Single Payer vs. Medicare for All

[RandySF]

Link to tweet

[Hoyt]

1. I think we get less opposition with Public Option or Medicare Option. Where I live, white wingers

go absolutely nuts when they believe they are being forced into "socialism." They are just too ignorant to get it.

But I think there is a chance with the ACA on the way out to offer a public option that would allow people to buy into the Medicare plan if they want to with appropriate subsidies for those who cannot afford the premiums. If it is as good as we think, it won't be long before almost everyone is in the Public Option.

Of course, Medicare has a lot of gaps and issues, but it sure beats going back pre-ACA.

[Demsrule86]

5. We won't get anything if we lose the ACA.

[Hoyt]

6. Unless Congress reins in trump, ACA is all but gone.

[Demsrule86]

9. Well it will end up in court.

But the GOP wants the ACA gone so they won't rein Trump in.

[Hoyt]

12. It's in court now, and trump administration isn't fighting for it. Sad.

[Demsrule86]

21. But we do have people fighting for it...so don't give up hope.

call and call...

[ecstatic]

39. +1. nt

[populistdriven]

2. wildly popular is an understatement:

[msongs]

3. single payer is meaningless hogwash to most people. not effective. nt

[KCDebbie]

4. Single payer is the best way to control prices charged for

medical goods and services. A single-payer puts limits and caps on the amount that can be charged for various medical procedures and medications and devices - this makes single-payer system the enemy of the entire US healthcare industry which is based on the for-profit business model!

All bills for medical treatment, services and devices for all patients can only be submitted to one entity/clearinghouse for payment! Only that entity/clearing house can approve, process and pay the bill.

The clearing house sends the bill to the patient for review, and when approved by the patient, the clearing house pays the bill.

But the best part about single-payer is the way disputed bills are handled. If the bill is reviewed by the patient and the patient disputes, for example, the # of home visits received while recovering, the clearing house stops paying all bills for that chain of hospitals or clinics until the dispute is settled fairly.

Another thing about single-payer are the price caps placed on services, medications and devices (price caps are good for the patient/consumer but bad for the for-profit healthcare industry) that keep healthcare costs from spiraling out of control as they do here in the US...

Holland, Germany, Switzerland, Canada, UK, Australia, Finland Iceland and a few other countries use a single-payer healthcare system...

[Demsrule86]

7. We don't have a 60 vote majority in the Senate and won't for years maybe decades...

if the ACA survives we can get a public option but medicare for all requires 60 votes because it can't be done in reconciliation. Also most people still have healthcare at work and would not support a large medicare for all similar to the Clinton bill. Insure those who don't have coverage at work and start lowering the age of Medicare. Those who don't have good exchanges or who's states have not passed the medicaid expansion should be allowed to use the public option.If the ACA goes down, we get nothing because without the ACA, we can't even get a public option without 60 votes.

[Sophia4]

44. Starting with a public option would be an alternative.

People will like it. I know. I lived in Europe for years. The countries were much poorer than ours, and there was no internet, no easy way to organize lots of information.

But it was great especially for prenatal, births and postnatal care.

I love comprehensive healthcare whatever you would call it - single payer, compulsory healthcare, whatever.

The US would have to figure out its own system.

[Demsrule86]

52. Sophia we are teetering on losing the ACA...if we lose it even a public option will not

be possible. I have advocated for a public option, but something must be done with wrap around plans which suck so as to deal with the 20%

[Sophia4]

54. Losing the ACA means death for a lot of people.

We should have had a public option in the first place.

I think that California may start its own plan if the ACA goes. We are populous enough to do it. A lot of the politicians in California are for it.

[Demsrule86]

64. Yes it does. Maybe if we had supported Pres. Obama in 10, we might have gotten one...

The votes were not there in 08...Lieberman put the kibosh on Medicare buy in for those 55 and older. You lose the ACA, you get nothing. The GOP hates healthcare so much they risk their majority by defunding chip and by suing about pre-existing...if the court rules in their favor then how does Medicare work? I imagine, there would be pre-existing in the current wrap around plans.

[Demsrule86]

10. I don't think it will work in this country.

[roamer65]

14. Yes. In Ontario, Canada it is known as OHIP.

[Wwcd]

28. What's our population compared to Canada & the other smaller countries?

Sanders numbers were not feasable for single payer when someone finally asked him, How?

Someone elsevhad to crunch the #'s for him & the costs became unattainable.

I hope someone figures it out because all it is now is a campaign bone to throw out to the masses.
Its a grand idea but with no way to make it affordable then what's his point?

Has he done the math yet?
Hope so. The US is a far greater population than the smaller countries named, Canada being closest.

We will demand facts this next time around. Not simply divisive soundbites.

[KCDebbie]

31. I don't believe that we can't figure out how to implement a

feasible single-payer system of healthcare. It's not like re-inventing the wheel - other countries have done it! We only need to replicate their systems and exclude the medical, health insurance and pharmaceutical industries from the planning to prevent them from sabotaging the system to their benefit...

[Blue_true]

34. If it was only that easy.

Europe got leveled in WWII, implementing systems like single payer and social welfare was the only way that social order could be maintained as those countries were rebuilt from rubble. Some countries like Switzerland that were not affected badly by war reformed their social welfare systems to match the rebuilding countries.

If Trump fully gets his way, maybe we will get bombed up, and have to rebuild from rubble like most of Europe after WWII.

[Blue_true]

33. Canada, just over 30 million, the US around 330 million.

The scale just isn't the same, the "startup" dollars for us would be astronomical. The kicker for me is when Vermont tried moving to Single Payer a few years back and needed $2-3 billion in startup money, Bernie gave them the cold shoulder, did not help at all. I think the failure emboldened republicans in Vermont and that ended with a republican being elected governor there.

Bernie talks a good game, but when one sits down and run the numbers using the most optimistic input, the math for his plans don't work.

What can be done once democrats regain control? Restore the ACA in full, including the public option. Remove the Cap on FICA taxes. Allow working people that can't afford healthcare or are buying shitty policies and who don't qualify for subsidies to buy into Medicare and get health insurance coverage through Medicare.

[Sophia4]

42. Vermont's market may have been too small.

The Northeastern states could probably spread the risk around, and it would be cheaper.

If the rest of the developed world can have Medicare for all or some sort of comprehensive healthcare system (they differ from country to country), we can too.

[R B Garr]

49. These are the kinds of considerations that he should

be making in context and not let it fall on others. He should be explaining why it didn’t work in Vermont before he points fingers at other politicians.

[Blue_true]

55. Yes, a regional healthcare compact could work.

Canada came about it's healthcare system that way. Early on, some of the more conservative provinces balked, so the liberal provinces were allowed to develop systems built on a national standard, their success was so good, that the conservative provinces soon gave in.

In the US, a Northeast compact that has New York, New Jersey, Conneticutt, Rhode Island, Massachusetts, Maine, New Hamoshire, and Vermont should work beautifully, with the more populous states spreading out the risk and bringing more savings. In the west, a compact of Washington State, Oregon and California would work, with Colorado and New Mexico being eligible to join the compact - with modern communication systems, NM and Col being geographically displaced would not be an issue.

The issue that I have with Bernie on a lot of things is that he often fail to see or just ignores alternatives to what he wants, alternatives that will make his ultimate goal more attainable. We are not going to get red states and states like my Florida to buy into universal healthcare until the politics in those places get changed, so Bernie is not going to get universal healthcare nationwide anytime soon, so why not craft a proposal for regional single payer healthcare systems for parts of the country that are politically open to the concept?

[Wwcd]

45. That is the most well thought out & sensible reply

Thanks Blue_true.

[Sophia4]

43. The rest of the developed world has comprehensive health insurance that covers

everyone. We can do. It is a matter of will and requiring everyone to pay a percentage of their income. Co-pays may be necessary for some who are fairly well off.

[a kennedy]

8. It has to be Medicare for all........

everyone knows of family members with Medicare and they love the coverage....so most people know that Medicare is the best insurance for them. It HAS TO BE MEDICRE FOR ALL or nothing. JMHO.

[Demsrule86]

11. No they don't...Medicare covers only 80% of expenses...and there are deductibles...

there is no prescription coverage. Some are forced to choose between eating and healthcare...Medicare is not perfect. My sis in laws has it ...she is disabled. I am thankful for it but we needed a big wrap around plan and she still pay a great deal for drugs.

[a kennedy]

13. Sorry......most people i've talked to love their medicare coverge......

[Kaleva]

15. Those who love it probably are those who can afford supplemental insurance

It took me 2 years to pay a portion of a bill that Medicare didn't cover. If one doesn't have supplemental insurance that covers expenses that Medicare doesn't, one goes to the hospital only when the situation is dire. Especially those of us who rely solely on a limited fixed income like SSDI.

[Demsrule86]

18. People have no understanding of how medicare works.

And I tell you right now...those with employer insurance will punish us if we try to force them on Medicare for all or any plan really just like with the Clinton health care plan...Obama's genius was in attempting to insure only those who did not have insurance. Also, we are two years at least away from any healthcare plan other than the ACA...thousands will die if the ACA goes down...every person on this board are elsewhere should call congress.

[Demsrule86]

17. I have dealt with medicare...anyone will tell you that they want it ...don't touch my medicare but

it's not perfect. How much do you think 80% of cancer treatment would be? People die because they can't afford chemo and it gets worse...chemo is under pharmaceutical and let me tell you that suck big time. There is no prescription plan within medicare and the Bush one sucks...I read about medicare for all. and I have to conclude that those painting it as free healthcare coverage have no experience with it. You pay premiums and there are deductibles...it cost a great deal to go to the hospital...My sis in law had hip surgery, we had to pay $1000.00 before the doctor would touch her. And she owed money afterwards.

[pnwmom]

22. Yes, you need a supplement policy, but those policies, even for the oldest and sickest,

only cost a few hundred a month -- far less than anyone would pay elsewhere.

And people on the lowest incomes can qualify for Medicaid.

[Kaleva]

25. I get $1158 a month SSDI

I don't have a few hundred a month to spend on supplemental insurance and I don't qualify for Medicaid. What saved my ass was getting VA healthcare later but I still have Medicare.

VA health care is an example of a single payer system.

[Sophia4]

41. The insurance payments should be a percentage of the pay or income of a person.

If you only have $1158 per month, you would pay almost nothing in a comprehensive health insurance system. It would be like Medicaid.

VA is not single payer. It is free (in that there is no required monthly payment) except for co-pays when you use it and medications for veterans. But it is not comprehensive health care coverage for the whole country.

[Kaleva]

57. VA is not free as it is funded by taxes.

"Single-payer healthcare is a healthcare system financed by taxes that covers the costs of essential healthcare for all residents, with costs covered by a single public system (hence 'single-payer')."

https://en.wikipedia.org/wiki/Single-payer_healthcare

[Sophia4]

61. VA is free for the veterans who use it except as to certain things like prescriptions.

My husband is a veteran and uses VA services. That is why I know.

He was paid almost nothing for his service when in the military, so the government is, the American people are, in my personal view, simply repaying to veterans what they owe them.

We also bought our house with a VA loan. We repay it, but it is much less expensive to borrow money from that program because you don't have to make a large down payment if you buy a house for a low enough price. I don't know whether the VA housing loan program still exists. I am writing about the past.

Health care insurance is never free. But in most developed countries, it is universally available at an affordable price. Here, it isn't available to all at an affordable price. We need some comprehensive, inclusive form of what is commonly called single payer or medicare for all. I don't care what it is called, and I don't care about the details of organizing it. But we definitely need to make healthcare insurance affordable and available for all. Healthcare insurance should not be a profit-making business. It should be non-profit. It used to be to a great extent non-profit. And it was good. We can at least do that again. Take the profit out of health care insurance, and good solutions to our national crisis in health care will be obvious.

[Kaleva]

62. The health care your husband and I got in the military is an example of a single payer system

Just as the health care we now get from the VA

[Demsrule86]

27. A few 100 a month is way more than many can pay...and there is no such thing as family plans on

Medicare either...it is not workable in its present form...a public option would work way better and lead to universal coverage of some sort. And those who get coverage from work won't want to be forced on Medicare for all...it will be the Clinton debacle all over again. Imagine if Democrats had the courage then as was shown in 08 by Nancy Pelosi and her majority...it would be a different world.

And here is the most important point, Medicare for all is at best two years away...if we manage to take the senate and the presidency by 20. However, medicare for all -given the costs- can not be done in reconciliation. We are years if not decades away from a 60 vote majority in the Senate. Now if we manage to keep the ACA , we can do a public option in reconciliation. However, if we lose the ACA , we get nothing for years if ever. That is the reality we face. I wish it was different.

[Sophia4]

40. Companies could save a lot of money if they did not have to cover their employees'

insurance needs.

So Medicare for all is very much an excellent option.

And that is especially true in this age when jobs are very insecure. Lose your job -- lose your health insurance. And it is precisely when you have lost your job that you most need it. Taking advantage of private plans can be prohibitively expensive when you have lost your job and have no or very little income and savings.

The cost of healthcare should be taken out of the paycheck of the person whether he or she is an executive or an employee, and everyone should have the same kind of basic coverage although there should be a choice of plans depending on how much a person wants to pay for coverage on top of the basic plan.

When I lived in Europe, my dental care was covered to some extent. There are now also co-pays for care in Europe. My dental care was never entirely covered.

I had two children while living there. Pre- and postnatal care was excellent. Just amazing. And it cost me next to nothing. I'm not even sure we had a co-pay. I don't remember. Because of "Kindergeld" -- a monthly stipend paid to parents for their babies at that time, a co-pay would not have been a problem even for the poorest parents. I always figured the "Kindergeld" about covered the cost of paper diapers. I used cloth ones for my oldest child, but my youngest was allergic to them.

We need universal healthcare in this country. Obamacare is better than nothing but really in my opinion not very good compared to the insurance we had in Germany, Austria and France.

[Demsrule86]

51. It is just not true. Those that talk about Europe do not understand how it works ...these are

relatively small countries...I know for a fact that Germany has a two tiered healthcare system. But it doesn't matter what goes on in Europe, it won't work here...people hate taxes and those with healthcare from the job will be smoking angry...which mean out we go and the GOP dismantles it all when they get in...assuming we could get it done. We simply aren't getting a super majority anytime soon in the Senate...look at the states. We can save the ACA and make it better...add a public option...go from there. But if the ACA goes, we get nothing.We only got the ACA because we had 60 votes...And if the court rules pre-existing conditions unconstitutional than what? Also, people are not considering the job losses from insurance...they shrug like it doesn't matter. It matters. Medicare has a 20% deductible and considerable costs for the insured with deductibles and hospital fees...now some are getting medicaid to pick it up if they are lower income. But would that continue? The wraps are expensive and many who would not be eligible for Medicaid won't be able to afford the wraps. This means they would be responsible for 20 % of all treatment. There is no simple solution to this problem. Medicare for all is a talking point; the devil is in the details of actually implementing it.

[Demsrule86]

59. I have dealt with medicare a great deal as I have a handicapped sister in law who is on it...it is

a blessing sure...but it has serious flaws and anyone who is on medicare will tell you this...there are people who can't get treatment because they can't afford the 20% and can't afford the wrap arounds...sure it is a catchy phrase 'Medicare for all' but it would take major prep work in order to prepare medicare for a 'medicare for all' program which honestly is a waste of time to discuss because we need 60 votes in the Senate and won't have that for years. Support the ACA improvements and a public option...it is are only chance...and if the ACA goes away, we get nothing. That is reality.

[forthemiddle]

65. As of right now

Medicare covers no prescriptions, no prenatal, no obstetric, no postnatal care. They also, obviously don’t cover pediatric care.
Until a few years ago, it covered no preventative medicine. And as of today, the preventive medicine it does cover has extreme limitations.
Medicare Part B monthly premiums are heavily subsidized, there is no way that premiums, per person would be as low as they are today. If Medicare Part A (the hospitization part) the prices will more than double. Plus it is per person, so a family of 4 could be looking at very high premiums what they get through their employment.
Medicare also has the lowest reimbursement rates to the providers, besides Medical Assistance in the industry, so you will see many independent providers going out of business.

[TexasBushwhacker]

56. There will be still be Medicare Advantage plans

just like they have now. Most of those cover medications and have little or no deductibles. They also have out of pocket maximums.

[Demsrule86]

58. Those plans are expensive...people will be in the same boat they are now...no point in that ...

better to keep the ACA and add a public option. Medicare is going to have to be updated for medicare for all to work.

[TexasBushwhacker]

60. I don't pay a nickel extra for mine. n/t

[Demsrule86]

63. Then you either have Medicaid or you have a 20% liability. I know how it works...or

you have a plan that doesn't keep you covered. I checked my sis's and she would have paid thousands if she was hospitalized. Sure she didn't pay anything or much as I recall...but there were gaping holes in coverage...we put her on a different one and pay it. Maybe check it out. If it is Medicaid, some states have such stringent rules that many fall through the cracks. Medicare is not single payer nor was it set up for families. It is very specific. As my sis was on disability for a number of years, she couldn't get the wrap around plans either which were for older folks. We paid thousands out of pocket. Before Obamacare she was turned down with pre-existing from some plans too.

[Sparkly]

16. Semantics and Principles

It's "One for all, all for one!" or it's "Every man for himself!" (And I leave the masculine pronoun as it is.)

We have a "socialized" fire department.
We have a "socialized" police department.
We have "socialized" schools, trash collection, road repairs, snow removal, courts, laws, national defenses and (hello!) federal government.

The government is designed to be of, by, and for The People.

"Single payer" is the same as "pooling resources," which is the same as "paying taxes." Republicans have pried apart our unity by exploiting and leveraging divisions. As in, "Those people don't deserve defenses against terrorist attacks *I* paid for!"

"Single payer" is the semantic for "We're all in it together." We're now divided to the point that many citizens feel such suspicion of others - in a zero-sum game - that the idea of TRUE national unity is frightening -- while usurping and claiming slogans and symbols of their special, separate supremacy is a balm on their fears...

Underlying all the logic about words and principles, I think what we're up against is illogical, deluded, emotionally-based "opinions" that have been decades in the making.

Not sure if this makes sense, but hitting "post" anyway.

[Demsrule86]

19. It has never been one for all in this country and pooling our resources will have no appeal for

those who have good work coverage.

[Sparkly]

23. "One for All" is at the root of this country's founding.

Very obviously, it has not yet been perfectly realized -- but the idea has been about a "more perfect union," and "the arc of justice," and the rule of the people. The principles were there, even when poor people, black people, and women had no recognition as "people."

The people who reject the idea that we're in it together, fellow citizens pooling resources, have fallen for the propaganda pulling us apart. There's no Walden Pond here. We rely on each other. The rightwing has just pushed the fiction that we're all lone wolves who must gather with like tribes.

[Demsrule86]

26. That is just not true.

There has never been a pooling of resources.

[Sparkly]

29. Oh my...

Again, the goal is to become a more perfect union; the arc of justice bends toward progress; we are, by design, Of, For, and By "The People," recognizing we remain very far from perfect.

TAXES = pooling resources.

[Demsrule86]

32. Right...and that is not working out is it? My goal is to win the midterm and then win in 2020.

[Sparkly]

35. Semantics and Principles

like I said.

[Demsrule86]

53. My principles say let's save lives by making sure that the GOP doesn't win elections...I am more

practical. I prefer to actually accomplish progressive policy goals which is only possible if we win.

[pnwmom]

20. Single payer fails miserably as a BRAND. Medicare for all is brilliant. n/t

[Sparkly]

24. Not so.

"Medicare" is considered an "entitlement." The deluded no longer think it was "deserved," unless they themselves are on the receiving end (the result of hostile divisions).

[Sophia4]

38. We pay for Medicare throughout our working lives.

When we turn 65, the Medicare insurance we paid for is activated for us.

It isn't "free." We are entitled to it because we paid the required portion of our income for it throughout our working lives.

The Medicare system makes sense because the most expensive years of our lives in terms of medical costs are the years beginning around 65 and over 65. Insurance companies would go broke trying to cover the healthcare of elderly adults. So Medicare is practically a necessity for most families and elderly patients. How else could we keep elderly people alive in our country?

[Sparkly]

46. I'm the choir

lauding your preaching.

[Sophia4]

47. You never know who else is reading.

I did not mean to talk down to you or insult you. Sorry if you felt I was.

[Sparkly]

48. Not at all.

[Garrett78]

30. As others have pointed out, Medicare without supplemental is insufficient.

So, what we really need is a new-and-improved Medicare that is available to all.

[Sophia4]

37. Right!

[Sophia4]

36. Another term is simply "universal healthcare" or "universal health insurance."

As long as it is affordable and available for everyone, I'm for it.

What it is called makes no difference to me.

Single payer is a term that probably doesn't mean much, but it is used so I have used it.

[area51]

50. PSA

I think some of the questions in this thread may be answered on this site.