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Thread: Universal Medical Insurance

  1. Top | #11
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    Quote Originally Posted by Trausti View Post
    This US tort system permits patients to sue doctors and hospitals for alleged medical error. The legal costs of defending and paying out on such claims - whether meritorious or to avoid the risk at trial - is substantial. Equally substantial is the professional insurance premiums that that some doctors have to pay (especially obstetricians and surgeons) and the costs of self-insurance and umbrella insurance for hospitals. If you impose Medicare for All, with its very low reimbursement costs, the likelihood is that the US medical system would collapse. Doctors and hospitals would no longer have the income to afford liability insurance. Be careful what you wish for.
    Medicare was first proposed as a trade-off for the existing situation in 1964. The providers were having to treat a large number of seniors without any hope of being paid for the treatments. The same held true for them treating the poor. Medicare said that that they would pay them somewhat less than normal but you will get paid something rather than nothing and as partial compensation, we will pay quickly as billed, subject to a clawback in the case of fraud.

    There is no question that reimbursement rates would have to go up under Medicare for all.

    There will have to be some tort reform in MoA. The existing situation with runaway abuse of the tort system is intolerable fiscally for everyone involved, except for the attorneys, not just for medical malpractice.

    There is no question that the most expensive health care in the world is provided by private for-profit insurance companies in the US for policies written for individuals. This is because they are enormously inefficient.

    The maximum loss ratio of 0.8 allowed by the ACA means that for every dollar spent on a premium 20¢ goes to an insurance company and only 80¢ goes to pay for health care. Medicare operates on a greater than 0.97 loss ratio, more than 97¢ goes to pay for actual health care from every dollar.

    But this is just the start of inefficiencies of the for-profit system.
    Last edited by SimpleDon; 01-16-2020 at 04:58 PM. Reason: added rather than nothing

  2. Top | #12
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    Quote Originally Posted by SimpleDon View Post
    There is no question that reimbursement rates would have to go up under Medicare for all.
    Why?

    I hate that even people who support progressive healthcare reform think this is a given. The cost of comparable services in every other country with universal healthcare of ANY kind is significantly lower than the US. Doctors in those countries aren't starving or suffering. Maybe, just maybe, along with the healthcare reform, we might need to do something about the ridiculously escalating educational costs so new docs don't come out of school oweing $200k, but that is something we need anyway.

  3. Top | #13
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    Quote Originally Posted by Worldtraveller View Post
    Quote Originally Posted by SimpleDon View Post
    There is no question that reimbursement rates would have to go up under Medicare for all.
    Why?

    I hate that even people who support progressive healthcare reform think this is a given. The cost of comparable services in every other country with universal healthcare of ANY kind is significantly lower than the US. Doctors in those countries aren't starving or suffering. Maybe, just maybe, along with the healthcare reform, we might need to do something about the ridiculously escalating educational costs so new docs don't come out of school oweing $200k, but that is something we need anyway.
    At the hospital I worked at, new doctors fresh out of training started at $180K/yr and had their student loans paid off. More experienced physicians got a good bit more.
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    Veteran Member James Brown's Avatar
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    On another board I frequent, this is a common argument by an educated, well-spoken liberal. In short, way too many people are handsomely compensated by the current system for them to quietly accept M4A. And if that segment of the population (8% to 9% of working Americans, according to his figures), who are well-organized, and fully lobbied-up don't get on board, then it will always be a non-starter. It's not just doctors--it's nurses and specialists and hospital admins. Nearly everyone in the US medical industry out-earns their foreign counterparts.

    Yes, it's inefficient on a macro scale. But tell a hospital lab tech that she'll have to take a 25% pay cut so that no one goes without health care, and a lot of decent folks like her will decide that maybe the current system isn't all that bad.

    The attack ads write themselves. "No, you won't be able to keep your doctor because he'll refuse to see you."

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    Australia built a hybrid public-private health system. Here’s how it works. - Vox

    It is a combination of "Medicare for All" single-payer and private insurance. The private insurance costs more, but it has a higher quality of care.
    Every decision has trade-offs. Australia is still figuring out what role private health insurance should serve alongside its universal public system. Over the past 45 years, it’s been a pendulum swinging back and forth: Conservative governments try to strengthen the private sector, pushing for the public system to act as more of a safety net, while the liberal governments focus on investing in and strengthening the public system.

    And a reckoning is coming. Experts warn that the private insurance industry is heading toward a death spiral, with premiums rising steadily and healthier people dropping private coverage and relying instead on the public system. The crisis is forcing Australia to ask fundamental questions about how the country distributes its health care resources, and whether to continue to prop up the private market or invest more in public providers and public coverage.

    ...
    The thread running through these dilemmas is the choice Australians made a few decades ago: to build a hybrid health care system. Can a country find a balance between universal coverage for all and private choice for some who can afford it?

    Eloise Shepherd stresses that Aussies are “fiercely proud” of their universal public insurance program. Medicare continues to enjoy robust approval from the public. But support for private insurance also remains strong (if not as strong as for Medicare).

    Australia is trying to keep both systems running. But as the problems start to pile up, it may be forced to choose one day.
    I think that a US "Medicare for All" system is likely to resemble Australia's system, at least initially, because the medical-insurance industry may be hard to dislodge.

  6. Top | #16
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    Quote Originally Posted by James Brown View Post
    The attack ads write themselves. "No, you won't be able to keep your doctor because he'll refuse to see you."
    If you do it as it is in Canada, he won't have a choice. This is why you don't make a two tiered system with both private and public health care.

  7. Top | #17
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    Quote Originally Posted by Jolly_Penguin View Post
    Quote Originally Posted by James Brown View Post
    The attack ads write themselves. "No, you won't be able to keep your doctor because he'll refuse to see you."
    If you do it as it is in Canada, he won't have a choice. This is why you don't make a two tiered system with both private and public health care.
    Ya, the solution isn't actually complex and you don't actually have to create something from scratch without knowing what it will end up being like.

  8. Top | #18
    Veteran Member James Brown's Avatar
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    Quote Originally Posted by Jolly_Penguin View Post
    Quote Originally Posted by James Brown View Post
    The attack ads write themselves. "No, you won't be able to keep your doctor because he'll refuse to see you."
    If you do it as it is in Canada, he won't have a choice. This is why you don't make a two tiered system with both private and public health care.
    And therein lies the problem, no? What doctor would support legislation that will take away her choice of how much to earn?

    Would a car mechanic who makes forty bucks an hour support being paid only twenty bucks an hour on the idea that car repairs are too expensive for the average American?

  9. Top | #19
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    Quote Originally Posted by James Brown View Post
    Quote Originally Posted by Jolly_Penguin View Post
    Quote Originally Posted by James Brown View Post
    The attack ads write themselves. "No, you won't be able to keep your doctor because he'll refuse to see you."
    If you do it as it is in Canada, he won't have a choice. This is why you don't make a two tiered system with both private and public health care.
    And therein lies the problem, no? What doctor would support legislation that will take away her choice of how much to earn?
    They earn quite a lot under the Canadian system. Its the insurance companies that lose out on a ton of money.

    If you want to make a loss of money/jobs argument, the best one would be for the people who work for insurance companies. Some of your insurance companies will adapt and others will go out of business entirely.

  10. Top | #20
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    Health care spending decreases under single-payer systems: Study

    It's been a persistent question on the campaign trail and during debates, whenever presidential hopefuls Sen. Elizabeth Warren, D-Mass., and Sen. Bernie Sanders, I-Vt., tout their respective Medicare for all plans: How much is this going to cost?

    The Warren campaign priced her plan at an eye-popping $52 trillion over the next decade. Sanders' approach would cost $34 trillion over the same period, according to the Urban Institute, a public policy think tank.

    While those steep price tags may spook some voters, new research, which analyzed nearly two dozen national and state-level single-payer health care proposals made over the last 30 years, suggests that single-payer plans are projected to save the country money over time, many in their first year after being implemented.
    When conservatives realize they cannot win democratically, they will not abandon conservatism. They will abandon democracy.

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