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I, too, like to bloviate about my principles and then at the end of the day just say f*ck it if a principled stand hurts my bank account too much.
Article: Would ‘Medicare for All’ really save money?
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deleted480308
I’m not ok with it, but govt is breaking the educational system and set this bad situation up
You’re telling the prisoner he’s a hypocrite for eating the warden’s food. I’m saying, the warden should let us go
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In the end, both parties will be forced to accept it. Democrats want a "Medicare for all" single payer system. Republicans want 100% private healthcare with govt. vouchers.
The middle ground will be a 2 tiered health system like Australia. As for which candidate is openly advocating for a 2 tiered healthcare system the answer is nobody. The "base" of each party would be against the open admission of a 2 tiered system even though we actually have one today.
Don't be so certain that a second term Trump won't make a deal with the Dems. Trump has been a Democrat for the vast majority of his life and would be open to compromise after the election. I think Joe Biden would be open to a deal as well.
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Because it's already there.
It's like being an ED doctor who objects to Medicare. Since you're not allowed to refuse to see anyone you are stuck seeing Medicare patients.
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Well that’s just plainly false. Both Biden and Buttigieg want to keep ACA and expand the choices for the public option (Medicare for those who want it) while letting anyone who wants private insurance keep theirs.
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I think the 2 tiered system is possible and Medicaid will be a "NP" type insurance for most of the participants.
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The wording matters and neither Biden or Buttigieg will openly advocate for a 2 tiered system. Medicare for those that want it is yet to be explained in detail. How much will it cost? Who will accept Medicare if millions more pour into it and hospitals/physicians must accept the lower reimbursement.
Any 2 tiered system requires open discussion and I haven't heard a word from the Dems on the meat behind the rhetoric. Both parties will need to be involved if the next, new ACA is really going to work well for the country.
Republicans don't have the backbone to repeal the ACA. They know that changes must be made to healthcare after the 2020 elections. Both parties are aware of the real issues here.
Again, Trump may surprise you if he wins re-election.
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A true idealist would hunger strike. It would be about as irrational and silly as pure libertarianism.
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deleted480308
Freedom is hard, far too many people prefer being the govts pet
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No, freedom is easy. Living within a society and making compromises that strengthen that social structure is hard.
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The wording does matter. Just because you can’t be bothered to look it up doesn’t mean it’s not there. Yes, the devil is in the details, but your claim that no candidate is espousing a two or multi tier system is still false.
THE BIDEN PLAN TO PROTECT & BUILD ON THE AFFORDABLE CARE ACT
I. GIVE EVERY AMERICAN ACCESS TO AFFORDABLE HEALTH INSURANCE
From the time right before the Affordable Care Act’s key coverage-related policies went into effect to the last full year of the Obama-Biden Administration, 2016, the number of Americans lacking health insurance fell from 44 million to 27 million – an almost 40% drop. But President Trump’s persistent efforts to sabotage Obamacare through executive action, after failing in his efforts to repeal it through Congress, have started to reverse this progress. Since 2016, the number of uninsured Americans has increased by roughly 1.4 million.
As president, Biden will stop this reversal of the progress made by Obamacare. And he won’t stop there. He’ll also build on the Affordable Care Act with a plan to insure more than an estimated 97% of Americans. Here’s how:
Giving Americans a new choice, a public health insurance option like Medicare. If your insurance company isn’t doing right by you, you should have another, better choice. Whether you’re covered through your employer, buying your insurance on your own, or going without coverage altogether, the Biden Plan will give you the choice to purchase a public health insurance option like Medicare. As in Medicare, the Biden public option will reduce costs for patients by negotiating lower prices from hospitals and other health care providers. It also will better coordinate among all of a patient’s doctors to improve the efficacy and quality of their care, and cover primary care without any co-payments. And it will bring relief to small businesses struggling to afford coverage for their employees.
Increasing the value of tax credits to lower premiums and extend coverage to more working Americans. Today, families that make between 100% and 400% of the federal poverty level may receive a tax credit to reduce how much they have to pay for health insurance on the individual marketplace. The dollar amount of the financial assistance is calculated to ensure each family does not have to pay more than a certain percentage of their income on a silver (medium generosity) plan. But, these shares of income are too high and silver plans’ deductibles are too high. Additionally, many families making more than 400% of the federal poverty level (about $50,000 for a single person and $100,000 for a family of four), and thus not qualifying for financial assistance, still struggle to afford health insurance. The Biden Plan will help middle class families by eliminating the 400% income cap on tax credit eligibility and lowering the limit on the cost of coverage from 9.86% of income to 8.5%. This means that no family buying insurance on the individual marketplace, regardless of income, will have to spend more than 8.5% of their income on health insurance. Additionally, the Biden Plan will increase the size of tax credits by calculating them based on the cost of a more generous gold plan, rather than a silver plan. This will give more families the ability to afford more generous coverage, with lower deductibles and out-of-pocket costs.
Expanding coverage to low-income Americans. Access to affordable health insurance shouldn’t depend on your state’s politics. But today, state politics is getting in the way of coverage for millions of low-income Americans. Governors and state legislatures in 14 states have refused to take up the Affordable Care Act’s expansion of Medicaid eligibility, denying access to Medicaid for an estimated 4.9 million adults. Biden’s plan will ensure these individuals get covered by offering premium-free access to the public option for those 4.9 million individuals who would be eligible for Medicaid but for their state’s inaction, and making sure their public option covers the full scope of Medicaid benefits. States that have already expanded Medicaid will have the choice of moving the expansion population to the premium-free public option as long as the states continue to pay their current share of the cost of covering those individuals. Additionally, Biden will ensure people making below 138% of the federal poverty level get covered. He’ll do this by automatically enrolling these individuals when they interact with certain institutions (such as public schools) or other programs for low-income populations (such as SNAP).Learn more about how Biden’s plan for health care benefits communities of color >>
II. PROVIDE THE PEACE OF MIND OF AFFORDABLE, QUALITY HEALTH CARE AND A LESS COMPLEX HEALTH CARE SYSTEM
Today, even for people with health insurance, our health care system is too expensive and too hard to navigate. The Biden Plan will not only provide coverage for uninsured Americans, it will also make health care more affordable and less complex for all.
The plan’s elements described above will help reduce the cost of health insurance and health care for those already insured in the following ways:
All Americans will have a new, more affordable option. The public option, like Medicare, will negotiate prices with providers, providing a more affordable option for many Americans who today find their health insurance too expensive.
Middle class families will get a premium tax credit to help them pay for coverage. For example, take a family of four with an income of $110,000 per year. If they currently get insurance on the individual marketplace, because their premium will now be capped at 8.5% of their income, under the Biden Plan they will save an estimated $750 per month on insurance alone. That’s cutting their premiums almost in half. If a family is covered by their employer but can get a better deal with the 8.5% premium cap, they can switch to a plan on the individual marketplace, too.
Premium tax credits will be calculated to help more families afford better coverage with lower deductibles. Because the premium tax credits will now be calculated based on the price of a more generous gold plan, families will be able to purchase a plan with a lower deductible and lower out-of-pocket spending. That means many families will see their overall annual health care spending go down.
The Biden Plan has several additional proposals aimed directly at cutting the cost of health care and making the health care system less complex to navigate. The Biden Plan will:
Stop “surprise billing.” Consumers trying to lower their health care spending often try to choose an in-network provider. But sometimes patients are unaware they are receiving care from an out-of-network provider and a big, surprise bill. “Surprise medical billing” could occur, for example, if you go to an in-network hospital but don’t realize a specialist at that hospital is not part of your health plan. The Biden Plan will bar health care providers from charging patients out-of-network rates when the patient doesn’t have control over which provider the patient sees (for example, during a hospitalization).
Tackle market concentration across our health care system. The concentration of market power in the hands of a few corporations is occurring throughout our health care system, and this lack of competition is driving up prices for consumers. The Biden Administration will aggressively use its existing antitrust authority to address this problem.
Lower costs and improve health outcomes by partnering with the health care workforce. The Biden Administration will partner with health care workers and accelerate the testing and deployment of innovative solutions that improve quality of care and increase wages for low-wage health care workers, like home care workers.
III. STAND UP TO ABUSE OF POWER BY PRESCRIPTION DRUG CORPORATIONS
Too many Americans cannot afford their prescription drugs, and prescription drug corporations are profiteering off of the pocketbooks of sick individuals. The Biden Plan will put a stop to runaway drug prices and the profiteering of the drug industry by:
Repealing the outrageous exception allowing drug corporations to avoid negotiating with Medicare over drug prices. Because Medicare covers so many Americans, it has significant leverage to negotiate lower prices for its beneficiaries. And it does so for hospitals and other providers participating in the program, but not drug manufacturers. Drug manufacturers not facing any competition, therefore, can charge whatever price they choose to set. There’s no justification for this except the power of prescription drug lobbying. The Biden Plan will repeal the existing law explicitly barring Medicare from negotiating lower prices with drug corporations.
Limiting launch prices for drugs that face no competition and are being abusively priced by manufacturers. Through his work on the Cancer Moonshot, Biden understands that the future of pharmacological interventions is not traditional chemical drugs but specialized biotech drugs that will have little to no competition to keep prices in check. Without competition, we need a new approach for keeping the prices of these drugs down. For these cases where new specialty drugs without competition are being launched, under the Biden Plan the Secretary of Health and Human Services will establish an independent review board to assess their value. The board will recommend a reasonable price, based on the average price in other countries (a process called external reference pricing) or, if the drug is entering the U.S. market first, based on an evaluation by the independent board members. This reasonable price will be the rate Medicare and the public option will pay. In addition, the Biden Plan will allow private plans participating in the individual marketplace to access a similar rate.
Limiting price increases for all brand, biotech, and abusively priced generic drugs to inflation. As a condition of participation in the Medicare program and public option, all brand, biotech, and abusively priced generic drugs will be prohibited from increasing their prices more than the general inflation rate. The Biden Plan will also impose a tax penalty on drug manufacturers that increase the costs of their brand, biotech, or abusively priced generic over the general inflation rate.
Allowing consumers to buy prescription drugs from other countries. To create more competition for U.S. drug corporations, the Biden Plan will allow consumers to import prescription drugs from other countries, as long as the U.S. Department of Health and Human Services has certified that those drugs are safe.
Terminating pharmaceutical corporations’ tax break for advertisement spending. Drug corporations spent an estimated $6 billion in 2016 alone on prescription drug advertisements to increase their sales, a more than four-fold increase from just $1.3 billion in 1997. The American Medical Association has even expressed “concerns among physicians about the negative impact of commercially driven promotions, and the role that marketing costs play in fueling escalating drug prices.” Currently, drug corporations may count spending on these ads as a deduction to reduce the amount of taxes they owe. But taxpayers should not have to foot the bill for these ads. As president, Biden will end this tax deduction for all prescription drug ads, as proposed by Senator Jeanne Shaheen.
Improving the supply of quality generics. Generics help reduce health care spending, but brand drug corporations have succeeded in preserving a number of strategies to help them delay the entrance of a generic into the market even after the patent has expired. The Biden Plan supports numerous proposals to accelerate the development of safe generics, such as Senator Patrick Leahy’s proposal to make sure generic manufacturers have access to a sample.
IV. ENSURE HEALTH CARE IS A RIGHT FOR ALL, NOT A PRIVILEGE FOR JUST A FEW
Joe Biden believes that every American – regardless of gender, race, income, sexual orientation, or zip code – should have access to affordable and quality health care. Yet racism, sexism, homophobia, transphobia, and other forms of discrimination permeate our health care system just as in every other part of society. As president, Biden will be a champion for improving access to health care and the health of all by:
Expanding access to contraception and protect the constitutional right to an abortion. The Affordable Care Act made historic progress by ensuring access to free preventive care, including contraception. The Biden Plan will build on that progress. Vice President Biden supports repealing the Hyde Amendment because health care is a right that should not be dependent on one’s zip code or income. And, the public option will cover contraception and a woman’s constitutional right to choose. In addition, the Biden Plan will:
Reverse the Trump Administration and states’ all-out assault on women’s right to choose. As president, Biden will work to codify Roe v. Wade, and his Justice Department will do everything in its power to stop the rash of state laws that so blatantly violate the constitutional right to an abortion, such as so-called TRAP laws, parental notification requirements, mandatory waiting periods, and ultrasound requirements.
Restore federal funding for Planned Parenthood. The Obama-Biden administration fought Republican attacks on funding for Planned Parenthood again and again. As president, Biden will reissue guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers that refer for abortions or provide related information and reverse the Trump Administration’s rule preventing Planned Parenthood and certain other family planning programs from obtaining Title X funds.
Just as the Obama-Biden Administration did,President Biden will rescind the Mexico City Policy (also referred to as the global gag rule) that President Trump reinstated and expanded. This rule currently bars the U.S. federal government from supporting important global health efforts – including for malaria and HIV/AIDS – in developing countries simply because the organizations providing that aid also offer information on abortion services.
Reducing our unacceptably high maternal mortality rate, which especially impacts people of color. Compared to other developed nations, the U.S. has the highest rate of deaths related to pregnancy and childbirth, and we are the only country experiencing an increase in this death rate. This problem is especially prevalent among black women, who experience a death rate from complications related to pregnancy that is more than three times higher than the rate for non-Hispanic white women. California came up with a strategy that halved the state’s maternal death rate. As president, Biden will take this strategy nationwide.
Defending health care protections for all, regardless of gender, gender identity, or sexual orientation. Before the Affordable Care Act, insurance companies could increase premiums merely due to someone’s gender, sexual orientation, or gender identity. Further, insurance companies could increase premiums or deny coverage altogether due to someone’s HIV status. Yet, President Trump is trying to walk back this progress. For example, he has proposed to once again allow health care providers and insurance companies to discriminate based on a patient’s gender identity or abortion history. President Biden will defend the rights of all people – regardless of gender, sexual orientation, gender identity – to have access to quality, affordable health care free from discrimination.
Doubling America’s investment in community health centers. Community health centers provide primary, prenatal, and other important care to underserved populations. The Biden Plan will double the federal investment in these centers, expanding access to high quality health care for the populations that need it most.
Achieving mental health parity and expanding access to mental health care. As Vice President, Biden was a champion for efforts to implement the federal mental health parity law, improve access to mental health care, and eliminate the stigma around mental health. As President, he will redouble these efforts to ensure enforcement of mental health parity laws and expand funding for mental health services.
In the months ahead, Biden will put forward additional plans to tackle health challenges affecting specific communities, including access to health care in rural communities, gun violence, and opioid addiction.
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deleted480308
I’m going to say we have vastly differing ideas on the word compromise
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If you really wanted to take a principled stand, you could’ve gotten into a top 5 ortho, plastics, med, peds, or psych residency and then joined a concierge, no Medicare/Medicaid practice. Even as an anesthesiologist there are still some cash only practices here and there. Your prison food analogy really only works for residency since it’s funded by CMS.
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deleted480308
Ah, the “avoid entire careers or you can’t have opinions about the govt being a bad actor” argument?
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Probably not. However, I think we have vastly differing opinions on the practicality of pure libertarianism. It’s a utopian philosophy...not unlike communism. It’s fun to talk about in high school political thought classes, but fails miserably in the real world...similar to communism.
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deleted480308
It fails in democratic elections, it would work just fine if we just stuck to it. People would need to adapt to a new definition of “it working” though that didn’t include making their neighbor by them things
You are starting at the wrong premise. It's not about being an ED and abiding by EMTALA. It's the premise that he had to go to medical school in the first place. He had alternatives. No one forced him to go to medical school or take loans. He could have found another career to pursue that stayed true to his principle. He's a hack and a hypocrite which is seemingly typical of libertarians. When it suits them (eg MY MONEY TAXATION IS THEFT!!11) they will defend their positions even if it harms society as a whole, but when it benefits them, they are more than happy to discard their ideals. If he really believed all that, he would have stayed true to his ideals. Instead, when it suits him and benefits him, he's more than happy to be on the public dole and take other people's money. But he's more than happy to pull the rug out from others to prevent them from having the same opportunities he enjoys.
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deleted480308
Again, I am paying my way.
And I’m paying a total sum drastically inflated by the govt interference and it started at a rate significantly higher than I get from the private market
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You can absolutely have an opinion. But the fact that you have a strong, negative, moral opinion about "X" and then choose to do "X" anyway out of convenience and not necessity informs all of us who are party to this discussion that your position on "X" is probably not something to be taken seriously.
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deleted480308
You expect far too much when ask someone to skip an entire career just to prove themself a true scotsman. I owe you nothing if you are going toargue in bad faith
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Really stupid argument. Unfortunately, unless you want to end up in jail, we all have to mediate life through the confines of what society dictates we can do. Having a belief and acting opposite to that belief (AKA Cognitive dissonance) is a very common thing, but we all do what we can to get by. Why would he not choose to go into a high paying field if he has A.) The intelligence B.) the motivation C.) physical/financial capacity to do so, just because he has beliefs that may align better with a different job?
So just because someone believes libertarianism is actually an effective approach, they have to ban together and live in a commune? Should all vegans go live on an island together somewhere?
I've been on SDN a long time now (like 3 years?) and I can 100% say that Ron Swanson over here is not a hypocrite. I may not agree with everything he says, but he always comes from the same angle regardless. He's the first to admit he functions in this society (as we all do) by going along with things (Taxation/Donating to charity/Probably works longer unpaid hours too) simply because he has to in order to keep his job, life, family, etc...
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Then why didn’t you use the private market or save up and pay your own way?
As problematic as the student loan situation is, you did benefit from easy government money whether you like to admit it or not. On what basis would a private bank give an 18 or 22 year old low interest loans for education? I don’t care how much of a sweetheart you were in high school.
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Bud, you have to wonder about who's arguing in bad faith here when your position is to tell old people to go die in a gutter because "f you, got mine"....while simultaneously being totally oblivious to the amount of tangible and intangible benefit you've gotten from others (including the govt) to get to where you are right now.
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Dude is non-traditional
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Even more of a reason he should have saved up cash. Bailed out by daddy government yet again...
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No, vegans just have to stop eating animal products or stfu about it. Libertarians just have to stop using all the government benefits they complain constantly about.....or stfu about it. Or since this is America, you really dont have to stfu about it, but just be prepared for no one to take your argument seriously ("Hey, I think America should go vegan," I shout....as I shove a juicy ribeye into my maw)
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So a) if we did away with Medicare/SS it would likely affect him just like any of us who live long enough. B) if we did away with government loans, med school would get awfully cheap awfully fast but because those loans are so easy we're getting massive tuition inflation, given that its hard to argue against taking loans.
It would be like the government adding a 250k tax onto buying a new home and then offering special government mortgages.
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Government is the reason very few people actually can pay for med school with savings.
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Partially, yes. There should have been more regulations in place on the banks and universities that were seeing the easy, guaranteed money.
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deleted480308
I think in a privately funded situation a TON of majors would all but disappear and that’s ok
A US med student would still get loans offered to them
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I think you vastly don't understand the point. Having an "idealistic political mindset" shapes your ideas about how you envision future plans working.
Everyone right now who is all for M4A, based on your logic, should not be, because it does not exist. They're wasting their time talking about an unreasonable and highly improbable financial feat - Therefore they should go treat patients for free right now because they "owe it to their fellow neighbors" .... or stfu about it.
Working within a particular mindframe does not mean you necessarily live that life 100% (we're all human and have physical/societal constraints placed upon us) but it does mean that is how you mold/shape your world views and therefore foster things that can help make such ideals a reality. Hence, people can crazily believe that M4A will work (It won't, BUT YOU'RE ALLOWED TO THINK THAT!) just as he's allowed to think a libertarian approach with a more Laissez-faire government would be a better approach (both are equally crazy, M4A just seems less crazy cuz you have a senile old man on TV yelling about it).
For what its worth, your notion that he thinks "all old people should die if they can't fend for themselves" is the biological reality of the world and universe we live in. Just ask Darwin. The dream of Medicare4All may get some people out of the gutter, but it's just a band-aid on the horrible wound we've carved into the Earth. Regardless of what healthcare plan we enact, our country is in for a rude awakening. We use far too many resources, are far too wasteful, and we are getting too fat to sustain ourselves (literally and figuratively). At this rate all our precious resources will run thin, our economy will collapse, and, we may very well be very much so living in a libertarian society 🙄
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You guys were brutal on sb247. We all live in the same society and abide by the rules set forth by our govt. whether we agree with them or not. For example, if you believe that higher taxes are the "right thing" for our nation then why accept the Trump tax cuts? Nothing is preventing these liberal posters from mailing in extra $$$ to the IRS. Is their position to pay what our govt. says they owe hypocritical?
Is wanting to go to med school and taking out loans to do so hypocritical for sb247 even though he believes in smaller government? I would say no because we all have an agreement to follow the law as it exists today but can keep advocating for those positions we believe in.
Whether I believe in a particular law or not is irrelevant as my over-riding principle is to obey the laws passed by our govt while not abdicating the right to oppose such laws philosophically or voting for candidates which support my position.
Human beings by their very nature are hypocritical to a degree. So, lighten up Francis.
Is wanting to go to med school and taking out loans to do so hypocritical for sb247 even though he believes in smaller government? I would say no because we all have an agreement to follow the law as it exists today but can keep advocating for those positions we believe in.
Whether I believe in a particular law or not is irrelevant as my over-riding principle is to obey the laws passed by our govt while not abdicating the right to oppose such laws philosophically or voting for candidates which support my position.
Human beings by their very nature are hypocritical to a degree. So, lighten up Francis.
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I have been hearing the "end of the world" scenario for decades. I remember being told in 1982 that we would run out of gasoline in 30 years. Now, it is "global warming" or "china" which will destroy our way life. IMHO, the only thing which can destroy us, is literally us, in terms of massive spending (think 200% of GDP in debt) or a war with nuclear or biological weapons.
I think the world we live in right here and now is the best in human history.
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From my viewpoint Medicare on the exchanges are to be priced at fair market rates. This means those plans would not cost "1/2" what private insurance does if the same coverage is offered. A public option is supposed to be one step above Medicaid but below private insurance. That's a real 2 tiered system with "no malarkey" as Biden likes to say. This bare bones Bronze plan is subsidized by the taxpayer to provide basic services not Gold level care. Is that what you think Biden is stating about his plan?
Government should be providing the basic services at a reduced cost or for free while the private insurance companies offer Gold/Platinum plans at an extra cost. This second tier system would reimburse hospitals and physicians less money as Medicare does today.
"Additionally, the Biden Plan will increase the size of tax credits by calculating them based on the cost of a more generous gold plan, rather than a silver plan. This will give more families the ability to afford more generous coverage, with lower deductibles and out-of-pocket costs."
So, I say again Biden's rhetoric is just that because he is touting the Gold Medicare Public Option as equal to Gold Private Health Insurance. The taxpayer will be forced to subsidize this Gold plan while the physicians and hospitals take a big pay cut. That is not a real 2 tiered health system.
Biden is walking a fine line espousing a massive Public Option with the same benefits that Warren/Sanders espouse on the campaign trail. These Gold plated Medicare Options will be supported with taxpayer money and do serious damage to the private healthcare plans and the hospitals/physicians.
Biden is simply following the Obama line that "if you like your health insurance plan you can keep it" but if you read the details Biden's plan is anything but a second tier public option.
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The world moves fast, and now with the rate we are expanding, the world is changing exponentially so - I don't think the "world will end" - But I think the way of life we have now will end (Think Hunger Games scenario but nothing like that at all actually...lol).
I agree the world we live in right now is the best in human history. I don't think generations 60 years from now will be able to say that. At one point or another, we're going to have a major paradigm shift.
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You're as hopelessly simplistic as he is if you think some high school level natural selection analogy is a good argument for 21st century first-world libertarianism.
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deleted87051
Government is the reason medical schools are so cheap in most other developed countries.
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deleted87051
Libertarians would probably argue that medicare is a disastrous experiment for our country. Maybe we should just go back to the good old days.....
www.politifact.com
Were the early 1960s a golden age for health care?
By Louis Jacobson on Friday, January 20th, 2012 at 5:58 p.m.
President Lyndon B. Johnson signs Medicare into law in 1965. How did U.S. health care work for seniors before that? We take a look at the statistics.
Were the early 1960s a golden age for American medical care? To hear Ron Paul tell it, they were.
"I had the privilege of practicing medicine in the early '60s before we had any government" involvement in health care, Paul said during the Jan. 19, 2012, Republican presidential debate in Charleston, S.C. "It worked rather well, and there was nobody out in the street suffering with no medical care. But Medicare and Medicaid came in and it just expanded."
As soon as we heard this, we wondered whether his portrayal was accurate. We considered putting his comment to the Truth-O-Meter, but we decided that it was impossible to do so. We couldn’t prove a negative -- that "there was nobody out in the street suffering with no medical care" during that era.
But we amassed research on the way to making that conclusion, most of it new to us. So we thought we’d share what we found about health care in the early 1960s.
We’ll start with one quibble with part of Paul’s statement -- that the early 1960s was a period "before we had any government" involvement in health care. That’s certainly true of two big programs passed into law in 1965 -- Medicare, primarily for senior citizens, and Medicaid, for the poor.
However, there were limited federal programs prior to 1965, notably the Kerr-Mills legislation (P.L. 86-778), which provided federal funding to states to cover medical costs for the indigent elderly. Kerr-Mills initially had been envisioned as serving 10 million people, but by 1965 -- when it was effectively supplanted by Medicare and Medicaid -- it only covered 264,687 Americans. So its impact was not that great.
As for the broader picture of pre-1965 health care in America, Rosemary Stevens, a historian and sociologist at the University of Pennsylvania, wrote that "in the early 1960s, the choices for uninsured elderly patients needing hospital service were to spend their savings, rely on funding from their children, seek welfare (and the social stigma this carried), hope for charity from the hospitals or avoid care altogether."
To double-check this assertion, we turned to a study by the Social Security Administration known as the Survey of the Aged.
The survey was taken in 1963, and its findings were published in 1964 -- the "early '60s" Paul is talking about. One downside of the data is that it only looks at Americans 65 and older. So it doesn't give a full picture of how the health care system functioned in the early 1960s. However, as we’ll discuss later, senior citizens are a key to analyzing the state of American health care, since their health needs were, and remain, more acute than the overall population's.
Overall, the study found that "the complex task of paying for necessary health services and providing adequate insurance for non-budgetable expenses remains beyond the economic capabilities of most aged persons."
In all, slightly more than half of Americans 65 and older had health insurance at the end of 1962. That works out to 64 percent of couples, 49 percent of un-married women and 37 percent of un-married men.
"And what they had was terrible insurance -- it didn’t do much to cover them," said
Dorothy Pechman Rice, a retired professor at the University of California at San Francisco who served as director of the National Center for Health Statistics from 1976 to 1982.
The study found that nine out of 10 couples, and eight out of 10 elderly individuals, "assumed responsibility for their own costs without help from government sources or private voluntary agencies." Some paid from their own savings or with the help of insurance, and some could pay "only because doctors or hospitals adjusted their rates in light of the patient’s limited resources."
Depending on the marital category, between 18 and 26 percent of seniors without health insurance relied on public assistance to pay some of the costs they incurred. The report concluded that such rates were "evidence of the fact that many of the aged simply cannot afford a hospital stay."
Indeed, the biggest distinction the surveyors found was between elderly patients who needed to be hospitalized and those who didn’t. For instance, in a year without hospitalization, married couples incurred median medical costs of $173, or $1,289 in today’s dollars. In contrast, a year with at least one hospitalization meant incurring median costs of $938, or just short of $7,000 in today’s money.
In other words, in the pre-1965 era, if you had to go to the hospital, the hospital may not have turned you down -- but if you were in the sizable percentage of Americans who had to pay all or much of the costs out of pocket, you’d be paying for your misfortune for years to come.
The report concluded that "the cost of medical care is high for the aged, principally for those requiring hospital care. Many aged persons never recover from the economic effects of a single hospital episode. Unfortunately, the heaviest burden is likely to fall on those with the least resources. Those with insurance are better able to absorb the blow than those without such protection, but even for the insured, there is no present guarantee against dependency in old age caused by catastrophic medical expenses."
None of this data demonstrates that there was "nobody out in the street suffering with no medical care" in the early 1960s. That’s why we’re unable to rate the accuracy of Paul’s statement on the Truth-O-Meter. As Paul has often noted, charitable care was an accepted part of the health care system during that period. "There were physicians who simply would not refuse care anyone who appeared in their offices and did God’s work," said Henry Aaron a health care specialist at the Brookings Institution, a Washington think tank.
But even if the 1950s and early 1960s were a golden age for medical care as Paul suggests -- a notion Aaron derides as "delusional’ -- experts we talked to suggested that the era’s model isn’t of much use for policy discussions going forward.
In the early 1960s, Aaron said, "health care was much less costly than it is today; and there was much less that doctors or hospitals could do for patients. It didn’t cost much for a hospital to let a heart attack victim lie in a bed or for a physician to stop by and prescribe nitroglycerin for someone with angina. It is rather different when pain in the chest calls for angiography and possibly for angioplasty and costly maintenance drugs. It is the rare physician today who can afford to give a full work-up to a person who presents with persistent chest pains, which calls for thousands of dollars worth of tests."
EDITOR’S NOTE: After we published our story, we were able to obtain some additional statistics about pre-1965 health care usage, which we will provide here for the benefit of readers who may be interested in learning more. In a 1963 survey, patients from the general population were given a list of symptoms and asked whether they had been able to see a physician about them. Among those who reported "pains in the heart," 25 percent said they did not see a physician; for "unexpected bleeding" it was 34 percent; for "shortness of breath," it was 35 percent; for "abdominal pains," it was 31 percent; for "repeated vomiting," it was 40 percent; for "diarrhea for four or five days," it was 38 percent. Meanwhile, comparing the annual rates of hospital admissions per 100 persons suggests that Medicare and Medicaid had a tangible impact on widening access to health care. In 1963, the rate of hospital admissions for patients with private insurance was 15 percent, compared to 9 percent for those without private insurance. By 1970, the rates had equalized at 13 percent each, with the rate for those without private insurance increasing due in part to expanded access through Medicare and Medicaid. "Many people in the U.S. prior to 1965 had very limited access to medical care," said Ronald Andersen, an emeritus professor of health services and sociology at the UCLA School of Public Health who has studied this data since the 1960s and provided the data to us. "This situation improved considerably after the implementation of Medicare and Medicaid."
Were the early 1960s a golden age for health care?
Were the early 1960s a golden age for American medical care? To hear Ron Paul tell it, they were. "I had the privilege o
www.politifact.com
Were the early 1960s a golden age for health care?
By Louis Jacobson on Friday, January 20th, 2012 at 5:58 p.m.
President Lyndon B. Johnson signs Medicare into law in 1965. How did U.S. health care work for seniors before that? We take a look at the statistics.
Were the early 1960s a golden age for American medical care? To hear Ron Paul tell it, they were.
"I had the privilege of practicing medicine in the early '60s before we had any government" involvement in health care, Paul said during the Jan. 19, 2012, Republican presidential debate in Charleston, S.C. "It worked rather well, and there was nobody out in the street suffering with no medical care. But Medicare and Medicaid came in and it just expanded."
As soon as we heard this, we wondered whether his portrayal was accurate. We considered putting his comment to the Truth-O-Meter, but we decided that it was impossible to do so. We couldn’t prove a negative -- that "there was nobody out in the street suffering with no medical care" during that era.
But we amassed research on the way to making that conclusion, most of it new to us. So we thought we’d share what we found about health care in the early 1960s.
We’ll start with one quibble with part of Paul’s statement -- that the early 1960s was a period "before we had any government" involvement in health care. That’s certainly true of two big programs passed into law in 1965 -- Medicare, primarily for senior citizens, and Medicaid, for the poor.
However, there were limited federal programs prior to 1965, notably the Kerr-Mills legislation (P.L. 86-778), which provided federal funding to states to cover medical costs for the indigent elderly. Kerr-Mills initially had been envisioned as serving 10 million people, but by 1965 -- when it was effectively supplanted by Medicare and Medicaid -- it only covered 264,687 Americans. So its impact was not that great.
As for the broader picture of pre-1965 health care in America, Rosemary Stevens, a historian and sociologist at the University of Pennsylvania, wrote that "in the early 1960s, the choices for uninsured elderly patients needing hospital service were to spend their savings, rely on funding from their children, seek welfare (and the social stigma this carried), hope for charity from the hospitals or avoid care altogether."
To double-check this assertion, we turned to a study by the Social Security Administration known as the Survey of the Aged.
The survey was taken in 1963, and its findings were published in 1964 -- the "early '60s" Paul is talking about. One downside of the data is that it only looks at Americans 65 and older. So it doesn't give a full picture of how the health care system functioned in the early 1960s. However, as we’ll discuss later, senior citizens are a key to analyzing the state of American health care, since their health needs were, and remain, more acute than the overall population's.
Overall, the study found that "the complex task of paying for necessary health services and providing adequate insurance for non-budgetable expenses remains beyond the economic capabilities of most aged persons."
In all, slightly more than half of Americans 65 and older had health insurance at the end of 1962. That works out to 64 percent of couples, 49 percent of un-married women and 37 percent of un-married men.
"And what they had was terrible insurance -- it didn’t do much to cover them," said
Dorothy Pechman Rice, a retired professor at the University of California at San Francisco who served as director of the National Center for Health Statistics from 1976 to 1982.
The study found that nine out of 10 couples, and eight out of 10 elderly individuals, "assumed responsibility for their own costs without help from government sources or private voluntary agencies." Some paid from their own savings or with the help of insurance, and some could pay "only because doctors or hospitals adjusted their rates in light of the patient’s limited resources."
Depending on the marital category, between 18 and 26 percent of seniors without health insurance relied on public assistance to pay some of the costs they incurred. The report concluded that such rates were "evidence of the fact that many of the aged simply cannot afford a hospital stay."
Indeed, the biggest distinction the surveyors found was between elderly patients who needed to be hospitalized and those who didn’t. For instance, in a year without hospitalization, married couples incurred median medical costs of $173, or $1,289 in today’s dollars. In contrast, a year with at least one hospitalization meant incurring median costs of $938, or just short of $7,000 in today’s money.
In other words, in the pre-1965 era, if you had to go to the hospital, the hospital may not have turned you down -- but if you were in the sizable percentage of Americans who had to pay all or much of the costs out of pocket, you’d be paying for your misfortune for years to come.
The report concluded that "the cost of medical care is high for the aged, principally for those requiring hospital care. Many aged persons never recover from the economic effects of a single hospital episode. Unfortunately, the heaviest burden is likely to fall on those with the least resources. Those with insurance are better able to absorb the blow than those without such protection, but even for the insured, there is no present guarantee against dependency in old age caused by catastrophic medical expenses."
None of this data demonstrates that there was "nobody out in the street suffering with no medical care" in the early 1960s. That’s why we’re unable to rate the accuracy of Paul’s statement on the Truth-O-Meter. As Paul has often noted, charitable care was an accepted part of the health care system during that period. "There were physicians who simply would not refuse care anyone who appeared in their offices and did God’s work," said Henry Aaron a health care specialist at the Brookings Institution, a Washington think tank.
But even if the 1950s and early 1960s were a golden age for medical care as Paul suggests -- a notion Aaron derides as "delusional’ -- experts we talked to suggested that the era’s model isn’t of much use for policy discussions going forward.
In the early 1960s, Aaron said, "health care was much less costly than it is today; and there was much less that doctors or hospitals could do for patients. It didn’t cost much for a hospital to let a heart attack victim lie in a bed or for a physician to stop by and prescribe nitroglycerin for someone with angina. It is rather different when pain in the chest calls for angiography and possibly for angioplasty and costly maintenance drugs. It is the rare physician today who can afford to give a full work-up to a person who presents with persistent chest pains, which calls for thousands of dollars worth of tests."
EDITOR’S NOTE: After we published our story, we were able to obtain some additional statistics about pre-1965 health care usage, which we will provide here for the benefit of readers who may be interested in learning more. In a 1963 survey, patients from the general population were given a list of symptoms and asked whether they had been able to see a physician about them. Among those who reported "pains in the heart," 25 percent said they did not see a physician; for "unexpected bleeding" it was 34 percent; for "shortness of breath," it was 35 percent; for "abdominal pains," it was 31 percent; for "repeated vomiting," it was 40 percent; for "diarrhea for four or five days," it was 38 percent. Meanwhile, comparing the annual rates of hospital admissions per 100 persons suggests that Medicare and Medicaid had a tangible impact on widening access to health care. In 1963, the rate of hospital admissions for patients with private insurance was 15 percent, compared to 9 percent for those without private insurance. By 1970, the rates had equalized at 13 percent each, with the rate for those without private insurance increasing due in part to expanded access through Medicare and Medicaid. "Many people in the U.S. prior to 1965 had very limited access to medical care," said Ronald Andersen, an emeritus professor of health services and sociology at the UCLA School of Public Health who has studied this data since the 1960s and provided the data to us. "This situation improved considerably after the implementation of Medicare and Medicaid."
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Yep, but that's irrelevant to the discussion at hand.
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Putting aside for a minute the 'how am I paying for med school?' question, I wonder what percentage of the curriculum and textbooks were eventually derived from taxpayer NIH money, not noble job creator pharmaceutical/device maker money. Here I am, sitting in my freedom shed thinking about how I never, ever go to the doctor, and yet my hard-earned tax dollars are being stolen so a bunch of nerds can do a bunch of research to prevent all those elderly moochers from dying.
D
deleted480308
Low tuition doesn’t mean the cost is cheap
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Snark of your post aside, probably a lot.
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Good discussion except for picking on SB247. Medicare 4 all simply won’t happen with the next President. The country isn’t ready yet and there isn’t a plan to actually come up with $40-50 trillion dollars.
I do think the country is ready for a 2 tiered health system out in the open. If you can’t afford a private plan then the govt will provide you one with review panels.
I actually hope the GOP will come around to support such a plan but it sure as heck won’t be Biden’s gold plated Medicare option at the taxpayers expense. The plan as I see moderate Republicans supporting it will offer basic health insurance with no deductibles for screening, basic care and emergency or cancer services. But, if you want elective surgery that would require approval from a govt panel of experts. The same goes for medications
The GOP also needs to provide solutions to the Medicaid problem. We can’t leave the poorest among us without basic healthcare. All states need to be part of the expanded Medicaid program.
I do think the country is ready for a 2 tiered health system out in the open. If you can’t afford a private plan then the govt will provide you one with review panels.
I actually hope the GOP will come around to support such a plan but it sure as heck won’t be Biden’s gold plated Medicare option at the taxpayers expense. The plan as I see moderate Republicans supporting it will offer basic health insurance with no deductibles for screening, basic care and emergency or cancer services. But, if you want elective surgery that would require approval from a govt panel of experts. The same goes for medications
The GOP also needs to provide solutions to the Medicaid problem. We can’t leave the poorest among us without basic healthcare. All states need to be part of the expanded Medicaid program.
D
deleted87051
This brings up an interesting point. We have public police and fire academies because we need policemen and firefighters. They are little or no cost to the student because society has decided they serve a societal need. Same with the military. What if it was the same for doctors and nurses? I think that’s how many other countries approach this issue.
D
deleted480308
We can, but we won’t
And the request is never for “basic” anything, there is always a cry for more
D
deleted480308
I get how other countries think, I just think they are deeply flawed
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You're saying that GOP won't support the gold plated Medicare option as if the GOP actually cares at all about spending. The number 1 issue that they got killed on in the midterms was the attempt to repeal ACA and take away protection for preexisting conditions. I think a "barebones death panel" plan would play very poorly with dems and the populist trumpy base.
D
