Pros and cons of "Medicare-for-all" (aka BernieCare)

[IglooDame]

So because I'd rather not have this diverge into a discussion of why ACA failed politically...

I hear about doctor shortages in other countries. In the US there tends to be nurse shortages. If M4A becomes reality, how many more doctors do we need, based on people going to see doctors where currently they don't? For better or for worse, the prospect of thousands of dollars (if uninsured) or dozens of dollars (if insured) keeps a downward pressure on the willingness to see doctors.

 

[amadeus]

Does M4A seek any price controls on staff? U.S. physician salaries tend to be higher than other industrialized countries; would the government taking over payments result in something like salary caps for public reimbursements?

 

[IglooDame]

Does M4A seek any price controls on staff? U.S. physician salaries tend to be higher than other industrialized countries; would the government taking over payments result in something like salary caps for public reimbursements?

My own understanding is "no". Medicare doesn't pay doctors salaries, it reimburses for procedures/activities/resources/etc, essentially the same way private health insurance companies do. Physician practices, hospitals, clinics and such are still the ones paying doctors and other health care professionals on an employee or contract-work basis.

Given doctor "shortages" in other countries, I'd be loathe to push down salaries artificially. Quite the opposite, really, but I'd settle for something coherent being done about medical malpractice insurance instead, which would have the same effect. People in the US expect perfect diagnoses from their doctors and zero false negatives, and multimillion dollar compensation when that doesn't happen.

 

[El_Machinae]

But let's also talk about "doctor shortages". Canada spends 11% of its GDP on Healthcare. Compared to 17%. If we were to cut 1/6 of our population from having access to a doctor and spend 50% more on health care, we wouldn't have "doctor shortage".

Keep in mind, we still get comparable results. The various Universal Health Care proposals end up being cost-savings. You could reverse some of those cost savings to get greater Healthcare. People will point out the various concerns from switching, and are worried about giving up various benefits that they currently have. But they are currently paying a 50% premium for those benefits.

One proposed reason for high doctor salaries is that they have high levels of student loan. And that becomes super weird. The government pays high salaries in order to pay high student loans as profits to banks. Meanwhile, the government is perfectly capable teaching medicine at cost. Cutting doctor salaries will require paying off their student loans. But since their student loans are at a higher interest rate than the government's borrowing rate, it pays for itself nearly immediately

 

[hobbsyoyo]

Obama had comfortable Democratic majorities in the House and Senate in 2009.

Not in the Senate, by the rules required for passing. He had 60 votes, which under the rules in place then meant he had 0 margin in the Senate.

He still thought he could compromise with a party that had been (and still is) overtaken by wingnuts.

It's not just the GOP that was the problem. The public option was killed by Democrats, not the GOP. I think it's dangerous to assume that a Dem takeover of Congress and the Presidency is sufficient in and of itself to pass M4A or really anything more expansive than Obamacare.

So because I'd rather not have this diverge into a discussion of why ACA failed politically...

I mean sure, but that makes it hard to properly frame the discussion on M4A passage. Divorcing the ACA passage from the discussion feeds back into my last point, that we shouldn't assume the Dems can pas M4A even if they have solid majorities (see ACA). The Dems didn't have comfortable majorities in the Senate then but they had enough on paper and even that wasn't sufficient.

but I'd settle for something coherent being done about medical malpractice insurance instead, which would have the same effect

I think this is something that is consistently overblown by the GOP who use it as an excuse to make businesses less accountable.

 

[Hrothbern]

But let's also talk about "doctor shortages". Canada spends 11% of its GDP on Healthcare. Compared to 17%. If we were to cut 1/6 of our population from having access to a doctor and spend 50% more on health care, we wouldn't have "doctor shortage".

Keep in mind, we still get comparable results. The various Universal Health Care proposals end up being cost-savings. You could reverse some of those cost savings to get greater Healthcare. People will point out the various concerns from switching, and are worried about giving up various benefits that they currently have. But they are currently paying a 50% premium for those benefits.

One proposed reason for high doctor salaries is that they have high levels of student loan. And that becomes super weird. The government pays high salaries in order to pay high student loans as profits to banks. Meanwhile, the government is perfectly capable teaching medicine at cost. Cutting doctor salaries will require paying off their student loans. But since their student loans are at a higher interest rate than the government's borrowing rate, it pays for itself nearly immediately

yes a weird mechanism indeed !

also:
Student costs are too often seen from the perspective of the student only (tuition and living cost)
But a study year medicine is much much higher in cost for a university.... and also much higher than a study year law or history etc
You have to pay for all those labs, dead bodies, the tools, etc, etc

When I did study chemistry in the 70ies, IIRC, the cost of the university (paid by government) were in the first years approx 25,000 guilders per year. Medicin was 80,000 guilders per year, and law etc, somewhere 5,000-10,000 per year.
IDK the current cost... but converting those guilders of then to Euro's of now is roughly 1:1

=> any medicin student is already a big investment for the government. Better take care that those students do have their focus on succeeding that expensive study and do not need to work in junk jobs.

 

[hobbsyoyo]

Better take care that those students do have their focus on succeeding that expensive study and do not need to work in junk jobs.

What happens here mostly is that if you can't afford/don't have the credit to just take on loans to pay for everything, you don't become a doctor. In other words, the economic ladder that colleges are supposed to be end up becoming barriers.

 

[Hrothbern]

What happens here mostly is that if you can't afford/don't have the credit to just take on loans to pay for everything, you don't become a doctor. In other words, the economic ladder that colleges are supposed to be end up becoming barriers.

High barriers to entry are mostly effective tools to generate semi-monopolies.

Any public state having the intention to generate competition for cost effective goods and services to the public will lower that barrier and long term plan resources.

 

[Zardnaar]

My own understanding is "no". Medicare doesn't pay doctors salaries, it reimburses for procedures/activities/resources/etc, essentially the same way private health insurance companies do. Physician practices, hospitals, clinics and such are still the ones paying doctors and other health care professionals on an employee or contract-work basis.

Given doctor "shortages" in other countries, I'd be loathe to push down salaries artificially. Quite the opposite, really, but I'd settle for something coherent being done about medical malpractice insurance instead, which would have the same effect. People in the US expect perfect diagnoses from their doctors and zero false negatives, and multimillion dollar compensation when that doesn't happen.

Here doctors gave to be grossly negligent vs being wrong.

I think they get it wrong a lot as without tests you're not gonna know.

Health care under stress is a worldwide problem. 7 years and 100k student loan here iirc.

If you can have free tertiary you might want to look at free/heavily subsided doctors, nursing, teachers and early childhood.

 

[Socrates99]

Blue Dog Democrats like Joe Lieberman tanked the public option in the ACA. That's why "any blue will do" is a stupid mentality. Blaming Republicans alone allows the grossest of behaviors in the Democrat party to slide by quietly.

Prior to the ACA private insurance companies had no restriction on how much of the money they collected needed to be passed on to healthcare providers. The ACA mandated that a minimum of 80 percent of the money taken in by insurers needed to go to providers. Most hover around that 20% in "administration costs" mark. Some of the better ones like Blue Cross keep their "costs" down around 12%. Medicare/Medicaid generally has administration costs between 1-3%. So even if everything stays the same we'd save ~15%.

Then there's the fact that currently Medicare reimbursement is already negotiated lower than most private insurers. Another saving.

Add in proposals to stop price gouging on pharmaceuticals similar to what other countries with a UHS have done. For example, insulin, a product that's been synthesized for almost a hundred years, costs a fraction of the US price in any given country. Same goes for another relatively old but necessary lifesaving device the EpiPen. We see stories about this type of abuse frequently, there was just one one the news yesterday morning about how a child's version of a hormone blocker costs 3 times more than the stronger adult version and the reasoning? Because they can.

An anecdotal story, my brother had Hep C from a dirty needle he used in his opiate addiction days. He's clean now and wanted treatment for his Hepatitis. The drug costs $84k in the US. His insurance wouldn't pay for it until his liver started to fail. In other words they wouldn't shell out the money until he was actively dying, likely banking on him being Medicare or another company's problem at that point. So he did some research and found out it was also produced in India for only $1000 a round. Why? Because the drug only cost about $200 to produce and package. The Indian government threatened to manufacture the drug itself if the company didn't bring down the cost because hep C was basically an epidemic there. The company charged that exorbitant price in the US because it could.

I'm not sure why Tim thinks his story is an argument against M4ALL. A dishonest doctor can game private ins in a similar fashion. Find out what's covered and tell the patient they NEED it while filling out any paperwork necessary for reimbursement. If anything I'd say that's an argument for a British style system rather than against single payer.

 

[Timsup2nothin]

I'm not sure why Tim thinks his story is an argument against M4ALL.

I'll go one better. I don't know why you think it was intended to be.

 

[Socrates99]

I'll go one better. I don't know why you think it was intended to be.

It wasn't? What was the relevance then?

 

[Timsup2nothin]

It wasn't? What was the relevance then?

That in transitioning into Medicare for all there are pitfalls to be considered, lest it turn into a disaster that is thrown in the face of every Democratic party candidate for the next forty years.

 

[Socrates99]

That in transitioning into Medicare for all there are pitfalls to be considered, lest it turn into a disaster that is thrown in the face of every Democratic party candidate for the next forty years.

pitfalls, a con then. So a devil's advocate argument against it.

 

[Manfred Belheim]

Isn't M4A the gun from Aliens?

 

[Timsup2nothin]

pitfalls, a con then. So a devil's advocate argument against it.

Maybe an argument against taking "medicare for all" as an accurate description of the legislative process. As in, a candidate who says "I'm for Medicare for all" who has a bunch of cheering sycophants that don't have the first clue what he even means by it may not be the best way to forward it...especially if said candidate also gives no indication that he has any idea what he means by it either. That you could accuse me of, because we all know I don't think very highly of Sanders. However, since I am in favor of healthcare reform just assuming I am arguing against "Medicare for all" as a general guideline to a solution is unwarranted.

Most of my participation in this thread has been "these are arguments we need to overcome to get this done." Most Sanders supporters appear to believe that "elect Bernie and he waves his magic wand" is how things work, but the truth is that anyone in congress that is willing to sacrifice their career for healthcare reform already did and got shelled out of office for it in 2010. So whatever Sanders means when he yells "Medicare for all" and his crowds go wild, it is going to be a very tough sell.

As to the specific "argument against M4A" that you are gnashing your teeth about...people who already think that there is far too much easily garnered graft in the Medicare system as it already exists are going to demand that their elected officials do something about that either before or during the expansion of the system to encompass "all." Currently, no one is really all that sure who to blame for that corruption. Medicare has been around so long that flaws in the structure aren't automatically assigned as "Democrats built in loopholes for their supporters," plus there's a sense that the GOP theory of "deregulation is always the answer" may be why no one is available to catch the corrupt. But it is a rock solid guarantee that if we elect enough democrats (again) to accomplish health care reform (again) and it is flawed (again) those flaws will haunt democrats for a generation (again).

So, yeah, I'm concerned if solving the known problems with Medicare isn't part of this expansion. My mom's former "doctor" is totally corrupt. She doesn't in any way practice actual medicine, and she has one of the most profitable practices in town. I have not the slightest doubt that when any politician says "Medicare for all" she hear's the classic "cha-chiiiiing" in her head. If she comes away from "health care reform" as being on her way to being a "self made billionaire who owes it all to the Democratic party" that is an albatross that none of us want to bear.

 

[Socrates99]

M41A Pulse rifle

 

[Berzerker]

Off the top of my head, pros include covering people and relieving businesses of the burden either giving them an advantage or leveling the playing field with foreign competition. Otoh right now government run health care systems are subsidized by the 'market', people who pay out of pocket or with private insurance pay more so old timers on Medicare pay less. That disguises the real costs of such programs.

 

[Socrates99]

Maybe an argument against taking "medicare for all" as an accurate description of the legislative process. As in, a candidate who says "I'm for Medicare for all" who has a bunch of cheering sycophants that don't have the first clue what he even means by it may not be the best way to forward it...especially if said candidate also gives no indication that he has any idea what he means by it either. That you could accuse me of, because we all know I don't think very highly of Sanders. However, since I am in favor of healthcare reform just assuming I am arguing against "Medicare for all" as a general guideline to a solution is unwarranted.

Most of my participation in this thread has been "these are arguments we need to overcome to get this done." Most Sanders supporters appear to believe that "elect Bernie and he waves his magic wand" is how things work, but the truth is that anyone in congress that is willing to sacrifice their career for healthcare reform already did and got shelled out of office for it in 2010. So whatever Sanders means when he yells "Medicare for all" and his crowds go wild, it is going to be a very tough sell.

As to the specific "argument against M4A" that you are gnashing your teeth about...people who already think that there is far too much easily garnered graft in the Medicare system as it already exists are going to demand that their elected officials do something about that either before or during the expansion of the system to encompass "all." Currently, no one is really all that sure who to blame for that corruption. Medicare has been around so long that flaws in the structure aren't automatically assigned as "Democrats built in loopholes for their supporters," plus there's a sense that the GOP theory of "deregulation is always the answer" may be why no one is available to catch the corrupt. But it is a rock solid guarantee that if we elect enough democrats (again) to accomplish health care reform (again) and it is flawed (again) those flaws will haunt democrats for a generation (again).

So, yeah, I'm concerned if solving the known problems with Medicare isn't part of this expansion. My mom's former "doctor" is totally corrupt. She doesn't in any way practice actual medicine, and she has one of the most profitable practices in town. I have not the slightest doubt that when any politician says "Medicare for all" she here's the classic "cha-chiiiiing" in her head. If she comes away from "health care reform" as being on her way to being a "self made billionaire who owes it all to the Democratic party" that is an albatross that none of us want to bear.

I don't think any of his supporters truly believe a magic wand will be waved. It's why he frequently says "not me, us." It will require a lot of political pressure including primarying incumbents and convincing people to support politicians that support the policy. Which is why if you do support the policy your time would be better spent convincing others.

Not trying to belittle your experience but there are grifters making bank off of private insurers too. Those grifters are making better money than your mother's doctor too. Medicare reimburses at a lower rate than most private insurers for most procedures. It might be more lucrative to not accept Medicare and only treat patients with good private insurance. Something my dad's former dermatologist does. He complained that he had to switch when he shifted to Medicare.

 

[Timsup2nothin]

I don't think any of his supporters truly believe a magic wand will be waved. It's why he frequently says "not me, us." It will require a lot of political pressure including primarying incumbents and convincing people to support politicians that support the policy. Which is why if you do support the policy your time would be better spent convincing others.

Not trying to belittle your experience but there are grifters making bank off of private insurers too. Those grifters are making better money than your mother's doctor too. Medicare reimburses at a lower rate than most private insurers for most procedures. It might be more lucrative to not accept Medicare and only treat patients with good private insurance. Something my dad's former dermatologist does. He complained that he had to switch when he shifted to Medicare.

Private insurers provide their own enforcement to prevent fraud. It's a cost of doing business that is an unconsidered consequence during the GOP's pushes for "deregulation." If you are in the business of treating patients, then yes, patients with private insurance pay better. If you are in the business of grifting the ensurer Medicare is definitely the way to go.

As to "primarying the incumbents"...so, you are looking forward to a similar "you're just a DINO" movement to match the "you're just a RINO" movement that has done so much for the Democratic party. Who exactly do you expect will benefit from that?