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There is an instinct among political pundits to confuse caution for practicality — an assumption that those who advocate for incremental change are being reasonable, while those pushing for bold reforms aren’t. This is seen most starkly in the debate around health care reform, despite the fact that the “practical” pushers of limited reform fail to address the real problems in our health care system.
We all recognize that the status quo isn’t working. We spend more per person than any other country on health care, but we aren’t getting any bang for our buck. We have lower life expectancy, higher infant mortality rates and more preventable deaths, and too many personal bankruptcies are due at least in part to medical bills.
[...]Time to get real. As an economist who has spent decades studying our health care system, I can tell you that Medicare for All advocates are the only ones who are being reasonable, because theirs is the only plan that will control health care costs while finally achieving universal coverage.
The problem with incremental plans, whether they are public options, buy-ins to Medicare or Medicaid, or pumping more money into subsidies in the Affordable Care Act's individual marketplace, is that they preserve the private health insurance system weighing down our health care. [...]they are leaving the main reason for our system’s dysfunction in place: the multipayer, for-profit financing model.
Commercial insurance companies are nothing more than middle men. They add no value to our system, but they do drive up costs with their bloated claims departments, marketing and advertising budgets and executive salaries. We pay for all of these things before a single dollar is spent on the delivery of care.
They also create extra costs for providers who need large administrative staffs to deal with billing systems, accounting for as much as $100,000 per physician.
Any plans short of Medicare for All leaves these costs in place. In other words, they leave hundreds of billions of dollars a year in savings on the table.
[...]Gerald Friedman, a health care and labor economist, is an economics professor at University of Massachusetts Amherst and the director of The Hopbrook Institute.
[Related]:
Democrats' promise of Medicare for All is remarkably misguided and unrealistic
Trump wants to drop a neutron bomb on Obamacare. Over to you, 2020 voters.
Take it from me, tweaks won't fix health care. Dems should focus on Medicare for All.
(Score: 5, Insightful) by bradley13 on Tuesday April 09 2019, @01:19PM (64 children)
I am basically a libertarian. Nonetheless, as screwed up as Obamacare is, well, right now, the US has the worst aspects of a socialist system combined with the worst aspects of a free market system. Massive government over-regulation combined with corporate cronyism and regulatory capture.
Moving all the way to Medicare-for-all probably would be an improvement.
In the long term, however, government systems are subject to Pournelle's Iron Law, and there is never any incentive to prune the bureaucracy back. Just like the NHS, you will have healthcare rationing, dictated by faceless bureaucrats. Just like the NHS, you will have months-long waiting lists for treatments. Just like the NHS, half of the people employed in the health care system will be administrators.
I'm not so sure this is the system you want long-term. A better solution would be to remove almost all of the regulations, and return to a free-market system. That would massively reduce costs to insured people. Let people choose to be uninsured. For people with catastrophic pre-existing conditions, let the government be the insurer of last resort: a mini Medicare-for-all, with all the rationing and inefficiency that will inevitably bring, but at least on a much smaller scale.
Everyone is somebody else's weirdo.
(Score: 4, Insightful) by TheFool on Tuesday April 09 2019, @01:33PM (14 children)
I won't comment on whether this is a good idea or not, but I that you're right in this case. It will never be pruned back, and if you have essentially guaranteed money being shoved in your face, you will naturally try to soak up every last penny of it. There's no incentive on the hospitals, doctors, or the rest of the medical industry to keep costs under control. Private insurance providing that money is the reason we're in the situation we are in today, and the government providing it won't really fix the waste problem (though it may fix other problems).
I disagree with this, though. Again, you (the "profit seeking hospital/doctor/medical industry" you) charge exactly as much as the market will bear. When we're talking about "how much will this guy pay to keep his life", that number tends to inflate quite a bit beyond what it actually costs for the treatment.
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @01:51PM (13 children)
This is an education problem. People need to start seeing the healthcare industry's propaganda for what it is and start paying attention to all the costs, risks, and tradeoffs they want you to ignore. They want you to think it is like magic that "just works".
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @02:11PM (12 children)
Seeing is nice, but if you have no choice…
(Score: 2, Interesting) by Anonymous Coward on Tuesday April 09 2019, @02:17PM (11 children)
I would rather let my body deal with 99% of health issues on its own rather than risk someone with rudimentary understanding messing around with it. Many people think this same way, which why "natural" cures that mostly do nothing are such a big thing. Doing nothing is often better than letting someone who doesn't know what they are doing try to help.
Just look at what they've been doing to cancer patients. They poison them until they can barely eat and then caloric restriction slows/stops the cancer growth. Why not just tell them to eat less? Oh, because then you couldn't charge $10k per day.
(Score: 5, Insightful) by Snow on Tuesday April 09 2019, @04:06PM (10 children)
Once upon a time, there was a rich asshole named Steve Jobs. He was so rich that he could buy stainless steel mega-yachts and things like that, but was also such an asshole that he refused to help support his own daughter.
One day, this asshole got cancer. He was sooo smart that instead of getting proper medical treatment (that he could have easily afforded) he decided to pursue 'alternative treatments' like having his ass filled with various liquids, 'healings', and naturopathic remedies.
Then one day he died because all those 'alternative treatments' were bullshit.
And the world was a better place.
The end.
(Score: 0, Touché) by Anonymous Coward on Tuesday April 09 2019, @04:26PM (8 children)
What basis do you have for saying he would have been better off with the non-"alternative" treatments?
(Score: 4, Informative) by Anonymous Coward on Tuesday April 09 2019, @05:38PM (6 children)
It's called "science." And it works, you sniveling little bitch!
(Score: 0, Disagree) by Anonymous Coward on Tuesday April 09 2019, @06:33PM (4 children)
I'm sure you think it is science, but if you link to an example you will find NHST (fake science). So please do link to what you think is science.
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @07:02PM (1 child)
You first, you whiny little bitch.
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @08:43PM
No link.
(Score: 2, Funny) by Anonymous Coward on Tuesday April 09 2019, @07:24PM (1 child)
Oh yeah!
You tell 'em, Tiger!
"Science" is complete bullshit! Nothing good ever came from that steaming pile of crap!
God provides all we need and all we ever will need. That's why he created us -- so he could take care of us, because he loves each and every one of us.
We don't need any fucking science, because it's all a load of crap! amirite?
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @08:46PM
No link plus a gratuitous strawman (fitting to defend NHST with more strawman fallacies)
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @10:18PM
Among sciences there is one called statistics. It says that if the official effectiveness of cures is rated best for 'scientific' treatments, then such a fact must be reflected OFTEN in your own anecdotal experience. So if you form an opinion based on impossible to fudge direct experience, while this opinion is NOT necessarily correct for one guy, it will be correct enough on average.
(Score: 2) by ElizabethGreene on Wednesday April 10 2019, @08:27PM
There is no scientific basis. There is a possibility that the 9 month delay in initiating treatment allowed the to expand beyond the confines of the organ. If that was the case then that significantly effected his survival probability. For surgical treatment of that type of tumor contained in the organ there is an 87% five year survival rate. Once it escapes those drop precipitously to a median survival of 27 months.
Unless his family chooses to release his medical records that will remain a known unknown. It's a slow growing tumor, so it's quite possible that the cat was already out of the bag. If it were contained I feel like he was a pretty smart guy and would have taken the 87% shot at surgery. I could be wrong.
(Score: 3, Interesting) by Gaaark on Tuesday April 09 2019, @05:42PM
Yep!
As I said before, "How's the collection of ALL those Billions of dollars going for you NOW Stevie!"
Hurt people like crazy to the point they'd be glad to see you die (like Billy Bob Gates) but Hey! You're the richest guy in the Funiverse!
And still, no one gives a shit about you.
Whats. the. point?
--- Please remind me if I haven't been civil to you: I'm channeling MDC. I have always been here. ---Gaaark 2.0 --
(Score: 2, Disagree) by takyon on Tuesday April 09 2019, @01:39PM (4 children)
The health care woes will be solved by technology, or not at all.
If we can cure most diseases and indefinitely prevent most aging-related conditions (organ failure, stroke, Alzheimer's, arthritis, etc.) then hospital visits, end-of-life care, and health care costs will drop.
[SIG] 10/28/2017: Soylent Upgrade v14 [soylentnews.org]
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @03:30PM (1 child)
No, they'll be solved by preventative care. Most of the health problems in the country can be traced back to things that could be prevented with healthy diet, exercise and stress management.
Yes, the is technology involved with the rest, but the bulk of the spending is on preventable illness and overhead.
At a certain point, people just due and no amount of technology will solve that.
(Score: 2) by takyon on Tuesday April 09 2019, @04:40PM
What I'm talking about is preventative medicine.
A good diet, exercise, no smoking, etc. can stave off health problems, but these things don't stop aging completely. So eventually you have to deal with expensive health problems.
We need drugs or nanobots capable of stopping aging and repairing aging damage.
[SIG] 10/28/2017: Soylent Upgrade v14 [soylentnews.org]
(Score: 2) by DutchUncle on Tuesday April 09 2019, @05:08PM (1 child)
And in the meantime? "If we can cure ... and prevent ..." is a big "if", and it doesn't apply anytime soon.
(Score: 2) by takyon on Tuesday April 09 2019, @05:26PM
The dead don't complain :)
[SIG] 10/28/2017: Soylent Upgrade v14 [soylentnews.org]
(Score: 5, Informative) by Anonymous Coward on Tuesday April 09 2019, @01:41PM (1 child)
The problem with believing fantasy is that it's not reality.
The Budget-Minimizing Bureaucrat? Empirical Evidence from the Senior Executive Service [jstor.org]
Free market ideology doesn’t work for health care [publicintegrity.org]
(Score: -1, Troll) by khallow on Tuesday April 09 2019, @01:54PM
Your links are great examples of that. Not really sure why that's supposed to be relevant to the topic at hand though. In the first link, the conclusion is:
Which is irrelevant. Just because a bureaucrat might prefer (assuming the researcher measured in a viable way that preference) something in an intellectual sense doesn't mean that's what they'll do when presented with a real world opportunity rather than a survey or similar device that doesn't cost their departments anything.
The second is just silly. The author offers absolutely no supporting evidence for his assertion of the title. Instead, it's a giant argument from tradition - nobody does free market health care thus it must be a bad idea.
(Score: 5, Informative) by Azuma Hazuki on Tuesday April 09 2019, @01:48PM (12 children)
Bradley, the reason removing regulations and letting "the free market" solve the problem won't work is that healthcare is not a free market.
You are familiar with the term "elasticity of demand?" Demand for healthcare is remarkably inelastic; people still get sick whether an aspirin is pennies or dollars. All you're doing by letting "the free market" have control is allowing corporate entities to, very literally, hold people hostage in "your money or your life!" situations. In fact, without proper regulation, we'll be back in the days of radium toothpaste and heroin syrup for babies; it'll be "your money AND your life, sucker! Whaddaya gonna do about it?!"
And that completely ignores the knock-on effects of a sick population. Healthy people are more productive, less likely to riot, cost emergency services less, and do better work. By ensuring healthcare, the benefits to be reaped extend far beyond simple first-order effects on the balance sheet.
"Free market" principles simply do not work when demand is this inelastic, constant, and growing, and you'd need to be either blindingly stupid or outright evil not to understand that after it's been explained to you. No more of that, okay? You're better than that.
I am "that girl" your mother warned you about...
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @01:56PM
Which is why scammers perennially run amok.
(Score: 1, Disagree) by khallow on Tuesday April 09 2019, @01:57PM (4 children)
But they will buy and use less aspirin as a result, if it's more expensive. But I suppose that would imply that health care is less remarkably inelastic than you assert.
I suppose we should have "proper regulation" then. Sigh.
One could use that babble to support the present system just with more vaccinations.
And once again, someone just asserts that "X doesn't work!" without actually trying X.
(Score: 5, Insightful) by DeathMonkey on Tuesday April 09 2019, @05:03PM (1 child)
Those regulations weren't formed by the Big Bang. We tried the full Free Market and started creating regulations because it kept killing people.
What we HAVEN'T tried here is the proven solution of socialized medicine.
(Score: 1, Touché) by Anonymous Coward on Tuesday April 09 2019, @05:15PM
Nono, THIS time we have Trump who will cut through the deep state that loves regatory capture and we will all be blessed with affordabke care. Oh wait, this came from khallow who doesn't see anything wrong with massive wealth inequality?
Woops.
(Score: 4, Insightful) by Azuma Hazuki on Tuesday April 09 2019, @06:53PM
You don't know your history very well, do you? Go research the era of patent medicines and radium in the toothpaste and privately-run asylums. That is, at BEST, what your approach would return us to.
Look, I get it, you are a slave to your ideology and nothing as silly as reality or history or facts or evidence is going to get in your way. Fair enough. Just don't expect me to humor you when you start pissing in the meme pool.
I am "that girl" your mother warned you about...
(Score: 3, Insightful) by aristarchus on Tuesday April 09 2019, @08:00PM
The Obvious Rebuttal is, khallow just posted in response. Wait a minute!
(Score: 5, Insightful) by bradley13 on Tuesday April 09 2019, @02:08PM (2 children)
To an extent, I agree. If I break a bone, it's got to be fixed, and I'll obviously pay what it takes to fix it. So, yes, some demand is inelastic. However, other things are more flexible. Do I want a check-up this year? Should I go to the doctor with this pain in my shoulder?
In my perhaps naive view of the world, if there were a true selection of different clinics to visit, I would choose the one that took care of both the optional and the not-so-optional things. When I break my leg, if the clinic screws me on the price, I'll go somewhere else with the rest of my business. In order for this to work, people need to care about the direct costs of their ordinary health care, which means that they need to pay those costs directly. Not through intermediate organizations that add no value, but do add lots of overhead.
Health insurance should only be relevant for life-changing catastrophic care - and should be accordingly cheap, because most people do not have catastrophic health problems. Here, too, if there were genuine competition (ensuring competition is a proper role for government), then people could also comparison shop. Look for the health insurance that provides the level of care you want, for the price you want to pay.
This can work. For example: when I first moved abroad (from the US to Switzerland), I was completely free of US regulations, and at the time Switzerland had minimal regulation. I found and used an insurance company in England - good service, inexpensive rates, it was great. Then Switzerland joined the ranks of countries heading towards socialized medicine. Suddenly, insurance was required, had to provide exactly the government defined benefits, was not allowed to turn anyone away...sound familiar?. Oh, and regulatory capture at work: I was no longer allowed to use a foreign company. The net result? My costs instantly doubled, and have gone up substantially every year since. In inflation-adjusted terms, I'm now paying at least 3 times as much as before.
Where I am admittedly naive: It seems to me that taking care of your health is an individual responsibility. But what do you do about people who don't? Someone doesn't bother to get insurance, gets horribly sick, and...do you just let them die on the street? Cold-bloodedly, yes, it's their own fault. However, people aren't that cold-blooded, and that scenario is the basis of the desire for big-brother, socialized medicine.
Everyone is somebody else's weirdo.
(Score: 4, Interesting) by slinches on Tuesday April 09 2019, @06:11PM
While I tend to agree that letting the market work by minimizing regulation will help reduce costs in the long term, that only works when there is competition. And competition only works when customers have ready access to the information needed to make comparisons and the time to make them. Currently, the health care system pricing is so opaque that it is impossible to comparison shop, even for non-emergency care. To fix that, some regulation may be necessary to ensure that prices are listed publicly up front and ensure they are fixed independent of who is paying. Doing that would also establish a market price reference to detect when health care providers are gouging people for emergency care when the time and capability to make an informed decision on care is limited or the care provider is making the choice for the patient.
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @08:03PM
In other words, you used to be one of those free-loading unbroken leg types? Oh, the shame, bradley13! American tend to bring America with them, no matter where they go.
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @03:08PM (2 children)
Maybe a solution would be to have a system where if you go to a doctor/hospital that costs less than average, you get the difference between the real cost and the average yourself.
Yes, short term that will increase the insurance cost, but it gives a big incentive to people to chose a cheaper doctor/hospital, and in return a big incentive to doctors/hospitals to get cheaper. All the while keeping your freedom to choose a more expensive doctor/hospital when you think you get a better treatment there.
(Score: 0, Insightful) by Anonymous Coward on Tuesday April 09 2019, @08:30PM (1 child)
People will get injured/sick intentionally so that they can turn a profit.
(Score: 0) by Anonymous Coward on Wednesday April 10 2019, @11:27AM
You are too uncritical of human nature. Assholes will deliberately make their partners and kids and elderly relatives sick or injured, then take them to the really low cost shyster and pocket the profits.
(Score: 5, Insightful) by fadrian on Tuesday April 09 2019, @01:50PM
You will have healthcare rationing, dictated by faceless bureaucrats.
Sort of like those limitations put on policies by the insurance company's faceless bureaucracy.
You will have months-long waiting lists for treatments.
As opposed to the months-long struggle to get approval from my primary care physician to see a specialist as he works through every alternate pathway dictated by the insurance company before I can see one, followed by a month or two waiting for the specialist to have an open slot, followed by another month or two to wrangle approval from the insurance company for the treatment, followed by a week or two of waiting to get an OR or for the couple days per month the specialist actually does his treatments. People who don't think there's a wait for most treatments here haven't had many treatments here.
Half of the people employed in the health care system will be administrators.
Hmm. Sort of like the private insurance industry where most of their employees are claim administrators.
So far I'm not seeing a lot of difference, except insurance costs another 15% or so off the top.
That is all.
(Score: 5, Insightful) by SemperOSS on Tuesday April 09 2019, @01:54PM (6 children)
The problem with a free market system is that it seems to always work best for the well-off and not at all for the poorest people. Modern day capitalism (i.e. free market systems) has shown that many of the assumptions about it are wrong. Free market forces require perfect competition to work, i.e. factors like perfect information and homogenous products. Perfect information is at best a Fata Morgana where services like price comparison sites pretend to give you an almost full picture, only they are not. Similarly, many products may be fairly homogenous (an iPhone and a Samsung phone are, after all, almost identical in functionality) but due to design choices, patents and similar intellectual monopolies, there are sufficient differences that people have preferences.
Another problem with free market systems is the presumption that increased wealth among the rich leads to increased living standards for the not-so-rich. There has been a long period, starting with the industrial revolution where the living standards grew better and better — something that is no longer true in most developed countries as research project after research project has shown. Reducing the taxing of the rich does not make the poor better off and the increase in automatising industrial production does not increase wealth or living conditions for the anyone but the wealthy. Similarly, it can be very hard to see how any privatised health system can avoid increasing their profits to the investors at the cost of the users. In fact, ugly as it is, the biggest problem with public health systems, like the NHS in the UK, is not that private companies can do it cheaper and better (they can't, which has been shown time and again in the UK with privatisation in health care and the railways) but rather that public systems inherently are political, which means that they are often changed for the sake of change (look, I'm the new Minister of Health, see how much better I can make it by reorganising the system ... again) and because they are not managing it properly really.
I could get into more detail, but this is probably already too long.
Open Source Solutions and Digital Sovereignty is the new black
(Score: 1, Troll) by khallow on Tuesday April 09 2019, @02:13PM (4 children)
The problem with a free market system is that it stops working well when you break it. And the more you break it, the worse it gets. Nothing else is like that. Right?
Almost free markets don't require that. Perfect is the enemy of the good enough.
It's not much of a problem really since the presumption isn't relevant to the free market system. Surely, you could come with serious problems.
So... we could go back to the things that worked in the Industrial Revolution for improving living standards like fewer burdens on job creation and avoid some of things that aren't working now like vast entitlement schemes? Am I getting that right?
Such things as a) greater internal efficiency, and b) offering vastly better services to the users. But then again, one doesn't need increasing profits in order to have profits. Privatization works even when a service merely provides more value than it consumes.
So... public system can be run better than private ones, but they won't because of the new Minister of Health. I think you're hitting some of the highlights of the pro-free market side in that quote.
(Score: 3, Informative) by NewNic on Tuesday April 09 2019, @05:46PM (3 children)
The "Free market" brought us Insulin that costs many diabetes sufferers thousands of dollars per month.
lib·er·tar·i·an·ism ˌlibərˈterēənizəm/ noun: Magical thinking that useful idiots mistake for serious political theory
(Score: 1) by khallow on Tuesday April 09 2019, @06:29PM (2 children)
Good thing you used scare quotes there. Someone might have otherwise thought you were speaking of an actual free market. Remember my first sentence about breaking free markets? This is the sort of thing you get when you do that.
(Score: 3, Insightful) by NewNic on Tuesday April 09 2019, @07:09PM (1 child)
So tell us how to fix the non-true Scotsman's "Free Market".
lib·er·tar·i·an·ism ˌlibərˈterēənizəm/ noun: Magical thinking that useful idiots mistake for serious political theory
(Score: 1) by khallow on Tuesday April 09 2019, @10:46PM
(Score: 2) by aristarchus on Tuesday April 09 2019, @08:17PM
Historically, in medicine, this was not true. The wealthy, who could afford the tender mercies of a "physician or barber" tended to die at greater rates than the poor, who from necessity did without. Only the development of evidence-based medicine has turned this around. But it has no relation to the free market. Back in the day when you paid for things like "the famous Bilious Pills of Benjamin Rush." [lewis-clark.org], active ingredient:Calomel (mercurous chloride), or Laudanum (a tincture of opium), you were not so much being treated as poisoned, and counted yourself luck to survive.
(Score: 2) by DannyB on Tuesday April 09 2019, @02:36PM (5 children)
We already know the problem with that. Those people go to the ER. All of us paying out of pocket and/or with private insurance end up bearing the cost of the uninsured. So why not make them get insured?
Or to you propose that the ER simply lets them die in the street? Oh, sorry, you cannot come into the ER without the ability to pay.
If your boy is chewing on electrical cords, then ground him until he conducts himself properly.
(Score: 5, Insightful) by fyngyrz on Tuesday April 09 2019, @03:16PM (3 children)
The underlying assumption in that question is that individual "them" can afford to get insured.
The massively unequal wealth distribution in the USA undermines that assumption to the point of total destruction.
I know two people who have unrevised hernias because the costs of fixing same are unmanageable. I know one guy who is nearly blind in one eye and can't afford the surgery to get that fixed either. I know a lady who got breast cancer, went ahead and got treatment for it, and then was forced into bankruptcy because, of course, the costs were far too high for her to bear. Before she hooked up with me, my SO had to choose between medical care for herself, or feeding her children. You can guess how that went.
The individual pay-to-play medical care system is broken if the goal is actually to take care of people (it isn't... it's to make a profit.) The only way to fix it is to (1) make the goal a healthy nation and (2) for the government, through taxation, to assume the costs — as an inherent requirement of a properly functional nation that sees to it that its citizens are healthy... and educated, etc.
We definitely should take care of everyone as needed and bear the costs nationally. This is the best approach because age, disease and accident are no respecters whatsoever of a person's financial state, except in that people with fewer resources may be under greater stress, living in poorer environments, eating more poorly, etc... and so in more need, rather than less.
And all of that is without even addressing the massive amounts of entirely non-medically related skimming being done by insurance companies, who incorporate the actual "death panels" that refuse care to the insured (and the virtual death panel that creates a care deficit for those who cannot afford care under the current system.)
--
Pollen: when flowers can't keep it in their plants.
(Score: 2) by DannyB on Tuesday April 09 2019, @03:42PM (2 children)
I agree. If a person's financial state causes health problems, then either the rich pay for their increased health care, or they have incentive to lift those people's economic status.
But (some) rich people consider themselves to be better than everyone else. They are made of something actually better than what we are made of. They (at least some) believe it is the breeding of their superior stuff rather than nurture.
If your boy is chewing on electrical cords, then ground him until he conducts himself properly.
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @04:17PM (1 child)
FTFY
(Score: -1, Troll) by Anonymous Coward on Tuesday April 09 2019, @08:40PM
FTFY
(Score: 1, Insightful) by Anonymous Coward on Tuesday April 09 2019, @03:23PM
Your taxes have already been paying for this. It has been going on for decades and is a rounding error. Start thinking quantitatively, almost no healthcare cost is attributable to ER care.
(Score: 5, Insightful) by ledow on Tuesday April 09 2019, @02:43PM
I'm going to assume you're in the US.
The problem you have is the target audience. Put aside prejudices, potential abuse of the systems, outright fraud, etc. - that can all be countered by implementing proper controls. Why anyone would want a national system without proper controls, I can't fathom.
However:
You want some people - those *most genuinely unable to work* - to pay more. Maybe even people who were *never* able to work, to pay from the day they were born.
That's like charging the stupid more for their education. It sounds really great in theory, but just results in a massive polarisation of service - the stupid get poorer and therefore (because they can't afford to pay for education) stupider. The rich get richer and smarter because they can get even more education for even less proportion of their income.
You have a choice in both systems - polarisation (make the sick sicker, the poor poorer, the stupid stupider) or levelling (make the sick healthier, the poor less poor, the stupid less stupid).
Everything else you mention is an implementation detail. Sure, you have to assume that the implementation will be abused... that's an *entirely* different problem, no different to how every government contract for IT costs 10 times what is actually deployed to make it work. But putting such blanket "costs" aside, you have to decide what kind of system you want.
And I guarantee you that if you're healthy, you won't want to pay for healthcare. If you're rich, you won't want to have to support the poor. But the exception is: If you're intelligent, you should recognise that you have to support the stupid.
It's a humanitarian issue. It's an idealism issue. It's a prejudice issue (the same way that every policy gets lumps into a small set of boxes - "socialist" or whatever. It's just creating obstacles to play on people's prejudices and equate a national healthcare system with a dictatorial "communist" regime, in essence).
I honestly query the thought process of a human so selfish that they say "Well, I'm healthy, I don't see why I should pay a penny for this kid that was born with a debilitating condition through no fault of their own, they should pay for themselves!". We're not asking you to take them into your homes, wipe their backside, and pay all your pay packet to them. We're asking *everyone* to pay a blanket cost, which covers all instances, including the most extreme, and which you yourself would be eligible to benefit from in their circumstances.
If you won't implement healthcare because "it might be abused at some point", you're literally never going to do it.
If you won't implement healthcare because "I don't need it", you're selfish, verging on the inhumane.
If you won't implement healthcare because "it'll get taken over by the management costs that everything suffers", then implement controls. On everything.
You can badmouth the NHS all you like too... dictated by faceless bureaucrats or not, I have *never* had to worry what happens to me/my family if we're injured. I've never had to consider whether I can afford to be off work sick. I've never had to consider not getting treated because I just don't have the cover. I've never had to consider that I will die before I get treated. I can walk into a hospital, display my condition, and be put into a queue proportionate to my condition's urgency. Sure, it might be a month before I get my hip operation, but if I *want to* I can pay to have it done now. But I don't have to. If I don't have a penny to my name, a single asset, or any credit whatsoever... I still get the operation before it gets too serious.
There is no "rationing", there are controls. Spending billions on a cancer drug that only ten people can benefit from is stupid. There is a cost to human life and that's far beyond sensible. Especially when those billions means everyone else gets their operations a month early, or we improve outcomes for hundreds or thousands of people by even a few percent.
You have to consider - even in the most heartless outlook - the people you're saving are taxpayers. While they aren't able to work, while they are dying early, while their productivity suffers because they can't afford to go to the doctor's... they are costing you money. The longer you can get them to live, the more tax in the long-run. The more they can support their families, the less families end up on social benefits. The healthier they stay, the more productivity and years of useful work they can do. The easier their lives, the more they will make and spend.
At the moment, the US spend around 6 percent of all their household's expenditures on healthcare insurance. That's a 6% "tax", over and above stated taxes, emergency care, etc. on your health and well-being, going to private industry, which has reasons to be as profit-making as it can. We pay less than half of what the US does, taxation-wise, on healthcare and still fund the NHS. For half the price, we get a service that treats everyone.
So, by scrapping health insurance, removing the profit-portion of it entirely, you could spend MORE THAN TWICE what we do on some national health service without affecting a single household that's already paying healthcare (pretty much all of them).
There are many things in which you don't want to just be throwing money at the problem and having blanket coverage. Healthcare isn't one of them. Education is another one, very similar. Both allow "private" care to be greater for those willing to pay, while providing a basic coverage to those who cannot even afford a penny. Sure, I wouldn't want to be paying a tax that, say, supported people driving gas-guzzling cars, or similar. But education and healthcare - you spend money there to ensure you spend much less in the future.
You're "mini-medicare for all" is an NHS, and with the costs you currently pour into basic healthcare, it could be better than your current top-of-the-line healthcare. You just need to vote for it. Those billionaires who want to pay a quack to give them a pill shouldn't even figure in your plans. You have to think of the guy who broke his legs working overtime trying to earn an extra wage to pay for his kid after his wife died... You can't just keep screwing him over in perpetuity and then looking down on him because he couldn't afford insurance, when you're already paying something that would cover everyone in the country to the standards of the NHS, twice over.
(Score: 2) by Tokolosh on Tuesday April 09 2019, @02:49PM (1 child)
To reap the benefits of Medicare for all, the middlemen, administrators, bureaucrats, hangers-on and associated staff will have to go, together with their offices and parking spaces. Total US health care employment is 13 million, excluding self-employed. That is literally millions of people out of a job, not counting their associated daycare providers, home builders, plumbers, bankers, etc. According to the March 2019 Bureau of Labor Statistics (https://www.bls.gov/web/empsit/ceshighlights.pdf) the US added nearly 400,000 health care jobs in the last 12 months. To reverse this trend and reach our goal will meet infinite resistance from entrenched incumbents protecting their turf.
We are doomed.
Costs (and prices) will not come down until each individual consumer of healthcare is strongly incentivized and empowered to drive them down. This will happen when they pay out of their own pockets, have transparency in prices, competition and the ability to take their business elsewhere. Currently, we have the opposite - someone else pays, you have no idea what the cost will be, and there is no competition. All of these problems are enabled or created by the government.
(Score: 2, Insightful) by Anonymous Coward on Tuesday April 09 2019, @04:05PM
There would be a reduction there, but there would also be a massive increase in productivity as a result of not having so many people being sick.
This whole lost jobs thing is a terrible basis for making decisions. There are ways around that, the most sensible being to go back to reducing the workweek like we used to do. The current 40 hour work week used to be a lot longer and cover more days of the week. But, back during a period of time where we weren't allowing the rich to buy politicians, there were measures that were put into place that made it expensive to employ people for more than 40 hours a week at the same company. We're now having people work multiple jobs to get over that limit because companies are againt buying politicians and not paying what work is worth.
There's also an awful lot of work that needs doing, that isn't currently being done. Things like fixing our embarrassing infrastructure.
(Score: 5, Informative) by Whoever on Tuesday April 09 2019, @03:35PM (1 child)
In my personal experience and that of my extended family, the NHS provides better care than you are likely to get in the USA. Doctors in the NHS have an incentive to actually cure you, unlike the USA, where your medical problem can be an ongoing source of income to a doctor/surgeon.
Yes, there is rationing in the NHS, but not for medical issues that need immediate treatment. A lot of what you think you know about the NHS comes from right-wing think tanks with an agenda to prevent actual solutions to the crisis that the USA is in right now.
(Score: 1, Informative) by Anonymous Coward on Tuesday April 09 2019, @07:31PM
There's rationing in the US, too, where people who don't have enough money can't get care and simply die of preventable medical issues. Tens of thousands every year, in fact.
And you have to love those private death panels, where insurance companies fight tooth and nail to avoid covering life-saving medical care in order to save money! Even better, before the ACA, insurance companies would deny people with preexisting conditions left and right! Nonexistent government death panels have nothing on the private ones.
But, of course, it's single payer that's the real problem.
(Score: 0) by Anonymous Coward on Tuesday April 09 2019, @03:59PM
I have Kaiser because as a self-employed person, it's all I can afford. I scheduled a test that should be done at my age (colonscopy) in December. The My appointment is in May. Not only do I get the worst of NHS, I pay through the fucking nose for it and when the test is done, I'll probably end up paying out of pocket for the most part anyway. It's like I'm spending $1400/mo (me and wife, cheapest there is) to get absolutely nothing at all.
(Score: 3, Interesting) by istartedi on Tuesday April 09 2019, @06:44PM (1 child)
I don't think Medicare for all or a short term laissez-faire period is the answer. The first would be long term problematic as parent describes, the 2nd would be a short-term disaster with potentially long term consequences.
I prefer to let the free market do what it does well, and government do do what it does well.
The government does a good job of providing simple, mass-produced baseline services. For example, rabies. Have you heard much about rabies in the USA? No. It's because this is handled by government institutions such as local animal control. It's a testament to the fact that the USA *can* do public health well under certain circumstances. Ditto for checking children in schools for things like scoliosis.
Extend routine care to adults via local institutions--everybody queue up periodically at a local college for free check-ups. The government is really good at doing things like that, probably because it's how Army induction works.
Routine care can and should be free at point of service, and often government provided.
Now, what does the free market do well? It sets fair prices, and we're suffering because the market is totally not free right now. It's captured by cronies, and regulated in ways that impede the market from functioning. Restore the free market by:
1. Requiring all providers to make prices public, and charge the same price to all payers, both public and private.
2. Require all insurers to reimburse for all providers--no more networks. Provider networks are like a divide and conquer strategy that destroys the free market. Along the same line, cross-state insurance providers.
Some of these market restoration ideas are already out there, but they just haven't been well implemented.
Finally, progressive taxation and payment, and a more easily administrated tax. Rather than the subsidy based on projected income, we should only base government assistance on income earned in the *past* year or quarter. In general, estimated tax payments of all kinds need to be abolished because they impose a burden of prognostication on tax payers, which is absolute rubbish.
It would work like this: Medical bills for the quarter are due to be paid two weeks after the quarter. Pay the bills to the best of your ability. At the end of the quarter, tally up what you've paid and if it's more than some fixed percentage of your income (let's say 10%), then apply to have the rest reimbursed by the government.
This would automatically mean that high income earners would usually pay most of their bills, and that low income earners would be heavily subsidized. The rate is flat, but the effect is mostly progressive taxation.
Yes, the private insurance market would mostly go away, perhaps continuing to offer some Cadillac features such as access to top doctors; but it'd be a far cry from what it is now. Good riddance.
Appended to the end of comments you post. Max: 120 chars.
(Score: 0) by Anonymous Coward on Thursday April 11 2019, @10:27AM
These two points alone would be an excellent start. Shame that they will never be accepted because there are too many entrenched players getting rich off the current system, who would lose money under your reforms.
(Score: 1, Insightful) by Anonymous Coward on Tuesday April 09 2019, @07:26PM
First, show me an example of such a system actually working.
(Score: 3, Insightful) by sjames on Tuesday April 09 2019, @08:03PM (3 children)
There are always dangers of administrative bloat whenever you have a bureaucracy. It can be pruned, but too often isn't.
But as for rationing, that is already a feature of our healthcare system, we just call it something else. Most call it "I can't afford to go to the doctor" or "these prescription co-pays are killing me!". Unfortunately, those statements are too often followed by "Call 911!" and often eventually "does anyone know a good funeral home?" or "how do you file for bankruptcy?". Make no mistake, that *IS* rationing. In fact it is rationing with a particularly poor criterion.
Have plenty of money, get cutting edge antibiotics for a cold, no money, wait for the STEMI rather than treating 98% coronary blockage.
The current insurance scheme is just an expensive way to push responsibility for the poor rationing decision to nameless and faceless administrators who are exceedingly unlikely to ever face any consequences.
Don't fool yourself into thinking we can EVER have a free-market system. In order to actually achieve that, we would have to eliminate prescription laws entirely, do away with patents, and make both FDA approval and medical licensing advisory at most.
As for any sort of ideological purity, it is primarily the "free market advocates" that have forbidden medicare from negotiating drug prices on the free market and even disallowed individuals from buying drugs on the free market from other countries or suppliers that might be violating a dubious patent. That would have to go too.
(Score: 3, Insightful) by slinches on Tuesday April 09 2019, @08:34PM (2 children)
You're confusing an unregulated market with a free one. Free markets require some regulation to ensure that information asymmetry is minimized and to allow investment in new technology to be profitable. The problem with health care currently is that there is no price competition. We need to make prices transparent and the same no matter who is paying. That way we can regulate the price when there is a monopoly (e.g. patented drugs/tech and emergency medicine) relative to the market prices for non-emergency procedures and generic prescriptions. That would allow us to set a fair price to ensure maximum affordability while still rewarding research and development investments.
(Score: 3, Insightful) by sjames on Tuesday April 09 2019, @09:51PM (1 child)
These days, "free market" is generally code for "unregulated market". What you're talking about is just called a market.
Many aspects of healthcare will never have price competition. Can you even imagine someone having a heart attack doing a quick price check for ambulance service and trying to decide if the extra 15 minutes to get to hospital B will be too long (and of course, the ambulance will take you to the closet, no choice offered)? Too many drugs have one and only one supplier due to patents and FDA grants. Even many generics have only one source due to FDA approvals and companies being paid NOT to sell a drug.
(Score: 2) by slinches on Tuesday April 09 2019, @10:45PM
I won't argue semantics about how free a free market must be to really be free. That's just talking in circles. I think everyone recognizes that natural monopolies exist and artificial ones are created for a purpose, and these need regulations to keep things in check and create a fair market.
It's true health care has many monopolies, but why not let the market work to minimize cost when choosing providers is an option. The complete lack of pricing transparency makes that impossible in the current system. If we can fix that, then we can use the market price as a basis to regulate the cost of similar services in emergencies and patented vs. generic drugs.
(Score: 2) by JoeMerchant on Tuesday April 09 2019, @08:46PM (1 child)
If we, as voters, made it a priority, above gun ownership abortion and tax breaks for the wealthy, we could elect candidates that promise to prune back bureaucracy and not re-elect those who do not.
Unfortunately, as Carlin said, 50% of the population has an IQ below 100, and I think it takes an IQ substantially higher than 100 to think past immediate issues into structural improvements.
🌻🌻🌻 [google.com]
(Score: 0) by Anonymous Coward on Wednesday April 10 2019, @09:55PM
It takes an IQ substantially higher than 100 to realize that IQ is pseudoscientific claptrap to begin with.