science; it's much more complicated than that.

[Recursion]

90. Medicare pays 80% of a given person's treatment. That's the limit

That's not a "claim", that's just what Medicare pays.

http://www.webmd.com/health-insurance/insurance-basics/medicare-part-b-doctor-costs-and-lab-tests

Medicare Part B pays 80% of most doctor's services, outpatient treatments, and durable medical equipment (like oxygen or wheelchairs). You pay the other 20%. Medicare also pays for mental health care costs.

If you mean "80% of the national health care budget", it's much less:









(Sorry, need to work on the crowding in that last one...)

[Scuba]

107. As I said, the thread hasn't ventured into costs vs. charges, nor into DRG's. Nor into ...

... the arcane world of insurance/provider negotiations and reimbursement.

This is not nearly as easy to dissect as your pie charts suggest.

[Recursion]

174. Which is why we should just move to FQHCs. Hell, Sanders supports them

They're efficient. They're scalable. They're a better idea than single payer, frankly.

[mythology]

221. Shouldn't math with real world dollars be done within the box?

Look at the various economic plans from the Republican candidates. Most of them to work require some magically high continuous economic growth to cover for tax cuts skewed highly to the wealthy.

I don't want people making the rosiest predictions in order to get the "answer" they want.

[jwirr]

91. And that is a bad goal? I thought the goal was to insure all

Americans.

[SickOfTheOnePct]

93. No one on this thread has said it's a bad goal

We're saying it's going to cost more money than it costs now, and we need to acknowledge that and figure out how to pay for it.

[jwirr]

96. Well I guess it never crossed my mind that it would not cost

more to cover more. I cannot name one thing that doesn't.

[eridani]

244. Per capita we are ALREADY SPENDING twice what other countries pay to cover everyone

How could it possibly cost more to cover everyone?

[Recursion]

94. That is the goal, but that's not going to *save* us money. It's going to *cost* us money.

We need to just face up to that. We will not cover the 90 million people who are currently not getting treatment for less than we are paying now.

[jwirr]

101. I did not think it would be any different. But one thing we

are not looking at is the cost of NOT insuring them. The emergency room visits, more serious illnesses, etc.

[Vinca]

6. If we can spend a trillion dollars on a war of choice, I don't really care what we spend

to make sure every single person in this country can get good medical care without going bankrupt.

[mountain grammy]

11. +1

[Recursion]

15. Sadly Medicare for everyone wouldn't do that

every single person in this country can get good medical care without going bankrupt

Medicare pays 80% of the cost treatments; you're on your own for the rest. People would definitely still go bankrupt. And paying more than 80% or instituting an out-of-pocket maximum would make that $293 billion per year go up even more.

I think it's the right thing to do (though I prefer France's model to single payer, though the numbers shake out roughly the same). But we need to then start talking about things like advocating a 20% national sales tax, or an additional 10% payroll levy.

[Vinca]

16. It doesn't have to be Medicare as it exists now. It can be anything that we want it to be.

Do you know how many medical bankruptcies happen in Canada? Zero.

[Recursion]

17. Their bankruptcy rate is identical to ours

And about 8% of debt discharged in US bankruptcies is for medical bills. But, yes: Canada has zero cost at delivery for health care, so by definition there can never be medical bill debt. That's a hugely attractive feature of their system. Even Medicare in the US doesn't do that.

Want to take a stab at how much that would cost here?

[CTyankee]

20. Higher taxes on the wealthy would very much help. And I agree with your suggestions, BTW.

If we, as a society, want Medicare for all we have to seek ways to pay for it. Let's revive the estate tax and the other tax proposals that the repubs in Congress have reversed in order to please the very rich (and those who aspire to being very rich but don't know they'll never make it).

The people have to wake up and demand reform of our tax system in this country.

[Vinca]

28. Yes. They have bankruptcies, but not "medical" bankruptcies.

I don't care what it costs. As I stated before, if we can blow a trillion dollars on a war with a country that didn't attack us, we can blow whatever it takes on medical care for the people of this country.

[Bigmack]

47. You keep saying $1 Trillion...

I believe it's more like $6 Trillion. http://time.com/3651697/afghanistan-war-cost/

The $1 Trillion is for one weapons system.. the F-35. Wait... the F-35 is $1.5 Trillion.

Of course, much of the $6 Trillion was "disappeared" by our allies, so it was truly flushed down the toilet.

[Vinca]

102. After you get to a trillion, it doesn't really matter.

One, two, six - it's all a giant waste of taxpayer funds.

[Bigmack]

143. With apologies to Everett Dirksen...

(although maybe Dirksen didn't say it...)
A Trillion here, a Trillion there... pretty soon it adds up to real money!

And waste...? Shit, we got a lot out of the war... besides a lotta debt. We got dead and wounded Americans, dead and wounded Pakistanis, Afghanis, Iraqis... now Syrians.... the entire region de-stabilized...

Lotta bang for those bucks!

[ronnie624]

52. The status quo of US imperialism is clearly not negotiable to the establishmentarians.

If it costs us our global economic and military dominance, then health care is off the table.

[Vinca]

105. Then it's clear the government doesn't work "for" the people. But we already knew that.

[Scuba]

37. Please cite your source for the claim that "about 8% of debt discharged in US bankruptcies is for ..

... medical bills."

[Scuba]

10. I advocate for Medicare for All, including dental, optical, hearing aids and mental health care.

And yes, we can afford it.

Whether it would cost less, or more, than the current cost of treating - and not treating - Americans is arguable. What is not arguable is whether or not we can afford it. We can; we just choose (or rather, it's chosen for us) to spend that money on other things.

Finally, you seem to be arguing that not treating people means there are no costs. That's laughable.

[Recursion]

12. Clearly the richest country in the world can afford it

But we need to start really getting our heads around the fact that we're talking about something along the lines of cutting defense spending by 80%, or adding a 12% payroll levy, or a 20% national sales tax. That's the scale of the expense we're talking about.

Finally, you seem to be arguing that not treating people means there are no costs

Unreimbursed emergency room care is in the hundreds of millions of dollars per year; it doesn't even show up as a rounding error here.

Quality of life issues are harder to measure -- certainly the economy would improve if more people were getting the health care they need. How to quantify that is difficult, and it probably wouldn't have any effect in the near-term.

[Scuba]

38. I don't believe your numbers will stand up to scrutiny, but I haven't the time (or inclination) ...

... to find the authoratative studies this morning.

It also appears that you've confused unreimbursed care with no treatment at all. I'm talking about costs like lost productivity and personnel turnover. I'm also talking about cost savings not realized from things like smoking cessation and alcoholism treatment.

Finally, I would have no problem reducing our military budget by 80%. We would still have one of the largest military budgets in the world and the other large players would all be our allies, as they are now.

[yellowdogintexas]

39. Don't forget to factor in that those already insured should no longer be paying premiums + Medicare

in their payroll taxes. Their FICA might increase some but a great many of those currently insured are hit with some fairly high premiums, plus high deductibles and co-pays.

Thinking about my last employer based coverage (and I worked for a Major Insurance Carrier with 40,000 covered persons in the group), removing my biweekly premiums of $124 for two people and replacing them with a 5% or even 10% Medicare withholding (currently it is 2.9% I think) would have given me a higher take home (or more money for my 401K). Even if the Medicare portion of withholding were to be based on # of covered persons in a family by linking it to their W-4 information, it would still be an improvement to their budget compared to some of the monthly premiums out there, especially on small group or individual plans.

The other consideration is pulling millions of healthy young people into the insurance pool who for a considerable portion of their lifetime will not use the system as much as older members. Just as a high % of safe drivers in an auto insurance pool protects the company against the losses for those who suffer accidents, loading a medical pool with those who are less likely to be ill helps reduce risk.

Everything goes out the window though when the clout of Big Insurance comes in to play. They will fight it to the end of the world. The only reason the ACA made it out of Congress to the President is that there was enough gravy in it for Big Insurance to get them to go along with it, and they realized they would all have a lot of profitable new business as a result. ( Medicare traditional Plan B is as close to a non profit coverage as you will find. Medicare Advantage plans were always structured to provide profit for the insurance companies. One of the cost savings in the ACA was a reduction of the profit on Advantage Plans. )

Many of you may have other info to add to this but these are things I gleaned from a 40 or so years working in medical insurance.

[Recursion]

48. What? No, the current Medicare levies would have to stay

The payroll levy would be in addition to that.

[ReasonableToo]

13. What sbout all the money going to the medical part of other insurance?

Car insurance, homeowners insurance, workmanship comp, business's liability insurance, doctor's liability insurance, etc.

Still collect it and have incentives to lower premiums but send it to the big pool AND STOP the fighting about who pays which claim.

How much time and money is wasted by admin folks at each of the above entities when they play the "it's not our responsibility" game. Meanwhile the policy holder is waiting for treatment and/or the doctor is waiting to be paid.

I bet the car insurance folks are hoping we forget about their medical collections do they can pocket the premiums.

[Recursion]

14. That's an interesting idea

Just a nationwide general indemnity pool?

[Turbineguy]

19. There are other, not so easily quantifiable numbers.

There are people who are treated at hospitals paid for by taxes. There are the costs of bankruptcies spread over society in the form of prices as interest rates.

[loyalsister]

226. People who must be treated for severe illnesses because it was not caught early

For example, a woman I knew had Hep C and was not aware until she developed cancer. If she has had access to her yearly women's wellness exams, they may have caught the early cancer cells rather than severe symptoms related to hep C and full blown cervical cancer.

I don't know if it is certain, but I do know that illness can escalate and treatment becomes more expensive if not available early. Aside from that, more and more productivity is lost as illness progresses.

[geek tragedy]

23. You're assuming that people without insurance don't already

get treatment at emergency rooms etc.

Also, preventive care more than pays for itself.

[Recursion]

24. I'm assuming that because unreimbursed emergency care is about $500 million per year

Like I said above, it doesn't even register as a rounding error for these numbers.

Also, preventive care more than pays for itself.

If that were actually true, insurance companies' actuaries would have forced their boards to provide free preventive care for all of their policyholders.

Preventive care is a wonderful quality of life improvement, however.

[geek tragedy]

26. Preventive care does pay for itself--over the long term.

But most insurance companies are not cradle to grave. The money they would spend on preventive care would benefit another insurance company.

[Recursion]

30. Fair enough

Though for that matter making people walk briskly 20 minutes a day and eat vegetables would do more than anything we do from a medical side...

[eridani]

239. No it does not. It saves lives, and dramatically improves the quality of life. It COSTS money.

My own family, with heritable insulin resistance, demonstrates this perfectly. My grandmother died at age 53, and my father at age 59. I've made it to 69 (next month) because preventive care has improved so dramatically. That, and the class privilege to work at a company that provided fitness centers to its employees. From accurate measurements of glycemic index (making dietary choices more informed), to cheap glucose meters, to accurate and cheap assays for hemoglobin A1c (in 1985 I was told that these tests were too expensive to be widespread), to aggressive use of metformin and similar drugs during the prediabetic phase, I have successfully fought my genome.

Of the three of us, who will have the highest lifetime medical expenses? Obviously me. That's why the Republican health plan is Die Quickly. Dead people don't use expensive medical care.


http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html

Preventing obesity and smoking can save lives, but it does not save money, according to a new report.

It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

"It was a small surprise," said Pieter van Baal, an economist at the National Institute for Public Health and the Environment in the Netherlands, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."

In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.

Van Baal and colleagues create Preventing obesity and smoking can save lives, but it does not save money, according to a new report.

[Recursion]

242. Very good point; it's the old "smoking saves the government money" thing

Which, as macabre as it is, is pretty undeniable.

It's odd. The women in my family live into their late 90s or early 100s pretty regularly. The men... don't. I was filling out an insurance form a while back and had to call my dad to ask him what men in our family die of when they don't drink themselves to death at 50. He said "when I die you'll know".

[geek tragedy]

255. dead people also don't pay taxes

to reformulate what I wrote a little bit--when you factor in lost productivity due to health issues, including early death, then yes preventive care does more than pay for itself.

[Yo_Mama]

127. A lot of preventive care doesn't pay for itself. I look at Canada's numbers, for example.

Here's a recent study:
http://www.colorectal-cancer.ca/IMG/pdf/Telford_CMAJ.pdf

Its conclusion is that of three testing regimes evaluated, ten year colonoscopies are the most cost-effective (highest value for the money spent), and cut mortality the most (81%).

But it does not mean that it is cheaper overall to screen everyone for colon cancer. It is not. It costs about double to do the colonoscopy screening versus not doing it! ($783 versus $1,529). Page 3. None of the ten screening strategies were cheaper then just letting people get cancer and treating them after they do. They are, however, generally good at avoiding excess deaths.

But the reason we pay for health care is not just to live the cheapest lives - it is to avoid dying in an ugly fashion.

[eridani]

243. "It is to avoid dying in an ugly fashion" Yes. And way too young

And to improve the quality of life. As for what tests are worthwhile, constant statistical analysis should help to determine that. Adjustments will continue as long as knowledge improves.

[Downwinder]

25. Proposal of the Physicians' Working Group for Single-Payer National Health Insurance

Executive Summary

http://www.pnhp.org/resources/proposal-of-the-physicians-working-group-for-single-payer-national-health-insurance

[Recursion]

29. Notice they don't address the current rate of underutilization

Which is where all of my numbers are coming from.

I agree that if we continue providing the treatments we provide now, and paid for them through Medicare, we would save a whole lot of money. That's not what Medicare For All would do, though: it would vastly expand the amount of treatments we provide.

[Downwinder]

35. How much does early diagnosis save?

[Recursion]

50. We don't actually know. More than zero. Probably.

But if you look at the recent mammogram study, it turns out at least there that it doesn't actually save money at all (or lives); it just costs a whole lot for no real purpose.

It saves it over the course of 50 years, though, and we budget over a 10-year window at most, which is another problem.

[Downwinder]

104. If we are looking at cost effective,

Death with Dignity is the most cost effective change.

[DirkGently]

136. And the cost of treating everyone in the Emergency Room?

Emergency Room care is the most expensive way to deal with the uninsured. It's a limited resource, and already wait times so bad that people die waiting for triage are well known.

Part of the sleight-of-hand going on with claims that single-payer is too expensive is that hospitals are simply forced to eat the costs, with local taxpayers often picking up part of the bill.

It's a form of magical thinking, that we can compress the need to treat the sick by sweeping them under various rugs with various hidden costs.

Credible studies consistently conclude that covering everyone and controlling administrative costs through a government program would be far cheaper than the haphazard mess we have currently.

[Recursion]

147. Odd that you mention magical thinking

Since that's what the idea that we can provide treatment for all of the currently uninsured and underinsured for less than we are spending now is.

Unreimbursed emergency care is $500 million per year. All of my numbers are in the tens and hundreds of billions, so that's not even a rounding error. The uninsured do not use emergency rooms at a greater rate than the insured (that's also in the Kaiser link above, which also concluded the uninsured do not significantly effect ER wait times). We have convinced ourselves that it is the use of emergency rooms by uninsured people that is driving prices up, but that's just not true; what's actually happening is that 90 million people simply aren't getting care at all, for the most part.

[DirkGently]

151. The studies don't agree with your Internet Logic.

You're basing your conclusions on pulling together numbers and drawing conclusions without any actual analysis.

Those who have actually looked at the likely results of a single-payer system comprehensively find that it would both save money and allow coverage for everyone.

Respectfully, I think they probably put a bit more into theirs.

Edit: I also just noticed someone pointing out you didn't subtract the cost of the employer-based system that would presumably be gone? As if we'd all be paying for the current system PLUS single-payer?

Say it isn't so -- that's the go-to Republican dodge on this issue -- remember how they trotted it out against Sanders to grossly inflate the cost of his proposals?!

http://www.pnhp.org/facts/single-payer-system-cost

June, 1991 General Accounting Office

“If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage” (“Canadian Health Insurance: Lessons for the United States,” 90 pgs, ref no: T-HRD-91-90. Full text available online at http://archive.gao.gov/d20t9/144039.pdf).

December, 1991 Congressional Budget Office

“If the nation adopted…[a] single-payer system that paid providers at Medicare’s rates, the population that is currently uninsured could be covered without dramatically increasing national spending on health. In fact, all US residents might be covered by health insurance for roughly the current level of spending or even somewhat less, because of savings in administrative costs and lower payment rates for services used by the privately insured. The prospects for con-trolling health care expenditure in future years would also be improved.” (“Universal Health Insurance Coverage Using Medicare’s Payment Rates”) http://www.cbo.gov/ftpdocs/76xx/doc7652/91-CBO-039.pdf

(snip)
June, 1998, Economic Policy Institute

“In the model presented in this paper, it is assumed that in the first year after implementing a universal, single-payer plan, total national health expenditures are unchanged from baseline. If expenditures were higher than baseline in the first few years, then additional revenues above those described here would be needed. However, these higher costs would be more than offset by savings which would accrue within the first decade of the program.”

August, 2005

The National Coalition on Health Care

Impacts of Health Care Reform: Projections of Costs and Savings

By Kenneth E. Thorpe, Ph.D.

This fiscal analysis of the impact of four scenarios for health care reform found that the single payer model would reduce costs by over $1.1 trillion over the next decade while providing comprehensive benefits to all Americans. The other scenarios would be improvements over the status quo, but would not reduce costs as dramatically or provide the same high-quality coverage to all.

[Recursion]

160. What? Yes, I did subtract it

Read the post. I took the treatments currently provided by private health insurance, gave them Medicare's overhead and rate fixes (which saved $220 Bn total). Then I extended those rates to the currently uninsured and underinsured.

[DirkGently]

161. And the savings from cost controls and a healthier pool?

Under the rug with those?

Back to the $15 trillion ten-year price tag for NHI - those are federal expenditures before almost $5 trillion in savings over ten years are deducted. As Gerald Friedman has written in an open letter to the Huffington Post:

(The Wall Street Journal article) correctly puts the additional federal spending for health care under H.R. 676 (a single-payer health plan) at $15 trillion over ten years. It neglects to add, however, that by spending these vast sums, we would, as a country, save nearly $5 trillion over ten years in reduced administrative waste, lower pharmaceutical and device prices, and by lowering the rate of medical inflation. These financial savings would be felt by businesses and by state and local governments who would no longer be paying for health insurance for their employees; and by retirees and working Americans who would no longer have to pay for their health insurance or for co-payments and deductibles. Beyond these financial savings, H.R. 676 would also save thousands of lives a year by expanding access to health care for the uninsured and underinsured. (9)

In addition to the federal government saving money with NHI, 95 percent of Americans would pay less than they now do for health insurance and medical care. NHI would be funded by a progressive system of taxation, mainly the payroll tax for those with annual incomes less than $225,000 - $900 for those with incomes less than $53,000 a year, $6,000 for those earning $100,000 a year, and $12,000 for those with incomes of $200,000. Employers would be relieved of their burden of paying for employer-sponsored health insurance, while gaining a healthier workforce and greater capacity to compete in a global marketplace.

So here's the bottom line - NHI would bring our entire population more protection against the costs of health care, at a lower cost than we now pay, with more efficiency and fairness, while eliminating today's narrow networks that restrict our choice of physicians, other health professionals, and hospitals. Opponents who decry its costs are distorting the issue as they try to perpetuate profit-driven markets at the expense of patients, their families, and taxpayers.

http://www.truth-out.org/news/item/32945-calculating-the-cost-of-bernie-sanders-single-payer-health-program

No one seems to agree with your back-of-the-napkin math here.

We are providing healthcare in the least efficient way possible right now -- by permitting for-profit industries to monopolize and control costs, and asking employers with no earthly idea how to administer health care to become de facto care providers. It's no accident we pay more for poorer outcomes than countries with nationalized care.

[Recursion]

172. What are you talking about? It's the exact same pool as private insurance has now

I'm taking the treatments people with private insurance are currently getting and applying the savings we would get from Medicare-style payment for those treatments (it comes up to $220 billion a year saved).

I'm then taking the uninsured population and assuming they would be as healthy as the insured population (which frankly is optimistic) and so having them get treatments at the same rate as the insured. That costs $513 billion a year.

[DirkGently]

184. So it's the $5 trillion in cost savings you're throwing out?

And it's the Medicare pool that's distorted, as you know.

Medicare itself would not cost as much as it does if the entire country were in the pool. And you're ignoring the estimated $5 trillion in costs savings from single payer, among many other things, no doubt.

(The Wall Street Journal article) correctly puts the additional federal spending for health care under H.R. 676 (a single-payer health plan) at $15 trillion over ten years. It neglects to add, however, that by spending these vast sums, we would, as a country, save nearly $5 trillion over ten years in reduced administrative waste, lower pharmaceutical and device prices, and by lowering the rate of medical inflation.

http://www.truth-out.org/news/item/32945-calculating-the-cost-of-bernie-sanders-single-payer-health-program

There are a lot of moving parts here, so it's pretty weird you're proposing you can grab a fistful of figures from the internet and overturn every credible study of the impact of single-payer. You've skipped by world-renowned economists, the CBO, doctors' studies, and everything else people have cited here with this off-the-cuff, anecdotal calculation.

What we know for sure is that private insurance administered by employers is a ludicrous way to pay for healthcare. No one besides us (and, I think maybe Mexico and Turkey??) has ever proposed to do it that way.

Insurers manipulate costs to screw both the insured and the actual healthcare providers, deny claims in bad faith, and raise prices every year based on whatever it takes to keep their executives in mansions. Meanwhile, our cost-per-patient is far beyond what any nationalized system costs, and yet results in a lower standard of care.

So tell us, how is that economists, physicians, private studies and the CBO have miscalculated so badly?

Are they not using Google correctly?

[Recursion]

185. Because they're ignoring the currently under-insured

If you're asking what error they're making, that's the big one: they're ignoring the people who have insurance now and are skipping treatments because they can't afford the deductible or copay. So they aren't accounting for the increase in usage that they would have.

[DirkGently]

186. So you've helped them by making up a theoretical increased cost?

Come ON now. That's just pretty silly. Off the top of my head, it's widely understood that preventative care, which the un and under-insured routinely skip, generally saves money in the long run. Get someone to a dentist, and they may not need dental surgery. Get someone on a diet, and they might not end up on dialysis.

And so on. In fact, that's another entire issue under our present system. Private insurers pay most readily for expensive procedures and testing, so the modern hospital experience is generally an endless stream of specialists with separate bills for separate treatments. A more generalized approach, without the fear of corporate red-lining of every non-critical expense, would increase efficiency if anything.

Surely you're not claiming employer-run private insurance is a better system than the ones all over the world that currently cost less than ours on the basis of a wild supposition like this?

[Recursion]

189. Well, no, that's widely believed but studies keep disproving it

Preventive care can save money, or it can waste money, and it's very difficult to thread that needle. Look at the absolute backlash when a panel tried to say that we shouldn't do annual mammograms for women under 50 (and that wasn't even based on lower costs, though that would lower costs, just the fact that it wasn't actually decreasing mortality).

[librechik]

31. Government control of healthcare is the ONLY way to lower costs. We have to do it soon

or the for profit companies will drag us all into oblivion. Period.

UIt doesn't matter how much it costs us. It's still going to save money in the long run.

[cprise]

55. It does hinge on the pushback from the insurer

A government insurer can be much firmer in the way they apply pressure on the healthcare providers. Multiple, smaller private insurers have less clout and different priorities.

[ronnie624]

85. +1

Now is not the time in our history for clinging to the illogical belief in capitalist magic. Resources need to be devoted to the rapid transition to a sustainable energy/economic system and mitigating the effects on our civilization from the damage we do to our biosphere.

People are rearranging deck chairs in the face of disaster.

[Recursion]

116. Why were my not-for-profit insurers never noticeably cheaper than my for-profit ones?

Seriously. I never noticed a difference in price. If profit motive is the problem, why was Harvard Pilgrim indistinguishable from Anthem on price? Why was BCBS no cheaper than Cigna?

[Yo_Mama]

118. Because what's driving costs is the mix of uninsured/underinsured plus low-paying government,

rather than profits.

If you look at all the narrow-network ACA plans, they are contracting with hospitals that serve a different set of hospitals.

Hospitals have to charge enough to private insurers to cover their costs, which include some subsidies for those with government insurance versus private insurance. The private insurers are trying to gain enough clout to pay similar amounts, but that won't always cover the costs of hospitals.

[Humanist_Activist]

33. Does this take into account the advantages of combining risk pools and premium differences?

I look at the data and I'm wondering about something, this seems to assume not many changes to Medicare beyond extending coverage to everyone.

However, I have a question, and I'm going to use my household as an example. I have employer provided health insurance at a little over 140 a month in premiums. I would say that the total I cost them, if my memory isn't failing me, is less than a thousand. I'm relatively healthy, had my checkups, a couple of trips to urgent care over a period of 3 years, etc. But no longer term care for anything. Pretty standard, I guess. 2,000 dollar deductible, 10/25/50 dollar 3 tier prescription coverage, 25 dollar copay for standard doctor visits, 75 for Urgent Care, 20% for hospitalization, etc. 6,000 dollar max out of pocket if I remember right.

My fiancée is on SS disability and so is on Medicare, her premium is 109 dollars a month for a Medicare Advantage plan, she hit the out of pocket maximum for her prescriptions last month which is great, but her maximum copays for prescriptions was about 6 dollars, though most were less than a dollar or 0 dollar copay. Her deductibles are covered due to the amount of disability she gets, she gets extra help. Her copays for standard doctor visits are 0 and for things like Urgent Care its 40 dollars or so. Hospitalizations and ER visits are covered at 20% copay.

OK, so this is what I don't get, we are in two different risk pools, me in a pool of people who are more representative of the general population in regards to their health and then you have Medicare's pool of people, mostly seniors and the disabled, who are much more likely to use the health care services they require than the general population.

If you were to increase my FICA contribution to offset my being added onto Medicare, or have a separate Medicare premium, would it equal or exceed my current insurance premium? If not, then I don't understand why this wouldn't be a good deal for all workers who have employer provided health insurance. Even if the Medicare premium was the same as my current plan, I'd still get a better deal because coverage through Medicare is better, at least if I was able to get the same or similar options as my fiancée.

[Recursion]

77. This is just aggregate *treatment* costs

This is what they're actually paying to providers. Medicare does have a better actuarial position, which is part of why its overhead can be half of what private insurance is. But the doctors and drug companies will still want money.

[Humanist_Activist]

88. But it seems incomplete to not account for the added income created by adding healthy...

and younger people into Medicare's risk pool.

As far as treatment costs, empower Medicare to negotiate costs, and/or institute price controls, like most other countries in the world do.

Its ridiculous, for example, for us or our insurance companies to pay several times the amount everyone else pays for the same products and services. Market economy doesn't work for healthcare, it needs to be managed.

[Recursion]

92. What does the risk pool have to do with this? We're talking about outputs, not inputs

The risk pool is about how those costs are distributed among individuals; I'm just talking about what the Medicare trustees will have to actually pay to providers.

Market economy doesn't work for healthcare

How would we know? We don't have one and haven't for a while.

I still think the real issue is that health care in the US is largely a problem of price discovery.

[Humanist_Activist]

129. Healthcare is inflexible, you cannot shop around except for some elective procedures...

there's a scarcity of specialists, and more importantly, when you need treatment, you actually need it, or worse things can happen, including death. Not to mention your choices are limited by your insurance plan as well, or your treatment will be prohibitively more expensive. Even if prices were upfront for treatment, how would that help?

If you want to talk about costs, here's an example, I work for a Pharmacy Benefit Manager, our clients are group plans, usually unions and employers, and we manage well over 300 clients, and we aren't a large company. We aren't the only PBM out there, and each of those plans will have different copays, deductibles, policies regarding drug coverage, etc. We are, to put it bluntly, an expense that wouldn't be necessary under a single payer plan.

The amount of redundancy and paperwork that doctor's offices, hospitals, and pharmacies have to deal with in order to know who to bill and for what is ridiculous, and represents inefficiencies in the system.

[Recursion]

145. You absolutely can shop around for non emergency care

But people are stuck with the idea that Dr. Smith is "my doctor" so I'll go to him.

Even if prices were upfront for treatment, how would that help?

About how it works with dentists now. People generally pay for dental care themselves because it's cheap enough that they can, dentists advertise rates, and people choose.

You're absolutely right that single payer would vastly simplify doctors' lives (as well as put a whole lot of people out of work in the process). But that overhead is not what makes us spend twice the percent of our GDP as other countries: what'she doing that is the high coststreet that forced people into this administrative framework to begin with.

I mean, what if we did groceries the way we do health care? Groceries are absolutely necessary to stay alive too. Your employer would pick a grocery plan, which would let you shop and two grocery stores in town, and take a referral to a specialist store from your primary grocery store if you needed special foods. A Single Grocery Payer plan in which the government decided what food you could get and just paid for it probably would be more efficient than that (this would be just putting everybody on WIC and SNAP, basically). But nobody would ever suggest that, because we've actually managed the inputs here: groceries are not so expensive that people need a third party to pay for them. And that's not just an accident: the government has done lots and lots of work behind the scenes for 80 years now to keep grocery prices affordable through ag policy, transportation policy, etc.

[Humanist_Activist]

154. You do realize that most poor people don't get proper dental treatment because its too expensive?

You call it cheap, and I guess it is, if you are willing to wait months and go to a subsidized community health center.

But they only do fillings, cleanings and checkups, if you need any other work done, you then need to go to a private dentists and/or oral surgeons, where extractions cost hundreds, and pretty much anything else costs thousands. Yeah, that's cheap enough.

Your comparison to groceries are a total fail, groceries are subject to the economies of scale, industrial farming means there can be a surplus in supply, leading to price drops, droughts can lead to scarcity, leading to price hikes, etc. There is no equivalent with medical care products or services, because I'm not going to go to the medical supply store and stock up on titanium knees on the off-chance that I will need them in the future. In reality, unless you want to confine access to medical care to the richest 3rd of Americans, most products and services are going to be far too expensive for anyone to afford without a third party paying for them.

[Recursion]

155. There were three dentists on my street in DC

With price lists ($45 for a cleaning, etc.) posted out front. Lots and lots of poor people were streaming into them every time I walked by.

[Humanist_Activist]

164. How many of them went in there to get crowns, implants, bridges, etc.?

How many opted to have extractions done because they couldn't afford the other procedures?

How many of them get help from third parties, or have dental insurance?

[Recursion]

233. I have no idea, but those procedures were listed so I assume it was non-zero

How many of them get help from third parties, or have dental insurance?

Dental insurance is fairly rare even among affluent Americans. I would imagine there was some amount of charity donation, but I can't say how much. The dentists seemed pretty busy all the time, though.

[SickOfTheOnePct]

95. Adding healthy people to the risk pool is only applicable

in an insurance model where the healthy people are paying premiums. There wouldn't be premiums under single-payer.

[Humanist_Activist]

124. Yes there would, either in the form of increased taxes, most likely under FICA, or as a separate...

premium that may be waived and/or based on income.

[GoneFishin]

41. Doesn't pass the smell test. We already spend the money for those services now, plus CEO bonuses

and Wall Street dividends.

Medicare for all would route the gravy train around Wall Street and Health Insurance pirates so more money would be available to pay for actual services.

[Recursion]

69. No. We don't. 90 million people are going without medical treatment that they need.

90 million. We're going to greatly increase usage if we make medical care free at the point of delivery. (And if we don't, we won't be solving the actual problem.)

[GoneFishin]

140. The ship has already sailed on pretending it can't be done. Unfortunately for those who profit from

our current system many other countries have proven that it works. So whatever fallacy the private health insurance pirates want to weave into the numbers, they have already been proven to be wrong many times over.

[Yo_Mama]

128. No, we don't. We haven't been. At least third of the population just gets basic care.

Childhood immunizations plus emergency/acute illness care.

If we do enact an actual universal coverage solution, which ACA has turned out not to be, with universal ACCESS (where ACA utterly fails), we will be paying either much more in aggregate or providing lower levels of care than many people in this country now receive.

[SickOfTheOnePct]

131. Thank you

That's what I've been saying all along - some individuals may pay less, but in the aggregate, it will be more expensive.

[Yo_Mama]

133. Some individuals will pay more and get less. On the whole, there will be more security. Less risk.

But what's stopping this is that Americans are not willing to pay what it would cost, especially the well-off.

You are simply not going to get people earning upwards of 100K with full medical benefits to agree to pay 20-30K more a year so that the people who make their sandwiches get any sort of healthcare comparable to theirs.

The whole GOP/Dem thing is a complete miscasting - there are many affluent Dems who won't touch this, and when I asked the question here at DU, very few were willing to accept any reasonable level of taxation.

The cohort least likely to vote for this are government workers and affluent urbanites, a solid Dem block.

[whatthehey]

42. No need for spurious extrapolations. Follow the examples out there.

http://www.nhsconfed.org/resources/key-statistics-on-the-nhs

About half the % of GDP and covers everyone. Doctors are still well to do. Nurses are still solidly middle class, and the upper income brackets can still overpay for equivalent private care in fancier rooms with nicer furniture to make themselves feel special.

About the only useful statement you made is that we need to control costs. Easy to do. Control them.

[SickOfTheOnePct]

71. The NHS isn't single-payer

It's nationalized medicine, which is very different.

[Recursion]

72. The NHS isn't single payer

The NHS is government-operated, which is very different. The FQHC model comes closer to that, which incidentally is I think the best part of the ACA.

[eridani]

179. True, but it's interesting to note that countries that have adopted universal health care--

--since 1990 (Taiwan and South Korea) have used the single payer model rather than NHS or Scandinavian government-run models.

[Tanuki]

43. I'm no expert, but when employers provide private health plans,

don't they write it off as a business expense and thus lower their tax obligation, causing the public at large to pay higher rates? It seems to me that the current system has a hidden cost to taxpayers that nobody ever talks about, like many other business perks.

[Recursion]

53. Yes, that was a WWII-era way to get around wage limits

Wages were fixed during the war, but the companies wanted a way to attract more workers, so they lobbied to make health care "not count" as a wage, which also made it advantageous for their taxes.

[SickOfTheOnePct]

49. Yep

It's absolutely going to cost more.

It seems that many on this thread confuse admitting it will cost more is the same as saying it shouldn't be done.

I absolutely believe we should go to single-payer, but it's going to be expensive to do so. We should start looking at how we'll pay for it, whatever that might be.

[treestar]

51. There's some prevention that would make it cost less

That's what I notice about the ACA - now I can afford preventive stuff.

They say people would go the ER when things got really bad - if they couldn't pay for it, everyone else did in higher prices to cover that. But by the time they got to the ER it was all more expensive.

[Recursion]

54. It's possible. But look at the recent mammogram study

Annual mammograms for women under 50 save neither money nor lives. But we still push them.

[treestar]

56. that's another one

though the study could suggest raising the age. I believe it is 35.

[Recursion]

61. I just mean that preventive care *can* save money, or it can waste money

But it's very hard to thread that needle with politics being as they are.

[BlueCaliDem]

63. Me, too. All insurance companies enrolled in the ACA exchanges

here in California, must offer free preventative exams and care once a year. That will go a long way into helping make Americans healthier, paving the way for single-payer, eventually, which would be far less expensive by then (if it takes as long as Canada to implement, which was 30 years).

President Obama and Democrats are strategic geniuses!

[portlander23]

57. Nope

‘Medicare for All’ would cover everyone, save billions in first year: new study

[Recursion]

70. Nope. PNHP does not address current underutilization

It's shameful, frankly, that they published that.

[portlander23]

73. I'm good with them posting it

You can't look at all the other nations that spend less than us and get better outcomes and assume single payer will be worse.

Furthermore, healthcare is not an economic good, it's a right and a social obligation.

[discntnt_irny_srcsm]

58. In a medicare for all program would doctors still need malpractice insurance? n/t

[Recursion]

62. Sure. Don't they need it now? (nt)

[discntnt_irny_srcsm]

74. Just have the government deal with malpractice suits

It seems only logical if the government would pay 100% of doctor's wages and effectively be their employer that the government take on that responsibility. The wages would be then lower as the government's umbrella coverage would stand for the doctor. There would be no high priced out of court settlements.

Government could end having to pay docs with frequent well founded malpractice cases and cut the impact on medical costs that rise due to those rising insurance costs.

[Recursion]

76. The government isn't paying doctors' wages under single payer

That's the thing. Providers are still in private practice in a single payer system, they just have a single organization they bill. The practice or hospital is still paying the doctor's wages, though, which means they are still liable for torts.

There would be no high priced out of court settlements.

Why should someone injured by a doctor's negligence not receive a settlement?

[discntnt_irny_srcsm]

97. Do UK docs pay malpractice insurance?

"Why should someone injured by a doctor's negligence not receive a settlement?"

They should, as determined by a jury. No out of court settlements.
We need a 3 strikes rule for malpractice. After that you don't get medicare payments.

[Recursion]

100. No, because it's government-operated healthcare. Which is not the same thing as single payer.

The government self-insures for malpractice.

[discntnt_irny_srcsm]

103. I'm okay with either gov-operated or single

[SickOfTheOnePct]

81. Doctors won't be government employees under single-payer

That's nationalized medicine, which is totally different than single-payer.

Malpractice insurance will still be necessary, but it should be less expensive. The only thing that would have to be covered is punitive damages, since under single-payer, any lifelong medical care would already be paid for.

[discntnt_irny_srcsm]

99. That is what I was thinking

[eridani]

245. Other countries provide malpractice insurance at 1/10 of what our providers pay.

In Japan, $100/month gets you the medical association journal and the malpractice insurance. Why? Because only in America do people with adverse outcomes sue so often. They do it to get money for the extra necessary care--regardless of whether malpractice has taken place or not. If you have health care as a right of citizenship, you are not going to sue a provider except for truly egregious screwups.

[Recursion]

246. Yup. Also government healthcare funding means only punitive damages need to be covered

Also, the other countries I know anything about treat malpractice less as a tort and more as a crime, or at least as a career-ending event (their version of the AMA handles that; ours doesn't seem to do that much).

[SickOfTheOnePct]

59. Also, and maybe I missed it

But are you basing the new costs on HR 676 Medicare for All? If so, add so more dollars, as it calls for no co-pays, no deductibles, and includes dental and long-term/nursing home care as well.

Again, all laudable goals and something we should work towards, but it won't be cheap, and it won't be the same/less that is spent now.

[Doubledee]

66. So what you are basically saying

Last edited Mon Nov 2, 2015, 03:24 PM - Edit history (1)

is that many nations, less wealthy than our own, can enjoy free health care for all but we cannot. Nonsense.

[Recursion]

68. Healthcare that is free at point of delivery is very rare worldwide

There's Canada and the UK. I think that's about it. Even Taiwan and Austria have some fees at point of delivery.

[Doubledee]

251. Doing your homework

might avoid future posting of such absurdities:

http://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/

Thirty-two of the thirty-three developed nations have universal health care, with the United States being the lone exception [1]. The following list, compiled from WHO sources where possible, shows the start date and type of system used to implement universal health care in each developed country [2]. Note that universal health care does not imply government-only health care, as many countries implementing a universal health care plan continue to have both public and private insurance and medical providers.

https://en.wikipedia.org/wiki/Universal_health_coverage_by_country

Universal health coverage is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient at the time of consumption but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others tax revenues are used either to fund insurance for the very poor or for those needing long term chronic care. The UK government's National Audit Office in 2003 published an international comparison of ten different health care systems in ten developed countries, nine universal systems against one non-universal system (the U.S.), and their relative costs and key health outcomes.[2] A wider international comparison of 16 countries, each with universal health care, was published by the World Health Organization in 2004[3] In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.

The UN has adopted a resolution on universal health care. It may be the next stage after the Millennium Development Goals.[4]

[Recursion]

252. Yep. Do your homework

That was pretty embarrassing for you.

Research those, and find out which ones are free at the point of delivery.

Come back when you have. It's what I said: Canada and the UK.

Japan covers 70% of costs (it's simply not single payer; I have no idea where the website got that idea). Scandinavian countries have a deductible.

Actual free-to-the-patient healthcare is really just Canada and the UK.

[Doubledee]

257. Aside from showing your massive ego

you only demonstrate that discussion with you is pointless. I do not blame you for your errors in factual reportage, and even applaud your ability to post with your head so far up your rectum.

As one who has visited Switzerland, having a relative living and working there, I immediately knew the falseness of your premise. I did not immediately understand the worthlessness of your personality devoid egotistic insistence upon being the sole proprietor of truth and fact yet. I do now and, as I do with all childish and rude imbeciles, I will no longer respond to your inability to have a discussion without betraying the fact that your parents did such a very poor job raising you...:

The Swiss and Singaporean models

The two advanced economies with the most economically free health care systems—Switzerland and Singapore—have achieved universal health insurance while spending a fraction of what the U.S. spends. Switzerland’s public spending on health care is about half of America’s, and Singapore’s is about a fifth of ours. If we had either of those systems, we wouldn’t have a federal budget deficit.

http://www.forbes.com/sites/theapothecary/2015/01/27/conservative-think-tank-10-countries-with-universal-health-care-are-economically-freer-than-the-u-s/

[Recursion]

258. And Switzerland and Singapore both have costs to the patient at delivery

Which was the question at hand. Try to stay focused, OK?

[Doubledee]

260. Gee. Almost polite this time

I am certain that, should you truly try, you might even attain civility one day.

Swiss healthcare is outstanding. Its combined public, subsidised private and totally private healthcare system create an extensive network of highly qualified doctors (many of them from elsewhere in the EU) and hospitals, the best equipped medical facilities and no waiting lists, but it all comes at a price: around 10 percent of the average Swiss salary goes towards health insurance premiums. ­ There is no free state health service in Switzerland.

In the US the equivalent cost is around 18%. To those who can afford it. The real point is not your inability to be civil but that US health care is atrociously expensive, and unnecessarily so when we have so many models around the world showing how it can be done.

[SickOfTheOnePct]

75. No, he's not saying that at all

He's saying that we should do it, but that it's going to be expensive.

Yes we can afford it, but we need to figure out how.

[Politicalboi]

78. If we can pay for war

We can pay for free healthcare. At first it will be costly and may take time to see a specialist. But as the years go by and most have seen their doctors, it will be cheaper.

[Hoyt]

82. I think you are right about cost and need to change Medicare a bunch. Doesn't mean we shouldn't go

for it, or something close. But it does mean it is going to be costly and difficult to implement. But it will definitely still sux during the transition, but perhaps it won't sux as much as the current system does.

[SickOfTheOnePct]

84. Agree 100% on all counts n/t

[still_one]

83. actually it wouldnt, if you are talking about actual Medicare the way it is today. first of

All Medicare is not free. It costs about 107 dollars for part A and B. The drug plan also costs. In addition, most people will need supplemental which also costs , and some of these premiums are not so cheap.

If there was medicare for all it should actually reduce the costs since you would have more healthy people in the pool. Right now medicare is for 65 and older, and the older one gets the more problems occur, by adding a younger group not only would that risk be reduced, but so would the cost

It won't happen withe the current make up of congress

[Recursion]

86. Part A is $440. Part B is $107

But retirees have the $440 paid for out of the Trust Fund. We couldn't do that for non-retirees.

[still_one]

108. Thanks for the correction, my comment still hold though. A younger age demographic should reduce

the cost, even though they couldn't collect from the SS trust fund before 65, they would have to pay something, and since it is a younger demographic the premiums should be cheaper, since it wouldn't be used as much

[SickOfTheOnePct]

110. There aren't premiums under a single-payer system n/t

[still_one]

120. The cost is through taxes

[SickOfTheOnePct]

123. Yes, I know that

But that isn't the same as premiums.

[still_one]

126. agreed. Anyway, good points are being discussed in this thread

[SickOfTheOnePct]

130. I wholeheartedly agree!

These are discussions that we NEED to have - we can't just sprinkle fairy dust and provide healthcare for everyone.

Aside from the costs of providing the actual care, what about doctors? We'll need more, that's for sure. If doctors will make less money, which is almost a certainty under single payer, will enough people want to take on the debt load of medical school?

And if we say "We'll pay for medical school", which again, isn't a bad idea, how will we pay for that?

What about all of the people in the insurance industry that will lose their jobs? Certainly some can transition over to similar work (claims, etc.) in a single-payer model, but not all of them. And I would venture to say that most of them wouldn't be able to become actual healthcare providers, so what do we do for them to help them find other work? And what work?

This isn't to say we shouldn't do it, but it's not going to be as simple as waving a wand and having single-payer for all.

[still_one]

134. "fairy dust", I love it... Also, not every doctor will accept Medicare. The reimbursement

from Medicare for services rendered is very low. In Texas, "while nearly 80% of the Texas Medical Association’s doctors were taking new Medicare patients in 2000, last year fewer than 60% were, according to a recent PBS NewsHour report."

http://www.forbes.com/sites/nextavenue/2013/06/11/what-to-do-if-your-doctor-wont-take-medicare/

Whether this is a real problem or not only time will tell.

[Recursion]

111. No, the risk pool has nothing to do with this.

Read my OP.

I took the treatments people are currently getting through private insurance.

I applied the savings that Medicare has over private insurance. That came to $220 billion per year.

I took the 90 million people who either have no insurance (40 million) or cannot afford needed treatments because their copay/deductible is too high (50 million) and assumed they would start getting treatments at the same rate the rest of the people with private insurance do.

That would cost an additional $500 billion per year to provide at Medicare rates.

This has nothing to do with the risk pool. This is just "X number of gall bladder surgeries need to happen".

[still_one]

122. interesting. Then the short fall would need to be made up with increased taxes. This is really

just academic since no one has explained how it would even get through Congress today

[SickOfTheOnePct]

89. It wouldn't be like Medicare is today

There would be no Medicare premiums, no deductibles and no co-pays.

[still_one]

109. I was specifically addressing the title of the OP, not single payer or universal healthcare which

was discussed in the body OP's message

There is no doubt that to implement that would require an increase in tax revenue, which is not necessarily a bad thing, but it would never make it through Congress

[SickOfTheOnePct]

112. Medicare for all is the current term for single-payer n/t

[Recursion]

113. Though just to be clear, the calculations in my OP were not based on HR 676, just on literally

extending parts A and B of Medicare to the entire population.

As you point out, HR 676 would be significantly more expensive.

[SickOfTheOnePct]

115. Oh got it, my bad and I apologize!!

You're still right though - it's going to cost much more.

[still_one]

119. You points are good, and there is no doubt it would require an increase in taxes. There was a lot

displeasure here on DU when the ACA came out, but what they failed to acknowledge, the blue dogs were never going to vote for it. There was a proposal for Medicare for those 55 and older, and a lot of Democrats in Congress would not go for that.

Another issue at the time was we were going through the largest financial collapse since the great depression, and increasing taxes, which would have been required to support single payer would have been the worst thing to do at the time. The whole point of the recovery was to provide liquidity, lower the interest rates, not increase taxes, and pass legislation that would stimulate the economy. Unfortunately, many of the jobs programs that could have helped us recover faster, were blocked mostly by the republicans in Congress.

That we were able to get the ACA is nothing short of amazing. In fact that applies to what the Obama administration was able to accomplish.

Vermont tried to implement Single Payer, but had to back track because they found it was to expensive, and the tax burden would not have been acceptable at the time.

[still_one]

114. Thanks for the accepted vernacular. It would have to be paid for with increased tax dollars, and

while that would work, there is no way it would pass in the current Congress

[Yo_Mama]

117. Yes, I figured the payroll tax would be about 15-17%. That doesn't include SS taxes, which must rise

And that's why we don't have it - people are not willing to pay that, especially those with higher incomes. They have to pay far more out of their earnings for single-payer than they do now for their insurance.

The additional tax would be 12-15K for a family earning 100K a year, but only about 6-7K for a family earning 50K a year. It's a good deal for lower earners and a bad one for higher earners.

A well-off family earning 150K a year would be paying probably 20K a year.

There isn't any magic way to deal with this - health care is relatively expensive, and taxes levied to pay for it in other countries commonly do run about this much.

[PowerToThePeople]

121. Lol, I can search any right winger site to get articles like this.

Trashing this pile of bullshit.

[Live and Learn]

125. Irrelevant and untrue. nt

[DirkGently]

135. Here's a few studies showing that's not a fact at all.

http://www.pnhp.org/facts/single-payer-system-cost

June, 1991 General Accounting Office

“If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage” (“Canadian Health Insurance: Lessons for the United States,” 90 pgs, ref no: T-HRD-91-90. Full text available online at http://archive.gao.gov/d20t9/144039.pdf).

December, 1991 Congressional Budget Office

“If the nation adopted…[a] single-payer system that paid providers at Medicare’s rates, the population that is currently uninsured could be covered without dramatically increasing national spending on health. In fact, all US residents might be covered by health insurance for roughly the current level of spending or even somewhat less, because of savings in administrative costs and lower payment rates for services used by the privately insured. The prospects for con-trolling health care expenditure in future years would also be improved.” (“Universal Health Insurance Coverage Using Medicare’s Payment Rates”) http://www.cbo.gov/ftpdocs/76xx/doc7652/91-CBO-039.pdf

(snip)
June, 1998, Economic Policy Institute

“In the model presented in this paper, it is assumed that in the first year after implementing a universal, single-payer plan, total national health expenditures are unchanged from baseline. If expenditures were higher than baseline in the first few years, then additional revenues above those described here would be needed. However, these higher costs would be more than offset by savings which would accrue within the first decade of the program.”

August, 2005

The National Coalition on Health Care

Impacts of Health Care Reform: Projections of Costs and Savings

By Kenneth E. Thorpe, Ph.D.

This fiscal analysis of the impact of four scenarios for health care reform found that the single payer model would reduce costs by over $1.1 trillion over the next decade while providing comprehensive benefits to all Americans. The other scenarios would be improvements over the status quo, but would not reduce costs as dramatically or provide the same high-quality coverage to all.

[HughBeaumont]

137. Maybe the CEOs could escalate the coming economic dystopia.

You know, the one where our supposedly wealth-fattened poor and homeless gain millions more members thanks to displacement by job offshoring, automation or just plain being too costly in the quest for mega-profits.

Then, when the inevitable deaths occur thanks to rampant crime, disease, suicides or starvation, the population will be thinned out worldwide and there'll be tons of public money for the remaining upper middle class to wealthy survivors (search me how a thinned out population collects enough tax revenue . . . .). They'll get the multi-payer systems other countries have (but ours, mysteriously, cannot) and not worry about those nasty peasants breathing on them. The insect population will thrive, now that humans can no longer consume them.

America - It Just Can't Be Helped, So Let's Just Allow it to DIE.

[GeorgeGist]

138. Please explain why we have the highest PER CAPITA health care costs in the world.

Show your work.

[Warren Stupidity]

139. Same faulty assumptions as last time.

1. premiums for everyone, including seniors, would be lower as instead of medicare being assigned the single most expensive cohort, old people, it would, by covering everyone, be including huge numbers of healthy people who would not be using expensive services. Your calculations start out bogus.

2. when calculating the cost you just choose to ignore the zeroing out of employer based health insurance costs - both employee and employer premiums and employee out of pocket expenses. Somehow that savings just doesn't make it into your calculations. Odd that you ignore that.

3. you insist on keeping medicare exactly like it is while expanding the membership. That is a great assumption if one wants to argue that it would cost too much, but while we are reforming medicare to cover everyone there is no reason we can't fix the worst parts of the current system. Like for example the prescription benefit disaster, and other idiocies.

[GoneFishin]

142. All excellent catches. I knew there was a mound of horseshit burried amongst the weeds but chose

not to bother digging since I know eliminating health insurer's CEO bonuses and Wall Street dividends was a damn good place to start.

[Recursion]

163. Wrong on all three counts

1. I didn't get into premiums at all here, except to mention that any premiums for Medicare would probably prevent some care from happening.

2. Nope. I didn't. Read the OP. I took the treatments being provided through private insurance and then showed the savings we could get for those treatments if we zeroed out private insurance and moved them to Medicare (6.5% overhead reduction, 20% provider reduction)

3. I mentioned we could make it more generous, so clearly I'm open to changing it.

[Rex]

208. Yep.

[marmar]

259. Yep.

[riderinthestorm]

141. Bernie Sanders has a plan to pay for it. A .1% tax on financial transactions

and a .001% transaction tax on derivatives transactions.

Ie: Wall Street pays for free public education and single payer.


http://www.alternet.org/economy/bernie-sanders-bold-idea-make-wall-street-pay

Bernie Sanders' Bold Idea to Make Wall Street Pay
Why a financial transactions tax is good policy.

There are three points people should understand about an FTT. The first is that it can raise an enormous amount of money. An FTT could be imposed at different rates. Sanders proposed following the rate structure in a bill put forward by Minneapolis Congressman Keith Ellison. Eleven countries in the European Union are working to implement a set of FTTs that would tax stock trades at a rate of 0.1 percent and trades of most derivative instruments at the rate of 0.01 percent.

Extrapolating from a recent analysis of the European proposal, a comparable tax in the United States would raise more than $130 billion a year or more than $1.5 trillion over the next decade. This is real money; it dwarfs the sums that have dominated most budget debates in recent years. For example, the Republicans had been trying to push through cuts to the food stamp program of $40 billion over the course of a decade. The sum that can be raised by this FTT proposal is more than 30 times as large. The revenue from an FTT could go far toward rebuilding infrastructure, Medicare for all, or paying for college tuition, as suggested by Senator Sanders.

The second point is that Wall Street will bear almost the entire cost of the tax. The financial industry is surely already paying for studies showing the tax will wipe out the 401(k)s held by middle income families. This is nonsense. Not only is the size of the tax small for anyone not flipping stock on a daily basis, research indicates that most investors will largely offset the cost of the tax by trading less.

Most research shows that trading volume falls roughly in proportion to the increase in transaction costs. This means that if an FTT doubles the cost of trading then the volume of trading will fall by roughly 50 percent, leaving total trading costs unchanged. Investors will pay twice as much on each trade, but have half as many trades. Since investors don't on average make money on trades (one side might win, but the other loses), this is a wash for the investor.

[Recursion]

165. $130 billion a year gets us about half of the way there

And that doesn't leave anything left over to pay for free college.

[riderinthestorm]

171. Shrug, then raise the percentages by a fraction

The basic idea is sound

[eridani]

144. We pay twice per capita for health care compared to other developed countries

They cover everybody. So it's nonsense to say we couldn't do the same. As Kucinich said in 2004 "We are already paying for universal health care--we just aren't getting it."

[Recursion]

173. Ironically we have a plan that would work nationally, that Sanders has strongly supported: FQHCs

This is a great way of paying for health care, it's effective, it's scalable. FQHCs get an operating budget from the government and charge patients on a sliding income-based scale. This is much better than trying to patch up the insurance system.

[eridani]

177. That's true, but why stop there? We could eliminate deductibles entirely

Yes, for Medicare also. Single payer will do that. There are arguments for and against copays--I'm against them because they add unnecessary complexity and they prohibit necessary as well as unnecessary care.

[daredtowork]

146. Please explain why you keep posting fiscal attacks on progressive ideas.

I know we're not supposed to question anyones Democrat bona fides around here, but you have made this a pattern. And your dedication to undermining progressive ideas and platform positions has to make one wonder.

[Recursion]

169. Getting people to face what this will cost isn't "undermining" it

What actually undermines it is people pretending the magic health care unicorn will let us have health care without paying for it.

Besides, when did single payer become the sine qua non for being a Democrat? I don't really like single payer, and I think there's a reason almost no countries have it. I would much prefer a system like France, or Germany. Or just a vast expansion of the FQHC model so that they can provide most primary care.

[HughBeaumont]

181. And defending NAFTA. And Job offshoring. And free trade in general.

And gleefully giggling at how all those things, plus automation, is going to slaughter anyone making below $100,000 a year knowing that no Guaranteed Minimum Income or WPA is coming to save us.

And telling America's homeless and poor rurals that they have it awesome because they're not eating insects or living in mud hovels.

You know, the sort of things conservative economic bootstrapper pundits like to tell us. ALL THE GODDAMNED TIME.

[Rex]

211. But this one is funny!

He knows everything about everything!

[GoneFishin]

253. +100,000. LOL. Awesome.

[daleo]

149. I saw an OECD graph the other day

The U.S. spends 16% of its GDP on health care, while Canada spends 10% of its GDP on health care. Yet, average lifespans in Canada are more than 2 years greater than the U.S..

[Recursion]

158. Canada's poverty rate is 9% and ours is 14%. Their Gini is 32 and ours is 41.

They have a largely-effective gun control regime, and we don't.

[polly7]

162. Did you ever think that having the health-care system we do is one of the largest

reasons for a lower poverty rate?

[Recursion]

166. I think the opposite: they can do it because they have less poverty (nt)

[polly7]

167. No.

Having to pay for expensive medical treatments without the system we have currently would end up throwing millions into poverty, or not being able to seek help at all. Why would you think it's the opposite?

[Recursion]

170. Yeah, that's really not why very many people are poor in the US

People are poor in the US because wages haven't risen appreciably in 40 years.

There are a lot of bankruptcies in which medical debt is discharged, true, but bankruptcies are also rarely done by people living under the poverty line (at that point you're largely off the grid anyways).

[polly7]

176. Yeah, our wages haven't been so shit-hot for the middle and lower class lately

either. We're really not all that different in that regard.

I've heard that is the exact reason many people are poor in the U.S., and many times, it's either medicine, paying bills, or eating? Were they all lying?

My own parents, had they not had health insurance, with nine of us kids and their own later life health issues, would have definitely been thrown into bankruptcy, even after my dad farmed and worked in the oilfield all his life. He would have been wiped out in months with my mom's cancer. I don't understand how you believe that millions more just like him that would have gone through the same thing wouldn't have an impact on total poverty rates.

[quaker bill]

152. The error in your math

is the assumption that the under and uninsured do not get care. They do not get as much care, but uncompensated care is provided to the uninsured and indigent. This has cost which your math does not account for.

Secondly, the uninsured do not contribute premiums to the existing system. This will change.

[Recursion]

156. OK, so add that in

the uninsured do not contribute premiums to the existing system

How much will the premiums be, and how will they afford them?

[lovuian]

168. Reality Check ....our Hospital Bills Healthcare can't continue

to rise more than our wages or anything else

It is Unsustainable as is and everybody knows it


Universal payer .....is to reign in costs and give healthcare to everybody

[Recursion]

175. Except it wouldn't magically reign in costs -- Medicare pays way too much as it is.

Medicare pays more than twice what the NHS in the UK does for a whole lot of things.

Moving to FQHCs would reign in costs, very effectively. And since they charge on a sliding income-based scale they are affordable.

[Hiraeth]

178. I don't even know where to start there is so much wrong here.

[MannyGoldstein]

180. I don't think that's right

I did my own math a few years ago, and found that it would save a bundle. I'll try to find what I did.

[PatrickforO]

182. Nice post, full of good stats.

But there is one thing you omit. Why should we not organize our economy around helping each other? These are OUR tax dollars - why not use them for a program that benefits us instead of a forever war?

And you know, there are two huge reasons we even worry about the cost:
1. Big corporations like GE, Paccar, Wells Fargo and Mattel are not paying their fair share of federal income tax because of a loophole that allows them to 'offshore' profits. Billionaires also take advantage of this loophole. Some say there is as much as $20 trillion in untaxed profits offshore. The Bush tax cuts were disastrous. You simply cannot lower taxes for the wealthy and at the same time increase spending.

2. The national debt, if you think about it, is money we owe to ourselves if in fact our government is of, by and for us, the people. So why do we owe it to Wall Street banking lizards, with interest? Because of the Federal Reserve Act of 1913. And, you know what? The Fed is NOT 'quasi governmental.' That's bullshit. The Fed is OWNED by banks, and the majority interest in it is held by Citi and JP Morgan Chase. As Bill Murray would say, 'That's the fact, Jack!'

If we wanted a society of abundance instead of scarcity where people have to die because some greed head wants too much profit for a drug, then we'd end the Fed's charter and begin issuing our own money as it says we should do in the Constitution. Will there be inflation? Nope. That's a myth, because as money expands, goods and services also expand, so the market keeps prices in equilibrium.

Now, if we did this, the bankers would come out with the long knives. They would attack the new currency, counterfeit it and attempt to cause steep recessions. But if we stuck it out, and ran our show like the founders did in PA and NY, and like Lincoln did with his greenbacks, then a Wall Street lizard could very well say, “If this mischievous financial policy (the Greenback), which has its origin in North America, shall become endurated down to a fixture, then that Government will furnish its own money without cost. It will pay off debts and be without debt. It will have all the money necessary to carry on its commerce. It will become prosperous without precedent in the history of the world. The brains, and wealth of all countries will go to North America. That country must be destroyed or it will destroy every monarchy on the globe.” –Times of London

So there it is. For more read Ellen Brown's Web of Debt. Here's another link that elaborates the position more: https://realcurrencies.wordpress.com/2013/10/11/the-difference-between-debt-free-money-and-interest-free-credit/

Besides, no one (except Bernie and a couple others) asked how much Bush's forever war would cost. Why must we ask how much something that's actually GOOD, like single payer healthcare, cost?

[Recursion]

183. Moving off of scarcity-based pricing is a huge interest of mine

But we don't really have a post-scarcity economics yet. Would money still work, per se? (Probably, but it would need to be created as equity rather than debt.)

But that's a huge, huge structural change.

[PatrickforO]

198. Yeah it is. I don't know if it will happen in our lives or not, but

I'm supporting Bernie because he's a step in the right direction.

[TexasBushwhacker]

187. Well, perception is everything

You say we can't afford to provide universal healthcare.

I say we can't afford not to.

When someone dies prematurely or becomes disabled, that is a cost. Survivor's benefits to widows and widowers and their children is real money. Disability payments to those who can't work is real money. Lost tax revenue from workers who died or became disabled is real money too.

Every business has to account for bad debt. Hospitals, doctors and other healthcare providers handle this s by charging patients (and their insurance companies) enough to cover their costs, including the costs of the uninsured. Those who have insurance pay for those who don't.

When everyone gets healthcare, chronic diseases like diabetes can be managed better, preventing complications like heart disease, blindness and amputations. Routine cancer screenings can catch cancers earlier, when they are more treatable.

It makes no sense for us to be paying so much for the people who are insured, while millions continue to be uninsured. We aren't inventing the wheel. Plenty of other countries have universal health care. Why aren't we learning from their successes and failures. What is the point of spending almost 18% of our GDP, when it doesn't cover everyone? We spend $8.5K per capita NOT covering everyone, while Norway, the closest in per capita cost at $5.7K, covers EVERYONE. How does that make financial sense?

[Recursion]

190. Plenty of other countries have universal health care. Very few have single payer.

Those are two separate questions.

Plenty of other countries have universal health care. Why aren't we learning from their successes and failures.

Good question: why are we fixated on copying Canada, and only Canada? Why not France? Or the Netherlands?

[TexasBushwhacker]

194. I'm not wedded to single payer

I'm all for looking at all the systems and coming up with something that works for our country and it's unique needs. The ACA was certainly a step in the right direction, but there are still far too many who are uninsured. I think a public option, basically letting people buy into Medicare, would have been good. There would be more healthy people in the risk pool, more money and more bargaining power for Medicare since they would be covering more people. They also need to allow Medicare to negotiate drug prices.

[Recursion]

201. Would a public option be affordable to people who need it?

Remember that the full premium for Medicare is $800 per month (retirees get subsidized from the Trust Fund -- we couldn't do that for participants in the public option), and that gets you a $1000 deductible and 20% co-pays for everything with no out of pocket maximum.

The premium would come down with a younger pool -- how much, though? Would it be enough to make it affordable? Is a 20% co-pay ever going to be affordable for people who currently can't get insurance?

[TexasBushwhacker]

219. I think $800 sounds a little high

If you sign up for a plan through the marketplace, most plans charge $30 or less for a PCP visit and less than $10 for generic drugs, so the deductible only becomes an issue if you have surgery or have to be in the hospital.

I actually pay the bills where I work and the only person who has an $800 premium is a 64 year old woman. That's for a Blue Cross Blue Shield gold plan. We pay less than $300 each for the employees in their 20s.

[Recursion]

223. That's the full premium for Medicare Part A and B

If you (or a spouse) never paid in to the trust fund

[polly7]

206. Because ours works?

And works very well.

We also don't even pay the taxes you do, and still get excellent!!! health-care.

I'm no economist, but I have no problem with this, and my taxes paying to keep all Canadians healthy.

The tax wedge is the difference between what businesses pay to employ a worker, and the net take-home pay of the employee’s after income taxes, employee-plus-employer social security contributions, and minus benefits.

Germany came in second, with a tax burden at 49.3 per cent.

Canada, meanwhile, is ranked 26th among the 31 OECD nations, with a 31.1 per cent tax wedge. The U.S. ranked 25th, with a slightly higher tax wedge of 31.3 per cent.

Think Canadians pay some of highest income taxes in the world? Think again

http://www.ctvnews.ca/canada/think-canadians-pay-some-of-highest-income-taxes-in-the-world-think-again-1.1771575

[Recursion]

207. France's does too. Better, in fact

And our population looks a lot more like France than Canada.

[polly7]

209. We're very happy with ours. nt.

[Recursion]

210. And I'm glad you have it, and it seems to work very well for you

What I'm not convinced of is that simply by cloning your system here in the US we would get the same outcomes.

[polly7]

212. Why not?

Getting rid of the middle-man making obscene profits and dictating what diagnostics and treatment should be doled out (by people who know nothing about actual medicine) and having a much larger pool, including both sick and healthy alike from which to draw from seems to me to be a no-brainer. What's so hard about getting it done?? Where is the real resistance to it coming from?

[Recursion]

215. Because Medicare already does that and pays twice as much for the same procedure as you do

We have a much different political system than you do, and medical providers have a lot more influence. Hell, look at the "doctor fix": for 20 years now the AMA has bullied Congress into artificially raising doctors' reimbursements by 20%.

[polly7]

216. Overhaul it all, then.

Get rid of the fucking 'insurance providers' first though - the vultures of your medical system. Then the rest will all fall into place, in my humble opinion. Your federal gov't and states will have to work together, just as in our system, and each state would form committees including medical personnel to decide the specifics.

[Recursion]

225. But Mississippi would really rather let people die

This is what we saw in the Medicaid expansion. The poorest states are the ones whose legislatures absolutely will not cooperate with the Federal government on this, at all.

[TheKentuckian]

267. You fix that only by some degree of control of the purse, either single payer and forcing providers

it by law or close up shop or by going even further and doing an NHS.
The current model forces Medicare rates up so everyone in the chain profits.

Other countries did not have to unwind our jacked up for profit system so their baselines and worldview of care are very different.

[eridani]

188. There is only one thing you need to know about our health care costs

They are twice what other developed countries pay. What we are paying now would pay for universal health care, if it were devoted to that, and if the government had a negotiating role in capital and operating budgets and determining pharmaceutical prices.

[Matariki]

191. It's completely erroneous that 'very few countries' have Single Payer

Makes me wonder about the rest of your facts

http://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/

Thirty-two of the thirty-three developed nations have universal health care, with the United States being the lone exception [1]. The following list, compiled from WHO sources where possible, shows the start date and type of system used to implement universal health care in each developed country [2]. Note that universal health care does not imply government-only health care, as many countries implementing a universal health care plan continue to have both public and private insurance and medical providers.

Countries with Single Payer: Norway, Japan, United Kingdom, Kuwait, Sweden, Bahrain, Brunei, Canada, United Arab Emirates, Finland, Slovenia, Italy, Portugal, Cyprus, Spain, Iceland

that's hardly "very few".

[Recursion]

193. "Single Payer" and "universal health care" do not mean the same thing

Single payer does not have to be universal, and universal health care comes in many forms besides single payer.

Seriously, whoever pushed the meme that "single payer" is what the rest of the world has needs to leave politics forever.

[Matariki]

196. No kidding. Read the link, it has a long list of countries that have SINGLE PAYER

And also countries that use a Two-Tier system. The fact that everyone is covered regardless of ability to pay is what makes these all "universal"

Don't hurt yourself with all that head butting.

[Recursion]

197. It's simply false.

Norway is not single payer; there is a deductible all adults must meet.
https://en.wikipedia.org/wiki/Healthcare_in_Norway

Japan is not single payer; it's two-tier with the patient meeting 30% of all costs. https://en.wikipedia.org/wiki/Health_care_system_in_Japan

The UK is not single payer; it's government-operated with funding coming from national and local sources.

Did you bother to actually investigate that blogger's claims?

Should I go on with the rest of the countries he claims are single payer?

[Matariki]

199. Disingenuous

here: https://en.wikipedia.org/wiki/Single-payer_health_care

just countering your claim that 'very few countries' have single payer.

[Recursion]

200. Name one other than Canada

That article mentions Canada (which has single payer), Australia (which has a deductible, so isn't single payer), Taiwan (which has fees at delivery, and so isn't single payer), the UK (which is government-operated, not single payer), and Spain (which has a parallel private system available, so isn't single payer). I'll throw in Austria (which is like Spain) and South Korea (which is like Taiwan). None of those except Canada are single payer. I'll even throw in New Zealand, which used to be single payer but got rid of it and moved to a multi-tier model.

Most of the countries with universal healthcare do not use anything approaching single payer to achieve it. Canada actually does single payer. Spain, Austria, Taiwan, and SK are somewhat like single payer. Most everybody else uses a full on multi-tier system. And pretty much only in Canada and the UK is health care actually free at delivery for the patient.

[TubbersUK]

227. "UK .....funding coming from national and local sources"

I'm puzzled by reference to "local sources" here.

Can't think what they might be other than a few charitable efforts.

[Recursion]

229. The towns and counties. But government-operated healthcare is not "single payer" to begin with

It's just not what the phrase means.

[TubbersUK]

230. "Towns and Counties"

Have you checked that one out ?

[Recursion]

231. Yes, I did some work for Leeds a few years ago

They pay some of the operating costs of their medical centers. I forget the exact phrase but it's something like a "non-binding obligation" (or something equally absurd) from Westminster to particularly the large cities to kick in some for their hospitals. It was particularly biting Leeds because they took in a bunch of asylum seekers and were having to pay to upgrade some of their clinics for them.

[TubbersUK]

234. Do you have a link? n/t

[hill2016]

192. bookmark to read later

but US health care spend is about 17% of GDP or about 3 trillion.

you're not including a lot of things. Medicaid is one.

[Recursion]

195. Medicaid, the VA, public health

Here's some charts I made:

[Doctor_J]

202. complete bullshit

I wish you would stop posting this right wing meme once a month. We pay 2-3 times as much as any other developed country. It is literally impossible for our healthcare to cost more with the profit taken out. Medicare at present treats only the very old and very sick.

Why do you insist that we have to either further enrich the insurance executives, or have people go without healthcare? No one except for dinos and republicans believes this bullshit.

[Recursion]

204. You can't seriously think that.

It is literally impossible for our healthcare to cost more with the profit taken out.

90 million Americans aren't getting treatment.

You actually think it's impossible to treat 90 million more Americans than we do now for more than we are currently paying?

You actually can't see how that would cost more, even with profit taken out? It's nearly a third of the country. We aren't spending anywhere close to a third of our health care expenses on profits for insurance companies; it's closer to like 3% (about 50% of spending is through health insurance and about 6% of that goes to profits above Medicare's overhead rate).

[elleng]

203. Right, health care is expensive.

The rest of the world knows this, and lives with it (higher taxes.)

[Recursion]

205. And I'd vote for that in a second. Bring on a 20% VAT

(BTW I know this isn't GDP, but apparently an O'Malley healthcare white paper is coming out soon.)

[Thinkingabout]

217. It may surprise lots of people but Medicare Part B cost $104 a month, the average SS is $1200 a

Month, many people this is all they get a month. The co-pays are high, Part D is for drugs, those do not come free either. I have a Medigap and at a group rate is still $172 a month and another $36 a month for Part D. This is $312 a month, so Medicare for all is not free by a long shot. BTW, if Medicare does not approve a procedure then the amount comes out of pocket.

[RichVRichV]

218. The single payer bill already submitted to congress was calculate to cost 15 trillion over 10 years.

That's $1.5 trillion per year.


We already spend $3 trillion per year (on the books) according to the Centers for Medicare & Medicaid Services. It's expected to rise substantially over the next 10 years from that $3 trillion. Last I checked $1.5 trillion is a lot less than $3 trillion (and rising).


And would you quite saying $293 billion is 80% of the defense budget. That's not even close to accurate. Our discretionary military spending alone is more than double that. Not even taking into account the off the book wars and black box spending.

[Recursion]

224. Sorry, thank you: I read the wrong line there. It's about 50%

Last edited Mon Nov 2, 2015, 11:21 AM - Edit history (1)

Appropriations + war spending comes to just under 600 billion for 2015. Editing.

[RichVRichV]

254. Now I think you're overestimating.

If it was 600 trillion this year we would bankrupt the world.

[pinboy3niner]

235. Veterans would demand continuation of their VA health care

Despite problems and scandals, veterans still love VA health care and would reject any attempts to put them into the civilian healthcare market.

[Recursion]

236. Though VA centers could pretty easily be brought into the FQHC fold

It wouldn't have to be a public-facing change at all; it would just be a different way of accounting for the payments.

[pinboy3niner]

237. Being 'brought into the fold' is what they fear

Vets--and all the major veterans organizations--will reject any slippery slope changes that may threaten the contnuation of a healthcare system dedicated to serving veterans. They don't want to be brought into the civilian healthcare fold.

[Recursion]

238. I know the Legion is against the idea

It's really not a cost center to begin with, so I don't think there's much need to change it.

[pinboy3niner]

240. It's not just the Legion, it's all of them

DAV, VFW, VVA, IAVA and more covering vets of all eras. They may look at any new plan suspiciously as something that could lead to kiiling their VA healthcare system devoted to veterans' care.

[Recursion]

241. And I don't think we should change the VA, particularly (I was just throwing that out as a response)

As we both know, veterans face a set of health problems that are quite distinct from the rest of the population. Since we've built up a system that is effective at providing that care, and it does so pretty efficiently, I think it would be crazy to change that.

[SunSeeker]

256. Yep. The eye-popping tax increases needed is why Vermont abandoned single payer.

I still think it would have been worth it, but since even people like Bernie Sanders will not fight for those tax increases, single payer is toast.

[lumberjack_jeff]

264. private insurance inflation *is* an eye popping tax increase.

Single payer has some promise to control that inflation - private insurance does not.

[SunSeeker]

266. I agree. But Sanders didn't defend the proposed tax increases in Vermont.

No politician in the US would. Americans are apparently accustomed to those insurance premium numbers, but will not agree to double digit tax increases, even if it makes economic sense.

[KamaAina]

262. "most achieve universal health care some other way"

What other ways are out there? Does India have it?

[Recursion]

268. Tons of other ways. Look at France, Switzerland, Japan...

Really everywhere but Canada and the UK. And even of those two the UK is a better system than Canada.

India has a hodgepodge of federal and state programs, and its health care system is not one the world should emulate.

[lumberjack_jeff]

263. Your entire argument rests on a shaky foundation: the belief that 50 million don't get any care.

They in fact still get care - just not preventative care and the costs the expensive deferred care are passed on to everyone else in the form of higher costs of treatment for the rest of us.