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

[IglooDame]

So with Bernie Sanders appearing likely to get the Democratic nomination, I figure we're due for a thread about his (and Elizabeth Warren's, and others') medicare-for-all proposed health care reform, distinct from the political campaigns.

As I understand it, the proposal is for a Canada/UK-style nationalized healthcare (aka expanding US Medicare), though also including vision and dental. It does not address how the federal government would pay for it, though it is also worth noting that it would save US employers and employees significant amounts of money annually, and that money would become taxable, something I don't usually see mentioned in criticism of the price tag.

Personally, I am on the fence. Ideologically (as a classical liberal/socially-liberal libertarian) I'm not a fan, and seeing how poorly healthcare is delivered via the Veterans' Administration doesn't make me think well of the feds' capabilities in this area. On the other hand, there's a health insurance industry built around cutting costs but failing to do so, I don't really get what choice people are giving up given employer control of plans and sometimes complicated issues of what is in-network vs out of network, and the prospect of the need for lifesaving healthcare (especially prescriptions) destroying one's finances. I'm legitimately open to being convinced either way, notwithstanding the presidential campaigns in progress, though I don't and won't regard healthcare as a "human right" any more than, say, transportation is - but that doesn't mean that I think road administration is not better handled by government.

So what I'm requesting, OT, is for you to give me some food for thought on either side of this matter. And one thing in particular, the only impression I (and I think, most USians) get from Canadian/UKish (and of course other countries') national healthcare is about wait times. So I encourage everyone outside the US here to offer their own experiences and their national sentiment/issues in their own country to give us the sort of global perspective that I truly love getting here.

 

[Birdjaguar]

Pro: Returns billions of dollars of private company excess profits to tax payers.

 

[aimeeandbeatles]

Just want to say:

I was recently hospitalized for two nights with an infection. Thanks to Canadian universal health care, the total cost was.... 5 dollars, the co-pay on my antibiotics at the pharmacy. (I would've also added the parking costs, but the machine was malfunctioning and they let us out for free.)

If I was in the U.S., it would have been lot more. And due to that cost, I might decided not to go to the ER in the first place. And my infection may have worsened.

 

[IglooDame]

Pro: Returns billions of dollars of private company excess profits to tax payers.

Could you explain what you mean by "excess profits"? And which private companies (as in, health insurance? pharmaceuticals? hospitals?) are you referring to?

 

[stinkubus]

Health insurance is not a competitive market. There are high barriers to entry and information asymmetries which allow firms to earn profits in excess of their opportunity costs.

 

[Timsup2nothin]

Personally, I am on the fence. Ideologically (as a classical liberal/socially-liberal libertarian) I'm not a fan, and seeing how poorly healthcare is delivered via the Veterans' Administration doesn't make me think well of the feds' capabilities in this area.

This is a false comparison that is frequently used because it seems reasonable. The appropriate model for prediction of what "medicare for all" looks like is nothing like the VA, it's like current Medicare, just for everybody. The VA is a top to bottom system, providing actual medical care...poorly. Medicare is, at root, an insurer/method of payment. There are no "medicare hospitals" like there are VA hospitals, or "medicare clinics" like there are VA clinics. In fact one of the biggest pushes in VA reform is "why not just put veterans on something like medicare and let them go to regular doctors and hospitals and just pay for that for them?"

This of course is dead wrong if you expect this "medicare for all" to be actual "nationalized health care" where "doctor" becomes an actual government job and "hospital" becomes an actual government facility, but from the way I read it that isn't what anyone actually is proposing.

 

[EgonSpengler]

My understanding is that Medicare is more popular than the VA medical system, but I don't know much about either one. As for the "Medicare for all" plan(s), my question is whether it will reduce costs and make the whole system more transparent. Right now, a completely free-market system of healthcare would be an improvement (to be clear, I'm not advocating for that, I'm just saying that the healthcare system we have now isn't even capitalism, it's some kind of maneating swamp monster from an HP Lovecraft story). You have situations where, for example, costs are negotiated between hospitals and insurance companies, not only without input from the consumer, but without even allowing the consumer to know what the cost is, in the end.

 

[Birdjaguar]

Could you explain what you mean by "excess profits"? And which private companies (as in, health insurance? pharmaceuticals? hospitals?) are you referring to?

Folks like United Health Care and the Big Pharma friends.

UHC for example turned $21 billion in profit in 2017 and 2018 (total). that is after pretty extravagant salaries and lobbying bills. If you add up the profits of the major players in insurance and plan providers along with drug manufacturers, there is a whole lot of maney there. Any non profit approach would reduce consumer costs by a bunch. BTW, it was Reagan that encouraged the shift from non profit to for profit healthcare companies.

The top 10 pharma companies are mostly international now with all the recent mergers. Parsing out US profits is not easy.

 

[Timsup2nothin]

My understanding is that Medicare is more popular than the VA medical system, but I don't know much about either one. As for the "Medicare for all" plan(s), my question is whether it will reduce costs and make the whole system more transparent. Right now, a completely free-market system of healthcare would be an improvement (to be clear, I'm not advocating for that, I'm just saying that the healthcare system we have now isn't even capitalism, it's some kind of maneating swamp monster from an HP Lovecraft story). You have situations where, for example, costs are negotiated between hospitals and insurance companies, not only without input from the consumer, but without even allowing the consumer to know what the cost is, in the end.

Well, that last part is basically medicare in a nutshell. Hospitals that provide a service to a medicare covered patient bill medicare the amount that medicare lists as appropriate for that service, no more no less, and the person receiving the treatment has no idea (and generally no interest in) what that cost might be.

 

[Birdjaguar]

Medicare is great. We are on it with a supplemental plan F. Most things seem to be covered and we pay a few grand a year in premiums.

 

[Hrothbern]

Could you explain what you mean by "excess profits"? And which private companies (as in, health insurance? pharmaceuticals? hospitals?) are you referring to?

If I buy a product X in the US for 200 and can buy that same product for 100 in other OECD western countries.... where does that 100 difference go ?

Can be waste, can be higher salaries employees, can be profits.

Does that really matter ?

You pay twice the price needed.

 

[GoodEnoughForMe]

I have an American perspective I'd like to offer that has nothing to do with the wide ranging politics but is a story repeated far too often, just under different circumstances.

When I was 19 I was hospitalized for over a week. I had attempted to end my life and had been self harming for years. I knew I was horrifically depressed, so when I was in the ER, and I was offered an inpatient hospital stay, I took it. I didn't really want to, but I knew I needed a reset, and figured a closed environment to get me away from school, home, etc., might be good for me. I had literally 0 thought or conceptualization of health care costs. I had always mostly been 'healthy.' I had no idea how it all worked. Blah blah. Which was good! Because if I had, well, I might not have done what I did (choose the hospital).

I'm not going to say the hospital stay was perfect; screaming patients being brought in and sedated at 3am gets old, getting spied on by security in the shower because I had to be supervised got old, and the worst thing, honestly, was the food, but it probably was the correct decision. I was setup with a psychiatrist and medication and did leave feeling a bit better than I went in, although I was far from 'cured.' I was there for over a week and my already white skin was so pale from never having gone outside.

But hey, you know, do what it takes, right? About 1 month later my dad asked me to grab something from his car (he was sick) and I went and popped open the trunk to grab it and saw a massive stack of hospital papers. They were bills. $12000. That was the cost to try to save their kid from killing himself.

A couple weeks later we went to buy myself health insurance. I live in Michigan. At the time (pre Obamacare), my hospitalization was a pre-existing condition and nobody would cover me. If I had ended up in the hospital again, it'd be another 5 figure bill.

Anyways, I don't know what my point is other than people who argue for Pete's medicare for some or keeping your private insurance or something are probably actually sociopaths. The end.

 

[Estebonrober]

Egos is right about the VA/UK systems being nationalized healthcare versus Medicare/CA systems being basically nationalized health insurance.

the pros are numerous the cons revolve around nanny state things and corruption things which should just be addressed for what they are and not accepted that bad government is the norm. Short list

pros:
Universality
Cheaper for most people
No longer tied to employer due to healthcare
No longer fearful of car accident over a state line or out of network region


Cons:
No longer possible to “Superman” it as Tim lives to talk about
Bigger government
Corruption potential

 

[Lexicus]

how the federal government would pay for it,

The federal government would pay for it the same way it pays for everything: Congressional appropriation directing the Treasury to cut checks, creating money out of nothing. This is how the US federal government currently pays for all its spending.

In macroeconomic terms, all projections are that Medicare-for-all or some other form of universal healthcare, free or nearly so at the point of use, would significantly reduce overall health spending. So asking "how can we afford it" rests on a fundamental misunderstanding of the issue.

So what I'm requesting, OT, is for you to give me some food for thought on either side of this matter. And one thing in particular, the only impression I (and I think, most USians) get from Canadian/UKish (and of course other countries') national healthcare is about wait times. So I encourage everyone outside the US here to offer their own experiences and their national sentiment/issues in their own country to give us the sort of global perspective that I truly love getting here.

I'm American, and here's a story for everyone to consider.

I tried to make a dentist appointment using my ~$400/month insurance purchased on the Obamacare exchange through Kaiser Permanente. The first place I called had an appointment available on March 11, so about a month ahead from the time I called. I set up the appointment, then the following week they call me up to tell me they no longer accept my insurance, and asking if I wanted to cancel my appointment (yes). So I called several other dentists' offices listed on the website of my insurance plan, but all claimed they "stopped taking my insurance recently" or some variation thereof. I got sick of this so spent about an hour working through a phone tree and then being on hold until I could talk to a Kaiser representative. He informed me that I should be telling dentists' offices that I have Dominion National insurance, not Kaiser, because Kaiser has a contract with Dominion for all its dental benefits. Okay. So if I make an account on the Dominion website and input my medical record number, it will tell me where I can find a dentist who takes my insurance? Great, thanks, have a nice day. I go to make an account on the Dominion website, they shoot me an email with a randomly-generated password and a link taking me to the login page, where you input that password and it takes you to a new page where you input a new permanent password. Okay, so I do that, then click the "change password" button...and nothing happens. This website doesn't fudging work! I tried this same process about ten more times, thinking at first this was surely a one-time bug. Nope. Their website is completely non-functional. So I go back to just calling dentists' offices from the list I had been working from initially, and after another hour found one who said they took my insurance. My appointment is on April 2nd, the earliest they had available.

Another anecdote: my brother got a tooth abcess while studying abroad in Germany last year. Spent three days and two nights in hospital while they pumped him with antibiotics. Whole thing cost him about 1200 Euros, which was reimbursed by his student insurance after several hours' worth of work navigating the required bureaucracy. A family friend of ours, about the same age as my brother, had the same thing happen in Miami (he went to college there). His parents got a bill for $17,000.

So yeah. People who think that there is literally anything good about the current healthcare system in the US are either literally psychotic, or being paid well by the insurance industry. One of the two.

Anyways, I don't know what my point is other than people who argue for Pete's medicare for some or keeping your private insurance or something are probably actually sociopaths. The end.

This x10000. The more I interact with our health insurance system the more I wonder how anyone can possibly like their current insurance. I think it goes back to a point I've made before which is that Americans have a prisoner mentality when it comes to their healthcare. Getting a letter from your insurance company talking about something changing just creates this horrible sick feeling, like oh god, what nonsense do I have to go through now...and the slick moderate Democrats like Pete Buttigieg who "trust you to figure out your own health care" understand this and exploit it. They make changing to M4A seem like one of those bureaucratic nightmares where your doctor is no longer in your network and now you might suddenly owe twenty thousand dollars for no reason.

They are swine and if there was justice in the world they would be rounded up and shot.

Moderator Action: That will be enough of the shooting suggestions. You have been here long enough to know that the advocating for the death or killing of anyone is strictly forbidden on CFC. It carries a one week ban penalty which you very well know. I trust you will not repeat this mistake. --LM
Please read the forum rules: http://forums.civfanatics.com/showthread.php?t=422889

 

[Timsup2nothin]

The problem with medicare, which is far more likely to just expand with "for all" than be solved, is that it is a system that just demands to be gamed. My mom's 'primary care physician' specialized in medicare patients. All these old folks trooped into her office for "geriatric wellness checks" on the shortest intervals that medicare would cover, and every such wellness check was conducted based not in any part on examination of the patient, but on 'what plausible diagnosis results in the most expansive battery of tests and consults being approved?' Every test result and report from a consulting specialist was delivered independently in an office visit that was duly paid for by medicare. My mom got three wellness checks per year, each of which spawned between six and fifteen office visits worth of results.

Now, my mom really liked her doctor, and all the attention, and had nothing better to do than go to various doctors, at least once a week and sometimes more. We can predict that the ordinary working Joe is not going to provide that kind of revenue stream. But that's how the system can be worked and there is no shortage of doctors who know how to work it.

 

[Hrothbern]

Egos is right about the VA/UK systems being nationalized healthcare versus Medicare/CA systems being basically nationalized health insurance.

the pros are numerous the cons revolve around nanny state things and corruption things which should just be addressed for what they are and not accepted that bad government is the norm. Short list

pros:
Universality
Cheaper for most people
No longer tied to employer due to healthcare
No longer fearful of car accident over a state line or out of network region


Cons:
No longer possible to “Superman” it as Tim lives to talk about
Bigger government
Corruption potential

Perhaps add to the cons near that "Superman" argument that I guess having a system that has a very good base level that is for everybody the same is against the American culture (too socialist-communist), even if adding more features with private insurances on top would be a smooth part of the system.

On that bigger government argument.
Yes
But near it is another culture aspect I guess there to be: why would I as American believe in a reliable government ?
For example: during my superman years I pay (by taxes) that insurance premium... and then when I am older and need much more health care, having become a retired lossmaker for the system, the government in charge decides to lower the level of health care.
I guess Americans put in general so little trust in government reliability, that any other health insurance construction is seen as better.

 

[Birdjaguar]

From today's WSJ:

Health Insurers Lose Their Immunity

A great investment for a decade, the industry faces virus-related and political risks

Health insurance offered some of the best investment opportunities of the past decade. The prognosis, however, now looks shaky.

Health insurers have dramatically outperformed the stock market since the Affordable Care Act became law in 2010. Over the past decade, Centene beat the S& P 500 by more than 600 percentage points while UnitedHealth Group topped the broad index by about 500 percentage points. Others such as Cigna, Humana and Anthem have done nearly as well. Aetna and WellCare shareholders were bought out at large premiums.

There were good reasons to explain this performance, with one of the biggest being expanded access to insurance. The Affordable Care Act allowed states to offer Medicaid to more individuals and enabled individuals to buy insurance plans on state exchanges. That meant large, predictable increases in revenue and profit for underwriters. Adding to their attractiveness, most health insurers do nearly all of their business within the U.S.

While insurance stocks have sold off from time to time over the extended bull run, a quick recovery always followed. Insurer share prices, however, have been hit hard during this week’s market selloff. For the first time in recent memory, the industry faces both short-term and long-term risks to its profits.

The coronavirus hasn’t been diagnosed in many Americans, but that could soon change. A top official at the Centers for Disease Control and Prevention warned Tuesday that disruptions in the U.S. could be severe. UnitedHealth cites “large scale medical emergencies” as an example of what could cause actual costs to exceed projections.

While the virus may threaten this year’s profits, a significant threat looms if Sen. Bernie Sanders secures the Democratic presidential nomination: He has proposed replacing the ACA with Medicare for All. The effects of that overhaul on the insurance industry, while unclear, aren’t likely positive.

And while earnings multiples have shrunk, investors aren’t exactly getting a bargain for assuming the risk. Humana and UnitedHealth trade at about 17 and 16 times forward earnings estimates, according to FactSet. That is roughly in line with the average over the past year.

Investors betting on health insurers as a haven in these turbulent times are risking a surprise bill.

Grant —Charley

 

[Birdjaguar]

Best short term solution? Stop treating patients with 6 months or less to live. We could start with Rush.

 

[Arwon]

"How will you pay for it!!!"

 

[Arwon]

And one thing in particular, the only impression I (and I think, most USians) get from Canadian/UKish (and of course other countries') national healthcare is about wait times.

What do you mean by "waiting times"?