healthcare - socialized or free market

[LivingAlmostLarge]

Taking politics aside do you guys support a socialized single payer system? Would you support a free market system? Do you support decoupling insurance from employment? What do you think would happen if we did? If we go free market should we not have medicare? Politics aside let's discuss the financial implications and ramifications either.

How would we structure a single payer? How would we implement it? What would be the most feasible solution? How do we get rid of employer provided coverage?

How do we go to a free market health care? High Deductible Health Plans were supposed to create HSA and move to a more single payer. Instead I've found that company are taking the cheaper way out and moving from HMO to HDHP and paying less per employee. What would happen if we didn't have any ties to employment?

I'm a single payer supporter but I will admit to being okay if we went to a true free market healthcare. Where everyone is dumped from work and sent into a marketplace. I'm not sure how that would work. I am a bit cynical that employers wouldn't give us a penny in increased salaries. But at the same time then wouldn't healthcare have to come down because of it?

Also do you know what it costs companies to self insure? Last year out DH's w2 box 12DD code was $28k. That was the cost of "insuring" our families. Companies bear the cost of self-insuring their employees and families and BCBS is more an administrator. Hence why bigger companies have more clout with better deals. Think Costco or Starbucks.

Final question when will the USA decide that heathcare is really broken and need a different solution instead of continuing down our path?

No politics. Talk real ideas and solutions. I'm interested in also how to fix the employer provided plans.

[disneysteve]

41% of the US population is already on a single-payer, government-run insurance plan.
18% are on Medicare
20% are on Medicaid
3% are on Tricare (military insurance)

I think we should move to get that number to 100%. There should be universal coverage for every American. It should be funded through taxes, just like the above plans are. Transition into it over a few years by putting all newborns on the plan from now on and gradually lowering the age of eligibility of Medicare by 10 years every 1 year. So from 65 to 55 in 2021; from 55 to 45 in 2022; etc.

[ua_guy]

I also support single-payer healthcare run by the government at a national level. Private healthcare tied to employment is another form of slavery. Healthcare should be a right in America if we plan to maintain our status as a global leader...

It's a big change but we have the structure already in place. Imagine being able to walk into any facility and having your medical record instantly accessible when you need it most. Imagine being able to walk out, without a bill (and one won't be coming in the mail, either).

The numbers on medical debt and bankruptcy in America is devastating. The costs of healthcare in old age are well known, yet we continue to let it deplete life savings and ruin financial progress. It's time for a method that no longer works for us, to go....

[Like2Plan]

I hope you guys hurry up and get this all figured out!

What I am opposed to is paying all the $$ for a government run/national level health care AND then having to pay what I am paying now to cover the extra expenses, copays, deductibles and then be on long waiting lists to get care.

I am almost eligible for medicare--in addition to the premium I must pay to be covered for part B medicare, I still need health insurance to cover co-pays and deductibles, etc.
Apparently, this secondary insurance is pretty profitable for insurance because my phone has been ringing off the hook from these vendors.

[bjl584]

Our government is big, slow, and wasteful.
They also don't have a very good track record of executing things smoothly, quickly, or efficiently.

While healthcare for all sounds good, it's probably pie in the sky.
Doing something and doing something well are two different matters.

[disneysteve]

Our government is big, slow, and wasteful.
They also don't have a very good track record of executing things smoothly, quickly, or efficiently.

While healthcare for all sounds good, it's probably pie in the sky.
Doing something and doing something well are two different matters.

Big private insurance companies are also big, slow, and wasteful with no track record of executing things smoothly, quickly, or efficiently.

I can tell you that of all of the dozens of health insurance plans we accepted in my office, Medicare was far and away the easiest to deal with, the best run, and the most organized. They also had the huge advantage of being Federal so the rules are exactly the same no matter where you live or where you receive care. Whether you see a primary in NJ, a podiatrist in PA, or have an ER visit in Florida, it's all the same. That isn't true at all with Aetna or Blue Cross or Cigna. Then it is completely different depending on geography. That is particularly challenging in an area like mine. We were just a few miles from some major medical centers in Philadelphia, but since that's a different state, it can be very hard or impossible to refer patients for the care they need or get it covered by their NJ insurance plan.

[ua_guy]

Our government is big, slow, and wasteful.
They also don't have a very good track record of executing things smoothly, quickly, or efficiently.

While healthcare for all sounds good, it's probably pie in the sky.
Doing something and doing something well are two different matters.

I offer this as good perspective. Medicare/Medicaid are comparatively very efficient programs and are better at containing costs compared to private insurers. There's a ton of reading on the subject but this is a great column which makes for some good talking points:

https://www.hopkinsmedicine.org/about/Crossroads/06_13_03.html

[LivingAlmostLarge]

Our government is big, slow, and wasteful.
They also don't have a very good track record of executing things smoothly, quickly, or efficiently.

While healthcare for all sounds good, it's probably pie in the sky.
Doing something and doing something well are two different matters.

bjl what do you suggest? How would you fix or propose as a different system. I think it's worth discussing. Shooting down Medicare for all is easy. What is the suggestion instead? That's a lot harder. Or do you suggest that it's fine and we need 0 changes?

[Singuy]

Lets look at some math.

Total revenue taken in by healthcare insurance is 530 billion dollars/year

Total revenue taken in by medicare is 755 billion/year, where 80% of it comes from corporate/payroll taxes, 16% comes from premiums.
Medicare + Medicaid spending is at 1.3 trillion/year
Medicare liability is at 32 trillion

So just looking at this, our payroll taxes does not cover Medicare and Medicaid, the 38% of the population.
If we convert all private healthcare insurance premiums into taxes, that will finally bring Medicare+Medicaid to be revenue neutral, but leaves 59% of the population not insured. So the other 59% by my rough calculation is another 1.3 trillion dollars. So to make this revenue neutral, we need x3.5 what you pay in healthcare insurance today in the form of taxes.

This is the type of math people like Bernie Sanders need to talk about. People just assume "taxing the rich" will do it, but we are talking about 1.3 trillion dollars in taxes in additional revenue to make it revenue neutral, or else we will just borrow. Here's a spoiler alert, our total income tax revenue is only 1.4 trillion dollars. So basically we will need to double our taxes for Medicare for all.

0-18 yo, spending per person is $3700/year (74 million population)
19-64: $7100/person/year (193million)
65>: 19k/person/year (49 million)


The reason why the math looks so grim is because our healthcare here is expensive since higher education is expensive and difficult so high pay is used to attract talent. Other countries have much cheaper higher education(sometimes free) while also paying healthcare workers at 1/3 of the rate here. This is however just one of the many things that make our healthcare expensive. I honestly don't know what is keeping our healthcare system intact because doing the math doesn't make sense. Insurance companies actually made a 3.3% profit on the revenue they take in...so where's the rest? Are people being stuck with the medical bill the result?

Edit: so after thinking it over, the numbers above is what is needed to have 100% free health care. As medicare has pointed out 20% are premiums I didn't calculate. I guess the gigantic deficit I can't find are co-pays and out of pocket expenses. But if you want 100% free healthcare, the math above is about there.

[Snicks]

If people were really serious about this we could do some of it in increments. For instance why do we not look at catastrophic care and just start with that? trying to do it all in one swoop is ridiculous. Take small bites and do that right before you would move onto other aspects.

[Singuy]

I think taking away private insurance as a whole is not nothing. It saves 530 billion dollars in a 3 trillion dollar healthcare cost. However the government will be stuck with the admin and logistics which will cost money, but unlike private insurance with large compensation packages and advertisement, the amount of money should cost way less.

There needs to be a systematic review of cost cutting and maybe shift a lot of R&D to universities vs drug companies. Lower the cost of medical school while also easing entry. So hard actuary work to see cost benefit analysis.

The problem with trying to lower healthcare is how much more emphasis Americans put on the value of human life. This is a country that is willing to spend 3x more money for not much better healthcare because the thought of spending less MAY lead to additional deaths that are preventable. This is not something countries like China will do as it's not cost beneficial. The question other countries ask is, is it willing to spend 10 billion more to prevent 10 extra deaths? The US answer is, you should spend unlimited amount to prevent 10 extra deaths.

[ua_guy]

Lets look at some math.

Total revenue taken in by healthcare insurance is 530 billion dollars/year

Total revenue taken in by medicare is 755 billion/year, where 80% of it comes from corporate/payroll taxes, 16% comes from premiums.
Medicare + Medicaid spending is at 1.3 trillion/year
Medicare liability is at 32 trillion

So just looking at this, our payroll taxes does not cover Medicare and Medicaid, the 38% of the population.
If we convert all private healthcare insurance premiums into taxes, that will finally bring Medicare+Medicaid to be revenue neutral, but leaves 59% of the population not insured. So the other 59% by my rough calculation is another 1.3 trillion dollars. So to make this revenue neutral, we need x3.5 what you pay in healthcare insurance today in the form of taxes.

This is the type of math people like Bernie Sanders need to talk about. People just assume "taxing the rich" will do it, but we are talking about 1.3 trillion dollars in taxes in additional revenue to make it revenue neutral, or else we will just borrow. Here's a spoiler alert, our total income tax revenue is only 1.4 trillion dollars. So basically we will need to double our taxes for Medicare for all.

0-18 yo, spending per person is $3700/year (74 million population)
19-64: $7100/person/year (193million)
65>: 19k/person/year (49 million)


The reason why the math looks so grim is because our healthcare here is expensive since higher education is expensive and difficult so high pay is used to attract talent. Other countries have much cheaper higher education(sometimes free) while also paying healthcare workers at 1/3 of the rate here. This is however just one of the many things that make our healthcare expensive. I honestly don't know what is keeping our healthcare system intact because doing the math doesn't make sense. Insurance companies actually made a 3.3% profit on the revenue they take in...so where's the rest? Are people being stuck with the medical bill the result?

Edit: so after thinking it over, the numbers above is what is needed to have 100% free health care. As medicare has pointed out 20% are premiums I didn't calculate. I guess the gigantic deficit I can't find are co-pays and out of pocket expenses. But if you want 100% free healthcare, the math above is about there.

I think addition and multiplication provide a picture of what the cost could look like, but there is other modeling that would need to happen. Things like:

-Since healthcare is available to all, calculating the initial spike in demand for care and the higher severity/illness that comes from a historically uninsured population.
-The reduction in cost over time as population health improves, and the severity of visits decreases and people seek more routine care.
-Removing the cost of uninsured care from our health system as a whole
-Removing the high administrative cost burden from our health system as a whole -- one payer, one set of rules.

It would change the game for the hospitals/providers as well, as their reimbursement would be fixed. Typically, there is higher reimbursement from commercial payers. So there would be work to do there, but maybe not since a huge gap in uncompensated care would potentially be closed as well. One of the big costs for providers and health systems as a whole is liability. Malpractice premiums are insane, hospitals get sued all the time. I don't see this model working without also significantly reshaping the legal landscape as well.

I talked to a doctor recently who had an interesting add, which was to nationalize electronic medical records as well. Universal access, same format, basically using readily available and standardized information to improve health outcomes, reduce errors, and increase the speed of delivering care, as well as lowering the insane administrative and maintenance costs of those systems.

[mumof2]

I don't know how your system works...but I have a friend over there and she was fired after she had time off for surgery,because she lost her job she lost her insurance...and she couldn't afford it after that and because of her health issues she can't work...and because she has no insurance she can't see a doctor ehich means her health is getting worse..without going into detail...she NEEDS to be seen by a doc but even the er has sent her away because she has no insurance....it is disgusting that she can't get the health care she needs..can't get financial help and only has a little money each month to live on...she has to live with family as she can't afford to live by herself...its really sad if she had the healthcare she needed she could go back to work and be productive...so I think socialised medicine..have the govt pay for it...they would actually save money as other companies wouldn't rip them off

[disneysteve]

I don't know how your system works...but I have a friend over there and she was fired after she had time off for surgery,because she lost her job she lost her insurance...and she couldn't afford it after that and because of her health issues she can't work...and because she has no insurance she can't see a doctor ehich means her health is getting worse..without going into detail...she NEEDS to be seen by a doc but even the er has sent her away because she has no insurance....it is disgusting that she can't get the health care she needs..can't get financial help and only has a little money each month to live on...she has to live with family as she can't afford to live by herself...its really sad if she had the healthcare she needed she could go back to work and be productive...so I think socialised medicine..have the govt pay for it...they would actually save money as other companies wouldn't rip them off

So very true. Universal health coverage would SAVE money. Less overhead. Less administrative costs both for the government and for medical practices and hospitals. Better care for everyone, including those who have good coverage now and obviously far better for the folks that have poor or no coverage now.

No longer would people be trapped in dead end jobs simply to have insurance.

No longer would smaller medical practices be forced out of existence because of the expense of having full time staff to manage the dozens of different insurance plans they accept.

No longer would hospitals have to eat the costs of providing care for the uninsured.

No longer would medical bills be the leading cause of personal bankruptcy.

No longer would people put off seeking care early in a disease state instead of waiting until it is so far gone that care either costs tremendously more or it's too late to do anything and they suffer and die needlessly.

I could go on and on but the benefits to the country as a whole of having everyone covered everywhere would be a tremendous boost financially, in productivity, and more.

[Fishindude77]

The big fear I have regarding socialized healthcare is cost. Our government has a long history of over spending way too much for just about anything they get involved in, so I'm confident healthcare would be no different.
Remember, these are the same folks that bought $300 hammers.

I could see the taxes we'd have to individually pay for healthcare through the government would outweigh the cost it takes to buy it privately.
We are already are getting a taste of this with the ACA. Health insurance for a couple my age (pre medicare) before ACA was in the range of $6-800 per month. We now pay $1500 per month thru ACA.