How do you move from for profit to single payer/Medicare for all?
Great logistical challenges.
Any Dem running should have a plan.
Do it incrementally? How about taking an income range above Medicaid and say they will be added in year 1.? Next level up, year two?
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zaj
(3,433 posts)It's called the Medicare Option, and it was part of Obamacare until nearly the end of negotiations.
Then the private providers have to compete with a nonprofit with size and scale.
kennetha
(3,666 posts)Isn't at all the same as medicare for All.
And moving from our current system to Single Payer Medicare for all will not be "very simple." It will be extraordinarily complicated.
zaj
(3,433 posts)They saw it as a pathway to Medicare For All. That's what the opening post asked for.
It's actually a simple pathway to the OPers stated goal.
Property Question
(17 posts)Simple. Make medicare the default and offer folks the option to buy health insurance.
ask the countries who did it How they did it!
homegirl
(1,427 posts)the health insurance industry. In return for nationwide Medicare for All we give them a more lucrative group to insure..
GUN OWNERS
Every gun must carry its own liability insurance--no package coverage permitted.
There are more than 350 MILLION guns in the country. How about a sliding scale based on magazine capacity?
Ohiogal
(31,924 posts)Allow Medicare buy-in starting at age 50. It’s a good start.
Laura PourMeADrink
(42,770 posts)It's probably the younger people with young children that probably need it more. Big duh.
If many are as ignorant as I was, they're in for a rude awakening. Medicare is by no means free, duh. My sister moved from a $750 per month private health care plan 2 Medicare and to get the same coverages she's paying about 450. Definitely, of course a savings, but still, there are plenty who can't afford even $450.
That said, it's a good incremental first step.
zipplewrath
(16,646 posts)Step 1: I would suggest that first we lower the age of medicare to about 60 or so. Also, put a prohibition on companies forcibly moving their employees off of the company insurance plans, onto medicare until they are 65. It could be arranged that employed people that ELECTED to switch, be able to do so on a "before tax basis" through their employers. (It'd be a bit like a FICA deduction).
Step Two: Probably about 2 - 5 years after that, allow "buy in" to medicare as an alternative form of employee health insurance for companies smaller than some target number (50, 20, 5, whatever). Self employed people would probably be all over this. You'll have a small issue having to do with "family plans" since there is no such thing in medicare (that I am aware but the system changes all the darn time).
Step Three: Establish a schedule for slowly lowering the eligibility age down to about 50 or so. It phases in over 5 years or so. Again, it will have to be discussed how and whether companies with existing health plans can "push" employees over to medicare. Some where in here we may want to "allow" this, but only if the company is paying some portion of the cost commensurate with the costs of their own plans.
Step Four: Pretty much "clean up". This is probably a good 10 - 15 years in, but it becomes time for medicare for "all". And this still won't be "all" because there will be Veterans care and Tri-care and all of that. Various municipalities may still be on some form of specific "private" insurance for their employees. Retirees that have access to union benefits or something may be some of the last to be phased out.
A big part of this process is so that the costs get picked up "correctly", in the sense that as companies are unburdened of the responsibility of providing health insurance, it doesn't just become another big windfall for their profit margins. It also allows a transition period for the entire health care and insurance markets. Such changes could have large benefits for hospitals and doctors and we're gonna want those savings to get to the market to control costs to medicare so as that it doesn't appear more expensive than it truly is. Union contracts also need time to be renegotiated. And health insurance companies are going to morph into medicare plan management services for the government.
Laura PourMeADrink
(42,770 posts)Your suggestion about lowering the Medicare age to 60, for example, that would be only for people without plans at work? Because you say they would be prohibited from moving people to it until they were 65?
Reading what you wrote makes me realize how incredibly detailed it will all be. I would hope, and suggest that people who devise potential plans can synthesize the incremental steps into a one liner phrase (with detail following). Doing this will sell it better and help people buy into the idea. We don't want to present so much detailed information at the start to turn people off
zipplewrath
(16,646 posts)The goal in step one is to start expanding medicare to the people that need it most, i.e. those that aren't under and existing group plan. And this age group has some of the higher insurance rates. It also will create the market information to establish what the "buy in" costs should be.
This will be a crucial feature of medicare expansion. The expansion will create efficiencies which, once realized, can reduce the costs of health care. That will make the costs of expansion lower. Furthermore, we need to slowly move the employed off in a process that also moves the funds for covering them from the employers into medicare. Otherwise, the employers will reap large windfalls. Properly staged, the employers will probably see lower costs as their employees are shifted off, and yet they will still be funding some portion of their employees health insurance coverage (medicare).
JayhawkSD
(3,163 posts)Just Do It.
"We choose to do these things not because they are easy, but because they are hard." And because they are the right thing to do. America used to be a nation that did the right thing even when it was hard to do. Even when it cost us a tax increase to do it. Even when it cost us the lives of our soldiers and the wealth of our treasury to do it. We did the right thing.
Now we will do the right thing only if it doesn't cost us any money. Only if it isn't "too disruptive." Only if we can get a tax cut at the same time.
Switch from a "for profit" system to universal health care? The question isn't whether we can or not. The question is whether or not we, as a nation, have the moral fiber to do it.
kennetha
(3,666 posts)It is not a question of "moral fiber." It's a question of diverse means to a common end. Unless you are just morally opposed to markets, there is no moral argument for saying that you shouldn't never ever try to achieve universality through any scheme that relies even partly on the market.
JayhawkSD
(3,163 posts)Nor is it the answer. It still leaves the provision of health care in the hands of "for profit" providers who can and will "game the system" for excessive profit and massive fraudulent cost to the government. It is still a "for profit" health care system.
Anyone advocating "Medicare for all" is, at best, advocating for half measures. At worst they are advocating for a continuance of the problem -- for a continuance of a "for profit" health care system that delivers more money to the providers than it does health care to the patients.
I am not "morally opposed to markets" in general, but I am morally opposed to allowing a consumer being forced into a for profit market where he can be fleeced because he is buying out of dire necessity, in a severe time crunch, and is buying a product which he is utterly unqualified to evaluate.
I would totally agree that "there is no moral argument for saying that you shouldn't never ever try to achieve universality through any scheme that relies even partly on the market."
Which is why "Medicare for all" is such an utterly corrupt concept. Medicare relies upon the market, and "for all" is a clear statement of universality.
Laura PourMeADrink
(42,770 posts)Medicare for more or all could be a stepping stone to universal or single pay coverage?
JayhawkSD
(3,163 posts)We are losing wars because we utilize "force protection" instead of having the willingness to take the casualties that are necessary in order to storm a position and defeat the enemy that holds the position.
You either do something or do not. When you halfway do something you incur losses without the gain that would be the product of actually doing it fully. You get the cost of doing it but not the benefit. There are three kinds of people who do that. People who are stupid, people who are morally weak, and people who are both.
Laura PourMeADrink
(42,770 posts)Through a commitment of incremental steps?
JayhawkSD
(3,163 posts)The public will settle for the half measure. Actually, the public is settling for half measures in advance.
Laura PourMeADrink
(42,770 posts)Single-payer healthcare is a type of universal healthcare[1] financed by taxes that covers the costs of essential healthcare for all residents, with costs covered by a single public system (hence 'single-payer').[2][3]
Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). "Single-payer" describes the mechanism by which healthcare is paid for by a single public authority, not the type of delivery or for whom physicians work, which may be public, private, or a mix of both.[4][5]
JayhawkSD
(3,163 posts)The clamor for "Medicare for all" rejects the idea that those who benefit should pay higher taxes for those benefits. They want to "tax the rich" or simply inflate the national debt to pay for the program.
Laura PourMeADrink
(42,770 posts)JayhawkSD
(3,163 posts)I didn't say I was opposed to paying taxes, I said that the general clamor was for that.
Laura PourMeADrink
(42,770 posts)we sell a couple states. I remember a long time ago, someone did a poll, If you had to sell one state, which one would it be. And New Jersey "won."
Sorry, I digressed there. Gotta be something in the budget we could reallocate. Like, I have always wondered why on earth do we need 1.3 million active military?
JayhawkSD
(3,163 posts)Of course, I think MMT is utter nonsense. Anyway, MMT ays that taxes are only necessary to reduce consumer spending in order to control inflation. That is, take people's money away so that they can't spend it, because if people are spending too much they bid against each other for goods and services and drive prices up.
You do that every time you buy gas, right? You drive in and shove the next guy away from the pump, telling the gas station you'll pay more for his gas than that guy will.
MMT also says that taxes are not needed to pay for whatever the government provides, because the government can just create the money to pay for it. It used to be thought that doing that would cause inflation, but no longer, as proved by the fact that we are creating money at the rate of $1.8 trillion per year ($1 trillion by the government and $0.8 trillion by the Federal Reserve) and we have no inflation.
Of course, people on fixed income think we have inflation, because they can't buy as much as they used to and are eating cat food, but economists tell us they are wrong.
Property Question
(17 posts)Laura PourMeADrink
(42,770 posts)Are saying "let's do it!"
We will be facing extreme head winds. Healthcare lobby, Republicans who don't give a s*** if someone can see a doctor or not.
Personally, I think we owe it to the public to have a solid plan to move forward. One that we can sell in the real world. One that will minimize negative impacts. I don't really think you can make such an enormous change by just willing it to happen.
JayhawkSD
(3,163 posts)We do not have to moral fiber to do the right things when they are hard.
Property Question
(17 posts)Well said.
Anything less is meaningless.
The "incremental" moderate approach never works. We need Democrats to FIGHT for OUR interests - not cave to the interests of the lobbyists and right wingers.
area51
(11,897 posts)Buzz cook
(2,471 posts)I'm surprised more people aren't aware of this.
One year after the bill is enacted people over 55 and under 19 will be enrolled in Medicare. One year later the rest of the population will be enrolled.
https://jayapal.house.gov/medicare-for-all/medicare-for-all-act-of-2019/
I just posted this in another thread. I've only read the summary, so if you want details the entire bill is there.
An interesting article about writing the bill.
https://theintercept.com/2019/02/27/medicare-for-all-bill-congress-pramila-jayapal/
marie999
(3,334 posts)There isn't a premium and copays are very small or 0 depending on your disability or income. Almost 1/3 of Americans are already on single payer healthcare such as Medicare, Medicaid, and VA. Medicare being the only one that needs a supplemental. I am 100% service-connected disabled and I have not paid anything since 1995.
franzwohlgemuth
(65 posts)Before 1973 it was illegal for hospitals to make a profit. Nixon and the GOP changed that. Since then, every other facet of healthcare stuck it's hand out. That is the cause of the situation.
To fix it, repeal every act/bill/law that allowed this, all the way back to pre-1973. Then let the dust settle. Not only will it save Americans money, the government won't have to spend enormous amounts of money, which it can use for SSI, SNAP... Getting the government involved is what started the mess.
Let us not forget the 10th amendment as well.
I'm ALL for making health care less expensive and easily available. But one cannot cure the issue without getting rid of the cause.
Laura PourMeADrink
(42,770 posts)napkin over martinis. The question back then was, " Ok guys, how can we make $ off of something the world needs?
franzwohlgemuth
(65 posts)What is needed to fix it is to reverse it. And BOTH sides of the aisle are guilty. If they ACTUALLY wanted to fix the healthcare system here, it would have been done already.
