Use your head! Medicare for All, a.k.a. single payer health insurance

[MannyGoldstein]

1. The US is the only industrialized country that doesn't have universal health care
2. The US is the only industrialized country that doen't have Medicare for All or another mechanism which can be leveraged to control health care costs
3. The US has the highest medical costs per person in the world, by far.
4. US health care sucks compared to health care in virtually any other industrialized country. Just sucks. Our outcomes suck, we treat patients like @#$& unless they're rich or connected, we have far fewer doctors per capita, etc. We suck.
5. If you think that 1. and 2. don't relate to 3. and 4. you're either not using your head, or you're harboring an agenda that prevents you from seeing simple reality. Wake up; you're causing harm.
6. If you think we can't fix these problems - really fix them - then either you think Americans are cretins (because every other industrialized country has them fixed), or you're shilling for a cynical candidate for political office who just doesn't want to do the right thing. Please adjust accordingly.
7. If you think Americans don't want Medicare for All, think again: two-thirds do.
8. Saying "I don't want to pay the health insurance of able-bodied people who don't want to work" is a specious Republican bullshit talking point. Sorry, the Democratic big tent is not big enough to hold you or anyone else that wants to rid the world of "Welfare Queens". Go the @#$& away.

[TIME TO PANIC]

1. K & R

If you don't support single payer health care, you are not a liberal/progressive.

[MannyGoldstein]

3. +1 nt

[neverforget]

2. According to a vocal group here, we're right and everyone else is wrong.

and it's too hard so it's not worth fighting for

[Jesus Malverde]

4. I've always felt the older DU'ers who are on medicare don't want to share their program with others.

Even my republican mom loves her medicare. It's an interesting divide and concur strategy from the politicians.

The same group that had affordable employer plans through most of their lives, want to make the younger people join private for profit insurance plans.

[MannyGoldstein]

5. I suspect if we call it Medicare for All

Instead of single payer, many more people would be in favor of it. In fact, polling shows that this is absolutely true.

[eridani]

6. I'm in the geezer demographic and I would sure like to share my Medicare with everyone else

Under single payer, Medicare would be improved by eliminating deductibles and establishing negotiated fees with practitioners, hospitals and drug companies.

[Jesus Malverde]

11. Doesn't medicare..

already have "negotiated fees with practitioners, hospitals and drug companies"?

I was under the impression that was one aspect of it's affordability.

[eridani]

12. No. Doctors can charge higher fees than those reimbursed by Medicare

Hospitals likewise. ACA specifically forbids negotiating drug prices. And then there is the deductible, which would be gone with single payer.

[Jesus Malverde]

13. Interesting thanks.

Its a screw the consumer and taxpayer all around system. Personally I'm waiting for technology to disrupt the doctors monopoly. If you see what they do most often they interpret lab tests and imaging something that can be automated and managed through robotics and computers. Eventually their boat payment days will be over.

I remember going to a walk in clinic to get some stronger medicine for athletes foot. The doctor suggested I visit a podiatrist, Ive never seen dumber advice as a school nurse with prescription privileges could have been as much help.

[1939]

17. What is there about the definition of "single payer"

that would automatically preclude deductibles and co-pays as a part of the system? Having deductibles and co-pays might well be way to make the system work financially when it is being hammered out in congress.

[eridani]

23. All proposed single payer bills (state and national) call for the elimination of deductibles

The notion that we have to have extra charges is nonsense. As Kucinich said in 2004 "We are already paying for universal health care--we just aren't getting it."

[1939]

24. Yes, but

In the sausage-making stage of putting a detailed single-payer bill together, co-pays or deductibles may be necessary to make the thing work. A token co-pay might be needed to inhibit casual use or "doctor-chasing" by hypochondriacs and drug addicts.

[-none]

30. That is a Republican talking point

Other countries get along just fine without co-pays. Deductibles are only for insurance. There is no insurance with Single payer.

[1939]

33. Is Medicare "insurance"?

Medicare has deductibles and co-pays.

Deductibles and co-pays are not "Republican Talking Points" they are means of controlling costs. Anything that is "free" has by its nature unlimited demand. In the armed services with free medical care, they limit the demand for medical care by making going to get medical care so miserable and humiliating that many service personnel just say "Screw it, I'll just be sick".

[-none]

34. Medicare is administered by the states and IS a form of insurance.

Co-pays do not control cost, they increase profits while at the same time keep the poor from proper health care.
They only limit demand because segment of people cannot afford to pay the co-pays.
That is a myth that without co-pays the system will be over run with hypochondriacs. Canada does not have co-pays and they are just fine.

Other countries have what they call Medicare, but it is nothing like our version. Maybe that is where the confusion comes in.

[1939]

38. MedicAID (for the impoverished) is administered by the states

MedicARE (for the elderly) is administered by the feds (actually by contractors that the feds pay to administer the program).

[Jim Beard]

47. Don't they have to pay some premiums in Canada and I understand each Province is different.

Please Correct me if I am wrong.

[eridani]

51. Under single payer, deductibles would be eliminated for Medicare as well n/t

[MADem]

36. They have expenditures to be paid by the patient under the NHS.

It's not all free--much is covered, though, but the taxes reflect that, too. Medicines are not free, either.

https://en.wikipedia.org/wiki/National_Health_Service_(England)

Some specific NHS services do however require a financial contribution from the patient, for example eye tests, dental care, prescriptions, and aspects of long-term care. However, these charges are often free to vulnerable or low income groups, and when not free, often lower than equivalent services provided by a private health care provider.[2][3]

If you need specialized equipment, orthotics, braces, stuff like that, you are paying for most of that.

[eridani]

50. If the doctors and hospitals are free at the point of service, I'll take it n/t

[Hoyt]

31. Very few do, 95% accept Medicare rates. And the other 5% can ony charge roughly 15%

above Medicare. There are some some docs, not many, who opt out completely. But they have to make special arrangements with their patients. So you are not likely to be surprised.

The biggest problem with traditional Medicare is the coinsurance. Any significant illness will bankrupt most people, unless they buy a supplemental policy.

With all that said, modified Medicare would probably be the best start for universal coverage. But it won't be cheap. And, as patients, we'd have to accept some restrictions too to make it work. I'm fine with that.

But, we might as well be talking about snapping our fingers and curing cancer. The political realities aren't going to change just because we wave our arms and talk sense.

[Jim Beard]

8. I'm 68 & on Medicare

I was paying $930 a month before I got on Medicare. I wish everyone could be on Medicare although it is not free. Part B is $130 a month and my supplement is currently $180 a month and my part D prescription drug plan is $66 a month. I pay nothing when I leave the doctors office. Its still going to cost $376 a month. It can be cheaper but I don't worry about anything with what I have.

[Jesus Malverde]

10. Amazing that one of the largest at risk groups

for hospitalizations and long term illnesses can have such low premiums. Last time I had insurance It was a grand a month.

[1939]

25. Ummmm

Everybody currently working is paying into the cost of hospitalizations and long term illnesses for us old farts. They do it through the Medicare deduction in their paychecks. I hope you don't think that money is being tucked away for your use when you are on Medicare.

[Jesus Malverde]

27. I see the smallest demographic bulge in the economy is subsidizing the biggest.

Gen X subsidizing the Boomers.

LOL

Thats rich. The locust generation continues to feed.

[1939]

28. Not a boomer

I am a "depression baby" and there aren't many of us which is why the draft was close to "universal military service" wehn i was coming of age.

Medicare has been "pay as you go" since its inception when the boomers were still in grade school.

[Jim Beard]

46. All you other old codgers like me

Every time I get my statement from Medicare it breaks down each medical bill in several columns like, amount billed, amount paid, amount paid by supplemental insurance and amount you may owe.

I have never been billed anything. Where is the cost?

[1939]

55. Everyone doesn't have supplemental insurance NT

[Jim Beard]

48. Like I stated in my post,

I was paying $930 a month for my private insurance before Medicare. I guess we all have to pay our dues first.

[eridani]

15. Improved Medicare for all would eliminate deductibles entirely

And negotiate drug prices. It would be cheaper than the current Medicare for seniors.

[jamzrockz]

32. People should understand this.

Not only that it is not free but you only get the discount after paying in all your productive life without collecting. I am sure when you calculate the actually amount you paid and number of months you stay in the program, the average mostly cost would be very similar to the ACA mostly premium.

[elmac]

7. Some of the bigger insurance companies are starting to complain

about losing money, one is even getting out of the exchange. This may be the start of single payer, if enough insurance companies call it quits the government will have to step in, do a medicare for all type deal.

[Jim Beard]

9. Hell, Pfizer merged with a small European corporation

and moved its headquarters to Ireland. So did Apple.

[dawg]

19. Apple is still American.

I think they have an Irish subsidiary though.

[elmac]

21. That Irish subsidiary

saves them millions in taxes each year, money we could use for roads, bridges, schools, ect..., I no longer think of Apple as being American.

[MADem]

37. I'd say they're pretty much Irish and Asian, these days. nt

[Moostache]

14. K&R

There is no way to justify the status quo without being a shill on multiple levels.

Profits in healthcare delivery is immoral. Period. Full stop.
Adding a for-profit middle-man organization between the doctor and the patient was NEVER a good idea and since the rest of the industrialized world HAS better options to model off, there really is no excuse...

[PatrickforO]

16. I agree. For once, we need to do the right thing, not some bullshit thing

that lines a few peoples' pockets at the rest of our expense.

[Scuba]

18. Sending our precious healthcare dollars to fatten the bank accounts of corporate investors ...

... in London, Tokyo and Hong Kong isn't just fiscally stupid, it's immoral.

[think]

20. Medicare for All. It just makes sense /nt

[tk2kewl]

22. I heard that this was all pie and ponies

http://www.democraticunderground.com/1251844708

[hifiguy]

40. And wtf is wrong with pie and ponies?

[edhopper]

26. It just won't work here

we must ignore that it works everywhere else in the world.

It won't work here...
It won't work here...
It won't work here...
It won't work here...


because.......?

[restorefreedom]

29. another winner, manny! nt

[hifiguy]

41. I envy his batting average.

It's stratospheric.

[restorefreedom]

42. INR? can we coin a new term...batting average envy? heh heh nt

[hifiguy]

43. Even better is his uncanny ability

to always get the goats of alll the 'right' people.

[restorefreedom]

45. yes, that is truly an art form. nt

[DonCoquixote]

35. signature worthy

"Sorry, the Democratic big tent is not big enough to hold you or anyone else that wants to rid the world of "Welfare Queens". Go the @#$& away."

[hifiguy]

39. Kick and fckin REC!!!

[madokie]

44. I have to admit

that not too many months ago I was ready to strangle you. well not really but you get my drift. Now I can't get enough of third way manny

Keep up the good work and I hope you have a wonderful Thanksgiving.

I personally use the VA but I have brothers and sisters who use medicare and they're all very happy with the care they get.
When joining the Navy all those years ago I was promised good health care for life. Didn't use it until my 54th birthday when my left foot was about to swell up and burst and having spent my life working construction I never had a job with healthcare so I had no choice but to go to the VA. I was diagnosed with a DVT and spent a week in the hospital dissolving it.

[Jim Beard]

49. I am glad you were taken care of....

we promise our veterans so much and rarely deliver all that is promised. I always think of the Bonus Army when I hear of our government not keeping is promises.

Republican way......

President Herbert Hoover then ordered the army to clear the veterans' campsite. Army Chief of Staff General Douglas MacArthur commanded the infantry and cavalry supported by six tanks. The Bonus Army marchers with their wives and children were driven out, and their shelters and belongings burned.

A second, smaller Bonus March in 1933 at the start of the Roosevelt administration was defused in May with an offer of jobs for the Civilian Conservation Corps at Fort Hunt, Virginia, which most of the group accepted. Those who chose not to work for the CCC by the May 22 deadline were given transportation home.[2] In 1936, Congress overrode President Franklin D. Roosevelt's veto and paid the veterans their bonus nine years early.

[Recursion]

52. Your #2 hides a lot, though

The US is the only industrialized country that doen't have Medicare for All or another mechanism

Yeah, exactly: another mechanism. The kind of mechanisms some of us are getting called Turd Way Neoliberal DLCers or whatever it is this week for saying will probably work better than Medicare For All, which almost no countries use (Canada, UK in a sense, sort of Austria, that's literally it). For instance, I'm pretty fond of the Global Budget idea (this isn't GD-P, but you can guess who supports it, no doubt).

If we go to single payer without getting provider costs down first, then every single attempt to lower costs later gets attacked as "cutting Medicare" (look at the absurdity of the Doctor Fix over the past two decades: everyone agrees doctors are overcharging Medicare by 15% but Congress can't bring itself to do anything about it because it's "cutting Medicare" to actually enforce that).

Being a medical provider needs to be much, much less lucrative than it is now. Like literally about 50% less lucrative if we want to get our health care spending as percentage of GDP down to what other countries spend. Drug companies, doctors, hospitals, and device manufacturers need to make less than they do, and in the process of cutting their pay we need to provide medical care for 80 million people that aren't getting it now. Looking at how Medicare has performed over the past several decades, particularly Congress's inability to use it to control provider costs, I am convinced Medicare for All is not the way to do that.

[MannyGoldstein]

53. I'm a member of the medico-industrial complex

Doctors get paid way too much. So does everyone else in the food chain (except for me, of course - I'm incredibly underpaid ).

The biggest problem is that the mechanism set up by CMS has the AMA setting reimbursement rates for docs, which is the fox guarding the hen house.

That being said... CMS has the leverage to lower rates, particularly if they become the only payer. It's necessary but, to your point, not sufficient to rein in costs.

[Recursion]

54. It's not even necessary, though: look at Maryland, the only state with hospital costs going *down*

They didn't do it by having a monopsony; they did it by setting a global capitation budget for every practice, hospital, and clinic (the FQHC system works similarly).

CMS has the leverage to lower rates

And has spectacularly failed at it, nearly as badly as unregulated private insurance has. And MFA means that's the only basket left to put any eggs in.

We have an OECD full of countries who have managed to make healthcare affordable and universal, and almost none of them used Single Payer; most use a multi-tier paying model with some form of global budgeting (e.g. a doctor in Germany simply can't make more than about $90K per year, period).

Remember: whatever system we make we will are handing off to Paul Ryan or somebody like him. This is the problem.