What would a "medicare-for-all" system look like?

[KeikoTanaka]

To my understand the libertarian healthcare platform consists of non government intervention and complete control of healthcare by the private market. The inevitable consequence of this means that most people will be priced out of hospitalized care. The for profit healthcare model we have today is failing, while the socialized medicine model of the country to the north has, is, and will continue to thrive. I don’t understand how doubling down on what is a broken system will work.

From what I gathered by the "libertarian" thing is that, the cost of healthcare is super expensive because of the initial steps that government has taken to mandate/regulate the private insurance companies. Then the government started paying off certain things, and the greedy corporations were like "well if the gov is gonna pay, i'm gonna hike up my rates". While I can kind of see this picture (and I know I'm most definitely over-simplifying it), it doesn't change the fact that we need to change something to fix it. We cannot reverse what has been done. So unfortunately it is looking like a switch to a socialized healthcare model is appealing simply because it would offer us the opportunity to begin building from the ground up. I don't understand why we can't "apply for healthcare", similar to how we apply for a credit card, and depending on various factors, you will be allotted certain $$ to use per month for your healthcare needs. And because your income was factored in, you'll be able to pay those bills off over time. Idk.

Something's gotta change because its way expensive right now. Canada seems to be a good middle ground right now compared to European models. But, the problem is, is Canada only sustaining that system for right now because they know they need to pay their physicians well out of fear they will jump the border? As soon as we institute some socialized system, will they drop their physicians pay substantially because they lost their fear of losing them to a better paying system?

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[deleted480308]

From what I gathered by the "libertarian" thing is that, the cost of healthcare is super expensive because of the initial steps that government has taken to mandate/regulate the private insurance companies. Then the government started paying off certain things, and the greedy corporations were like "well if the gov is gonna pay, i'm gonna hike up my rates". While I can kind of see this picture (and I know I'm most definitely over-simplifying it), it doesn't change the fact that we need to change something to fix it. We cannot reverse what has been done. So unfortunately it is looking like a switch to a socialized healthcare model is appealing simply because it would offer us the opportunity to begin building from the ground up. I don't understand why we can't "apply for healthcare", similar to how we apply for a credit card, and depending on various factors, you will be allotted certain $$ to use per month for your healthcare needs. And because your income was factored in, you'll be able to pay those bills off over time. Idk.

Something's gotta change because its way expensive right now. Canada seems to be a good middle ground right now compared to European models. But, the problem is, is Canada only sustaining that system for right now because they know they need to pay their physicians well out of fear they will jump the border? As soon as we institute some socialized system, will they drop their physicians pay substantially because they lost their fear of losing them to a better paying system?

The other part of the libertarian thought that people miss (or just don't like) if that we don't have a "right" to health care.

You want to keep smoking and come back the hospital with COPD every 3 days? at a certain point you go broke and the hospital should be allowed to say no. Let's say you don't even make a bad decision and life just happens? You still don't have a right to medical care. Find a charity willing to pay for it or write a check.

A number of things would come from adopting this "it's my problem to figure out" philosophy.
1) Now a huge market for generics and the makers of the brand name stuff would need to demonstrate worth if they want to get a higher price than a generic. Maybe COPD'ers don't buy the triple combo inhaler if they can buy them separate for half the price. Maybe the walmart 70/30 suddenly isn't such a bad idea because you can't afford the pump.
2) hopefully some better decisions about life style, but even if people don't make better decisions it's their problem. You want to eat poorly? no one else is buying you a cpap.
3) stop the certificate of need system so there can be more competition for hospital patients to drive pricing down
4) maybe if the hospital knows they have actually collect money from patients instead of the seemingly bottomless govt pocket, they stop wasting so much money on overhead
5) maybe people actually take their meds if they actually had to buy them

It's important to acknowledge that a true libertarian model means some people would not get care they need. It still doesn't mean anyone has a right to labor/services from others.

 

[KeikoTanaka]

The other part of the libertarian thought that people miss (or just don't like) if that we don't have a "right" to health care.

You want to keep smoking and come back the hospital with COPD every 3 days? at a certain point you go broke and the hospital should be allowed to say no. Let's say you don't even make a bad decision and life just happens? You still don't have a right to medical care. Find a charity willing to pay for it or write a check.

A number of things would come from adopting this "it's my problem to figure out" philosophy.
1) Now a huge market for generics and the makers of the brand name stuff would need to demonstrate worth if they want to get a higher price than a generic. Maybe COPD'ers don't buy the triple combo inhaler if they can buy them separate for half the price. Maybe the walmart 70/30 suddenly isn't such a bad idea because you can't afford the pump.
2) hopefully some better decisions about life style, but even if people don't make better decisions it's their problem. You want to eat poorly? no one else is buying you a cpap.
3) stop the certificate of need system so there can be more competition for hospital patients to drive pricing down
4) maybe if the hospital knows they have actually collect money from patients instead of the seemingly bottomless govt pocket, they stop wasting so much money on overhead
5) maybe people actually take their meds if they actually had to buy them

It's important to acknowledge that a true libertarian model means some people would not get care they need. It still doesn't mean anyone has a right to labor/services from others.

I'm actually a big believer in this model. The problem is, <1% of the population actually is libertarian, and these philosophies would never work in America. It's a nice thought that we would all be responsible for ourselves and hopefully that would bring about more ownership and therefore better health outcomes....while letting survival of the fittest deal with others and those individuals die off (This would actually be great for the environment/planet and economy) - But alas, until there is a mass die off of human population or the US government crumbles, this model of thinking will NEVER take hold in America.

 

[deleted480308]

I'm actually a big believer in this model. The problem is, <1% of the population actually is libertarian, and these philosophies would never work in America. It's a nice thought that we would all be responsible for ourselves and hopefully that would bring about more ownership and therefore better health outcomes....while letting survival of the fittest deal with others and those individuals die off (This would actually be great for the environment/planet and economy) - But alas, until there is a mass die off of human population or the US government crumbles, this model of thinking will NEVER take hold in America.

"free" crap is popular

 

[762513]

The other part of the libertarian thought that people miss (or just don't like) if that we don't have a "right" to health care.

You want to keep smoking and come back the hospital with COPD every 3 days? at a certain point you go broke and the hospital should be allowed to say no. Let's say you don't even make a bad decision and life just happens? You still don't have a right to medical care. Find a charity willing to pay for it or write a check.

A number of things would come from adopting this "it's my problem to figure out" philosophy.
1) Now a huge market for generics and the makers of the brand name stuff would need to demonstrate worth if they want to get a higher price than a generic. Maybe COPD'ers don't buy the triple combo inhaler if they can buy them separate for half the price. Maybe the walmart 70/30 suddenly isn't such a bad idea because you can't afford the pump.
2) hopefully some better decisions about life style, but even if people don't make better decisions it's their problem. You want to eat poorly? no one else is buying you a cpap.
3) stop the certificate of need system so there can be more competition for hospital patients to drive pricing down
4) maybe if the hospital knows they have actually collect money from patients instead of the seemingly bottomless govt pocket, they stop wasting so much money on overhead
5) maybe people actually take their meds if they actually had to buy them

It's important to acknowledge that a true libertarian model means some people would not get care they need. It still doesn't mean anyone has a right to labor/services from others.

This is a philosophy that isn’t a solution, and while its interesting to debate, it’s academic only.

 

[Gyuji]

Oh God. LoL. We're still at this.
"Medicare-4-All" system shouldn't be discuss or debate. It needs to be implemented for the masses. Anyone who's against it, argue all you want but just take the L, it's a losing battle/war.

 

[Little Green Mensch]

Anyone who's against it, argue all you want but just take the L, it's a losing battle/war.

No.

Just because something is popular does not render it inevitable, let alone prudent. Look at the problems Britain has had with the NHS, and tell me you trust our government to do better with a vastly larger and more heterogeneous population.

 

[BeautifulSmiles523]

If there wasn’t so much government meddling, healthcare would be far cheaper. Think of all the unnecessary tests used to meet regulations or prevent law suits. And patents that drug companies toy with in order to keep drugs highly priced.

How much does generic insulin cost vs the wonder insulins out there?

 

[Gyuji]

No.

Just because something is popular does not render it inevitable, let alone prudent. Look at the problems Britain has had with the NHS, and tell me you trust our government to do better with a vastly larger and more heterogeneous population.

The problem with Britain's NHS is because Tories trying to cut funds on it, which they did with the austerity - Neoliberalism 101, and wanting the nation to be like the US. Same with the EU.

We all know why a universal system hasn't been implemented in the US.

There's no argument against a "Medicare-4-All" system when it comes to the ballot box.

 

[BeautifulSmiles523]

So few in America actually take care of their health. Maybe if they were paying out of pocket for things, they would think about it more.

Our current healthcare system is unsustainable and so is any system capable of providing decent care for everyone.

 

[Gyuji]

People care about two things: economics and healthcare.

Americans knows how expensive healthcare is and would love to have an "Euro" system. You can't hide the facts anymore. Americans are aware of it and more and more find it appealing due to it brings a "peace of mind" when the time comes. Just take the 'L.' There's already a presidential candidate campaigning hard on it and pretty much a landslide in November 2020 if he wins the nomination. You can argue and argue and argue but the People are fed up with the neoliberal agenda. We already seen it in the EU election and Trump winning in 2016.

 

[Little Green Mensch]

Just take the 'L.' There's already a presidential candidate campaigning hard on it and pretty much a landslide in November 2020 if he wins the nomination.

I would be fine if individual states required their citizens to have insurance for catastrophic illness or injury, much like most states require car insurance. That would bypass the (significant) constitutional issues with universal Medicare, and preserve for citizens the option of voting with their feet.

As has been stated numerous times upthread, the problem with universal Medicare is that federal payments for healthcare, as they are currently structured, create substantial perverse incentives. People need not take care of their health, because Medicare will pick up the tab if they are 65 or older, and Medicaid will pay once you run out of your own money. In what possible universe does expanding that system lower healthcare costs?

Government-run health insurance must be actuarily sound in order to fund itself rather than relying on Uncle Sam's credit card. In order for it to get there, it probably needs to stop covering health maintenance, especially in people who have chronic conditions, and it needs to charge more in proportion with the greater risk of payout for the obese, diabetics, smokers, etc. You can deny that until you're blue in the face, but at some point, you are going to run out of other people's money.

 

[VA Hopeful Dr]

People care about two things: economics and healthcare.

Americans knows how expensive healthcare is and would love to have an "Euro" system. You can't hide the facts anymore. Americans are aware of it and more and more find it appealing due to it brings a "peace of mind" when the time comes. Just take the 'L.' There's already a presidential candidate campaigning hard on it and pretty much a landslide in November 2020 if he wins the nomination. You can argue and argue and argue but the People are fed up with the neoliberal agenda. We already seen it in the EU election and Trump winning in 2016.

This is overwhelming false.

It only has majority support if a) private insurance is still a thing b) there's no increase in wait times c) no tax increases

You can't achieve all of those with this.

 

[321931]

I guess I’ll take the L on this one

 

[BeautifulSmiles523]

I would be fine if individual states required their citizens to have insurance for catastrophic illness or injury, much like most states require car insurance. That would bypass the (significant) constitutional issues with universal Medicare, and preserve for citizens the option of voting with their feet.

As has been stated numerous times upthread, the problem with universal Medicare is that federal payments for healthcare, as they are currently structured, create substantial perverse incentives. People need not take care of their health, because Medicare will pick up the tab if they are 65 or older, and Medicaid will pay once you run out of your own money. In what possible universe does expanding that system lower healthcare costs?

Government-run health insurance must be actuarily sound in order to fund itself rather than relying on Uncle Sam's credit card. In order for it to get there, it probably needs to stop covering health maintenance, especially in people who have chronic conditions, and it needs to charge more in proportion with the greater risk of payout for the obese, diabetics, smokers, etc. You can deny that until you're blue in the face, but at some point, you are going to run out of other people's money.

Still sounds pretty unconstitutional.

 

[Little Green Mensch]

Still sounds pretty unconstitutional.

How so?

I don't remember hearing about any court challenges to the health insurance mandate in Massachusetts, and I wasn't able to find any with a cursory search, either.

 

[BeautifulSmiles523]

Being forced to buy a product? Doesn’t sound like what this country was based upon.

Sounds like it IS being challenged, little by little.

Here's How the Texas Ruling Could Effect Massachusetts | Health Care For All

www.hcfama.org

 

[deleted927028]

"free" crap is popular

No one wants free crap but avoid getting robbed by the insurance companies. You either pay premiums or tax. I just want to pay one third of premiums as tax, with no copay or deductibles just like all other countries. It is stupid to pay three times in premiums than other countries and on top of that copays and deductibles. The only people getting free crap in this countries are private insurance companies

 

[deleted927028]

If there wasn’t so much government meddling, healthcare would be far cheaper. Think of all the unnecessary tests used to meet regulations or prevent law suits. And patents that drug companies toy with in order to keep drugs highly priced.

How much does generic insulin cost vs the wonder insulins out there?

Which government meddling raises premiums? Be specific. It is your wild imagination. The premiums are sky high because the private insurance companies can charge as much as they want and nothing or no one is there to stop them. I don’t understand why you people can’t understand such a simple thing. The premiums are one third of what we have here, in other countries where government runs healthcare. But we are too stupid and stubborn to understand that. The government has no power in this country, it is run by the corporations and rich people. Don’t get brainwashed. Drug companies are toying with patent laws so that they can continue to rob the people by charging $2000 for the same drug that they sell for $8 in other countries. Why the hell you blame the government? Blame your corrupt, greedy and unethical private drug companies. Same thing with blocking generic insulin by the drug companies. Things are fine in all other countries where government works for the people and run the healthcare.

 

[Wingie]

Which government meddling raises premiums? Be specific. It is your wild imagination. The premiums are sky high because the private insurance companies can charge as much as they want and nothing or no one is there to stop them. I don’t understand why you people can’t understand such a simple thing. The premiums are one third of what we have here, in other countries where government runs healthcare. But we are too stupid and stubborn to understand that. The government has no power in this country, it is run by the corporations and rich people. Don’t get brainwashed. Drug companies are toying with patent laws so that they can continue to rob the people by charging $2000 for the same drug that they sell for $8 in other countries. Why the hell you blame the government? Blame your corrupt, greedy and unethical private drug companies. Same thing with blocking generic insulin by the drug companies. Things are fine in all other countries where government works for the people and run the healthcare.

 

[BeautifulSmiles523]

Do you think monopolies can exist without the government? Do you think regulations helps or hurts competition with the free market? Hmm.

I wonder why medications for animals is so cheap, but the same medications for humans is so expensive..

Don’t mistake me for saying private companies are altruistic. But in a true free market, competition forces them to have lower costs and better quality products or lose business.

You don’t find “too big to fail” in a true capitalist economy.

 

[deleted480308]

No one wants free crap but avoid getting robbed by the insurance companies. You either pay premiums or tax. I just want to pay one third of premiums as tax, with no copay or deductibles just like all other countries. It is stupid to pay three times in premiums than other countries and on top of that copays and deductibles. The only people getting free crap in this countries are private insurance companies

you are either being dishonest or have no idea what you are talking about. People LOVE “free” crap. And there are millions of people not paying into the system nearly what they are taking out

Which government meddling raises premiums? Be specific. It is your wild imagination. The premiums are sky high because the private insurance companies can charge as much as they want and nothing or no one is there to stop them. I don’t understand why you people can’t understand such a simple thing. The premiums are one third of what we have here, in other countries where government runs healthcare. But we are too stupid and stubborn to understand that. The government has no power in this country, it is run by the corporations and rich people. Don’t get brainwashed. Drug companies are toying with patent laws so that they can continue to rob the people by charging $2000 for the same drug that they sell for $8 in other countries. Why the hell you blame the government? Blame your corrupt, greedy and unethical private drug companies. Same thing with blocking generic insulin by the drug companies. Things are fine in all other countries where government works for the people and run the healthcare.

First of all, generic insulin is literally sold at walmart. You can keep a diabetic alove for less than $50/month worth of insulin

Next specific ways the govt makes insurance expensive:
1) require everyone to buy it
2) kids covered till older age
3) banning pre-existing condition exclusions
4) requiring what things are covered by the insurance plan (making it “comprehensive “ instead of catastrophic)

 

[VA Hopeful Dr]

Which government meddling raises premiums? Be specific. It is your wild imagination. The premiums are sky high because the private insurance companies can charge as much as they want and nothing or no one is there to stop them. I don’t understand why you people can’t understand such a simple thing. The premiums are one third of what we have here, in other countries where government runs healthcare. But we are too stupid and stubborn to understand that. The government has no power in this country, it is run by the corporations and rich people. Don’t get brainwashed. Drug companies are toying with patent laws so that they can continue to rob the people by charging $2000 for the same drug that they sell for $8 in other countries. Why the hell you blame the government? Blame your corrupt, greedy and unethical private drug companies. Same thing with blocking generic insulin by the drug companies. Things are fine in all other countries where government works for the people and run the healthcare.

I feel like we've already addressed this, but OK...

Inhaler ban boosts costs for people with asthma

A 2008 ban on chlorofluorocarbons (CFCs) has ended up being particularly costly for people with asthma.

www.reuters.com

 

[VA Hopeful Dr]

Do you think monopolies can exist without the government? Do you think regulations helps or hurts competition with the free market? Hmm.

I wonder why medications for animals is so cheap, but the same medications for humans is so expensive..

Don’t mistake me for saying private companies are altruistic. But in a true free market, competition forces them to have lower costs and better quality products or lose business.

You don’t find “too big to fail” in a true capitalist economy.

Part insurance part greedy chain pharmacies.

For example, 2 years ago I needed some liquid griseofulvin for my kid's tinea. We had Cobra but no drug coverage at that time as I was in the 2 week period between jobs.

Cash price for a bottle at Wal-Mart, $400.

Cash price at the independent pharmacy 1/2 a mile away? $17

Exact same product, 15X price difference.

Same kinda thing can happen with insurance.

For example, I will sometimes need some meloxicam after running for long standing knee issues. With my insurance, a 30-pill supply costs me a $15 for any generic. A 90 pill bottle is $7 at my local grocery store if I pay cash for it.

 

[tr]

Next specific ways the govt makes insurance expensive:
1) require everyone to buy it
2) kids covered till older age
3) banning pre-existing condition exclusions
4) requiring what things are covered by the insurance plan (making it “comprehensive “ instead of catastrophic)

#1 is actually what makes insurance cheaper. If only sick people buy health insurance, obviously the price will be unsustainable.

#2 also makes insurance cheaper because 25 y/os are generally healthy so they are a net gain to the system. (Note they still pay premiums, it's not free to be on your parents' plan.)

No argument that #3 and #4 cost more but they are just ensuring that the product does what it is supposed to do, vs just being a profit generator that never actually covers any medical care.

 

[deleted480308]

#1 is actually what makes insurance cheaper. If only sick people buy health insurance, obviously the price will be unsustainable.

#2 also makes insurance cheaper because 25 y/os are generally healthy so they are a net gain to the system. (Note they still pay premiums, it's not free to be on your parents' plan.)

No argument that #3 and #4 cost more but they are just ensuring that the product does what it is supposed to do, vs just being a profit generator that never actually covers any medical care.

#1 that grouping certainly doesn’t make it cheaper for those of us who are young and watch our health. If you are 70 with 9 chronic conditions your insurance should cost more because that’s how actuarial science works. But the forced grouping isn’t even what I mentioned, forcing everyone in makes it more expensive because the customer can’t just walk away if the product costs too much

#2 a 25 yr old should be allowed to go buy their own, appropriately statistically stupidly cheap policy, instead of forcing them into the pool with older/sicker customers

#3/4 an insurance company is supposed to make money. That’s what companies are for, just like doctors and hospitals want to make money too. There is not arbitrary “should cover” the only thing an insurance company “should cover” is the stuff they promised to when you bought the policy and that should be allowed to vary with the market

 

[tr]

#1 that grouping certainly doesn’t make it cheaper for those of us who are young and watch our health. If you are 70 with 9 chronic conditions your insurance should cost more because that’s how actuarial science works. But the forced grouping isn’t even what I mentioned, forcing everyone in makes it more expensive because the customer can’t just walk away if the product costs too much

#2 a 25 yr old should be allowed to go buy their own, appropriately statistically stupidly cheap policy, instead of forcing them into the pool with older/sicker customers

#3/4 an insurance company is supposed to make money. That’s what companies are for, just like doctors and hospitals want to make money too. There is not arbitrary “should cover” the only thing an insurance company “should cover” is the stuff they promised to when you bought the policy and that should be allowed to vary with the market

You sound like you don't agree with the basic idea of insurance, which is risk pooling. The healthy/lucky pay for the sick/unlucky.

If everyone only pays for care they expect to use, it would be more straightforward to ditch insurance altogether and just have people pay their own fee for service. Resulting in poor people dying of treatable conditions, which I understand you are fine with, OK. But it's not insurance.

 

[VA Hopeful Dr]

You sound like you don't agree with the basic idea of insurance, which is risk pooling. The healthy/lucky pay for the sick/unlucky.

If everyone only pays for care they expect to use, it would be more straightforward to ditch insurance altogether and just have people pay their own fee for service. Resulting in poor people dying of treatable conditions, which I understand you are fine with, OK. But it's not insurance.

But health insurance isn't really insurance either, at least not in the traditional sense.

Every other type of insurance covers things that don't happen all that often. It doesn't cover oil changes or painting the house. Its designed to cover things that are expensive, not things that are affordable. Tornado damage, car accidents, stuff like that.

Health insurance doesn't do that - it covers things we know will happen (prevention) and things that are cheap (routine primary care).

 

[deleted480308]

You sound like you don't agree with the basic idea of insurance, which is risk pooling. The healthy/lucky pay for the sick/unlucky.

If everyone only pays for care they expect to use, it would be more straightforward to ditch insurance altogether and just have people pay their own fee for service. Resulting in poor people dying of treatable conditions, which I understand you are fine with, OK. But it's not insurance.

As VA mentions below, health should be more like home insurance

 

[tr]

But health insurance isn't really insurance either, at least not in the traditional sense.

Every other type of insurance covers things that don't happen all that often. It doesn't cover oil changes or painting the house. Its designed to cover things that are expensive, not things that are affordable. Tornado damage, car accidents, stuff like that.

Health insurance doesn't do that - it covers things we know will happen (prevention) and things that are cheap (routine primary care).

Totally agree, and I think it would be ok to have a two-tiered system with (public/not for profit) insurance for catastrophic needs and pay-as-you-go for routine preventative care. For whatever reason, that option hasn't been a big part of the public conversation.

Regardless, if you are talking about an insurance-based system, you have to accept risk pooling. You can't demand that your premiums should be minimal because you are healthy.

 

[VA Hopeful Dr]

Totally agree, and I think it would be ok to have a two-tiered system with (public/not for profit) insurance for catastrophic needs and pay-as-you-go for routine preventative care. For whatever reason, that option hasn't been a big part of the public conversation.

Regardless, if you are talking about an insurance-based system, you have to accept risk pooling. You can't demand that your premiums should be minimal because you are healthy.

Yeah the liberals who are in medicine that I've discussed this with think we should have a medicaid for all with a private option for people who don't want minimal bare bones coverage. I don't love it, but I could get behind that before medicare for all with no private option.

Its not talked about because the political liberals all want what most of Europe has.

 

[BeautifulSmiles523]

Tr, it sounds like you’re not looking for insurance, but just socialism.

The idea of insurance, is that something is unlikely to happen, but in the event it does, youre covered. Not “yeah you have a host of medical problems that you know about, and we know about. Let’s just make this healthy 25 year old pay for it and prevent him from getting his life off the ground.”

I am NOT responsible for people’s stupid choices such as smoking, heavy alcohol use, drugs, etc. Therefore I should NOT have to pay for it.

It’s like having homeowners insurance with someone that has a condemned house, but you’re forced to cover them, even though they didn’t get the initial necessary repairs/prevention.

Just because people have available healthcare doesn’t mean they’ll use it. The problem isn’t “everyone wants to take care of their health but they just can’t afford it”. No, most Americans are lazy, unhealthy, and don’t care about their health. Even when they can afford it.

 

[762513]

Tr, it sounds like you’re not looking for insurance, but just socialism.

The idea of insurance, is that something is unlikely to happen, but in the event it does, youre covered. Not “yeah you have a host of medical problems that you know about, and we know about. Let’s jist make this healthy 25 year old pay for it and prevent him from getting his life off the ground.”

I am NOT responsible for people’s stupid choices such as smoking, heavy alcohol use, drugs, etc. Therefore I should NOT have to pay for it.

Ironic since in our current healthcare system with EMTALA you already are paying for it.

 

[BeautifulSmiles523]

The problem isn’t so much EMTALA, but the fact that basic stabilizing treatment is no longer all that’s required. The initial idea I could get behind.

 

[deleted480308]

Totally agree, and I think it would be ok to have a two-tiered system with (public/not for profit) insurance for catastrophic needs and pay-as-you-go for routine preventative care. For whatever reason, that option hasn't been a big part of the public conversation.

Regardless, if you are talking about an insurance-based system, you have to accept risk pooling. You can't demand that your premiums should be minimal because you are healthy.

That’s how actuarial science works.

 

[tr]

That’s how actuarial science works.

You mean that's how insurance companies use actuaries to drive profits at the expense of consumers.

 

[tr]

Yeah the liberals who are in medicine that I've discussed this with think we should have a medicaid for all with a private option for people who don't want minimal bare bones coverage. I don't love it, but I could get behind that before medicare for all with no private option.

Its not talked about because the political liberals all want what most of Europe has.

Europe has all different kinds of things. Germany has a little bit like what you're describing. Pretty much every nation with any kind of organized system does better on the cost/outcome curve than the haphazard overpriced dumpster fire we have in the US.

 

[VA Hopeful Dr]

Europe has all different kinds of things. Germany has a little bit like what you're describing. Pretty much every nation with any kind of organized system does better on the cost/outcome curve than the haphazard overpriced dumpster fire we have in the US.

True. But we do better on numerous pure outcome measures.

And yes, there are definitely places that do what I'm describing. But for some reason, everyone is focused on single payer with no option for private coverage. I am 100% against that.

 

[Lawpy]

True. But we do better on numerous pure outcome measures.

And yes, there are definitely places that do what I'm describing. But for some reason, everyone is focused on single payer with no option for private coverage. I am 100% against that.

I haven't followed the thread so i apologize if it's already asked. But thoughts on single payer with an opt out for private coverage?

 

[VA Hopeful Dr]

I haven't followed the thread so i apologize if it's already asked. But thoughts on single payer with an opt out for private coverage?

I don't like anything with single payer, but as long as a private option exists it'll be the best of a bunch of bad choices.

 

[BeautifulSmiles523]

What does everyone here think of the removal of the penalty for not being insured?

 

[deleted480308]

You mean that's how insurance companies use actuaries to drive profits at the expense of consumers.

You say “profit” like it’s a bad thing

 

[BeautifulSmiles523]

You say “profit” like it’s a bad thing

Right, profit is incentive to be better and more efficient.

I wish someone would explain to me how less competition is a good thing? Look at phone companies. Back when it was “Ma bell” service was terrible and expensive. Now with more phone companies it has definitely improved.

 

[deleted480308]

I haven't followed the thread so i apologize if it's already asked. But thoughts on single payer with an opt out for private coverage?

So I still have to buy bloated insurance for everyone else but I have permission to buy my own seperately?

No thanks

 

[BeautifulSmiles523]

The private market has done incredible things. Produced the iPhone, launched a car into space, etc. Somehow though, affordable and effective healthcare is impossible.

 

[tr]

You say “profit” like it’s a bad thing

It's not inherently bad or good, but in the case of health care, it isn't aligned with the goal of improved health outcomes.

Because of several factors that pertain to the health care insurance market (opaque pricing, misalignment of incentives between the patient and the payer, short horizons due to patients moving between insurance companies/plans, 'medical loss' eating into the bottom line, etc), appropriate payment for the efficient delivery of good health care does not improve profits, but reduces them.

Basically it is against the economic interest of the insurance company to pay for health care, which is the product that they are offering. Hence the profit motive actually militates against the improvement of efficiency and health outcomes.

The Relative (In)Efficiency of the U.S. Health Care System

www.nber.org

Right, profit is incentive to be better and more efficient.

I wish someone would explain to me how less competition is a good thing? Look at phone companies. Back when it was “Ma bell” service was terrible and expensive. Now with more phone companies it has definitely improved.

See above. Phone service is a straightforward exchange of money for service, with transparent outcomes and pricing. None of those apply to health insurance.

 

[BeautifulSmiles523]

It's not inherently bad or good, but in the case of health care, it isn't aligned with the goal of improved health outcomes.

Because of several factors that pertain to the health care insurance market (opaque pricing, misalignment of incentives between the patient and the payer, short horizons due to patients moving between insurance companies/plans, 'medical loss' eating into the bottom line, etc), appropriate payment for the efficient delivery of good health care does not improve profits, but reduces them.

Basically it is against the economic interest of the insurance company to pay for health care, which is the product that they are offering. Hence the profit motive actually militates against the improvement of efficiency and health outcomes.

The Relative (In)Efficiency of the U.S. Health Care System

www.nber.org

See above. Phone service is a straightforward exchange of money for service, with transparent outcomes and pricing. None of those apply to health insurance.

Not now it doesn’t. But if there were more providers all vying for your service, don’t you think they’d improve? What incentive is there for a single payer program to be “better”?

 

[VA Hopeful Dr]

It's not inherently bad or good, but in the case of health care, it isn't aligned with the goal of improved health outcomes.

Because of several factors that pertain to the health care insurance market (opaque pricing, misalignment of incentives between the patient and the payer, short horizons due to patients moving between insurance companies/plans, 'medical loss' eating into the bottom line, etc), appropriate payment for the efficient delivery of good health care does not improve profits, but reduces them.

Basically it is against the economic interest of the insurance company to pay for health care, which is the product that they are offering. Hence the profit motive actually militates against the improvement of efficiency and health outcomes.

The Relative (In)Efficiency of the U.S. Health Care System

www.nber.org

See above. Phone service is a straightforward exchange of money for service, with transparent outcomes and pricing. None of those apply to health insurance.

The Myth of Americans' Poor Life Expectancy

It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. If we would just hop on the European health-care bandwagon, we’d live longer and healthier lives. The only problem is it’s...

www.forbes.com

 

[deleted480308]

It's not inherently bad or good, but in the case of health care, it isn't aligned with the goal of improved health outcomes.

Because of several factors that pertain to the health care insurance market (opaque pricing, misalignment of incentives between the patient and the payer, short horizons due to patients moving between insurance companies/plans, 'medical loss' eating into the bottom line, etc), appropriate payment for the efficient delivery of good health care does not improve profits, but reduces them.

Basically it is against the economic interest of the insurance company to pay for health care, which is the product that they are offering. Hence the profit motive actually militates against the improvement of efficiency and health outcomes.

The Relative (In)Efficiency of the U.S. Health Care System

www.nber.org

See above. Phone service is a straightforward exchange of money for service, with transparent outcomes and pricing. None of those apply to health insurance.

The existence of profit is why there are insurance companies to meet the mandated need created by govt.

Profit isn’t “against outcomes”, it’s why someone is willing to do things for the same reason that ability to make money is why your coworkers show up and mine show up and why we have companies that exist to pay us.

Profit is a good thing

 

[BeautifulSmiles523]

I don’t understand why people think that with a true free market, companies will have the ability to survive without providing outstanding service.

These are the same people that complain about corporate welfare. YES! That is a huge problem. The bank and auto company bailouts were a terrible idea.