I’ve got to admit that I don’t know what “Medicare for All” means. We’re presently spending about $10,000 per Medicare beneficiary. A little back-of-the-envelope calcuation suggests spending of $3.1 trillion or about twice as much as we’re spending on healthcare now. Presumably, that isn’t what is meant.
If it’s a nice slogan for a single-payer system, fine. I supported a single-payer system for decades. When Congress stopped conforming to their own Sustainable Growth Rate formula and started passing “doc fixes” year after year, it became obvious to me that we don’t have the steely-eyed determination and, frankly, hardness of heart that would be needed for a single-payer system. Basically, you’ve got to be willing to cut spending. Unless something drastic were to change here single-payer in the United States would, in fact, mean $10,000 per beneficiary. To infinity and beyond!
That would be worse than a crime. It would be a mistake.
Medicare covers old people who are (as we both know) rather more likely to break down and require medical help. For the first 18 years of his life my son has cost maybe a grand a year, check-ups, shots, meds all-in. Ditto my daughter. So I don’t think 10 grand times the population is a very valid number.
We’re the outlier on that, Michael. I’ve published these statistics before. Germany, France, and the UK don’t spend as much on the elderly as we do or, said another way, we spend as much as we do because of Medicare.
I see no reason to believe that “Medicare for All” in the U. S. would result in less spending for any age cohort.
I see no reason to believe that “Medicare for All†in the U. S. would result in less spending for any age cohort.
I agree. I think the numbers would be staggering.
So what? what it costs? Fifty billion for Solyndra. Trillions for Iraq. 780 billion for Goldman Sachs. Fifty years ago I was told that increased productivity would allow us all to work only a 20 hour week. Now here I am in the future working a 60 hour week and my wife too just to pay rent and utilities, oh, and taxes. If our advanced society cannot take care of our own people, WHAT THE Hell IS PROGRESS FOR?
The program Sanders is pushing empowers empowers the Medicare administration to negotiate peices rather than either pay or don’t cover the procedure.
I think a lot of people are missing the ACA was approved by the Supremes by classifying the penalties as a tax; therefore it logically follows the premiums are also a tax. Sander’s plan, even with the taxes it introduces, eliminates these premium taxes and results in a net reduction in tax burden for households while increasing access to medical care.
Well, I think the AMA would have something to say about negotiating prices. Remember that the ACA was going to pay for itself and reduce the deficit?
All of this is irrelevant anyway. The Democrats couldn’t get majority support for a public option among their own caucus, much less the GoP – the idea that the politics on this will turn around and enable such a radical remaking of healthcare is a pointless fantasy.
Ideally the AMA, which currently effectively determines what Medicare pays for covered procedures would be limited to negotiating doctors’ salaries. For drugs, equipment, beds etc. the administration would go directly to the providers.
The Democrats couldn’t get majority support for a public option among their own caucus. . .
I don’t think that’s true. Obama gave the public option away very early in the game and in exchange for exactly nothing from the insurance industry. As a negotiator the guy sucked.
Ben,
There were never enough votes in the Senate for the public option, and at the end there were probably not enough in either chamber under reconciliation. Even without the public option the ACA barely passed the house (with a few dozen Democrats voting against it).
As for negotiating prices, I think the problem is a political one – because of lobbying and interest groups, the incentives to get Congress to carve out exceptions will be tremendous. I have little faith that the government would actually be allowed to “negotiate” prices.
Two words: regulatory capture.
Medicare pays about 80% of what private insurers pay. Medicaid pays even less, unless you I’ve in Alaska, ND or Wyoming, usually in the 50% -80% of Medicare range. Medicare for all would cost more because more people would be insured. If we left the same number of people insured and utilization rates remained constant, we would save money by going to Medicare for all. You could only achieve your $10k per person if all the young people started having bypass surgeries and chemo at the same rates as old people. How is that going to happen?
Seriously, I believe in PID as much as anyone, but if docs don’t have the will or ability to generate $10k per beneficiary right now in the under 65 group, why would they do it under Medicare when they would have to work 20% harder to achieve that $10k?
Steve
“As for negotiating prices, I think the problem is a political one – because of lobbying and interest groups, the incentives to get Congress to carve out exceptions will be tremendous. I have little faith that the government would actually be allowed to “negotiate†prices.”
Yup, it is a political problem. Other countries let their govt programs negotiate for prices. I wonder why we don’t let that happen? Why do special interests here dominate that issue so much more than just about anywhere else?
Steve
Medicare pays about 80% of what private insurers pay. …
Honestly, I have no doubt that the healthcare industry is as “creative” as the financial industry. If Medicare is always 80%, it ain’t a bargain. You all are hustling private insurance companies. Let’s call it “liar markdowns”.
For folks playing the home game, here is how it works:
Dr. I. Ama Scammer charges private patients $10 for the tongue depressor, but he can only charge his Medicare patients $8. In order to charge his Medicare patients $10, he increases the private patients charge to $12.50. Voila, Medicare now pays 80% of $12.50.
Doctors and the rest of the private healthcare industry are no better or worse than the financial industry.
“If Medicare is always 80%, it ain’t a bargain. ”
Sorry. I keep forgetting that people who like to talk about health care policy never actually read it or know anything about it. That 80% is an average. In some uncommon instances Medicare pays better than private insurers. In some cases Medicare pays about 35% of private rates. The 80% number is just an over all average that has held up fairly consistently in a number of studies.
Dr Scammer doesn’t really get to set his charges for much of anything, or rather he can charge whatever he wants, but it doesn’t matter. The private insurers pay him whatever they want. He can accept it or not. Since private insurers pay better he will almost always accept. Medicare also sets rates. You don’t get to negotiate with them. Only the very large or very prestigious (usually both) actually get to negotiate with insurers(private). (This is the simplified but mostly accurate version since most states are dominated by 2 or 3 major carriers. When a new carrier tries to penetrate the market you can actually negotiate with them, demanding and generally receiving much higher reimbursements.)
What i suspect is really happening is that private insurers need to keep their reimbursements about 20% above Medicare so that providers will take their patients since the administrative costs of caring for private patients is higher. I also think that Medicare has to be sure to not let private reimbursements get too far ahead for fear providers wont take Medicare clients.
Steve
@steve
This is what happens when a person refuses to acknowledge reality, and, instead, pushes the narrative. I will do this slowly.
Unless the percentage decreases over time, it is not a bargain. It is simply increasing at the same rate. The actual percentage does not matter. If Medicare cost is X% of private cost in 1980 and it is X% in 2015, it’s rate of change is the same as private healthcare.
In order for there to be a bargain, the percentage would need to decrease each year. The costs could still rise, but they would not rise as fast as private costs. This may be too much for you.
Dr. Scammer was an example of the practice. As you demonstrated, the healthcare industry is exactly like the financial industry. Both like to take a simple concept and distort it until it is no longer understood by even the industry experts.
Andy,
There was no point at which a vote, or even an attempt to whip up support for a vote, regarding the public option occurred. The president and leadership made no efforts in this regard because the administration never supported it. It was dropped the moment industry negotiators said they wanted it off the table.
“Unless the percentage decreases over time, it is not a bargain. ”
Umm, actually there would be a one time 20% decrease in costs. Also, Medicare has many restrictions placed upon that private insurance does not that keeps it from cutting expenses. Take those away and you have the potential to cut costs further than that 20%. That might still be one time thing, who knows, but might as well start from a lower baseline.
Back to my initial point, Dave remains incorrect that if went to Medicare for all that we would then spend 10k on everyone because that is what we currently spend on Medicare beneficiaries. Take whatever we spend on those people now and cut it by 20%.
Steve
You’re confusing two different things: reimbursement rates for procedures and spending per recipient.
You’re confusing two different things …
Much like the financial industry, the healthcare industry deliberately conflates multiple issues in order to confuse the public. That is how scammers work.
@steve
Umm, actually there would be a one time 20% decrease in costs. …
That is one scenario, but if the 80% remains in a steady-state, nothing changes. Furthermore, the 20% could be due to the formula or classification modification.
I will help you. It could be:
– 80% and falling (good)
– 80% and rising (bad)
– 80% consistent (neutral)
I assumed the neutral case, but it could be the bad case. I know it is not the good case because you did not tout it. It is also irrelevant that it is an average. You used the number, and there is a reason. You could have used many numbers, but you picked this specific one.
When it comes to people using statistics, I do not believe in accidents. I do believe that, more often than not, the person conflating numbers do assume their audience consists of fools.
As to what might be, it is beside the point. If Caitlyn Jenner had her d*ck cut off, I might think of her as a woman, but since she can still stand to piss, it is beside the point.