johnfree7

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It seems inevitable to me the US will adopt a medicare-for-all style healthcare system. The question is when. The health insurance industry has had decades to correct its behavior. In the marketplace of ideas, if you don't appeal to consumers they'll find a larger organization (in this case, government) to fix the problems.

Edit: Apologies, if this is re-post. Didn't see similar topic from earlier
 
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siliso

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You can look around the developed world for various examples of how it can be done and how it works out, in terms of health outcomes and expenditures and satisfaction. In some countries healthcare is almost entirely nationalized but with some private alternatives - in others insurance is nationalized without private alternative, but doctors/hospitals aren’t government employed/owned - in others there is a mix of public and private insurance with a universal baseline. The closest to “Medicare for all” (one public health insurance, non government owned/employed hospitals and doctors) would be IMO Canada.
 
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It’s a horrible idea and will not be the panacea it will be pitched as
Swanson, if you got a better reform idea than "socialized medicine," pitch it to Trump & Republicans because they got no answer to the right-wing conservative idea of the individual-mandate system known as Obamacare.
 

sb247

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Swanson, if you got a better reform idea than "socialized medicine," pitch it to Trump & Republicans because they got no answer to the right-wing conservative idea of the individual-mandate system known as Obamacare.
The answer is people paying for their own care. Yes, I know the problems that come with that and it’s still the best system
 
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The answer is people paying for their own care. Yes, I know the problems that come with that and it’s still the best system
Good luck with telling that to the voters with those astronomical prices for healthcare and overpriced premiums of health insurance with lousy coverage.
 

sb247

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Good luck with telling that to the voters with those astronomical prices for healthcare and overpriced premiums of health insurance with lousy coverage.
Both problems were actually caused by govt. as long as insurance has to cover something the price of it gets to stay high because there are tons of customers who can now pay for it. The premiums for the insurance went up because of the absurd requirements the govt put on coverage (no prior existing exemptions)

You literally cannot have a system with modest insurance costs that covers literally any condition a patient walks in with particularly if they are allowed to have the condition before buying insurance

The answer to stop the crazy requirements both on what insurance has to cover and on people having insurance. And with that, stop having hospitals be forced to give out free care and stop govt coverage. Everyone can have what they can pay for (or get donated). When there aren’t enough people to pay some of the insane prices being charged for some things, the price will go down to a more market rate

Before you ask if I’m aware of the obvious. I know some people will not get services this way, those services are not a right. The basis of the problem in healthcare today is the incorrect assumption that everyone should have everything without paying
 

Gurby

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Both problems were actually caused by govt. as long as insurance has to cover something the price of it gets to stay high because there are tons of customers who can now pay for it. The premiums for the insurance went up because of the absurd requirements the govt put on coverage (no prior existing exemptions)

You literally cannot have a system with modest insurance costs that covers literally any condition a patient walks in with particularly if they are allowed to have the condition before buying insurance

The answer to stop the crazy requirements both on what insurance has to cover and on people having insurance. And with that, stop having hospitals be forced to give out free care and stop govt coverage. Everyone can have what they can pay for (or get donated). When there aren’t enough people to pay some of the insane prices being charged for some things, the price will go down to a more market rate

Before you ask if I’m aware of the obvious. I know some people will not get services this way, those services are not a right. The basis of the problem in healthcare today is the incorrect assumption that everyone should have everything without paying
Wouldn't a 2-tiered "Medicaid"-for-all situation actually push us towards this vision? Rich people will get "what they can pay for", poor people will be denied joint replacements or wait 2 months to begin cancer treatment like in the UK. They'll be able to get care but it will be heavily rationed and cost-controlled.

I think repealing EMTALA and condemning people with pre-existing conditions would be unpalatable to the vast majority of Americans.
 

VA Hopeful Dr

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Wouldn't a 2-tiered "Medicaid"-for-all situation actually push us towards this vision? Rich people will get "what they can pay for", poor people will be denied joint replacements or wait 2 months to begin cancer treatment like in the UK. They'll be able to get care but it will be heavily rationed and cost-controlled.

I think repealing EMTALA and condemning people with pre-existing conditions would be unpalatable to the vast majority of Americans.
And I could get behind that, except a) it'll never happen because Americans won't accept being denied anything and b) the list of what is covered would go up every year negating cost savings
 
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sb247

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Wouldn't a 2-tiered "Medicaid"-for-all situation actually push us towards this vision? Rich people will get "what they can pay for", poor people will be denied joint replacements or wait 2 months to begin cancer treatment like in the UK. They'll be able to get care but it will be heavily rationed and cost-controlled.

I think repealing EMTALA and condemning people with pre-existing conditions would be unpalatable to the vast majority of Americans.
And I could get behind that, except a) it'll never happen because Americans won't accept being denied anything and b) the list of what is covered would go up every year negating cost savings
Pretty much what VA said (with the exception that I still wouldn't support it). The nation would get offended that rich people could buy better stuff and then would just want the rich people to buy them everything anyway. As I said, the problem is the expectation that people get things without buying them, which doesn't work
 

Osminog

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Bernie Sanders' "Medicare for all" platform is just a superficial spin on single-payer healthcare, an old idea that has been tossed around in the US since the mid-20th century. The reason it's now being called "Medicare for all" is that this framing serves to boost public support; most people are already familiar with Medicare, and they are more likely to support an expansion of a (presumably) tried-and-true program than to support a total overhaul of the healthcare system.

Anyway, there is really no question that a single-payer system would lower quality of care, increase wait times, and cost much more for taxpayers. But would a single-payer system's inefficiencies be outweighed by the sense of "equality" that it would offer? I guess that's a value judgment. Personally, I don't believe that everybody should have an equal right to healthcare, because I have difficulty conceiving of healthcare as a right; I don't think that a man should be granted a right to another man's labor under any circumstances, even if the former's life depends on this labor. In the minds of people with my moral worldview, single-payer healthcare is a truly horrendous idea.
 

sb247

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And yet, you don't hear anyone from those other countries with uhc/single-payer say "Our healthcare system sucks! Let's be like the United States'."

There's no turning back. This topic will keep pushing and pushing every election cycle until it becomes a reality.
The hordes are uninformed and unprincipled. They would rather have free crappy care provided for by the evil rich people than self reliance
 
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Bernie Sanders' "Medicare for all" platform is just a superficial spin on single-payer healthcare, an old idea that has been tossed around in the US since the mid-20th century. The reason it's now being called "Medicare for all" is that this framing serves to boost public support; most people are already familiar with Medicare, and they are more likely to support an expansion of a (presumably) tried-and-true program than to support a total overhaul of the healthcare system.

Anyway, there is really no question that a single-payer system would lower quality of care, increase wait times, and cost much more for taxpayers. But would a single-payer system's inefficiencies be outweighed by the sense of "equality" that it would offer? I guess that's a value judgment. Personally, I don't believe that everybody should have an equal right to healthcare, because I have difficulty conceiving of healthcare as a right; I don't think that a man should be granted a right to another man's labor under any circumstances, even if the former's life depends on this labor. In the minds of people with my moral worldview, single-payer healthcare is a truly horrendous idea.
I never thought about it this way, but I like this thinking
 

SurfingDoctor

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No one could honestly say what it’ll look like because economic and social predictions are always wrong. But, eventually it will catch on simply because the other party’s platform is to tell people to go f—- themselves, which while a fun campaign button, doesn’t work.

We have the Democrats who are a party of bad ideas, and the Republicans who are a party of no ideas.

It’s gonna be awesome.
 

sb247

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No one could honestly say what it’ll look like because economic and social predictions are always wrong. But, eventually it will catch on simply because the other party’s platform is to tell people to go f—- themselves, which while a fun campaign button, doesn’t work.

We have the Democrats who are a party of bad ideas, and the Republicans who are a party of no ideas.

It’s gonna be awesome.
freedom and self-reliance are ideas

The republicans are not a party of no ideas, they are a party of significantly less bribes to voters
 
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sb247

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Nope, no ideas. You can put sprinkles on a turd and convince yourself it’s a cupcake... but I’m not buying it.
I'd view the analogy as more accurately the democrats trying to sprinkle turds and calling the republicans the "party of no cupcakes"

I'll try and be fair in criticism and express how much I dislike the republicans for occasionally supporting these sprinkled turds despite campaigning against them and for balking on their promises to delete sprinkled turds from law
 

SurfingDoctor

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I'd view the analogy as more accurately the democrats trying to sprinkle turds and calling the republicans the "party of no cupcakes"

I'll try and be fair in criticism and express how much I dislike the republicans for occasionally supporting these sprinkled turds despite campaigning against them and for balking on their promises to delete sprinkled turds from law
Occasionally? Saying “X” and then doing nothing is how one gets elected, it’s not an occasional occurrence.

Nearly every GOP candidate for the past 8 years ran on the “repeal” mantra and accomplished nothing. Not a single piece of legislation despite being in control. They are the do-nothing party. Now, there are clearly people who like a party of getting nothing accomplished, but that wasn’t my argument. However their complete inability to accomplish anything gave the Democrats the ability to control the conversation and then go full Monty on whatever they plan for healthcare.
 
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sb247

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Occasionally? Saying “X” and then doing nothing is how one gets elected, it’s not an occasional occurrence.

Nearly every GOP candidate for the past 8 years ran on the “repeal” mantra and accomplished nothing. Not a single piece of legislation despite being in control. They are the do-nothing party. Now, there are clearly people who like a party of getting nothing accomplished, but that wasn’t my argument. However their complete inability to accomplish anything gave the Democrats the ability to control the conversation and then go full Monty on whatever they plan for healthcare.
I agree with you on their political spinelessness. I just don't view lacking the guts to do what you promised as not having an idea in the first place. Semantics for me.

They suck. But for me the amount they suck is far less than the democrats given the democrats specifically promise to do horrible things, have a history or really carrying through on horrible things, and want to do even more horrible things
 
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Both parties are pretty much owned by corporations. The only difference is that Democrats are better by 2-4%. they don't go overdrive on the neoliberal policies, which in fact SUCKS, than the Republicans.

In the Overton window, you got Republicans who are far-right and the Democrat who are to the center-right.
 

sb247

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Both parties are pretty much owned by corporations. The only difference is that Democrats are better by 2-4%. they don't go overdrive on the neoliberal policies, which in fact SUCKS, than the Republicans.

In the Overton window, you got Republicans who are far-right and the Democrat who are to the center-right.
You propose the democrats are “more free” than the republicans?

I’m with you on near equal corporate ownership but you’re off otherwise
 
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The Democrats are really not "center-right" any more than the milquetoast GOP establishment is "far-right." Neoliberalism/neoconservatism (the two are essentially interchangeable) has been the dominant ideology in Washington, D.C. since the first Bush administration. Deregulate business, abandon enforcement of antitrust laws, encourage global labor arbitrage, invade random countries and then "nation-build" for a decade or two.

Back on topic, universal Medicare would be an outright disaster, especially if it continues along in the present mold. Medicare should have required a certain threshold of mortality or morbidity benefit, demonstrated in the literature, before paying for a given intervention. The willingness to spend other peoples' money is the main driver of why medicine costs so much in this country, and expanding Medicaid and Medicare without substantial reform will only exacerbate the situation.

There was a universal healthcare proposal in Oregon (I think) that was voted down because it wouldn't cover experimental (and very expensive) cancer drugs. That, not lack of single-payer, is the root of the problem.
 

IknowImnotadoctor

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Healthcare should be viewed as a cost controlled, conditional right for those who are unable/unwilling to contribute towards its costs. The non/compliant drug addict does not deserve the same coverage as the compliant chronically ill patient. This will help control costs while fulfilling what many on the left see as our moral style obligations. Non-compliant patients using immense resources is a huge factor in our out of control healthcare costs.
 

Rainee

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Healthcare should be viewed as a cost controlled, conditional right for those who are unable/unwilling to contribute towards its costs. The non/compliant drug addict does not deserve the same coverage as the compliant chronically ill patient. This will help control costs while fulfilling what many on the left see as our moral style obligations. Non-compliant patients using immense resources is a huge factor in our out of control healthcare costs.
And thus you will have democrats, republicans, supreme court arguing over this kind of things.... and the people aren't going to be exactly happy knowing that the government is telling YOU what you can and can't do with your body.

All together, because we can't come to agreeance- I sincerely don't think anything will change for a long time.
 
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I don't understand why people are demanding that Medicare be doled out to everyone. There simply isn't enough money. Ok then.
 
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And yet the U.S. bailed out corporations and banks, giving huge tax cut, increase the military spending - under Trump, it increase by 40% and corporations are paying waaaaay less taxes than ever. Yet you don't hear that from the media when it comes to those issues but when comes to policies that benefits its citizen or even improving infrastructure, it's always "Oh, how are we going to pay for it? We have no money."
 

VA Hopeful Dr

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And yet the U.S. bailed out corporations and banks, giving huge tax cut, increase the military spending - under Trump, it increase by 40% and corporations are paying waaaaay less taxes than ever. Yet you don't hear that from the media when it comes to those issues but when comes to policies that benefits its citizen or even improving infrastructure, it's always "Oh, how are we going to pay for it? We have no money."
Math isn't your strong suit is it?

Military yearly budget: 600 billion

Bank bailout total cost: 700 billion (most of which has been repaid)

Medicare for all 10 year cost: 30 trillion, or 3 trillion per year. That amounts to 5X per year what we spend on the military.

For perspective, the Federal government total spending for 2017 was 4 trillion. So Medicare for all costs almost as much as the total annual spending of the federal government.
 

sb247

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And yet the U.S. bailed out corporations and banks, giving huge tax cut, increase the military spending - under Trump, it increase by 40% and corporations are paying waaaaay less taxes than ever. Yet you don't hear that from the media when it comes to those issues but when comes to policies that benefits its citizen or even improving infrastructure, it's always "Oh, how are we going to pay for it? We have no money."
My response to your argument is we shouldn’t bail out companies, increase military or have medicare

Are we cool now?
 

Mad Jack

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Math isn't your strong suit is it?

Military yearly budget: 600 billion

Bank bailout total cost: 700 billion (most of which has been repaid)

Medicare for all 10 year cost: 30 trillion, or 3 trillion per year. That amounts to 5X per year what we spend on the military.

For perspective, the Federal government total spending for 2017 was 4 trillion. So Medicare for all costs almost as much as the total annual spending of the federal government.
That still amounts to an overall reduction of health care spending of nearly half a trillion yearly, and likely far more than that over time due to inflation curbing, so it ends up being less expensive of a system overall
 
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VA Hopeful Dr

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That still amounts to an overall reduction of health care spending of nearly half a trillion yearly, and likely far more than that over time due to inflation curbing, so it ends up being less expensive of a system overall
That's assuming that 10 year figure is accurate and doesn't increase over time. What government program has that ever been true of?
 

Mad Jack

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That's assuming that 10 year figure is accurate and doesn't increase over time. What government program has that ever been true of?
NASA, the CDC, and every other governmental agency that the Republicans view as a cost sink. They would likely view health care the same way and axe it every chance they got to keep costs down
 
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VA Hopeful Dr

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NASA, the CDC, and every other governmental agency that the Republicans view as a cost sink. They would likely view health care the same way and axe it every chance they got to keep costs down
I said program not agency.

Medicare has been increasing spending every year since 2000 (couldn't easily find data from before that in a 90 second Google search). Why would Medicare for all be any different?

Social security too, FWIW.
 
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Mad Jack

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I said program not agency.

Medicare has been increasing spending every year since 2000 (couldn't easily find data from before that in a 90 second Google search). Why would Medicare for all be any different?

Social security too, FWIW.
The CDC has numerous programs under its umbrella, as does NASA. Agencies are collections of programs, and the vast majority of programs under both agencies have had budgets slashed
 

VA Hopeful Dr

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The CDC has numerous programs under its umbrella, as does NASA. Agencies are collections of programs, and the vast majority of programs under both agencies have had budgets slashed
OK, so when has Medicare or SS been decreased?
 

Mad Jack

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I said program not agency.

Medicare has been increasing spending every year since 2000 (couldn't easily find data from before that in a 90 second Google search). Why would Medicare for all be any different?

Social security too, FWIW.
Once the government is the only player, pharmaceutical payments, medical device payments, availability of services, etc all become nothing but costs. At our current point there is competition in the market and enough competing corporate interests to limit the ability of the government to control costs, since if they were to lower rates enough hospitals, physicians, pharmaceutical companies, etc would simply stop taking government insurance. When the government is the only payor, they don't have much choice in the matter, and if the government says you're only getting X number of dollars per Y and the alternative is a 0% share in the US market, most people will choose whatever they are willing to pay out
 
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Mad Jack

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OK, so when has Medicare or SS been decreased?
SS and Medicare have an increasing number of recipients, which is an entirely different scenario than other government programs. On an inflation-adjusted basis, Medicare pays far less per procedure/hospital stay than it did twenty years ago. Social Security, similarly, has not kept up with inflation and has kept cost per recipient down. SS could easily be maintained indefinitely with a very small tax increase at current funding levels, while Medicare could easily control overall health care costs by constraining payments or simply keeping them flat and limiting payments for end-of-life care, a likely scenario under single payer that could save trillions and free up GDP for other areas of the economy
cover01_image02.jpg
 
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VA Hopeful Dr

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Once the government is the only player, pharmaceutical payments, medical device payments, availability of services, etc all become nothing but costs. At our current point there is competition in the market and enough competing corporate interests to limit the ability of the government to control costs, since if they were to lower rates enough hospitals, physicians, pharmaceutical companies, etc would simply stop taking government insurance. When the government is the only payor, they don't have much choice in the matter, and if the government says you're only getting X number of dollars per Y and the alternative is a 0% share in the US market, most people will choose whatever they are willing to pay out
Right because all of those groups are just going to quietly accept that. They don't have massive lobbying budgets to prevent exactly that scenario. And we haven't seen similar scenarios play out before - like why Medicare can't currently negotiate drug prices.

And there's no way that service would get worse and lead to the public complaining as well (most universal coverage countries don't have private rooms for example) demanding more money be put into fixing whatever the problem is - kinda like what's happened recently with the VA.

But sure, we'll get massive cost savings.
 

VA Hopeful Dr

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SS and Medicare have an increasing number of recipients, which is an entirely different scenario than other government programs. On an inflation-adjusted basis, Medicare pays far less per procedure/hospital stay than it did twenty years ago. Social Security, similarly, has not kept up with inflation and has kept cost per recipient down. SS could easily be maintained indefinitely with a very small tax increase at current funding levels, while Medicare could easily control overall health care costs by constraining payments or simply keeping them flat and limiting payments for end-of-life care, a likely scenario under single payer that could save trillions and free up GDP for other areas of the economy
View attachment 259803
Sure, M4A COULD control prices. But that actually happening is very unlikely. Go look around, all of the countries with socialized medicine are having similar problems and they already do much of what you're suggesting. And yet costs are still a problem.

And yes, Medicare costs per/whatever aren't increasing by huge amounts - but we're doing more.

As for increasing numbers of recipients, that's exactly the point. If it goes universal it will be LOTS more recipients.
 

sb247

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SS and Medicare have an increasing number of recipients, which is an entirely different scenario than other government programs. On an inflation-adjusted basis, Medicare pays far less per procedure/hospital stay than it did twenty years ago. Social Security, similarly, has not kept up with inflation and has kept cost per recipient down. SS could easily be maintained indefinitely with a very small tax increase at current funding levels, while Medicare could easily control overall health care costs by constraining payments or simply keeping them flat and limiting payments for end-of-life care, a likely scenario under single payer that could save trillions and free up GDP for other areas of the economy
View attachment 259803
Except we all know that medicare won’t actually cut people off from end of life care. There will always be a politician willing to promise away someone else’s money to keep your gramma on a vent.

And if they actually grow some stones and just stop paying more than “x” for a particular thing then eventually some of the companies will just stop making the thing or stop offering it to medicare and only offer it to private pay. And that’s when we’ll see real calls to ban private pay because “it’s unfair to have two classes of medical care”
 

Mad Jack

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Except we all know that medicare won’t actually cut people off from end of life care. There will always be a politician willing to promise away someone else’s money to keep your gramma on a vent.

And if they actually grow some stones and just stop paying more than “x” for a particular thing then eventually some of the companies will just stop making the thing or stop offering it to medicare and only offer it to private pay. And that’s when we’ll see real calls to ban private pay because “it’s unfair to have two classes of medical care”
And perhaps that will happen, we shall see. I think it's an inevitability at this rate that some form of universal coverage is adopted. Personally I prefer the German model of private nonprofit insurers provided through employment, with a Medicare-like option provided to all not working (this is simplified as an explanation, obviously, but is the gist)
 
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VA Hopeful Dr

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And perhaps that will happen, we shall see. I think it's an inevitability at this rate that some form of universal coverage is adopted. Personally I prefer the German model of private nonprofit insurers provided through employment, with a Medicare-like option provided to all not working (this is simplified as an explanation, obviously, but is the gist)
In my ideal world we'd have more of a Medicaid for all option. A fairly bare bones public option. Its enough to provide for basic care but not so much that it discourages people from getting private insurance.

The German system is a close second.
 
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Rainee

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Regarding efficiency...no offense...but does anyone think that the gov can run things more efficiently? With our current insurance companies...I can call, talk to someone, look up benefits, dispute a claim, and guess what- I get paid in 2 weeks for work I have done.

I've only heard bad things about medicaid and gov benefits. Even though insurance companies suck- and yes they need to have some changes....at least things get done on time.

Sometimes I get an emergency patient into the chair, lookup benefits within 20 min, know their complete coverage and what everything looks like, and patient accepts or declines treatment and we move on. With gov...I shudder to think what kind of wait times we looking at.
 
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Mad Jack

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Regarding efficiency...no offense...but does anyone think that the gov can run things more efficiently? With our current insurance companies...I can call, talk to someone, look up benefits, dispute a claim, and guess what- I get paid in 2 weeks for work I have done.

I've only heard bad things about medicaid and gov benefits. Even though insurance companies suck- and yes they need to have some changes....at least things get done on time.

Sometimes I get an emergency patient into the chair, lookup benefits within 20 min, know their complete coverage and what everything looks like, and patient accepts or declines treatment and we move on. With gov...I shudder to think what kind of wait times we looking at.
Medicare and Medicaid have very straightforward processes for basically everything. Only the private insurers seem to put me through the utilization review wringer.

The government actually does a very good job running social security, which has around 1% overhead, and Medicare, which has a fraction the overhead of private insurers
 
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sb247

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Medicare and Medicaid have very straightforward processes for basically everything. Only the private insurers seem to put me through the utilization review wringer.

The government actually does a very good job running social security, which has around 1% overhead, and Medicare, which has a fraction the overhead of private insurers
“Good job” is only true in terms of overhead on paper. Neither of those programs are solvent long term and so they don’t get credit for being well ran
 

Rainee

7+ Year Member
Mar 31, 2010
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Medicare and Medicaid have very straightforward processes for basically everything. Only the private insurers seem to put me through the utilization review wringer.

The government actually does a very good job running social security, which has around 1% overhead, and Medicare, which has a fraction the overhead of private insurers
Very interesting. My oral surgeon basically does accept medicaid but hes one of only few in the state. He tells me that basically he can pull out some wisdom teeth on generic PPO plans and get paid 2 weeks later no problems...but with Medicaid its literally 50-75% less then the PPO fees and in addition sometimes payment isnt MONTHS after and or noone to contact with for disputes. He does it for the general good of the public. He says he doesn't do it for money but rather to help the community.

I guess the medical system is different.
 

VA Hopeful Dr

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Jul 28, 2004
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Attending Physician
Medicare and Medicaid have very straightforward processes for basically everything. Only the private insurers seem to put me through the utilization review wringer.

The government actually does a very good job running social security, which has around 1% overhead, and Medicare, which has a fraction the overhead of private insurers
Yes and no. Medicare/caid pay easily and quickly when they want to but there's no appeals process if they decide not to. You can work with insurance companies, government plans are hard rules.

Medicare's overhead figures are a bit misleading though: Administrative costs for private insurance versus Medicare