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Thread: The Heartland Institute’s Very Stupid New Medicare for All Report

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    Senior Member Alcoholic Actuary's Avatar
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    Quote Originally Posted by T.G.G. Moogly View Post
    Quote Originally Posted by Alcoholic Actuary View Post
    The question was "shouldn't there be financial incentives to prevent loss?". The answer is Yes. And there are. You get discounts for safe driving, you get discounts for getting regular check-ups. There are financial incentives all over the place.

    My only other point is that you don't get them up-front in the price of the premium. Insurance companies will start out assuming you are an average risk until you can demonstrate otherwise.

    aa
    No. That was not the question. The question was how to pay for the spiraling cost of healthcare when there is no financial incentive to be healthy and no financial disincentive to being unhealthy by engaging in unhealthy behavior. That was the question brought up by both sohy and dismal.
    See that sounds like the same question to me. I've just said that there ARE financial incentives to being healthy. I'm still not sure why you think there aren't. As for disincentives, what do you call having higher priced insurance for smoking vs. non-smoking?

    So I used auto insurance as an example of how a person't behavior can cost them more or less money for insurance. I asked you about an owner who's car is under warranty. I asked you if the warranty will replace their engine even if they do not live up to the terms of the warranty and you said "yes." That tells me you are uninformed or just trying to bullshit me, or perhaps you've never owned a car and serviced it under warranty. I don't know but your answer was certainly wrong.
    Yeah, I'd be careful using dismal's 'internet point scoring system' - dude suffers from dunning-kruger and wets his pants any time he can catch someone in a mis-statement. I'm not sure his age, but he is - I promise you - a child.

    It is true that you can void a warranty through neglect. I wasn't trying to lead you astray or suggest you stop changing your oil. A warranty is a different kind of insurance (and no I don't write them or reinsure them) that guarantees performance. So that's a long way from health insurance right? No one is going to 'guarantee' the performance of your heart or liver or bone integrity subject to certain conditions. Health insurance covers are meant to indemnify against a sudden and accidental change in conditions (like homeowners and auto property coverage). You can mitigate risks against a sudden and accidental change in condition.

    But I'm sure you and dismal knew all that already. I'm just some idiot who said 'that's what it's there for'.
    So the question sohy and dismal and I are asking is why behavior doesn't matter when it comes to health insurance.
    I still don't understand why you think it doesn't? What is an example of detrimental behavior that doesn't matter? (And of course, if there is to be a financial incentive attached to the behavior it has to be monitored and measurable).
    If auto and homeowners insurance worked like health insurance we couldn't afford those either. But with auto and homeowners insurance the behavior of the person taking out the policy absolutely matters. Why is health insurance different?
    Actually the reason we can afford auto and homeowners insurance is because we all know the exact cost of auto parts and home appliances - and we tell the insurance company when we get the policy what we want (Actual Cash Value or Replacement Cost). The costs in healthcare are what's out of control. Why does it cost $3000 to use the MRI at the hospital, but the independent imaging company across the street only charges $900? Why does giving birth in one part of town cost $8000 and in the opposite part of town cost $2000. Healthcare expenses make absolutely no sense - and people really aren't in the mood to shop around when they need care. But if you wanted to make healthcare affordable, standardize medical costs. Then healthcare insurance will be just as affordable as Home and Auto.

    aa

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    Quote Originally Posted by T.G.G. Moogly View Post
    Quote Originally Posted by southernhybrid View Post
    I see nothing wrong with expecting everyone to pay reasonable premium and copays, especially when you consider that lifestyle choices impact one's health to a large extent, yet most people make no attempt to change some of their unhealthy habits.
    If I smoke or use tobacco should I have to pay an additional cost for my health insurance over and above what someone pays who does not smoke?

    If I am overweight should I have to pay an additional cost for my health insurance over and above what someone pays who is not overweight?

    If I have three speeding tickets on my record should I have to pay an additional cost for my auto insurance over and above what someone pays who does not have three speeding tickets?

    Should my auto insurance pay for my new engine because I did not check or ever change the oil?

    If I use tobacco, drink, am 80 pounds overweight and take diabetes medication, blood pressure medication, and cholesterol medication should I have to pay an additional cost for my health insurance and medications over and above what someone pays who does not smoke, is not overweight, does not smoke and does not need these medications?

    Should my auto insurer be allowed to deny my claim for a new engine simply because I never checked or changed the oil?

    Should there be any financial incentive of any kind in an insurance policy that would encourage a person to not need to make claims?

    I'll stop there for now.
    Some of these yes, some of these no.

    I'm in favor of adjusting premiums for things that are reasonably under a patient's control, but not for things not under the patient's control. Smoking, alcohol use and overweight without a medical cause are examples of things under your control.

    The medicines you mention, however, are consequences, not causes. They should not have any bearing on your premium.

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    Quote Originally Posted by T.G.G. Moogly View Post
    The obvious point I'm trying to make is that it all comes down to cost when we're talking insurances. For some reason, health insurance is a separate, sacred case, and there is nothing I can do that will make me in any way responsible for anything I do or do not do to affect those costs.

    It's the reason health insurance is so costly.
    No. Take that example of smoking. It doesn't really raise the insurance cost much at all. You smoke, you get lung cancer, generally it's picked up too late to do a lot, you die.

    Obesity is a much bigger cost issue.

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    Quote Originally Posted by Loren Pechtel View Post
    Quote Originally Posted by T.G.G. Moogly View Post
    The obvious point I'm trying to make is that it all comes down to cost when we're talking insurances. For some reason, health insurance is a separate, sacred case, and there is nothing I can do that will make me in any way responsible for anything I do or do not do to affect those costs.

    It's the reason health insurance is so costly.
    No. Take that example of smoking. It doesn't really raise the insurance cost much at all. You smoke, you get lung cancer, generally it's picked up too late to do a lot, you die.

    Obesity is a much bigger cost issue.
    They should make insurance cheaper for smokers

  5. Top | #65
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    Quote Originally Posted by barbos View Post
    Quote Originally Posted by Loren Pechtel View Post
    Quote Originally Posted by T.G.G. Moogly View Post
    The obvious point I'm trying to make is that it all comes down to cost when we're talking insurances. For some reason, health insurance is a separate, sacred case, and there is nothing I can do that will make me in any way responsible for anything I do or do not do to affect those costs.

    It's the reason health insurance is so costly.
    No. Take that example of smoking. It doesn't really raise the insurance cost much at all. You smoke, you get lung cancer, generally it's picked up too late to do a lot, you die.

    Obesity is a much bigger cost issue.
    They should make insurance cheaper for smokers
    That's what it's there for!

    Why should you absorb the cost of your risky behavior when someone else can?

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    Quote Originally Posted by southernhybrid View Post
    Not because I oppose it in principle, but because I find it very difficult to believe that the US would be able to provide decent care to all Americans if we adopted Medicare for All, I oppose it for practical reasons.
    We currently provide good care for all but twenty million people under our combination of ...

    • Government provided health care, primarily for the military and veterans, provided in government-run clinics and hospitals
    • Government employee provided health care administrated by both government and private health insurance companies largely from private providers
    • Medicaid, government-provided insurance for health care from the private health care providers for low-income families
    • corporate self-insurance administered by the private health insurance companies
    • employer provided group insurance purchased from private, primarily for-profit insurance companies
    • Medicare, government-provided insurance for health care from the private health care providers for seniors
    • individual health insurance purchased from private, primarily for-profit insurance companies with lower incomes receiving partial ObamaCare subsidies

    ... listed from the lowest to the highest cost per capita for those covered.

    Medicare has a high cost per capita because it covers seniors who require a large amount of health care. Medicare has a small portion of the insurance component supplied by private, for-profit insurance companies. But these companies have always required a government subsidy to provide this part of Medicare.

    Overall the government pays for a little more than 50% of the health care in the country.

    Trump and the Republicans have promised health care much cheaper and better than ObamaCare. However, the bill that they almost passed, falling a single vote short in the Senate from John McCain, it is obvious that the secret plan was to return to the status quo before ObamaCare.

    Such a return would be untenable. Before ObamaCare, medical costs were increasing 7 to 10% a year. If you bought an American car the costs of health insurance was greater than all of the production costs except for the labor. Medical costs would have hit 25% of GDP in just twelve years if it continued to increase at the same rate that it was in 2008. The private insurance companies were over-paying the medical bills in order to increase their profits.

    ObamaCare relied on the exchanges to lower the cost for small business to provide health care coverage to their workers, on Medicaid expansion, and on the subsidized individual policies to expand the number of people who were covered. Two of the three are the most expensive ways of covering the people in our country. These have been less than sterling in accomplishing the expansion of coverage. But ObamaCare did slow the inflation in medical costs. And more businesses have dropped coverage entirely or forced their employees to bear much more of the costs of their health care insurance as a method of increasing their profits, similar to how they got out from under their defined benefit pension plans in the 1980s.

    The reasons that ObamaCare fell short are obvious. They failed to expand coverage to everyone and they relied on the private, for-profit insurance companies to provide the insurance, the most expensive way to provide health care in the world. Why did they do this?

    The major reason was that Obama and the blue dog, conservative Democrats were beholden to Wall Street for their campaign contributions. The insurance companies are a part of the intangible range of the financial sector, selling only trust and promises.

    The other major reason was to get it passed. The insurance companies and the drug companies lobby heavily in Congress and as the Democrats learned in the first Clinton administration the insurance companies could generate considerable opposition to changes in the health care system by lying to conservatives.

    Quote Originally Posted by southernhybrid View Post
    No candidate so far seems to even understand the complexity involved in going from where we are now to a single-payer system.
    In the 1960s and into the 1970s the US had a health care system that was no more costly than the UHC systems in Europe on both a per capita and a percentage of GDP basis. It was based on hospitals owned mainly by governments and charities and insurance from non-profit, community rate based insurance companies, that is, the Blue Cross-Blue Shield companies who controlled the costs from the health care providers, no one could make a health care business succeed unless their charges were accepted by Blue Cross-Blue Shield. it was effectively a single-payer system because just about everyone had their insurance from one of the Blue Cross-Blue Shield companies. The few who had health insurance from for-profit companies were cherry-picked by the insurance companies because they were low risk. As late as the start of the 1990s the for-profits wrote only about 5% of the at-risk health care policies for small businesses and individuals.

    That changed starting in the 1970s as the health care industry slowly changed into for-profit businesses, starting with hospitals. This trend accelerated in the 1980s as corporate profits and the incomes of the already rich increased due to the adoption of neoliberal policies meant to do those things and they needed new enterprises to "invest" in. Another boost in turning non-profit entities into profit-seeking ones was when the Republican Congress and Bill Clinton allowed the Blue Cross-Blue Shield companies to become for profits and "deregulated“them to allow them to refuse to sell to classes of individuals, that is to no longer be community rate based, like the for-profit insurance companies. The for-profit insurance companies slice and dice their offerings to try to get their ideal clients, healthy people who can afford to pay high rates. There is no reason to do this if you are running a UHC.

    Basically, all Medicare for All is doing is to turn the providing of the insurance back into a single-payer, community rate based provider like it was in the 1970s, using the model of Medicare. Not hard to do but hard to pass through a Congress who is more beholden to Wall Street and the corporate interests than they are to the interests of the people who elected them.

    Quote Originally Posted by southernhybrid View Post
    Nobody has discussed how to deal with all of the fraud and abuse that exists in the current Medicare system.
    Medicare can force health care providers to refund charges that Medicare finds to be excessive without a court order or other finding outside of their review process.

    There is no reason to believe that fraud in Medicare is any greater than the fraud in private medical insurance. The only difference is that private insurance companies don't actively pursue fraud while Medicare does. The more it costs for health care, whether fair or fraud, the more profit the insurance companies make.

    Quote Originally Posted by southernhybrid View Post
    Nobody has discussed how hospitals will survive if they go from receiving the much higher payments that private insurance companies give them, to the much lower Medicare payments.
    Are you discussing the annual shakedown by Congress of the health care providers called the "doc fix?" That Congress always eventually passes?

    Quote Originally Posted by southernhybrid View Post
    Nobody has discussed where all of the money will come from to support such a system. It's insane to think the wealthy Americans have enough money to pay for it, even if they were taxed at 100 percent.
    There is no reason to think that Medicare for All will cost more than we pay now for health care for the people who have health care insurance now and every reason to believe that it will cost less. It depends on how many of the twenty million who still have no coverage in the US aren't covered by Medicare for All. There are always people who want to freeload on the system. They don't want to sign up for coverage because they don't want to pay for the health care of others. That is until they get sick. Then they want the hospitals and the doctors for free. We call these people libertarians.[/ha ha]

    Quote Originally Posted by southernhybrid View Post
    Nobody has said how much more taxes the middle class would have pay to support such a system, or what percentage of doctors would simply become concierge providers. If you're not familiar that means doctors that only take cash for their services and sometimes charge a monthly fee for access.
    I had a similar program to that. My family doctor and another doctor turned his practice into a physician (something) practice, (I don't remember what they are called,) something like what you described. We paid like $300 a month and didn't have to pay for office visits or for vaccines or health maintenance medicine, ie vitamins. they would make house calls. They gave us their cell phone numbers and encouraged us to call them. It was like a small HMO. He had a lot of programs to live healthy, to lose weight, quit smoking, exercise coaching, etc. Our insurance provider paid the $300 and provided the major medical for hospitalization. I and my son did well on the program but my wife and daughter ignored it. Obviously, the healthier you were the better for them and us. I remember reading that the AMA doesn't like these kinds of practices but I don't remember why and since I can't remember what they are called I can't search for the answer. Perhaps, in the unlikely event that anyone reads this to here, they might know the answer.

    There is no reason to believe that the middle class would have to pay more in taxes or premiums than they do now, even if they structure it as taxes the middle class shouldn't have to pay more.

    Quote Originally Posted by southernhybrid View Post
    And, nobody had even mentioned that many other countries are having problems supporting their own UHC systems.
    This has very little to do with how the UHC is structured. Medical care is getting to be more expensive because the costs of technology are high. If you want to argue that we should ration health care, I don't think that you will get very far, ala death panels. There are some indications that some legislators around the world try to restrict UHC programs because these programs are unpopular with neoliberal ideology. These legislators are pretty much all conservatives, just another indication of why we shouldn't elect conservatives to run a government.

    Quote Originally Posted by southernhybrid View Post
    Plus, nobody has discussed how to manage the insane cost of aggressive end of life care that many people expect and many doctors prescribe. That's just for starters.
    We will have this problem and many more like the medical error lawsuit abuse, the doctor shortage from too few medical schools, etc. no matter which health care delivery system we use. And we have to solve these problems no matter which system we use. No one in their right mind is saying that Medicare for All is going to solve all of the problems with health care. No one is even claiming that Medicare for All is even the least costly system we could go to, not even me. The British National Health Service is probably the least costly system operating in a highly developed country in the world.

    Quote Originally Posted by southernhybrid View Post
    It's far more complicated than most people think. I did audits for Medicare patients, helped with billing and Medicare reviews, etc. when I worked as a QA/UR nurse. It's very easy to abuse Medicare guidelines, by over or underutilizing based on how much profit would be made.
    As it is for private, for-profit insurance companies. Once again, any health care system that you use is finally going to depend on the professionalism of the health care providers. This is what we are stuck with and the type of system that we use can only nibble around the edges of professionalism.

    Quote Originally Posted by southernhybrid View Post
    I'm against health care for profit,
    I am too. It completely baffles me why anyone believes that we are better off assigning health care, education, national defense, etc. to corporations whose only obligation is to do whatever is required to make the highest profit possible instead of the one organization whose only obligation is to best serve the public welfare, the government.

    Quote Originally Posted by southernhybrid View Post
    ... but how the fuck do we get it out, when almost everything from hospice to hospitals, from drugs to long term care are based on profit. And, btw, in case you don't know, Medicare doesn't pay for long term care. There must be a better way to help more people get adequate care without causing chaos.
    Unfortunately, we can't do it the way that it happened over fifty years or so, by frog boiling, changing so slowly that nobody notices. We have to attack it openly, and Medicare for All is a good way to start.

    Quote Originally Posted by southernhybrid View Post
    The following is from an institution in Canada that describes itself as nonpartisan. Maybe our resident Canadian knows if it has any credibility. But, I have read many other articles about the problems with the British and the Canadian systems when it comes to financing. Considering the rabid increased costs of health care, I find these claims believable.

    Perhaps, as patients, we expect too much. I know far too many people who run to their provider for every little sniffle, itch, or sore. I'm the extreme opposite, in that I put off medical exams until I'm sure I need one, and I refuse at least half of the tests and procedures ordered for me, at least in part because I don't want cause the system unnecessary expenses, but most people aren't like me. But, I digress.
    The Japanese go to the doctor more often than in any other developed country. Yet they spend half of what we spend on a per capita basis.

    Quote Originally Posted by southernhybrid View Post
    https://www.fraserinstitute.org/arti...gement-problem

    Government health spending is growing at unsustainable rates, while patients are facing shortages of medical resources and declining access to necessary medical care. The president of the Canadian Medical Association recently called on the federal government to become more involved in the management of provincial health systems in order to solve the serious problems plaguing Medicare. Unfortunately, the CMA president seriously misdiagnosed the cause of the health system’s ills.

    The Canadian health system has been run as a government monopoly since 1970. It doesn’t really matter which level of government tries to manage the system, our experience shows that political planning doesn’t work. Adding federal management would be as effective at averting disaster as rearranging the deck chairs on a sinking ship.

    The current health system does not have a “management” problem; it has an “economics” problem. The looming crisis in our system has three identifiable causes: the government’s monopoly over funding for medical care, the politically planned allocation of medical goods and services, and the lack of consumer exposure to the cost of using health care.

    Politically managed, 100 percent redistributive financing produces a “pay more, get less” result: unsustainable cost growth and rationed access.

    According to a recent Fraser Institute study using provincial government data, total government spending on health grew at an average annual rate of 7.5 percent across all provinces over the period from fiscal years 2000-2001 to 2009-2010. During the same period, total available provincial revenue from all sources, including federal transfers, grew at an average annual ratef only 5.7 percent. At the same time the economy, measured by gross domestic product (GDP) grew by only 5.2 percent.
    Do some of your own DD. Read articles from many sources. Many countries are having problems financing their health care programs. We need to be very careful before we adopt something that doesn't work. I'm not a political conservative in any way, but I am a realist.
    The most radical health care system we have ever had was the one we had before ObamaCare when we turned over the whole system to the profit motive. This was nuts supported by the believers in the free market, that the free market can do everything that the government does now and produce a better result because of the magic of the free market. I will tell you who doesn't believe in the magic of the free market, the executives of the corporations. They profess to do be believers but they fight every avoid market discipline and to avoid competition setting the prices that they get for their products.

    Quote Originally Posted by southernhybrid View Post
    I want to see a realistic plan as to how we can go from the mess we have now to a better, more cost-effective way of providing health care to all Americans. I haven't seen one yet from the candidates, although Biden's plan does sound a bit more rational than most of the others. Don't worry. I'm still going to vote for the Democratic nominee, regardless of who it is. Anybody else 2020!
    Medicare for All will be very hard to pass through Congress, even one with the Democrats in charge in both houses of Congress and the presidency, as unlikely as that is. The entire Republican party and fully one half of the Democratic party are fully in the hands of Wall Street and the corporate interests. We are therefore stuck with the liberals and their ideas to try to start turning this nation around.

  7. Top | #67
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    Quote Originally Posted by SimpleDon View Post

    We currently provide good care for all but twenty million people under our combination of ...

    • Government provided health care, primarily for the military and veterans, provided in government-run clinics and hospitals
    • Government employee provided health care administrated by both government and private health insurance companies largely from private providers
    • Medicaid, government-provided insurance for health care from the private health care providers for low-income families
    • corporate self-insurance administered by the private health insurance companies
    • employer provided group insurance purchased from private, primarily for-profit insurance companies
    • Medicare, government-provided insurance for health care from the private health care providers for seniors
    • individual health insurance purchased from private, primarily for-profit insurance companies with lower incomes receiving partial ObamaCare subsidies

    ... listed from the lowest to the highest cost per capita for those covered.
    Why are the insurance companies both at the top and the bottom of the list?? That suggests there's something else going on here--it's not the insurance, but the patients.

    Note, also, that Medicaid frequently mandates payments below cost and Medicare sometimes does.

    Also, note that the individual health insurance will include people who can't work and thus can't get the corporate coverage. You would expect such a pool to cost more.

    There is no reason to think that Medicare for All will cost more than we pay now for health care for the people who have health care insurance now and every reason to believe that it will cost less. It depends on how many of the twenty million who still have no coverage in the US aren't covered by Medicare for All. There are always people who want to freeload on the system. They don't want to sign up for coverage because they don't want to pay for the health care of others. That is until they get sick. Then they want the hospitals and the doctors for free. We call these people libertarians.[/ha ha]
    No reason?? The cost shifting that's going on from Medicare/Medicaid can't continue if that's the whole system.

    This has very little to do with how the UHC is structured. Medical care is getting to be more expensive because the costs of technology are high. If you want to argue that we should ration health care, I don't think that you will get very far, ala death panels. There are some indications that some legislators around the world try to restrict UHC programs because these programs are unpopular with neoliberal ideology. These legislators are pretty much all conservatives, just another indication of why we shouldn't elect conservatives to run a government.
    The problem is that UHC does ration healthcare. It's called waiting lists. And not offering more expensive options when the first one fails.

    The Japanese go to the doctor more often than in any other developed country. Yet they spend half of what we spend on a per capita basis.
    Because it's not the primary care visits that are the big cost driver.

  8. Top | #68
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    Quote Originally Posted by Simple Don
    There is no reason to believe that fraud in Medicare is any greater than the fraud in private medical insurance. The only difference is that private insurance companies don't actively pursue fraud while Medicare does. The more it costs for health care, whether fair or fraud, the more profit the insurance companies make.
    I don't have much time to address all of the things mentioned, but I have serious reservations regarding the claim that Medicare has no more fraud and abuse compared to private insurance. When I started working as a nurse caring for patients on Medicare, Medicare had enough claim examiners so that every single claim we made was either approved or denied. This is no longer the case, and unless one has an Advantage Plan, ( private insurance plans with cheaper premiums than traditional Medicare ) most things are covered without prior approval. This, imo, has made it very easy to scam the system. There is a huge amount of fraud and abuse in Medicare. Abuse is much easier to get away with, compared to outright fraud. By abuse, I mean not following the basic guidelines. For example, let's look at the home health benefit. The rule says that one must be homebound and in need of skilled nursing, or therapy, OT, PT, ST. It's very easy to cheat on these regulations and offer "skilled nursing" on a patient that is stable. It's very easy to say that someone is homebound, when it fact, they are still driving, assuming the care will be short term.

    Doctors can and do order unnecessary tests and procedures without any problem, since Medicare almost always will pay for that things, simply assuming that doctors would never over order things. It's not that easy to fool private insurance companies as they spend a lot to have nurses reviewing claims, and prior approval is often required. The system would need to change to avoid this problem.

    And, here's a few other concerns that I have.

    I'm not saying that people who have unhealthy habits should be forced to pay higher premiums, but the fact is that lifestyle issues, primarily obesity and lack of exercise are putting a large strain on the health care system. Obesity, which I consider a disease, or an eating disorder if you prefer, leaves one at high risk for hypertension, type II diabetes, stroke, heart disease and many types of cancer. Plus, it takes more staff and extra equipment to care for morbidly obese folks. I'm not making a value judgment here, but rather explaining the fact that obesity is a high risk problem, which has the potential to greatly add to the cost of health care. Until or unless we find a good way to treat obesity, this will continue to cause an upward spiral in the cost of care. There are other lifestyle habits that add to the cost of care. I only mentioned obesity because this has become an epidemic, which wasn't the case 50 years ago.

    I also disagree that most Americans are getting great health care. Our system is broken, partly due to profit. But other issues include poor coordination of care, shortages of nurses, and physicians, especially in rural areas, lack of effective quality control, including poor infection control in many hospitals. And, yes. It's crazy how much is charged for things. I just had a mammogram. The hospital bills over 1000 dollars for it. Of course, Medicare will probably only pay them less than 100 dollars, so they can write off the rest as a tax loss. The entire system is out of control, and I see no magic bullet as how to fix or improve it. Perhaps, having worked in health care for 42 years, has allowed me to see things that most others never do.

    You can't just throw out a dollar amount and say it doesn't matter where the care comes from because the money is currently coming from premiums, and Medicare would have to come from increased taxes. That's two very different things. And, as you know, Medicare already has premiums for Part B and Part D, as well as copays. It's not free and for most older adults, it's pretty expensive.

    I do agree that Medicare for All will not pass in Congress. I remember how difficult it was to pass the ACA. Obama wanted a public option but that wasn't acceptable to many Democrats. No Republicans were willing to vote for the ACA and the expansion of Medicaid was rejected by many conservative governors/ Plus, as I'm sure you all know, SCOTUS was responsible for allowing these governors to deny the Medicaid expansion. The mess we have is so complicated, that I just don't see a reasonable solution. And, things will only get worse unless the Democrats take back the Senate as well as the presidency, while keeping the House. It's going to take time and motivation to improve things. I'm probably not going to say more about this, because nobody here seems open minded and we all seem to be "talking" over each other.

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    Quote Originally Posted by Loren Pechtel View Post

    Even if the economy isn't at 100% doesn't mean you won't get inflation--the economy isn't monolithic.
    Only in the neoclassical economists' models is the economy monolithic.

    Quote Originally Posted by Loren Pechtel View Post
    Some real resources are already capacity-limited. (For example, look at what has happened to New York and San Francisco.)
    When demand increases you build more capacity.

    I don't understand your reference to New York and San Francisco.

    Quote Originally Posted by Loren Pechtel View Post

    And as healthcare technology improves spending should increase. When you save somebody rather than let them die because there's nothing you can do you still spent money.
    I am not sure what you are trying to say here. Technology should improve outcomes. New drugs reduce or eliminate the need for surgery. Vaccines prevent disease. New imaging improves diagnostics. New surgery techniques result in reduced recovery time. Which one of these additions to the costs of medicine that you think that we should give up?

    Of course, if you save someone from dying the medical costs for that person continue to add up as they continue to live.

    You seem to be fixated on some reverse "death panel" idea where the medical community keeps people alive to profit from them.

    No matter how the health care system is structured we can't escape the fact that it is solely dependent on the professionalism of the doctors and the other health care professionals and their dedication to their patients above anything else, including profit. Yes, there are exceptions to this but they are at risk of losing their livelihood if they are found out.

    Quote Originally Posted by Loren Pechtel View Post
    The shatterproof heart of the matter is that almost every procedure and pharmaceutical costs more in the US than in UHC countries. If UHC isn't affordable, then the US model is even less affordable. But UHC is affordable. Most of the developed world has been affording it since nearly a century ago when GDP per capita was substantially lower despite the increased ratio of retirees to current workers since then. That means it should be more affordable now.
    I do agree we can afford it, but I don't think the current examples are adequate evidence. They all shortchange those who have expensive problems that can wait.
    Once again, the "dying while waiting for treatment" under any non-profit health care system canard. The belief that we can't provide health care to the uninsured because it costs too much and it will consume all of the excess capacity in our health care system. Besides, they can just go to the Emergency Room and the hospital has to treat them. This is preferable to you?

    It is the system preferred by the Republicans, apparently, unless you believe them that they have a plan to cover everyone at a lower cost than ObamaCare that they have kept hidden for the last eleven years, waiting for the best time to reveal it.

    What we know about our current system is that it is much more expensive than any other system and that fact puts at a serious competitive disadvantage in foreign trade.

    Quote Originally Posted by Loren Pechtel View Post
    My objection to stems from the fact that it seems to universally have serious problems with inadequate capacity. I don't object to Medicare for all as an option, but I don't want to see it forced.
    Medicare for All would replace the private, for-profit insurance companies with government administrated insurance. There is no way that the for-profit insurance companies would be able to compete with Medicare for All as an insurance product. You might be willing to pay more to buy your coverage from a private insurance company, but I doubt that many people would follow your example.

    As a quick review, let's see how the insurance companies price their product.


    They set their premiums based on what they think that their "losses" will be.
    What they call "loss" to them is the money that they actually have to pay to the health care providers, the medical care for you, their customer. They then multiply this "loss" by 1.25 to determine what your premiums would be. This is what they mean when they say that they have a loss ratio of 0.8. That every dollar that you pay in premiums only 80¢ goes to pay for health care and 20¢ goes into the pockets of the insurance company.

    The health insurance companies are limited to a loss ratio of 0.8 by ObamaCare. They complain that this not sufficient for them, they wanted 0.7 or 0.75 which would put more money in their pockets.

    On the other hand, the cost for Medicare to administer their plan is between 2 to 3% of the medical costs. Their multiplier is in the worse case, 1.03. 1.25 is substantially more than 1.03. Medicare's loss ratio is a smidge above 0.97.


    Yes, they can put an option in Medicare for All to allow the option for people to opt-out of the program. But there has to be a mandate to buy another plan from private insurance companies and a provision that once you refuse to buy-in to Medicare for All you are out for your entire life.

    We can't have people trying to game the system by exercising the option to stay out of MFA and then expect the system to treat them when they get sick or injured. And I know that you can opt-out of paying for the mandatory automobile insurance by not owning a car, but the completion of that analogy is that until you can figure out how to live without a human body you have to have health care insurance to pay for the illness and injuries that the human body is subject to.

    And yes, under MFA community rate based premiums young males* can get lower premiums even from for-profit insurance companies than they will have to pay under MFA. But when they get older their premiums from the private insurance will increase dramatically. Once again, we have to prevent people from gaming the system by buying private insurance when they are young and switching over to MFA when they are older and a higher risk for the insurance company. This is the way that it is handled in the German system. But most UHC systems, for this reason, support the system through taxes on the individuals and on the employers, meaning that you can't opt-out.

    * this is why ObamaCare decided that males should have to pay through their premiums for half of the maternity costs, even though they aren't the ones who get pregnant, to reduce the males' advantage

    If we absolutely must pay Wall Street our pound of flesh in health care, a business that they have nearly destroyed by increasing its costs, then we could let them earn (undeserved) profits on the gap insurance for the 20% of the costs that Medicare doesn't cover. This would moderate the major problem with MFA, the unemployment created by the layoffs of so many people in the health insurance companies and the people employed by the health care providers to sort out our current health insurance mess with all of the different companies and policies.

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    Quote Originally Posted by SimpleDon View Post
    When demand increases you build more capacity.

    I don't understand your reference to New York and San Francisco.
    So you build more land? They are the extreme examples of where the demand for a limited resource has caused major pricing effects, it has nothing to do with whether the economy as a whole is running at capacity.

    Quote Originally Posted by Loren Pechtel View Post
    And as healthcare technology improves spending should increase. When you save somebody rather than let them die because there's nothing you can do you still spent money.
    I am not sure what you are trying to say here. Technology should improve outcomes. New drugs reduce or eliminate the need for surgery. Vaccines prevent disease. New imaging improves diagnostics. New surgery techniques result in reduced recovery time. Which one of these additions to the costs of medicine that you think that we should give up?
    I'm not saying we should give something up here. I'm saying we should expect health care spending to go up faster than inflation because it's also increased by now being able to treat things that couldn't be treated before.

    Once again, the "dying while waiting for treatment" under any non-profit health care system canard. The belief that we can't provide health care to the uninsured because it costs too much and it will consume all of the excess capacity in our health care system. Besides, they can just go to the Emergency Room and the hospital has to treat them. This is preferable to you?

    It is the system preferred by the Republicans, apparently, unless you believe them that they have a plan to cover everyone at a lower cost than ObamaCare that they have kept hidden for the last eleven years, waiting for the best time to reveal it.

    What we know about our current system is that it is much more expensive than any other system and that fact puts at a serious competitive disadvantage in foreign trade.
    You seem to have a very mixed-up impression of my position. I'm not saying that care should be denied, I'm saying that UHC systems translate into delayed/denied care. The fundamental problem is that UHC means you have the same people funding care and deciding what is proper care. This inevitably end up with reducing the standard of care in order to lower the price tag.

    My alternative: Take the ACA. Substantially lower the deductibles and stop-loss (I'd like to see them tied to your AGI in some fashion) and have the government pay the premium of the cheapest plan available to you, if you want something else you only pay the difference.

    Quote Originally Posted by Loren Pechtel View Post
    My objection to stems from the fact that it seems to universally have serious problems with inadequate capacity. I don't object to Medicare for all as an option, but I don't want to see it forced.
    Medicare for All would replace the private, for-profit insurance companies with government administrated insurance. There is no way that the for-profit insurance companies would be able to compete with Medicare for All as an insurance product. You might be willing to pay more to buy your coverage from a private insurance company, but I doubt that many people would follow your example.
    If the government doesn't play games with the pricing private insurance certainly can compete. Look at the current situation: Medicare advantage plans. That's private insurance successfully competing with Medicare.

    As a quick review, let's see how the insurance companies price their product.


    They set their premiums based on what they think that their "losses" will be.
    What they call "loss" to them is the money that they actually have to pay to the health care providers, the medical care for you, their customer. They then multiply this "loss" by 1.25 to determine what your premiums would be. This is what they mean when they say that they have a loss ratio of 0.8. That every dollar that you pay in premiums only 80¢ goes to pay for health care and 20¢ goes into the pockets of the insurance company.

    The health insurance companies are limited to a loss ratio of 0.8 by ObamaCare. They complain that this not sufficient for them, they wanted 0.7 or 0.75 which would put more money in their pockets.

    On the other hand, the cost for Medicare to administer their plan is between 2 to 3% of the medical costs. Their multiplier is in the worse case, 1.03. 1.25 is substantially more than 1.03. Medicare's loss ratio is a smidge above 0.97.
    Something to keep in mind here: The costs are far more related to the number of bills than their size. When most of your claims are little things (a basically healthy population where most doctor visits are routine and might result in a cheap script) you can't maintain a .8 loss ratio. Medicare, however, has a lot of patients with big problems, if you figure the same cost per claim you end up with much better loss ratio. (And the Medicare Advantage plans have caused this to happen even more as many of the perks they offer are of no interest to the seriously sick, they'll pick off more of the healthy ones.)

    Yes, they can put an option in Medicare for All to allow the option for people to opt-out of the program. But there has to be a mandate to buy another plan from private insurance companies and a provision that once you refuse to buy-in to Medicare for All you are out for your entire life.
    No, don't screw someone that badly. Do what we do now--if you're uninsured when you should be on Medicare your premiums are permanently raised by a small amount every month. I would permit resetting this via chapter 7 bankruptcy (with the insurance you are signing up for getting a last place claim of infinite size.)

    And yes, under MFA community rate based premiums young males* can get lower premiums even from for-profit insurance companies than they will have to pay under MFA. But when they get older their premiums from the private insurance will increase dramatically. Once again, we have to prevent people from gaming the system by buying private insurance when they are young and switching over to MFA when they are older and a higher risk for the insurance company. This is the way that it is handled in the German system. But most UHC systems, for this reason, support the system through taxes on the individuals and on the employers, meaning that you can't opt-out.
    I think we would fare better if we permitted age to be used to a fair degree in setting premiums. The current system looks very unattractive to the younger crowd because they rightly perceive they are being screwed to support the older people who generally have more money.

    * this is why ObamaCare decided that males should have to pay through their premiums for half of the maternity costs, even though they aren't the ones who get pregnant, to reduce the males' advantage
    Actually, I don't mind that--almost all pregnancies involve a man.

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