Let me ask again: how much would single payer or public option cost?

[Recursion]

And who would pay for it?

Currently, unsubsidized Medicare part A premiums are $464 / month
https://questions.medicare.gov/app/answers/detail/a_id/2260/~/medicare-premiums-and-coinsurance-rates-for-2010

The unsubsidized part B premiums are $353 / month
http://questions.medicare.gov/app/answers/detail/a_id/2261

(If you make less than $214,000, your part B premiums are subsidized)

That's $817. Most recipients pay $96 per month. The remaining $721 is paid out of the Medicare trust fund. Medicare is not free.

I have been assured repeatedly that under a single payer system we would pay less than the $817. How much less? And how do we know? Would I get a lower premium because I'm younger and healthier than current Medicare recipients? How much lower? Or would the savings just be spread to everyone? And how much would those savings be?

How much do you foresee single payer or a public option costing me, as a participant? How much would it cost the government? As a board we seem to be hell-bent on getting one of these passed but I can't seem to get anybody to commit to how much it would actually cost individuals and the government.

[Enrique]

1. about the same as it costs in Canada n/t

[Recursion]

2. What makes you think so?

The system health care reform puts into place is essentially what Switzerland has; will we end up paying what the Swiss do?

Our current non-universal single payer system, Medicare, costs a lot more than Canada's ($800 per month, as I showed above).

[Enrique]

7. the point is that there are models to look at

it's not just pie in the sky, actual countries actually pay for health care with a single-payer system.

Regarding the public option,

http://articles.cnn.com/2009-10-21/politics/health.care.cbo_1_public-option-cbo-house-democrats?_s=PM:POLITICS

A preliminary estimate from the Congressional Budget Office projects that the House Democrats' health care plan that includes a public option would cost $871 billion over 10 years, according to two Democratic sources.

CBO also found that the Democrats' bill reduces the deficit in the first 10 years.

(...)

[Recursion]

11. They also have healthier populations

Who don't eat Baconnaise



or go on nearly as many shooting sprees at workplaces, gyms, and schools, or drive 3 blocks to the store (to buy the Baconnaise) rather than walking. We are unhealthy. It's going to cost a lot to provide our health care (it already does). What I'm not seeing is some indication that single payer would stop that.

A preliminary estimate from the Congressional Budget Office projects that the House Democrats' health care plan that includes a public option would cost $871 billion over 10 years, according to two Democratic sources. CBO also found that the Democrats' bill reduces the deficit in the first 10 years.

As opposed to the non-public option health care plan, which costs $700 billion over 10 years, and reduces the deficit. So CBO says a public option would cost the Federal government $171 billion over 10 years.

[Capitalocracy]

67. Maybe we'd be healthier if we could see a frickin' doctor once in awhile

And don't blame me, I switched to Baconnaise Light.

We also have inflated health care prices compared to other countries, something that would probably change if we had decent regulations and at least a public option. The whole thing is a scam, the hospitals work with the insurance companies, raise the prices so high that nobody can pay them, which makes it necessary to have insurance for every little thing (not just major injuries or illnesses) and in the end, it's either pay or die. It's like a mafia. But a good public option along with some kind of public infrastructure to compete with that system would just topple it, there's no way they could compete. In nations where there are both public and private health care providers, the private services are extremely high quality at a much lower cost than the U.S. because that's the only way to stay in business.

The bottom line is that price trends for a service you must have in order to survive will trend upward and exclude people unless they have a public option to compete with.

[Recursion]

72. Healthier, yes. Would that be cheaper?

Hell, didn't Brown & Williamson prove that even with all the cancer, cigarettes save health systems money by killing us off faster?

Also, "is it cheaper" is obviously not the only question we should care about. But it's the question I'm trying to figure out at this point.

We also have inflated health care prices compared to other countries, something that would probably change if we had decent regulations and at least a public option. The whole thing is a scam, the hospitals work with the insurance companies, raise the prices so high that nobody can pay them, which makes it necessary to have insurance for every little thing (not just major injuries or illnesses) and in the end, it's either pay or die.

Seems to me that it's like bubbles in wallpaper. Put more people on a public option, insurance premiums for the rest of us go up because doctors have to recoup their losses from the medicaid patients.

But a good public option along with some kind of public infrastructure to compete with that system would just topple it, there's no way they could compete.

Blue Cross was popular, but didn't exactly topple the for-profit insurance world. What's the big difference between non-profit, like Blue Cross, and Public?

[SmileyRose]

96. Baconaise lite

:rofl:

[TheKentuckian]

57. You need to stop kickin it with Conrad. No objective view of our model would conflate it with Swiss'

I mean other than one rightish Senator making a dishonest claim, what would make you think so?

[Recursion]

61. That was from Krugman

Not exactly a right-wing hack.

From his column from a year ago, "The Swiss Menace":

http://www.nytimes.com/2009/08/17/opinion/17krugman.html

[TheKentuckian]

78. There was no bill last August. Wake me up when we get strict regulation of nonprofits

[kenny blankenship]

86. The Swiss law FORBIDS profit for insurance companies on essential healthcare

that's about 70-80 percent of the overall healthcare market that is put out of reach of profit mongering BY LAW. You are not mandated to buy any for-profit policy. You can if you feel rich, but the individual mandate is to cover basic and essential care, and insurers have to offer coverage for that at no profit. They can make money on bells and whistles. That's a far more radical "interference" by Big Government in the free market system, than for example, the proposal of a public option.

You don't know the first thing about the Swiss system. I should have read the above reply by you first, then I'd have known better what I was dealing with.

You're not the first joker to parade this lie about the Swiss system and our "reform". We've been smacking down much better than you since summer of last year.

[Recursion]

90. Who the hell is required to buy for-profit insurance in the US?

Looking at the policies available to me, there are more non-profit than for-profit policies I could buy if I were shopping for an individual policy.

[Hannah Bell]

3. In europe & elsewhere, health care spending is significantly less than here, with better results.

[Recursion]

4. I certainly agree

I am not convinced that the reason for that is our lack of a universal single payer health system. It might be, but simply saying it is doesn't make it so. Medicare, our non-universal single payer system, is very expensive; you just don't see the costs because it's taken out of your paycheck over the course of your career.

[Hannah Bell]

30. the costs are driven by government subsidization of a for-profit system.

as in the bush pharma medicare part d "reform" which is the major source of a lot of the ongoing deficit in the medicare program.

[Recursion]

42. I remember wondering if they were pushing Part D to make Medicare go broke

or if that was just a pleasant bonus to them after they gave all that money to pharma.

[Hannah Bell]

44. i think weakening the financial position of medicare was part of the plan -- as

well as nice rakeoffs for big pharma.

without that little bonus medicare would be in much better shape. & certainly medicare's buying power could be used to extract concessions on price from pharma if there were the will to do so, making the same program much cheaper.

bush did exactly the opposite.

[slackmaster]

5. How much do you have?

:D

[zipplewrath]

6. 0$

Frequently, such a system would be funded through the general revenues. More likely it would be connected to a payroll tax. But regardless the cost wouldn't really be on a "per person" basis in any direct sense. You won't be "buying" a policy. The US population would just become a "self insured" population, paying the cost of whatever health care was delivered. This would unify all of the funding already used by the federal government to pay for health care, including civil servant insurance, military personel insurance, medicare, medicaid, and various other health related programs such as SCHIP.

What it would all cost is highly dependent upon how much the federal government is willing to drive down health care costs. Once they are the only "customer", they can dictated prices to a very great degree. It has to be done in a rational manner, but they can force several cost savings measures upon the industries involved. In the end, it should reduce the total expenditure of health care in this country by whole integer multiples if other countries are any indication.

[phantom power]

8. A couple thoughts on that...

First, I assume we could look to countries like Canada to get some kind of real-world estimate.

Second, medical expenses tend to be back-loaded, that is most medical expenses occur toward the end of life. For that reason, I've read estimates that covering the remaining population (Medicare already covers the oldest segment of the population) would only add another 10% to its cost. I don't know how realistic the particular figure 10% is, but the basic logic seems reasonable.

It's certainly true that Medicare isn't, and wouldn't be, free. We would pay more to cover everybody. Then again, we would no longer have to pay our own premiums. Businesses would no longer have to pay for medical insurance, or administering medical insurance plans. Doctors would not longer have to employ as many staff to manage billing, etc. There is a lot of savings there.

And it would provide a safety net, allowing more flexibility for people to explore new economic niches. What's that worth?

And, there's always the observation that, if we needed some money, we could spend less on defense, get out of Iraqistan, etc, etc...

:shrug:

[Recursion]

9. Canada

First, I assume we could look to countries like Canada to get some kind of real-world estimate.

But we're not Canada. We're much less healthy. We have much more poverty. We have many more immigrants from many more countries. We have more violence. We use more alcohol, tobacco, and drugs. All of these things will make it more expensive for us, yes?

It's certainly true that Medicare isn't, and wouldn't be, free. We would pay more to cover everybody. Then again, we would no longer have to pay our own premiums.

People currently pay Part B premiums, and pay Part A premiums if they didn't have enough quarters of Medicare-deducted work. Are you saying we would change that?

[Dappleganger]

10. Raise the cap.

[Recursion]

12. What cap? Medicare levies haven't been capped in 20 years. NT

[m00nbeam]

20. The cap on Social Security tax for the wealthy

Social Security taxes are taken out of all wages earned up to $106,800. If you earn more than that annually, you are actually not getting the taxes taken out above that value.

[Recursion]

23. That's social security. This is medicare

We can't use revenues from one to pay for the other.

Medicare levies do not have a cap, and starting I think next year they will be taken from unearned income as well like investments and rent.

[m00nbeam]

29. Medicare is funded by Social Security.

[Recursion]

34. No. They are two separate systems. NT

[denverbill]

13. The costs for retirees won't go down under single payer.

It's the costs for everyone else that will go down.

Republicans passed a law allowing private companies to compete for Medicare at the same per patient cost as Medicare. No companies went after the business because they couldn't make money. So Republicans passed another law allowing the private companies more money per patient than Medicare and some companies did actually go in and offer Cadillac Medicare plans and naturally, people who could went onto those plans and cost us more money than regular beneficiaries.

The savings for single payer comes because young people won't have to pay the premium price for private insurance. No sales commissions, no advertising costs, no dividends, no exorbitant executive compensation. Additionally, doctors save money because instead of having 1000 different claim forms with 1000 different requirements and requiring extra staff to bill and collect, they have one system with one set of rules.

It's hard to say how much it would save, but Canadian health care costs 50% less than ours. Part of that is government negotiating drugs prices though. And since Congress refused to score single payer, we don't know what the CBO estimate would be.

[Recursion]

15. OK

Republicans passed a law allowing private companies to compete for Medicare at the same per patient cost as Medicare. No companies went after the business because they couldn't make money. So Republicans passed another law allowing the private companies more money per patient than Medicare and some companies did actually go in and offer Cadillac Medicare plans and naturally, people who could went onto those plans and cost us more money than regular beneficiaries.

Yes, and HCR stopped those handouts.

No sales commissions, no advertising costs, no dividends, no exorbitant executive compensation

How much do those really cost?

And with all of those, how come I'm paying less than the full Medicare premium?

[sinkingfeeling]

14. Well, I have an USAToday article from last month that says we spend $6565 per US citizen

a year on health care, over $2 trillion in total. It would seem that we'd have to come up with that amount some way.


http://www.usatoday.com/news/nation/2010-09-02-1Ahealthcare02_ST_N.htm

The figures cover the $2 trillion spent delivering health care to Americans— $6,565 per person — and paid for by employers, insurers, the government and individuals.

Medicare, Medicaid and other government programs paid a record 46.1% of the nation's medical bill in the second quarter, up from 42.3% before the recession began in December 2007.

[Recursion]

17. So a complete spread-the-pain plan would have a $547 premium

Which I suppose could be subsidized from general or dedicated revenues, which would hopefully come from people richer than me.

[kenny blankenship]

70. No, that figure is premised on the dominance of the insurer as a sticky fingered middleman

The point of a single payer system is to subtract the costs of middleman who does nothing but pool other people's money and ration their care to make his bottom line fatter year-over-year, every year. You can't evaluate per capita costs of a single payer system based on the gross costs of a greed-bloated for profit delivery system. That was just MORE willful stupidity. Put it on the pile beside your "butbutbut Canadians don't have immigrants!" objection and your "But Medicare costs so MUCH!" objection.

About one third of current health care spending goes to the insurance mafia, a racket that does nothing to make people well, or provide facilities for making people well, or to invent new devices, medicines or techniques to make people well. That third is consumed in profits paid out to executives, and shareholders, and in massive redundancies of staff and administrative overhead. We don't need or gain anything from having reduplication of paperwork and reduplication of staff, hundreds of times over. Most of that "third" can be eliminated by a single payer system at a stroke. That means a third of all healthcare spending - a category that represents one sixth of our whole economy- is pure waste. Just as importantly, by removing that middleman and his profits, you will remove a central player whose interest is in a perpetually more expensive system. A middleman makes a percentage on the gross. Therefore boosting the overall expense every year is always in his interest since that gives him more room to chisel out a bigger profit for himself. Yes, there's a REASON our system is so much more expensive than any other country's, and it has mainly to do with the fact that ALL sides of the healthcare industry can see opportunity for themselves in rapidly rising costs. Maybe their costs go up too, but as long as the pressure is all upwards, there is opportunity for them to find a greater increment of profit within that total at the expense of the other sides. Ultimately, this comes at the expense of the people. Ask yourself this, even as healthcare costs are exploding, have you heard of any insurance player going out of business? No way, they are all doing better than ever! Some of those players like doctors, hospitals, pharmaceutical companies actually contribute something of value to the system - but INSURERS DO NOT. They only extract value from the system. The other players need a check on their behavior but the insurance mafia needs to go away for good. Keeping them in the central position as the Health Care "Reform" bill of last year did only enshrined this exploitative arrangement as a matter of law. They will drive costs up, under their percentage of profit guarantee, and they will take their yearly profit and put it towards creating even higher costs in the future. Why? Because 15% of 10 billion is much sweeter than 15% of 7 billion. Because 15% of 17 billion is much sweeter than 15% of 10 billion. That's why.

[Recursion]

77. My HMO is non-profit. It gets no profit from anywhere in the system

Look, I agree that in principle profit is waste in the system. We disagree about how much of that waste there is. My non-profit HMO isn't particularly cheaper than any for-profit plan I've had.

Insurance companies in the aggregate have a 5% profit margin (the max seems to be about 7%). So, yes, by going non-profit we could cut out about 5% of costs (my HMO may well be 5% cheaper than an equivalent for-profit plan). In two years we're going to require all insurance companies to rebate premiums to customers if administrative costs go over 20% of revenue; insurance companies seem pretty confident they won't need to change much if anything to meet that.

They will drive costs up, under their percentage of profit guarantee, and they will take their yearly profit and put it towards creating even higher costs in the future.

OK, so since I'm with a non-profit I'm fine, right?

[Cleita]

47. Actually taking in all the government health programs

including the military, I read a stat that says 60% of medical costs in this nation are paid for by our government anyway. Really, how hard would it have been to cover the other 40% in a comprehensive health care system?

[Recursion]

56. Because doctors' practices would go bankrupt

Many internists and gps recoup their losses from treating medicare and medicaid patients by charging the insured a lot more. Medica(re/id) payment schedules are tilted way too highly towards specialists.

[Cleita]

88. Boy you are just full of insurance company talking points.

That's the system we have today. If everyone was covered under Medicare, pressure from the general population and the doctors would push for better reimbursement rates across the board, so there would be no need to overcharge cash payers to make up for the Medicare and Medicaid rates that the Republicans keep watering down because who cares about a bunch of poor and elderly people anyway. This is how it works in Canada and every other country that has basic health care paid for by the government. The private medical sector and the government hash out fee schedules every year. The doctors get enough and the government doesn't overpay. The truth is out there if you look for it.

[Edweird]

16. Well, if you're so 'concerned', you can figure it out for yourself. Remove the profit and

obscenely paid administrators and replace them with fairly paid civil servants. That's a helluvalotta money right there. Negotiate drug prices in bulk and again remove the profit - more savings. Who would pay for it? We would. Who else? I would happily accept a mandate that ensured actual HEALTHCARE FOR ALL - NOT RIPOFF FOR PROFIT 'INSURANCE'.

[Recursion]

18. Health insurance companies' profit margins are about 5%

http://biz.yahoo.com/p/522qpmd.html

So, we could cut 5% of the cost of insurance by removing profits. I don't think that's going to be enough. My insurance is through a non-profit; it's not any cheaper than the for-profit insurance plans I've had at other jobs. (For that matter, I pay a little more.)

[Hello_Kitty]

38. Lovely RW talking point you got there.

Walmart has even thinner profit margins. Gosh, they must be broke!

[Recursion]

41. How is that a right-wing talking point?

If the profit margin is 5%, how can removing the profit save us more than 5%?

Again, my current job gets insurance through a non-profit. It's not any cheaper than the for-profit insurance at my last job.

[Hello_Kitty]

76. Because I've only ever heard that talking point from wingnuts.

And profit margins are only part of the picture. Insurance companies skim 1/4 to 1/3 off of every premium for "overhead" which includes advertising, sales, training junkets, bloated CEO salaries, devising new and innovative technologies to deny people care, etc.

[Recursion]

79. I just got it from yahoo finance

I didn't think data had a right-wing bias.

Insurance companies skim 1/4 to 1/3 off of every premium for "overhead"

This and profit put together will have to be kept under 15% starting next year. Will that help?

[Hello_Kitty]

85. They'll just fold more of those things into MLR

IIRC there was even talk of considering CEO pay to be a medical expense.

[Safetykitten]

101. I'll say.

[Edweird]

60. If you were sincere you would already know that single payer costs about 1/3

of what we have now. You would also know that (at one time during the 'reform' discussion) it had support from about 2/3rds of the population. Maybe you were in a coma, or maybe you have short term memory loss or maybe it's just selective memory - in any event the facts are out there so have at it.

It appears the staus quo is your preference and you should be quite pleased with the way things have turned out.

[Recursion]

62. WTF? The status quo is horrible

And why do you say "single payer costs about 1/3 of what we have now"? Where do you get that figure?

[Edweird]

64. The information is out there.

I don't have a star, so I couldn't spoonfeed you even if I wanted to. Use the search. All the info is right here on this board.

[Recursion]

65. So, nothing, then?

This happens whenever I ask this. I get, "look it up". Look it up where? I've seen a whole lot of claims that it's cheaper. I've never seen someone actually describe how changing from multiple insurers to one pool will reduce the payments providers get.

[Edweird]

68. Like I said, I find your sincerity highly suspect. Do your own research.

[Recursion]

71. I have.

And it led me to conclude that the problem is the cost of services, not the way they're paid for. I've looked for evidence of lower costs through single payer and have only found claims like yours, with no evidence.

But, by all means, continue to dream that people who disagree with you are insincere.

[daleanime]

22. Hell yea...

:bounce:

[Recursion]

24. My current insurance at work is through a non-profit

Why isn't it any cheaper than the insurance at my last work, which was through a for-profit?

[Hello_Kitty]

40. Because nonprofit means you don't pay taxes

Not that you can't make money.

[Recursion]

46. It means you can't distribute surpluses to owners or shareholders

All the money you take in is supposed to further your organization's goal, which my my HMO's case is paying for health care.

[daleanime]

102. Right....

it goes to the CEO's where it belongs!







:sarcasm: Just in case it's needed.

[kenny blankenship]

19. Dude, Medicare is currently *just for old people* who are guaranteed to get ill

and need tests, surgeries and treatments for serious "end of life" illnesses. It's costs reflect the fact that Medicare is "insurance" for people whose care costs so much they literally could not get insured, unless they were millionaires.

Maybe we could talk, if you would agree to stop being deliberately stupid?

[Recursion]

21. First off, being 65 doesn't mean you're sick and decrepit

But, like I said in the OP, it will be cheaper to insure me as a young healthy person. How much cheaper? Will I see all those savings, or do they get spread around to everyone?

[kenny blankenship]

27. At 65 you're a hell of a lot closer to being sick and decrepit than you were at 35

That's why very few people who would be eligible for Medicare had any private health insurance at the time that the Medicare law was signed.

Why are you worried about the savings being spread around - are you a Republican? Your health insurance costs will go down, now and over your lifetime, as our healthcare spending as a percentage of our national GDP goes down and comes into line with other countries with sane, non-profit based social insurance.

If that's not good enough for you, join the Ayn Rand society and buy yourselves a private island. There you can lord it over each other and pursue your own narrow advantage until there's only one man left standing. Have fun.

[denverbill]

28. It doesn't mean you are sick and decrepit. It means you are much more likely to be though.

Per capita cost increases as you age. The older you get, the more likely you are to get high blood pressure, diabetes, heart disease, have a stroke, break a hip, get cancer, etc. Cost rise gradually though from teenager to old age.

You will see savings. Your monthly private insurance premiums will be eliminated and be replace by a smaller increase in Medicare tax or income tax, depending on how it's funded. How much of a decrease? Don't know, Congress won't score it and doesn't have a plan. For all I know the plan could just surcharge the wealthiest 1% and it wouldn't increase my taxes at all. Or they could do a flat tax which would be lower than your current premiums (company and yours combined obviously).

[kenny blankenship]

32. No, no - this guy or gal is a libertarian Ubermensch. He can simply WILL himself into health!

regardless of age. Therefore it's unconscionable that he or she pay into a general social insurance fund that covers old people, too; for when he or she gets old, perfect health will stay with him or her, right up until the very day he or she dies, the exact timing of which will also be a strictly personal choice. You have no claim on him and his income.

[Recursion]

35. What the hell are you talking about? NT

[denverbill]

36. I was a card-carrying, dues paying libertarian in my younger years, maybe 20 years ago.

That lasted a few years, and I gradually came to see the results of that philosophy.

It's nice to have a nice clean philosophy of how the world would work perfectly if the government just got out of the way, but throughout history it's proven to not work. Every corporation's ultimate goal is monopoly and let to their own devices they will use any tactic to achieve it. From Standard Oil to AT&T to Microsoft. And without government intervention, we'd be dealing with nothing but overpriced, subpar products. It's also incompatible with basic human decency.

I think everyone needs to go through a libertarian phase though, if only to know why it's ultimately as unworkable as communism.

[Recursion]

39. Why did libertarianism come up?

What does this thread have to do with libertarianism? I'm asking how much it's going to cost, and who's going to pay for it. Hell, I said I hoped somebody will subsidize my premium.

[denverbill]

45. Just answering the above post. Didn't mean to sidetrack the discussion.

[Recursion]

63. Sorry, just irritated that I was getting called a libertarian

for suggesting that single payer wouldn't make things cheaper.

[Spike89]

89. Willfully ignoring the insurance industry's true cost

A huge gap in your argument is the lack of accounting for the huge number of people currently "priced out" of health care today. To keep this simple, you do know that hospitals admit and treat lots of injured/sick people without insurance or means to pay, right? You do know that doctors and hospitals get "stiffed" on a fair percentage of cases? You probably know that most doctors will work with and offer significantly lower prices to patients without the ability to pay in full. The point here is that if a 20% of your clientele pays nothing, another 20% pays "below the rate card", and the rest are on insurance that has a vested interest in high rates/payouts...well, that insurance isn't going to be a good deal.
Even simpler, if I'm selling kool-aid that costs me a nickel a cup and I need to clear a penny per cup to stay in business, I can charge 6 cents. But, if I am obligated to provide free kool-aid to anyone that is "emergency-level" thirsty, and I care enough to make sure thirsty kids can get the kool-aid they need so I sell it at 3 cents to them--well, I'm simply going to have to charge much more than 6 cents to those that have drink insurance. Because the drink insurance company needs to "profit" the thirsty population must pay even a bit more, which means some have to drop coverage, meaning I'm providing more free kool-aid, meaning I've got to charge more from the few that are paying, which means the insurance company must charge more...this goes until it breaks.
Go single payer and everyone pays less, it sounds too good to be true, but it is. The insurance company's have incredible redundancy, huge overhead, and large profits--take them out and that is a huge gain. Most of what they currently provide simply doesn't need to be, and the rest can be handled for a fraction of the cost by the government.

[subterranean]

31. In every other universal health care system that I know of,

whether single-payer or multi-payer, the costs are spread around to everyone. The young and healthy don't necessarily pay less than the middle-aged or unhealthy. Instead, people pay a certain percentage of their income, whether through taxes or insurance premiums. So in practice, young people often do end up paying less because they typically earn less.

Also, in most systems, the government regulates the cost of medical treatments and drug prices to some extent. So the cost would also depend on whether our government is willing to do that.

[Recursion]

58. Even at the height of the New Deal, explicit price controls were a hard sell

Maybe one of the different assumptions I'm making than a lot of the board is that I'm assuming the government won't actually control prices. We've been allegedly about to cut Medicaid providers' reimbursements by 20%. But we never will. Ever. But we mark up our budgets as if we had already done it.

[area51]

25. Well,

we have a never-ending money spigot for two wars of choice and multiple overseas bases; there is plenty of funding that can be cut from the military to fund health care for all. How much sense does it make to spend shitloads of money to "protect" America when soldiers are coming home to people dead from lack of health care? You may want to look for answers on funding/costs at pnhp's website.

[Recursion]

26. Capital investment planning, spending targets, peer comparison, and professional guidelines?

How much history do we have with those? How well will they work at keeping costs down?

[Cleita]

33. Our health care costs are around $7,000 a year per person and only

those who can afford it or have health care plans from their jobs are covered. Canada is able to deliver the same quality health care to all their citizens for half of what it costs us or in round figures approximately $3500 a year per person. Some of our Canadians have posted here on DU that they pay about $70 a month for coverage in their Medicare program. It is administered provincially and various ways of collecting taxes are used to pay for it. If you search the DU archives there is loads of factual information about this that we debated last year. You can also go to www.pnhp.org an organization that has studied all kinds of health delivery plans and have come to the conclusion that single payer, or Medicare For All is the most efficient and cost effective way of delivering health care to everyone. Of course the insurance industry cut a deal with the Obama administration that it would never see the light of day nor be debated alongside other plans before Congress did the the costly program that they passed.

[Recursion]

37. I don't think that if we replicated Canada's systems we would pay their prices

We are less healthy. We eat worse. We exercise less. We have more guns. We drive cars more. We have a lot more poverty. We have more immigrants. It will cost us more. Probably significantly more.

[Cleita]

43. Nice to blame it on the immigrants again.

Canada has plenty of immigrants because as part of the British Commonwealth, they are expected to take in immigrants from all other parts of the Commonwealth. Also, it has been stated that it will cost a lot at first because all of those people who have medical conditions who weren't able to see a doctor or get care will be able to. But once that initial glut is over, people with NHC become healthier in the nations that have it because they are able to get the health care they need at the beginning of a medical problem, not when it has become a full blown and costly medical condition.

[Recursion]

49. What did I "blame" on immigrants?

I cited our higher immigration rate as a factor that would lead to higher health care costs. That's not "blaming" anybody, any more than I'm blaming gun owners or car owners, even though they lead to higher health care costs too.

[dpibel]

48. How about France, then? Or Japan? Or Germany? Or the UK?

I'd love to see your evidence for the healthy Canadian diet. They eat not much different from USians. Check out poutine.

Actually, I'd love to see your evidence for any of these propositions, other than guns, which is pretty much a given.

You're doing a lot of asking for facts and figures in this thread. It might behoove you to be a bit less conclusory.

I guess by your logic, the U.S. has pretty much the worst health in the industrialized world, because the double cost per capita holds across the board. It's not limited to Canada.

Interesting, though, that in this country with the best healthcare in the world (or so we're told) we are, according to you, tragically unhealthy.

[Recursion]

50. I was pretty sure we could all agree our healthcare is worst in the industrialized world

Was that even up for debate?

And while I have no idea what the Canadian diet is really like, Canada's overweight/obese percentage is 61%, the US's is 74%. I was attributing that to diet and lifestyle.

[dpibel]

51. Fine. What about the rest?

That's kind of a limited response.

What say you about how the rest of the industrialized world, all of which has some form of universal, government-supported, health care coverage, manages to do it for half the cost of US healthcare?

If we've got the worst in the world, why's it so expensive?

[Recursion]

54. (I added some stuff about diet above)

I have a tendency to hit Post before I'm finished...

If we've got the worst in the world, why's it so expensive?

That's part of why it's so bad. If we were paying what, say, Mali paid for health care, I'd say we were getting a great deal.

What say you about how the rest of the industrialized world, all of which has some form of universal, government-supported, health care coverage, manages to do it for half the cost of US healthcare?

Well, there are lots of reasons. The costs of procedures keep rising, mostly because they can. People with insurance are shielded from the cost of a procedure, so we have no inclination to try to do things more cheaply. England and Canada set limitations on what doctors do that Americans might not find appealing. It is illegal for a Canadian doctor to perform a covered procedure on a covered patient without going through the provincial medicare system (I assume the point of that is "for a private fee").

Americans love tests and machines that go ping and we want all of them, even though they cost a lot and often don't lead to better outcomes. Canada avoids these costs by how they define levels of care. They do a lot fewer tests than we do. Now, convince your neighbor that to save money we should avoid doing a test that has a 0.001% chance of saving his life. (As odious as the talk of "death panels" was, we do have finite resources, and we can't pay for every therapy, no matter what payment system we use. Somebody has to decide; Canada does it rather impersonally and nationwide. Which is probably better than our way, but is not without its problems.)

Also, frankly, we're subsidizing the rest of the world's drugs by refusing to negotiate lower prices with pharma. They can afford to sell their pills for less in Canada because they're selling them for so much more here. (It's the whole, "the second pill cost the company 5 cents to make. The first pill cost the company 5 billion dollars to make".) And as much as I hate pharma, the fact that drugs are profitable means that this is one area where business still actually does R&D, which lets scarce public research money do other things.

[valerief]

52. At costofwar.com, so far the wars have only cost $3515 per person in the US since 2001.

$7490 per taxpayer and $9212 per household.

Why can't we get the cost of healthcare to be the cost of war?

Of course, the defense budget is 1 trillion per year, so that's about $3300 per person in the US per year. That's astronomically absurd.

[Recursion]

59. Because that's 1/8th the cost of health care

$3000 per person over 8 years, vs. $3000 per person per year for health care.

But, certainly, I agree it would help tremendously to end the wars.

[valerief]

69. No, I asked why can't the cost of medical insurance be the same as the cost of war.

Not why is the cost of war cheaper.

[Recursion]

73. Well, and I was saying the reason it can't

is that the cost of the war is only 1/8th of the cost of health care, meaning insurance/government would have to take in at least 8 times the cost of the wars to break even.

[valerief]

74. Or cut the cost of medical insurancecare. nt

[TreasonousBastard]

53. Add to that that Medicare A&B aren't squat compared to the better...

group plans out there. (Not that there are that many really good group plans out there any more...)

The primary thing that all the yabbos demanding some sort of single payer forget is that the US has one of the highest cost delivery systems. After all is said and done, your broken bone, childbirth (including pre- and postnatal care) dialysis, or cancer treatment costs more here than just about anywhere else. Then, they forget that many primary care practices subsidize the pittance Medicare and Medicaid pays with the rest of their practice. If you can find a primary care practice any more.

A nice, shiny, new doctor just hitting residency has school loans of maybe half a million bucks and then has to eventually come up with the cash to establish a practice somewhere, which ain't cheap-- this is also an American phenomenon and ultimately affects costs.

Changing the fee-for-service model would be a more sensible first step.

[Recursion]

55. I completely agree

I think the problem is how providers get paid, not who's doing the paying. Doctors shouldn't have half a million in student loans. We should try to step away from fee for service (the much-hated-here HCR bill takes some steps in that direction -- payments are reduced to providers with repeat visits from the same patient for the same problem, etc.)

[uponit7771]

66. A 65% dem senate, that's how much....people act like congress doesn't exist

[TheKentuckian]

75. Devil is always in the details but we should be able to cover everyone and at least maintain per

capita costs. I don't get the impression you are seriously willing to consider that even after the "new" plan goes into effect that 15-20% is allowed for non medical costs (ie profits, huge salaries, lobbying, advertising, etc, etc) while Medicare's override is about 3.5%.

You also ignore that holding the purse gives the ability to check cost increases, especially the strings for everyone.

The ability to tell a provider no is a powerful control on gouging that insurance doesn't desire because their model relies on volume, they want a piece of as many dollars as possible. They have every possible motivation to make healthcare costs as large a piece of the GDP as possible.

Greed is not good and it never increases quality, access, affordability and over the long haul erodes all three.

We aren't so fat as to generate double the per capita cost without even covering everyone and to push such an assessment doesn't seem reasonable at all.

[Vinca]

80. Obviously taxes would have to be raised somewhere to pay for single-payer

and it would definitely be worth it. I can't even imagine what the peace of mind must be like to become sick in Canada and know you will be taken care of and your family won't end up living on the street in a Maytag box.

[Recursion]

82. You can lose your insurance in Canada

At least in the provinces that charge premiums; you can lose your insurance for not paying them (they are subsidized for the poor).

But, hey, I'm all for the idea of just paying for this with a damn tax. For that matter, I'd like to see income tax rates at about 75% once you get past $250K. Now, could we get that through Congress?

[harun]

81. Canada has a Single Payer system and spends out much less,

close to half as much, as people in the United States need to spend on coverage for one person now.

The reason for this is much of the waste in the system goes away. Think of the Health Insurance CEO's that make more than 10 million a year for companies bringing in billions a year in profits alone. They wouldn't be needed thus the cost would go off the balance sheet.

I think it is impossible politically right now, we would didn't even get a Public Option much less a Medicare Buy-In. So I don't really see why you are hung up on how much it costs YOU.

The real issue right now is Insurance does not equal Health Care coverage. Your Insurance company can always just say no and you have no recourse save legal action, not fun when you are sick or dead. With a system more tied to the state we at least have elected officials we can kick out of office if they aren't running it right. Good luck firing the CEO of United Health Care.

[Recursion]

83. I'm hung up on how much it costs period

Whatever premium I would pay was just as an example (I was asking, for that matter, if I was supposed to pay the costs with a premium, or if it would just be a fund from general revenues).

If we're just using a single payer system to keep paying these ever-increasing costs, I feel like we're missing the point.

[Recursion]

84. Waste in the system

Think of the Health Insurance CEO's that make more than 10 million a year for companies bringing in billions a year in profits alone.

It's irritating, but I don't see how that's really the problem. $10,000,000 is a drop in the bucket. And I'm sure my non-profit HMO's CEO is well-paid. Profits industry-wide are 5% of revenues. How much profit-fat is there really to cut?

[harun]

87. For one they aren't needed. How does an insurance company

who is trying to make a profit help in your Health Care? There is no need for them. Peoples money paid in should be used to pay for their care, not to pay for people to figure out how to give them less care and increase profit. That model is wrong, plain and simple. It is wrong economically and morally.

The cost increases you bring up are not a bunch of doctor's and nurses making a bunch more money. They are Insurance companies increasing profits and hording cash.

I don't care how much it ends up costing me in more taxes, if they need to raise them to pay for it so be it. In the end we all end up having to pay for this one way or the other, I don't expect it to be free.

[Recursion]

91. My insurance company isn't trying to make a profit

It's a non-profit HMO. Why isn't it cheaper than for-profit plans I've had?

[harun]

92. Mine is too. Not really cheaper but I do fight with them less about claims

than United Health Care (Super for-profit). Which I think is the worst Company on the planet.

About why it isn't cheaper, that is a good question.

I think my plan isn't actually paid by the HMO. I think my company just pays the HMO to administer claims and the payments are actually made by my company. Wish I had more info on exactly how that relationship works. It's all a big mystery as you have noticed, hehe.

[Recursion]

93. God I hate UHC

Yeah, they're up there with Monsanto for Satan's Own Corporation

[Spike89]

97. many possible reasons

The most likely is that your non-profit is willing to cover slightly more risky groups than the for-profit carriers. In other words, it may be part of their mission to provide affordable coverage trapeze artists and to subsidize that mission, they need to "profit" in other areas. I work for a non-profit (not insurance related) and that is exactly how we operate...we sell things (such as books) at the same prices as the for profit publishers, we just take the profits and spend them on things that we call "high mission".

The other, more complicated answer is that a non-profit often isn't as efficient as it should be...leadership isn't generally held as accountable as for profit management for maximizing returns.

[mmonk]

94. A larger healthier population paying in could reduce costs or outlays.

The current system sucks. I pay too much because I don't have an employer to pay in any.

[Recursion]

95. It could. It could also give providers a single target to corrupt

Instead of having to negotiate with hundreds of insurers, pharma, hospitals, etc. could concentrate all of their efforts on HCFA (or whatever that's called now) and conceivably raise prices even more.

[mmonk]

103. I tend to think differently on providers but pharma could still buy people off.

[depakid]

98. Way to put up a strawman! or strawmen to be accurate.

No one is arguing that Medicare (or a public option) is "free" -only that it's far more efficient, equitable, and would moves the nation away from a corrupt and unsustainable system that's harmful to indiduals and constitutes a major drag on the American economy.

[krispos42]

99. Other nations do it for less than $4000/person/year

We're currently running in the $7000/person/year range.

So... 310,000,000 x 4,000 = $1.24 trillion.

[Recursion]

100. Other nations have less income inequality and violence

And, again, less Baconnaise.