I do not believe it is a coincidence that Germany, the United Kingdom, and France all adopted their present health care systems at the time of greatest national social cohesion. I think that a commitment to cost reduction is a prerequisite for adopting a single-payer system or full-on national health system (like NHS). I think that a single-payer or full-on national health system without a commitment to cost reduction would be a political, fiscal, and economic disaster for the United States. I don’t think we can afford the status quo (I don’t think anybody could).
I also think that the right way to approach our present problem is to decide what we’re trying to accomplish first and then figure out ways and means. I think the overwhelming likelihood is that we’ll shoehorn a means into the problems we’re trying to solve in an irresponsible way.
“I also think that the right way to approach our present problem is to decide what we’re trying to accomplish first”
Totally agree. I have had to relearn that lesson several times. Solving the wrong problem doesn’t help things. More broadly, I also think you get in trouble sometimes when you try to accomplish too many things at once. Long term, we have to address costs. The sooner we do that better, but we dont really have functional leadership right now. What we could do is to just expand Medicare, say to 62 and up, then trial that. We would save costs as Medicare pays less than private insurers. It is a population that is expecting to go on Medicare soon anyway. It would give providers a chance to adapt. It would require very little infrastructure change.
Steve
Lots of people stay on the job till 65 because of medicare. Drop it to 62 and you’ll see many more early retirements and increased SSRI costs.
It sounds trivial but I don’t think there is general agreement about what reform should accomplish. For example, I don’t believe that most proponents of M4A are actually interested in health care insurance (look up “insurance” and you may see what I mean). What they really envision is a prepaid all-inclusive health maintenance plan, something that would be be prohibitively expensive without major reforms in other aspects of our health care system.
One of the factors most people don’t take into account is that most companies of any great size are presently self-insuring. Any plan in which employers pay a considerable portion of the costs will result in their paying a lot more than they presently do. That’s why they self-insure. It’s cheaper. No self-insurance, no savings for them. When employers figure that out the opposition to M4A will mobilize quickly. Alternatively, employers will figure out a way to be excluded from it which will mean that the financial resources available for the plan will dry up. Basically, we’ll have come full circle.
“What they really envision is a prepaid all-inclusive health maintenance plan”
Sure. If we want to say that people want are beer with their health insurance it will cost even more, but that is not what I suggested. I proposed just expanding Medicare as it currently exists. If we do that, it will cost less than private insurance. It could be implemented a couple of ways. Probably easiest is to just have employees that old leave the company plan and go to Medicare. Or, we could have corporations pay for Medicare which in most cases would cost less than they currently pay.
“I don’t think there is general agreement about what reform should accomplish”
Agree, but we dont really have concrete proposals at this point (Sanders is probably closest). I think that the tension will lie between wanting to expand coverage to everyone and wanting to work on costs. I think you do some of both with what I have suggested. If we were to try to address the cost issue now, we dont have the leadership to accomplish it. We could do the Medicare expansion since it would not require much change.
“Drop it to 62 and you’ll see many more early retirements and increased SSRI costs.”
As I recall, SS payments are lower if you start them at 62. I guess this could happen, but I dont see it happening a lot. Old people are working past 65 already. Manual laborers may take advantage, but they can use disability already and will probably be eligible for Medicaid until Medicare kicks in after 2 years. (Should also help wages as it will free up jobs for younger folks.)
Steve
No, no! I’m not saying you suggested that. But, given the content of the bill that has been introduced in the House, that is clearly the vision of its sponsors.
Yeah, we do. The House bill.
SS: Quite a few people who don’t really need the money per se at 62 actually do begin taking it. They distrust the soundness of the system, or that benefits will become means tested. Those considerations dominate the benefit reduction.
“The House bill.”
Strikes me as propaganda to garner votes. Sort of like voting 89 times to repeal Obamacare. They know they cant get it past the Senate and Trump wouldn’t sign it so they lard it up. I will wait for a serious attempt.
Steve
What they really envision is a prepaid all-inclusive health maintenance plan
Close. Include no deductible and no co-pays, and you have it. Or, what I call socialized healthcare. Medicare is such a wonderful solution that you must pay for additional insurance to cover what Medicare does not. Medicare is like a cellphone unlimited data plan. It is unlimited up to the limit.
I must be the only person who has had experience with pay-as-you-go, private insurance, employer insurance, and socialized healthcare, and I know a little about Medicare. Of these, socialized healthcare is the only guaranteed low cost solution for the users.
Health insurance makes used car salesmen and Nigerian scammers seem respectable. A common criminal does not pretend he is helping you in any way.
The premiums are not the problem. The problem is deductibles, co-pays, and no-pays. The premium is the entrance fee, and everything after that is going to cost out-of-pocket. From personal experience, I know that the platinum level plans are not that great.
Also, the “free-market” solution that requires healthcare providers to only charge the published price ain’t “free-market”. A free-market allows voluntary value for value exchanges, and the parties are “free” to decide what the value is based upon the “market”, hence free-market.
I have some relatives who were forced by circumstances to start taking SS at 62. The payments are lower and it’s generally not financially advisable if you can avoid it. These same relatives also have issues with maintaining health insurance. Obamacare is their only option, but they can’t really afford it.
I think reducing Medicare eligibility to 62 would be an interesting experiment. It kind of makes sense since SS is available at that age. But I wonder how much it would cost and how it would be paid for and if, like SS, there should be some penalty for taking it early (like more out-of-pocket costs).
Overall, my favored idea long-term is a national plan/coverage for catastrophic medical events and some severe chronic conditions with private insurance coverage for everything else. The government would subsidize private coverage for the poor based on income. I think this would solve a lot of perennial problems with health insurance without the disruption of trying to rebuild the car while we’re driving it.
But I don’t see any kind of political support for something along those lines from either the right or left, who are stuck in their dogmatic approaches.
“Close. Include no deductible and no co-pays, and you have it. Or, what I call socialized healthcare.”
One thing I’ve changed my opinion on is that I no longer consider such a plan socialize healthcare. It only socializes paying for healthcare. The rest of the system would be private. One could argue it’s crony capitalism healthcare since the private healthcare companies would be running the show and essentially telling the government what to pay them.
Or alternatively, it’s worse than socialized health care (like the UK NHS) as it actually combines the worst aspects of socialized and private healthcare to create the worst of all worlds.
Under the House bill no additional insurance would be available unless the procedure wasn’t covered under M4A at all.
Steve:
That’s a distinction without a difference. All House bills are “propaganda to garner votes”. I’m afraid you are doomed to disappointment. What has been submitted is as serious as it will get and I feel confident in believing that it will form the framework for any prospective M4A bill. That is simply the way the House works. The Speaker has complete control over the process no veto or override possible.
That is very much my point. Both Republicans and Democrats have settled on a solution without deciding on what problem they’re trying to solve. Republicans seem intent on reducing the government’s payments for health care without addressing the underlying problem—people can’t afford to pay for health care. Democrats are convinced that administrative costs are what separate the U. S. from the UK, France, and Germany. I’m in agreement with the late Uwe Reinhardt—it’s the prices, stupid!
” What has been submitted is as serious as it will get ”
Nope. They have a single payer/Medicare for all bill in the House almost every year since the early 2000s (Conyers) . They never even vote on it. Sanders had his bill in place in 2017 and as I recall they didnt vote on it. I think this is just signaling to the base. If the Dems win the Senate and POTUS then we will see a new serious bill.
Steve
The Conyers bill and the present bill have the same contours as does Sen. Sanders’s bill. I think it’s a stretch to believe that any M4A bill will differ substantially from them. In other words the present bill will serve for discussion purposes.