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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsI don't understand Bernie's Medicare for all
He just said on "All In" that with Medicare for all your insurance premiums would go away.
I have Medicare and I pay premiums for part B and D and for a suplimental plan.
And I paid for part A with payroll deductions.
I think calling Bernie's plan Medicare is a misnomer because with Medicare you pay premiums.
Medicare and Health Net are my insurance companies
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Response to wasupaloopa (Original post)
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guillaumeb
(42,641 posts)And it actually works better than the US system in every country where it exists. As Al Gore would say, An Inconvenient Truth.
Control-Z
(15,682 posts)If he said that then I don't understand either.
wasupaloopa
(4,516 posts)Hoyt
(54,770 posts)Last edited Thu Sep 14, 2017, 08:17 PM - Edit history (1)
what happened in California and Vermont when legislators did some calculations and said, "oh who is going to tell taxpayers about this," not to mention voters who defeated Colorado's single payer proposal.
Other countries make it work, but those countries make some tough decisions that would have people squealing here.
Egnever
(21,506 posts)first part of the problem for Vermont i think was a small population in a big healthcare system. The state simply does not have enough pull to realistically put cost pressure on prescription drugs for example. That causes their cost to skyrocket. second if I understand it correctly they had to carve out industries that were not based in Vermont which caused revenues from taxes to decrease.
I don't think it is easy to explain single payer.
Clearly the money is already being spent I think the only way to ensure the savings is for the nation as a whole or a large state to implement it otherwise there is no effective mechanisms to address the places where the savings would be gained.
Hoyt
(54,770 posts)present to their constituents.
I get the taxes would replace what is already being spent. Except the average Joe who is not suffering from an abusive lifestyle is going to say, my taxes are much higher than my usuage because I take care of myself, work hard, etc. In fact, many really don't care about paying for people with debilitating chronic diseases. And a lot, like 40%, just don't want a government financed system, at least until they have no other option. Yes, in some way they are paying for all that now, but it's not through a big tax increase that some politician says will save them money.
We can argue over whether Vermont is a big enough population. But you can't argue about California. And, as disappointing as it was, they ran from it quickly.
Egnever
(21,506 posts)This explains it probably better than I can.
The Vermont plan aimed to replace employer-sponsored and individually-purchased private insurance with a single, state-run insurer. But the state couldn’t preempt Medicare, or military health care, or large companies that directly pay for their workers’ health care using a process called self-insurance. Indeed, the Hsiao-Gruber report makes clear that for the Vermont plan to work, the state would need to gain waivers from Medicare, Medicaid, and Obamacare.
In addition, the state couldn’t prevent people from getting private health insurance in neighboring states like New Hampshire.
Hence, one of the key purported advantages of single-payer health care—that doctors and hospitals would only have to work with one insurer, simplifying their paperwork—turned out to be impossible.
Hoyt
(54,770 posts)couldn't handle this one.
Egnever
(21,506 posts)Difficult for a state to recoup the savings delivered through federal tax breaks on employer provided health care.
California would have stood a better chance with controlling costs when it came to provider reimbursement and drug prices but that still leaves a huge monkey in the room of the money the federal government currently puts towards health care in the form of tax cuts to employers.
I think that alone blows a huge hole in any state run attempt.
Hoyt
(54,770 posts)funding into the single payer pot. They still ran from it. California is bigger than most countries, population and economy. To make it work, a lot of people are going to have to lower expectations for single payer. I'm fine with that, not sure about most whiny American patients, whiny hospitals, whiny doctors, nurses, stockholders, company execs, clerical people, house-keeping, ambulance drivers, testing equipment vendors, etc.
The fact it's going to be tough for folks is not a reason to stick with current system, but we better be prepared including recognizing it will likely cost you more than you think for a long time. And we still have to face political realities unless you really think Congress will flip in 2018.
But I'm glad it's being discussed and hope at least a Medicare option becomes available soon.
Egnever
(21,506 posts)it leaves a big pile of missing money from the federal tax break for employers. Without that I don't see it as doable. You have to get that money that would have gone to subsidize the employer contributions or I don't think it can be done without huge tax raises.
Hoyt
(54,770 posts)health care for their employees? I think you are counting on something that wouldn't help fund a single payer system.
Currently employers are given tax breaks for contributions made to employee health plans. That is money "paid" by the government to ensure employers provide health care and provides up to 50% of the cost employers pay towards their employees health care. That is a huge sum of money somewhere in the neighborhood of 700 billion dollars that the fed is currently "paying" in the form of tax credits.
Going to a single payer system eliminates the need for the employment based health care so that money would no longer go to employers that are currently paying large portions of their employees health care costs. Essentially freeing up that 700 billion.
It is a large portion of the total current outlays for health care spending country wide.
The issue as I understand it for the states trying to enact this is that they can not recoup that money to put back into single payer as the fed does not give the money recouped to the states towards the single payer pool. That blows a huge hole in the funding for individual states as they have to replace that money with increased taxation. So a tax raise that might have been 4% is now 7% instead or worse.
If you take up to 50% of the money being spent currently on health care away before you even start budgeting you begin from a deficit when compared to a national plan.
50% is of course the high end but even 30% when you are talking about millions of people in a state like California is tons of money.
So they start with a deficit and then they have to work around national systems that are already in place on top of it. Very difficult to implement a true single payer as a single state when you have to work within a federal system.
As far as what you actually asked in a single payer system the employer would no longer pay for the health care so they would no longer receive a tax break for providing that health care. They wouldn't pay less they would not pay at all. So all of the money they are currently contributing is lost and the portion that the Fed currently reimburses them for can't be recovered either by the state.
That is the big stumbling block and makes the tax rate necessary to replace those funds much higher than is politically acceptable. Another part of what makes single payer more affordable is the savings when it comes to billing and that is also undercut when a single state tries to do it as they can not put everyone into the system( fed employees, service members, workers for multi state corporations...etc) so the savings from simplifying the paper work goes away as well.
Unless the fed changes it's reimbursement to states to reflect them picking up the costs they are currently covering for employers it is impossible to do without a huge added revenue source. If the fed was willing to do that though then they might as well just do it nationwide and move to single payer federally.
Hoyt
(54,770 posts)I get that if a company pays $1,000,000 toward premiums, they theoretically pay $300,000 less in taxes at the end of the year (assuming a 30% tax rate), just like they do if they paid $1 million for paper clips. But they are not paid to provide insurance.
I assume corporations will continue to pay a payroll tax to contribute toward single payer. That won't change, even under Sanders plan.
KPN
(15,642 posts)in comparison to the federal government. Sure it's big compared to Vermont, but California is actually relatively small in comparison to the nation as a whole. Sure there are challenges in making the case effectively/successfully, but overall, cost-benefit weighs in favor of single payer. Why not focus on the positives?
Hoyt
(54,770 posts)cutting edge of health care reform for decades.
Just focusing on the positives and ignoring the issues, ain't gonna get us there.
KPN
(15,642 posts)I'm not stupid. Stop talking down to me/us. I am beginning to understand after 66 years why some folks want to characterize Democrats as "elitists." Geesh.
Demsrule86
(68,552 posts)KPN
(15,642 posts)single payer system? Directly in the system itself, but more importantly, indirectly via massive cost savings freeing up consumers to spend elsewhere.
Some jobs are also predatory by nature. Do we really need those?
Egnever
(21,506 posts)Health care is almost 20% of our economy obviously not all of that would disappear but a lot of it would.
On the flip side there are a lot of people locked into jobs they hate currently because of health care. That would disappear freeing up a lot of people to do more entrepreneurial things. I think in the end it would create far more jobs than were lost but it would be a huge hit for the insurance industry and certainly the pharma companies would take a big hit to their bottom lines.
I am not one that thinks holding on to predatory industries because of jobs is a good idea. I don't think propping up the coal industry because of jobs is a good idea nor do I think propping up the insurance industry because of jobs is a good idea either. Short term it makes sense but long term it is disastrous.
As far as single payer not working that is provably false as it works in the vast majority of the world. Short term the switch will certainly have pain associated with it but long term the country will end up much stronger in my opinion.
TCJ70
(4,387 posts)...at least, premiums being the primary source of getting insurance. Moving to a tax based payment system means everyone is contributing to the pool. You're still paying, but the premiums people are used to paying would be gone and replaced with a different funding mechanism.
Part of the problem I remember from last year is people just seeing the tax increase and losing their minds. If they realize that they're premiums are going away, it will help them do the math.
it needs to be hit home repeatedly that while their taxes would go up their premiums going away should more than offset the tax increase.
TCJ70
(4,387 posts)...there are people that pay very little for their insurance through employer-based plans. Some people will pay more and I think it's fine to be honest about that. Most people would definitely come out ahead, though.
Egnever
(21,506 posts)I do think honesty is important but nuance is hard.
Demsrule86
(68,552 posts)TCJ70
(4,387 posts)...stance on the subject. You and your anti-Bernie friends here are being awfully persistent in trying to tear down these efforts and messaging opportunities. It's a common thread I've noticed among the most vocal opponents to this idea. Would it help you if someone else proposed it?
StevieM
(10,500 posts)One bill might be acceptable while the other is not acceptable.
Second, she said that Bernie's bill wouldn't happen. She didn't say that at no point in American history will there ever be a single payer health care system.
Is it your contention that if Bernie had been elected that he would be in good shape to get the votes needed to pass his legislation?
TCJ70
(4,387 posts)"People who have health emergencies can't wait for us to have a theoretical debate about some better idea that will never, ever come to pass."
It wasn't abou the bill. It was about the idea.
That is not my contention. The election would have to have been very different for that to happen.
StevieM
(10,500 posts)the long-term future of America.
It absolutely was about the bill. Her point was that Bernie was never going to have a shot of getting his legislation through congress, even assuming he won the election. And HRC wanted to focus on what could be done.
TCJ70
(4,387 posts)From an ad based on this same event.
Again, not about a specific bill but about the very idea itself. You can spin it any way you want I guess. But they're her words.
StevieM
(10,500 posts)She was referring to the presidential term that she and Bernie were both seeking and what they planned on doing with it.
HRC is not Joe Lieberman, Ben Nelson or Joe Manchin. She is a pragmatist who tries to move the ball forward as much as she deems possible.
It isn't reasonable to assume that if President Barack Obama had 49 votes in the Senate for single payer health care that Senator Hillary Clinton would have denied him the 50th vote, along with 6-8 other Democratic holdouts. That would not have been consistent with her career. But countless young people erroneously believed that it was.
KPN
(15,642 posts)without thought just as they've been conditioned to oppose "big government"/federal government. That's a challenge for sure, but it doesn't justify ignoring and just giving up on the huge benefits of single-payer. Momentum is building and the way the country is going, populism is only going to continue to gain speed in my view. People want solutions that work for the working class. If employers won't step up and provide a simple solution that works, that leaves only the people/the government. It will happen in some form.
brooklynite
(94,502 posts)...it's a line on your paycheck, but you don't see it as part of your income that you're paying out.
The big problem with a switch-over is that there's no guarantee that the new taxation will be less than what you/your employer are covering today.
TCJ70
(4,387 posts)...and discuss those things. I'm pretty confident we can come up with a way to fund it that does save money. The biggest piece is getting our costs under control. There's no reason we pay so much more than everyone else for the same or lesser services.
KPN
(15,642 posts)But far fewer will be hurt than helped.
Paradigms have changed and are changing. This holds true for politics as well.
tokalion
(15 posts)It would only make sense that employers who pay the premium to provide health insurance for an employee wouldn't redirect this to Medicare cost for that employee as a continued benefit. Thus, the employee would see know change in his/her medical coverage/costs.
still_one
(92,138 posts)Last edited Thu Sep 14, 2017, 01:49 AM - Edit history (1)
Medicare through our social security taxes, and are able to collect when we turn 65. However, that coverage is for Part A. Part B coverage essentially is for outpatient coverage, and the premium for that starts at around 107/month/person. However coverage is not 100%, and for the services NOT covered that is why people buy a supplemental policy which also requires a premium. Depending on how comprehensive and flexible coverage one wants, a supplemental premium can cost anywhere from 100, 200, and up per month, per person.
Then depending, a prescription drug plan will include an additional premium.
Some of those costs can be reduced with an Advantage Plan, which may also add more services covered, but usually they are less flexible, and limit where you can go.
So if as Sanders indicates that premiums would go away, that would only mean that the premiums one pays for Part B, Part D, and supplemental would need to be funded from another source, and the only answer to that is through increased taxes.
What needs to be detailed is how the distribution of services would be allocated, what the reimbursement of those services would be to the healthcare provider would be, and what services would be allowed, and what services would not be allowed. That will determine how much the tax increase would be.
If we look at those collecting Medicare today, here are what their premium costs are without a supplemental:
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
Here are the premiums costs for a drug plan:
https://www.medicare.gov/part-d/costs/premiums/drug-plan-premiums.html
Supplemental or Medigap premiums can very widely, but they can vary from 100 to 200 dollars or even higher per month
https://www.medicare.gov/find-a-plan/staticpages/learn/how-insurance-companies-price-policies.aspx
If the cost for reimbursement of services are too low, more healthcare providers would not accept Medicare assignment. If the reimbursement of services are too high, the system would have problems sustaining itself.
If Medicare for all would cover everyone, would the government assume the role as the insurance company, how would that be run?
Vermont presented a Single Payer bill had all three branches of its state government supporting it, including the governor, but when the bill finally came to his desk for a signature, he vetoed it because he determined the state couldn't afford it.
The California legislatures has a similar single payer bill, but the Speaker put it on hold because the details on how the services would be distributed, and where the funding would come from, and how much it would be wasn't provided.
Ironically, many of those self-identified progressives who refused to vote for the Democratic nominee, and undermined the Democratic party through many outlets, contributed to the republicans controlling the WH and Congress, which effectively made the prospects of Medicare for All a virtual impossibility in this environment. There is no doubt that if we had the WH, and the Senate, this would have at the very least been an active discussion with a real possibility of moving in that direction. There is no way I can see that happening in the next 4 years. Even if trump left office before his term was up, the order of succession is two more hardcore republicans before a Democrat would even get a chance.
wasupaloopa
(4,516 posts)that premiums will go away he should not call it Medicare. Doing that confuses the the issue and is disengeniuos.
Hoyt
(54,770 posts)KPN
(15,642 posts)covers most of my outpatient costs (approximately 70%). Part A includes most treatments for cancer whether administered as in-patient or not -- costs me zip. I don't have Part D, but have supplemental insurance that covers generic drugs almost completely and non-generic 50%. (And that's without the huge economy-of-scale benefit that would occur regarding pharmaceuticals with single payer!) My out-of-pocket costs per year are ridiculously low -- about $4,000 max. I haven't paid one penny beyond the very small deductible in the past two years -- not a penny.
What's not to like about that?
Single payer makes economic sense. Yes, there are challenges, but lets not throw out the baby with the bathwater.
still_one
(92,138 posts)prescription drug coverage. If you want prescription drug coverage today, you need to sign up for Medicare Part D.
Unless there is something I am not aware of, if you are saying that your supplemental covers generics, and 50% non-generics, I suspect you have a supplemental that was obtained before 2006. It doesn't sound like you have an Advantage Plan, which could also cover drugs, and perhaps other services not covered by standard Medicare.
For those that need Part D, the premiums for Part D depend on one's AGI
Medicare Advantage Plans usually bundles things together and sometimes include things that Medicare does not cover, such as drugs, vision, and dental., but Medicare Advantage plans can limit where you can go, or what services are covered, and have more restrictions than standard Medicare Supplemental Plan such as A, B, C........F etc. The most comprehensive supplemental plan would be F.
The 107 dollars that you pay is for Part B as you said, but you also indicated you have a supplemental, which should have a premium cost you have to pay also. As I mentioned above, a supplemental can cost an additional 100 dollar premium, and above depending on what type of supplemental you have.
Everyone's situation is different.
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#collapse-4811
LexVegas
(6,059 posts)
DemocratSinceBirth
(99,710 posts)Many nations provide universal coverage without single payer by using a hybrid system of private and public plans.
See:
Japan
South Korea
France
Australia
for starters.
My goal is to see that no American is denied continuous medical care, regardless of income:
Deng Xiaoping
I don't care how we get there.
Hoyt
(54,770 posts)Other countries also use private insurance for things like drugs. While it varies by Province, Canada's health system generally doesn't cover drugs, except for the poor. Most employers provide private insurance that covers drugs.
Point is, you are exactly right, there are any number of ways to get there. Considering where we are at the moment in the USA, I think a transition using a Public Option (which is essentially a Medicare buy-in) will work best.
DemocratSinceBirth
(99,710 posts)If the numbers are within reason by which I mean broadly acceptable to the American public I will support it. If the numbers make them run I won't. I don't see how any sentient person could demur from that calculus.
Hoyt
(54,770 posts)NewJeffCT
(56,828 posts)I'm guessing that the US will eventually end up with a public/private hybrid that involves a very strong public option to cover many Americans. I saw a prediction that the US would eventually have a system similar to Switzerland, which uses that sort of system to cover everybody.
as an FYI, American company AFLAC (the "aflac" duck from TV) makes huge money (75% of their revenue last I checked) selling supplemental health insurance plans in Japan.
alarimer
(16,245 posts)There are a lot of gaps.
ismnotwasm
(41,976 posts)Is it would put all reimbursement decisions completely in the hands of the government. The government will have to decide what to cover and when. We need to make sure providers are helping with these kind of decisions
Egnever
(21,506 posts)Even what we have now.
One would hope that a single payer system would make decisions based on health outcomes for the patient but there is certainly no way to be sure.
MichMan
(11,910 posts)That is a concern I have with the bill. No premiums, co pays or deductibles and everything is covered 100%. Great
Appears to me that if someone wants to make a doctors appointment every single day of the week, that they can. Of course, why worry about an appointment, you could just go to the emergency room for everything since it doesn't cost anything. Need a ride to the hospital, Why not just call an ambulance instead of a taxi.
You already see commercial after commercial telling people to get a motorized scooter since Medicare will pay for it and it won't cost you a dime. The amount of potential fraud could be massive . Will most patients do this? I doubt it, but I worry about unscrupulous providers that will run all kinds of unneeded procedures etc.
snooper2
(30,151 posts)You would basically have to have the feds take over BCBS, Aetna, all the big players and make one huge entity...
Or, they can start from scratch and spend a 300 Billion just on the back office systems 
HarmonyRockets
(397 posts)Here is the full text:
https://www.sanders.senate.gov/download/medicare-for-all-act?id=6CA2351C-6EAE-4A11-BBE4-CE07984813C8&download=1&inline=file
Here is a good summary:
https://www.sanders.senate.gov/download/medicare-for-all-act-of-2017-executive-summary?id=943E7DB5-FCCA-4EA4-B215-A92F6642BA2C&download=1&inline=file
Financing Medicare For All:
https://www.sanders.senate.gov/download/options-to-finance-medicare-for-all?inline=file
I think people are getting so hung up on "Bernie Bernie Bernie Bernie" that they aren't taking the time to actual read about the bill and making up their own minds. But yes, there are no premiums. From the summary:
This legislation will provide comprehensive health care coverage that includes:
1. Hospital services, including inpatient and outpatient hospital care, 24-hour-a-day
emergency services and inpatient prescription drugs.
2. Ambulatory patient services.
3. Primary and preventive services, including chronic disease management.
4. Prescription drugs, medical devices, and biological products.
5. Mental health and substance abuse treatment services.
6. Laboratory and diagnostic services.
7. Comprehensive reproductive, maternity, and newborn care, including abortion.
8. Pediatrics.
9. Dental health, audiology, and vision services.
Long-term care for seniors and people with disabilities will continue as it is currently covered under
Medicaid.
Putting People over Profits
Under this legislation, Americans will no longer have to pay premiums, co-payments, or deductibles to private health insurance companies that put profits over the needs of the American people. Instead of writing a big check to private health insurance companies, most Americans and businesses would be paying a much smaller percentage of their income to fund Medicare-for-all.
George II
(67,782 posts)....aren't going to vote for "OPTIONS TO FINANCE MEDICARE FOR ALL", that's too open ended and vague.
We're talking about legislation that would become "the law of the land", it has to be specific, and least with respect to sources of financing.
Demsrule86
(68,552 posts)stupid..give the GOP ammunition with a plan that will go nowhere.
