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from the But-I-*like*-getting-50-different-invoices-for-one-hospital-stay dept.
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: 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.
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(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.