Article: Would ‘Medicare for All’ really save money?

[BLADEMDA]

You're already paying for someone else's healthcare. Regardless, yes, sometimes you have to pay for other people. That's the cost of living in a society. If you don't like it, feel free to move into a cave.



The bill was not aimed at people like you who can afford cadillac plans. The bill is aimed at people who make less than 400% of the FPL (equal to $48,560 for an individual and $100,400 for a family of four in 2019), for whom the ACA-compliant plan is affordable since they receive the subsidy.

Furthermore, this cost discrepancy is directly due to the fact that this tangled mess was the best that Congress could do at a time. Federal subsidies for privately administered plans will always be more expensive than a federally administered plan, but unfortunately enough *****s were shouting DEATH PANELS at the time to make a two-tiered single payer plan untenable.

Next up for the ACA is the Medicare Public Option. That is where the Democrats are likely headed in 2021.

Medicare for all won't happen over the next 4 years as the cost is too prohibitively expensive.

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[BLADEMDA]

We all now that politics will prevent any real changes to the VA. Medicare should become Medicare Advantage where seniors pick their private plan with copays combined with govt. subsidized medicare payments. These policies would create a private/public partnership with competition among all the players. Seniors get good insurance and can pick from a basic plan all the way up to a Gold/premium plan. Millions of current Medicare beneficiaries have such plans today.

 

[deleted480308]

You're already paying for someone else's healthcare. Regardless, yes, sometimes you have to pay for other people. That's the cost of living in a society. If you don't like it, feel free to move into a cave.

We had society long before we made our neighbors buy our health care, that's not a requirement of a society

 

[BLADEMDA]

 

[vector2]

We had society long before we made our neighbors buy our health care, that's not a requirement of a society

I guess I'll count you into the group that's anxious to return to a time when 50% of seniors were uninsured and 30% of them lived below the poverty line

 

[BLADEMDA]

 

[BLADEMDA]

I guess I'll count you into the group that's anxious to return to a time when 50% of seniors were uninsured and 30% of them lived below the poverty line

This will never happen in our lifetimes. The govt. intrusion is here to stay and that means more Medicaid/Medicare not less.

 

[deleted480308]

I guess I'll count you into the group that's anxious to return to a time when 50% of seniors were uninsured and 30% of them lived below the poverty line

being old doesn't give me a right to my neighbors money

This will never happen in our lifetimes. The govt. intrusion is here to stay and that means more Medicaid/Medicare not less.

This is a likely accurate prediction

 

[BLADEMDA]

The only way Medicare for all works is if the govt. reduces services. There must be panels to approve elective surgery and treatments to extract a few trillion in savings.

 

[Planktonmd]

We had society long before we made our neighbors buy our health care, that's not a requirement of a society

Absolutely! for example 2019 years ago around this time of the year, there existed a society in Bethlehem, Palestine, and none of them had insurance! But they eventually got some one who provided health care and revived the dead for free!
That's what we need.

 

[vector2]

being old doesn't give me a right to my neighbors money

I'll at least give you points for your logic being internally consistent. It's sociopathic, but consistent nonetheless.


BTW, Nick Offerman has gone out of his way to mock all the people who think Ron Swanson is/should be a real guy/libertarian icon

 

[BLADEMDA]

The irony is Medicare itself is going broke and taxes need to be raised for current future expected participants. Are you aware most Medicare beneficiaries extract way more in benefits than they ever paid in?

 

[BLADEMDA]

Most Physicians will receive 60 cents on each dollar they have contributed to medicare over their lifetimes. The Medicare tax on income has no limits. But, the average lower middle income worker will get more monetary benefits from medicare than he/she ever paid in to the system.

 

[deleted480308]

Absolutely! for example 2019 years ago around this time of the year, there existed a society in Bethlehem, Palestine, and none of them had insurance! But they eventually got some one who provided health care and revived the dead for free!
That's what we need.

deal, let's do that instead

I'll at least give you points for your logic being internally consistent. It's sociopathic, but consistent nonetheless.


BTW, Nick Offerman has gone out of his way to mock all the people who think Ron Swanson is/should be a real guy/libertarian icon

I don't base my politics off the opinions of actors

The irony is Medicare itself is going broke and taxes need to be raised for current future expected participants. Are you aware most Medicare beneficiaries extract way more in benefits than they ever paid in?

View attachment 287931

yep

 

[BLADEMDA]

 

[vector2]

I don't base my politics off the opinions of actors

" “It didn’t really occur to me, until we got into this dire political situation, that people didn’t understand this was a joke. I think they thought ‘Parks and Recreation’ was a comedy and that Ron Swanson’s parts were a documentary.” "

 

[BLADEMDA]

Here is the real solution. Private/Public Partnership where the increasing burden of cost is shared with the Medicare retirees. They can choose from Bronze plans all the way up to Gold plans like the rest of us are forced to do with the ACA.

 

[deleted480308]

" “It didn’t really occur to me, until we got into this dire political situation, that people didn’t understand this was a joke. I think they thought ‘Parks and Recreation’ was a comedy and that Ron Swanson’s parts were a documentary.” "

that's a dishonest argument, clearly everyone knows it's a comedy. But it's a debate tactic to presume that sort of idiocy out of someone you disagree with so you don't have to address their principles/policies

 

[vector2]

that's a dishonest argument, clearly everyone knows it's a comedy. But it's a debate tactic to presume that sort of idiocy out of someone you disagree with so you don't have to address their principles/policies

That's why I said "BTW" when I first brought up the Offerman thing, aka it's only tangentially related to the discussion at hand. If you want to use a libertarian icon as your avatar, I'm not going to stop you. I would suggest, though, that you don't use an avatar that represents a parody of what liberal TV show writers think of libertarians.

Back to the matter at hand, I can tell you right now you and I are not going to get any further vis a vis a "society" argument because we fundamentally, axiomatically differ on whether part of the social contract includes others paying for old people. Part of my moral framework dictates that we should provide for the elderly even if it requires the fruit of some of my labor. Yours doesn't.

 

[deleted480308]

That's why I said "BTW" when I first brought up the Offerman thing, aka it's only tangentially related to the discussion at hand. If you want to use a libertarian icon as your avatar, I'm not going to stop you. I would suggest, though, that you don't use an avatar that represents a parody of what liberal TV show writers think of libertarians.

Back to the matter at hand, I can tell you right now you and I are not going to get any further vis a vis a "society" argument because we fundamentally, axiomatically differ on whether part of the social contract includes others paying for old people. Part of my moral framework dictates that we should provide for the elderly even if it requires the fruit of some of my labor. Yours doesn't.

you are correct that we have different base principles

you are incorrect that the ron swanson avatar is a bad choice, the character is funny and I like it

 

[aneftp]

Look 80-90% of the work we do any train monkey with half a brain can be taught the technical skills especially with the advancement in technology in anesthesia. Putting a breathing tube or doing an epidural is not rocket science.

What we get paid is for the other 10% of stuff the general public has no clue.

Most of my friends who fly airplanes can probably fly a commercial airplane with 200-300 hours of “training”.

So would u feel comfortable as a passenger with 200 passengers having one of my friends flying u solo even for 2 hours? After 300 hours of training

That’s why the public needs to know. Heck even airlines know they need 2 airplane pilots. Is that wasteful? Of course it’s waste ful.

 

[VA Hopeful Dr]

Unfortunately, just like blade's dream of having every 80 year old get a knee or a lumbar fusion or a stent with the snap of a finger, MD-only anesthesia is essentially an impossibility in many if not most ACT practices, even with advance notice.

Yeah I remember the thread here about that a few months ago. It was disheartening.

 

[VA Hopeful Dr]

The one who decides if it's right is again the physician, provided that the physician is not motivated by profit from doing more procedures.
No system is perfect but the current system is certainly failing, and all that fear from government dysfunction is partially justified but there is no alternative to government increased oversight and enforcement to create a stable patient focused system.

Meh, even Medicare now doesn't let me just decide what to do for a patient.

 

[BLADEMDA]

Take away points: Medicare is not going to remain solvent without raising taxes. Medicare doesn't pay the hospitals enough to keep their doors open. The average Medicare participant is sucking money from taxpayers because he/she did not pay enough into the Medicare system through taxes.

This is the system we want for everyone in the country? I guess the only good thing is Medicare for all would expose the lie that socialized medicine is superior to private healthcare and this would accelerate the two tiered health system. That is what this country needs anyway. A 2 tiered system where I can purchase the healthcare I need without the ACA mandating costs on me while Joe Q Public can obtain basic Bronze level Publicly subsidized healthcare at a low cost. The latter will come with heavy restrictions and likely be accepted only by public hospitals.

 

[aafisahar]

Take away points: Medicare is not going to remain solvent without raising taxes. Medicare doesn't pay the hospitals enough to keep their doors open. The average Medicare participant is sucking money from taxpayers because he/she did not pay enough into the Medicare system through taxes.

This is the system we want for everyone in the country? I guess the only good thing is Medicare for all would expose the lie that socialized medicine is superior to private healthcare and this would accelerate the two tiered health system. That is what this country needs anyway. A 2 tiered system where I can purchase the healthcare I need without the ACA mandating costs on me while Joe Q Public can obtain basic Bronze level Publicly subsidized healthcare at a low cost. The latter will come with heavy restrictions and likely be accepted only by public hospitals.

We already have a 2-tiered system. You just don't see it in anesthesia because of the nature of your work.

Last year in residency I sent home dozens of people to die of treatable diseases due to lacking insurance and being denied charity care. Had a 20-something lady with Hodgkins' lymphoma, 80-90% cure rate, no insurance, denied for disability/medicaid (no expansion state) and her charity care denied. Sent home to basically die or muster up the money to pay for treatment. Sent another 30-something year old with AML, favorable genetics (eg potentially curable with 7+3),, denied the same, no options left, discharged on doxy/amoxicillin/hydroxyurea for neutropenia. Saw multiple people who ended up destitute after receiving expensive care after our hospital sued and garnished wages for lack of payment. Saw multiple people who could not afford life saving meds (insulin, anti-rejection meds, etc) for lack of coverage or unable to pay the copays.

OTOH, we have executives who pay 10k/night in the private suites, who pay for a TAVR on the weekend to the tune of hundreds of thousands of dollars.

There's a two-tiered system already, you just don't see it as much in anesthesia. Our system is cruel and no amount of wordplay or cognitive hoop jumping will change that.

 

[aafisahar]

being old doesn't give me a right to my neighbors money

Except for student loans, which you have no problem taking.

 

[Planktonmd]

Take away points: Medicare is not going to remain solvent without raising taxes. Medicare doesn't pay the hospitals enough to keep their doors open. The average Medicare participant is sucking money from taxpayers because he/she did not pay enough into the Medicare system through taxes.

This is the system we want for everyone in the country? I guess the only good thing is Medicare for all would expose the lie that socialized medicine is superior to private healthcare and this would accelerate the two tiered health system. That is what this country needs anyway. A 2 tiered system where I can purchase the healthcare I need without the ACA mandating costs on me while Joe Q Public can obtain basic Bronze level Publicly subsidized healthcare at a low cost. The latter will come with heavy restrictions and likely be accepted only by public hospitals.

There are plenty of examples all over the world where single payer "socialized medicine" has been successful for decades, do you know any examples of a successful "private healthcare"?

 

[BLADEMDA]

We already have a 2-tiered system. You just don't see it in anesthesia because of the nature of your work.

Last year in residency I sent home dozens of people to die of treatable diseases due to lacking insurance and being denied charity care. Had a 20-something lady with Hodgkins' lymphoma, 80-90% cure rate, no insurance, denied for disability/medicaid (no expansion state) and her charity care denied. Sent home to basically die or muster up the money to pay for treatment. Sent another 30-something year old with AML, favorable genetics (eg potentially curable with 7+3),, denied the same, no options left, discharged on doxy/amoxicillin/hydroxyurea for neutropenia. Saw multiple people who ended up destitute after receiving expensive care after our hospital sued and garnished wages for lack of payment. Saw multiple people who could not afford life saving meds (insulin, anti-rejection meds, etc) for lack of coverage or unable to pay the copays.

OTOH, we have executives who pay 10k/night in the private suites, who pay for a TAVR on the weekend to the tune of hundreds of thousands of dollars.

There's a two-tiered system already, you just don't see it as much in anesthesia. Our system is cruel and no amount of wordplay or cognitive hoop jumping will change that.

I am not advocating a system where the poor don't get coverage. I think Medicaid expansion should occur in all states. Please do not conflate the arguments of the pitfalls of govt run healthcare for the middle class vs govt run healthcare for the poor. The latter need a safety net just as they need food stamps and welfare.

 

[BLADEMDA]

It’s true that Australians like their health care system more than Canadians like theirs — but it’s also true that wealthier Australians are more likely to enroll in private insurance than lower-income Australians, introducing an element of inequality that doesn’t exist in Canada. The health system you prefer turns on the values you hold.

Private health insurance exists in Europe and Canada. Here’s how it works.

The debate over eliminating health insurance is actually offering a false choice.

www.vox.com

 

[deleted480308]

Except for student loans, which you have no problem taking.

I absoluTely pay may my loans. I don’t think govt should be in the student loan business and have said repeatedly that tuition bloat is largely due to the absurd govt involvement in that arena.

 

[BLADEMDA]

It’s true that Australians like their health care system more than Canadians like theirs — but it’s also true that wealthier Australians are more likely to enroll in private insurance than lower-income Australians, introducing an element of inequality that doesn’t exist in Canada. The health system you prefer turns on the values you hold.

Private health insurance exists in Europe and Canada. Here’s how it works.

The debate over eliminating health insurance is actually offering a false choice.

www.vox.com

I'm advocating for a 2 tiered system where basic care is available to everyone. Medicaid expansion for the poor and Medicare for elderly. But, the ACA is not the way to go about it. Eliminate the ACA in terms of private plans and let the free market work. Private insurance will serve as the Gold and Platinum plans with no govt. subsidy but tax benefits like today.

 

[vector2]

I'm advocating for a 2 tiered system where basic care is available to everyone. Medicaid expansion for the poor and Medicare for elderly. But, the ACA is not the way to go about it. Eliminate the ACA in terms of private plans and let the free market work. Private insurance will serve as the Gold and Platinum plans with no govt. subsidy but tax benefits like today.

If you do this then we are literally back to where we started preACA where there are a huge number of adults who make too much money for medicaid but who cant afford private insurance even with a tax break.

Beyond that, Medicaid has way too many problems to be relied upon as the "basic" health plan.

 

[BLADEMDA]

Malaysia ranks 1st in world's best healthcare category

KUALA LUMPUR (Bernama): Malaysia, with a score of 95 out of 100, ranked first in the Best Healthcare in the World category of the 2019 International Living Annual Global Retirement Index.

www.thestar.com.my

Healthcare in Malaysia is mainly under the Ministry of Health. Malaysia generally has an efficient and widespread system of health care, operating a two-tier health care system consisting of both a government base universal healthcare system and a co-existing private healthcare system.
Healthcare in Malaysia - Wikipedia

https://en.wikipedia.org › wiki › Healthcare_in_Malaysia

 

[BLADEMDA]

If you leave your partisan politics behind the answer is clear: 2 tiered healthcare system.

That system needs to be without the ACA as we know it today. Medicare, Public Option for Medicare and Medicaid are all govt. run. Private healthcare is NOT subsidized by the govt but individuals can claim tax deductions like today. Private Plans offer "Advantage" Plans which allow one to pay extra in addition to medicare (like today).

Hospitals and Physicians can work in both tiers like they do today. This system isn't perfect but offers the most flexibility of any system and emulates the systems which work best across the world.

 

[BLADEMDA]

If you do this then we are literally back to where we started preACA where there are a huge number of adults who make too much money for medicaid but who cant afford private insurance even with a tax break.

Beyond that, Medicaid has way too many problems to be relied upon as the "basic" health plan.

Public Option buy-in. The ACA becomes Medicaid expansion and Public Option buy-in. Private insurance is no longer given subsidies. Individuals must purchase "advantage" plans or they get the basic Medicare plan.

For a liberal to advocate the use of tax dollars to enrich private corporations when the govt. can offer a much cheaper service is pure hypocrisy. If you are too poor to buy real, private insurance but too rich for Medicaid you get the Bronze Medicare plan.

Private Insurance is for the marketplace and consumers get to decide on what supplemental insurance they want to buy if any.

 

[BLADEMDA]

Think of how wasteful the current ACA is in terms of both taxpayers and recipients. Both get a raw deal. The taxpayer pays billions in subsidies to allow lower middle class citizens to buy health insurance. This health insurance can be offered by the govt. in the form of Medicare for 1/3 less cost.

Second, the recipient of this insurance gets a private healthcare plan with a very high deductible making it practically worthless in terms of utility for a poor working class family.

 

[KeikoTanaka]

I absoluTely pay may my loans. I don’t think govt should be in the student loan business and have said repeatedly that tuition bloat is largely due to the absurd govt involvement in that arena.

My undergraduate university had a Lazy River in the school gym's pool. I think that may have had something to do with tuition-bloat as well.... (Which was obviously afforded to them via the fact the gov was giving them money) lol

 

[MoMoGesiologist]

Not a fan of Medicare. We are subsidizing and encouraging old age and disease!

 

[deleted171991]

Not a fan of Medicare. We are subsidizing and encouraging old age and disease!

Not a fan of student loans. We are subsidizing and encouraging young age and debauchery! Let them earn the money and mature first.

 

[nimbus]

Except for student loans, which you have no problem taking.

And medicare which they will be accepting as a practicing physician.

 

[nimbus]

My undergraduate university had a Lazy River in the school gym's pool. I think that may have had something to do with tuition-bloat as well.... (Which was obviously afforded to them via the fact the gov was giving them money) lol

Use it or lose it....right?

 

[VA Hopeful Dr]

And medicare which they will be accepting as a practicing physician.

Not necessarily

 

[nimbus]

Not necessarily

True. Maybe a lucky few. For a multitude of reasons, it’s hard to make a living as an anesthesiologist without accepting medicare.

 

[Lawpy]

The left will try to make private insurance illegal. There will be court challenges to these laws based on the constitution. I don't see how the govt. can forbid a private citizen from buying a product or service which clearly benefits that individual. Our entire Constitution is based on our "rights" as individuals.

Eventually, healthcare becomes a 2 tiered system where those with money or private insurance seek out the Mayo Clinics of the world while the majority are stuck with the public healthcare system with rationed care.

Wait what party or candidate supports this 2 tiered system?

 

[ambiturner]

Children’s hospitals offer a pretty good model of what a 2-tiered system would look like since all kids have some form of Medicaid even if their parents are uninsured.

the result is the hospital makes virtually all its clinical revenue off of private insurance patients, offers lifesaving treatment to all (cancer, syndromes, transplants, congenital heart conditions, etc), and has a massive Medicaid waiting list for important but delay-able procedures (tonsils, MRIs, specialty clinic visits, etc). I would argue most of the kids on public aid get decent care.

Of course, all children’s hospitals would go bankrupt if not for the following:
1) specialty clinics and surgery centers in wealthy suburbs to attract as many pts with insurance as possible,
2) international patients who pay cash - the most prestigious children’s hospitals have more Arabic interpreters than Spanish as Kuwait, the UAE, Saudi Arabia etc basically write these hospitals blank checks, and
3) charity fundraising.

So this is what I imagine adult healthcare would resemble with M4A. Hospital employment may be favorable for many specialties, including ours, in such a model due to the need for revenues outside clinical billing and an increase in cases done at cost or worse.

 

[deleted480308]

And medicare which they will be accepting as a practicing physician.

taking medicare isn't approval of the system even if I get stuck doing it. The govt uses a it's power to seize a massive portion of the market then make laws which pressure consolidation under hospitals (with even more pressure to take medicare/medicaid). Acknowledging the landscape and getting stuck navigating it doesn't mean you approve, you are stuck with bad options because the govt is doing something it shouldn't

 

[vector2]

Children’s hospitals offer a pretty good model of what a 2-tiered system would look like since all kids have some form of Medicaid even if their parents are uninsured.

the result is the hospital makes virtually all its clinical revenue off of private insurance patients, offers lifesaving treatment to all (cancer, syndromes, transplants, congenital heart conditions, etc), and has a massive Medicaid waiting list for important but delay-able procedures (tonsils, MRIs, specialty clinic visits, etc). I would argue most of the kids on public aid get decent care.

Of course, all children’s hospitals would go bankrupt if not for the following:
1) specialty clinics and surgery centers in wealthy suburbs to attract as many pts with insurance as possible,
2) international patients who pay cash - the most prestigious children’s hospitals have more Arabic interpreters than Spanish as Kuwait, the UAE, Saudi Arabia etc basically write these hospitals blank checks, and
3) charity fundraising.

So this is what I imagine adult healthcare would resemble with M4A. Hospital employment may be favorable for many specialties, including ours, in such a model due to the need for revenues outside clinical billing and an increase in cases done at cost or worse.

A two tiered system isn't possible if the two tiers are (unchanged) Medicaid/Medicare for most and then private insurance for the rest. As you point out, Medicaid/CHIP doesn't pay for sht because the system, by its very nature of being a federal/state partnership, has been strangled in its crib. Conservative states severely restrict funding and most of them refused the medicaid expansion even though they have the poorest citizens. Individual states can also come up with all sorts of cockamamy schemes for deciding which procedures to cover and how much they will reimburse.

There's no way around the fact that some X number of dollars going into the private system are going to have to make their way into the basic tier system. Any system going forward in which the private pay/high tier is required to subsidize the low tier to make the whole thing work is destined to fail. The basic tier should be able to stand on its own two legs (adequate coverage and reimbursement) and the supplemental cadillac plans should be purely elective for those who can afford them.

 

[aafisahar]

I absoluTely pay may my loans. I don’t think govt should be in the student loan business and have said repeatedly that tuition bloat is largely due to the absurd govt involvement in that arena.

But you took the money without their explicit consent. You are a hypocrite. You don't want others to take your money but you have no compunction in taking theirs. The fact that you will pay it back is irrelevant. You took money that in your own words you have no right to take. When it benefits you (eg medical school, high income potential, prestige, etc) your supposed ideals crumble.

 

[VA Hopeful Dr]

But you took the money without their explicit consent. You are a hypocrite. You don't want others to take your money but you have no compunction in taking theirs. The fact that you will pay it back is irrelevant. You took money that in your own words you have no right to take. When it benefits you (eg medical school, high income potential, prestige, etc) your supposed ideals crumble.

Except there is pretty high interest on those loans. You pay back significantly more than you borrow (and often more than private loans would require).

 

[aafisahar]

Except there is pretty high interest on those loans. You pay back significantly more than you borrow (and often more than private loans would require).

Again, irrelevant to his starting position. It's money taken from others without their consent in his own words. He doesn't want any sort of government interference in Healthcare or education but he's ok to break those same rules when it benefits him.