PIC: How do we pay for Medicare for All?

[yurbud]

It is one thing for Republicans to ask that questions, but Democrats know better.

Medicare has far lower overhead because there are no profits skimmed, exorbitant exec salaries, advertising, or legion of customer "service" operators to deny claims.

Medicare's disadvantage is that it cannot make campaign donations, or offer lobbying or exec jobs to politicians who support it when they are voted out of office, a serious bipartisan disadvantage for any well-run government program.

[Ron Obvious]

1. We've already been paying for it.

We're just not getting it.

[CrispyQ]

3. +1!

[Rene]

2. a LOT of people and companies have full employment with current system

using Medicare IT/systems severely impacts all those peoples jobs

[GoCubsGo]

4. How so?

[mythology]

7. Jobs like insurance companies or the people at a doctor's office who deal with billing

The HR staff who work on insurance benefits.

I'm not saying that's a reason to not make the change, and the thing in the OP specifically lays out some money for that transition. Plus cars put buggy makers out of business. It's inevitable.

[GoCubsGo]

12. The people who currently handle Medicare will be needing help.

There are not enough of them currently working there to handle the massive influx of individuals into the system. Many of these people can be hired on with the government to handle Medicare. Also, people on Medicare currently can purchase supplemental insurance. This would not change if Medicare is opened to everyone, so many jobs in private insurance aren't going anywhere. HR staff will also still have insurance benefits to work on. They can work on supplemental insurance, as well as dental insurance, which is not covered under Medicare. Hell, with the money people save on health care can be put into dental insurance. AFAIIC, this "massive job loss" claim is just an excuse to scare people out of transitioning to Medicare for all.

[Delmette2.0]

19. Medicare can hire some the experienced employees from....

all the insurance companies and HR that are layed off.

[csziggy]

23. Insurance companies will still be selling supplemental policies

The same way that Medicare recipients like me now buy supplemental policies to cover the 20% co-pays and drug coverage, people will continue to buy those. And the numbers buying supplemental plans will be higher since people will not have to pay out of pocket for as much of their health care.

I can see employers offering cadillac supplemental plans as benefits, the same way now they offer health insurance as a benefit.

I couldn't find a information on what percentage of the health insurance business is presently Medicare supplemental plans, but the percentage of people under Medicare WITH supplemental plans is high. Only 14% do not have some form of supplemental insurance:

https://www.kff.org/report-section/a-primer-on-medicare-what-types-of-supplemental-insurance-do-beneficiaries-have/

[yurbud]

27. I think the danger in that approach is the supplemental providers can bribe politicians to make the

NEED for the supplement greater.

I would prefer to see insurance execs living under bridges or selling their plasma to survive.

[csziggy]

30. LOL, I like your plan for insurance execs!

I detest them, too. While my husband as a peon was working for a top shipping company they changed the insurance coverage on average every two years. During that time I had eleven different operations. Some of the insurance companies were OK, some delayed payments, Anthem stands out since they routinely refused payment on every claim at least twice.

Between that and an old policy on one of my mares that apparently covered nothing, I hate insurance companies. On the other hand, since my husband retired and we went on Medicare with an excellent supplemental, my coverage has been great and the only thing I have to pay out of pocket are co-pays for medication - and even that is low.

My response above was about the worry of the other poster for the unemployment of insurance sales people and those who have to administer insurance policies. I won't worry too much about their fate. Either they will find another niche in the insurance racket or get jobs that do more for humankind.

[yurbud]

31. true story: I worked for an attorney service in LA that had client like state AG...

but health insurance companies had far, far tighter security than prosecutors of murderers and mafia dons--probably because they know what their customers would rightly like to do to them.

[Mopar151]

6. That's why the $31 billion for retraining! n/t

[yurbud]

13. those jobs cost too much in human suffering and death

[shockey80]

5. Medicare for all is the answer. The American people are too fucking stupid to figure it out.

[lapucelle]

8. It's nice to see John Conyers' HR 676 is finally getting wider support.

It's been introduced in almost every session of Congress since 2003.

[Hoyt]

9. The biggest problem is explaining it to dense people. California, Vermont and Colorado ran into

that problem.

Legislators just couldn't face the voters and say, "You are already paying for it, so that 10+ percentage points your taxes will increase is a savings" (from the premiums and other costs you are already paying). They just couldn't do it.

I'd take it in a heartbeat, but a lot of ignorant white wingers just don't want it.

That's why a Public Option is the best approach from an acceptance standpoint.

Rather than trying to force something down ignorant peoples' throats, offer an option. If we are right that Medicare or whatever is a better approach, within a few years 80% will be in the Public program and a few more years, almost everyone. A public option won't provide the ultimate in immediate savings, but it also gives legislators time to make changes to the delivery system that makes the system viable long-term. I think a Medicare for everyone program is unacceptable to too many people, an option is more palatable and easier to sell.

[vi5]

11. Exactly. It just needs to be phrased as....

A medicaire option for all and not medicare for all which is just slightly more scary for people.

Like you said, it shouldnt be scary but a lot of people are either misinformed or ignorant.

[yurbud]

14. My guess is they didn't try hard enough to sell in those states

[yurbud]

15. the public option WOULD HAVE BEEN great in Obamacare, however...

because it was used to sell healthcare reform then cut from the bill, any mention of it sounds like another bait and switch.

You can only do the same trick so many times. The public option at best is something to negotiate down to now, not a starting position.

[Hoyt]

17. I wouldn't start with mandatory Medicare for all before election.

Too many stupid people — who vote — are opposed.

[yurbud]

22. Even a lot of Republicans like the idea--if you call it MEDICARE FOR ALL

Not socialized medicine or mandatory medicare.

Trying to avoid spooking skittish Republican voters is losing game--the GOP is going to do that to their base anyway.

[uponit7771]

21. +1, from my experience the public option is hard for Red Hatters to argue against. I can see why the

... GOP went after that the hardest, it would've been near impossible to kill ACA with public option.

[chowder66]

10. Couldn't they find more money to lower the taxes

in wasteful spending like oh, I don't know those trillions of dollars the military seems to constantly lose or new military equipment that never works? Or maybe from from corporate handouts, or Trumps golf outings, or Price and Pruitt's spending sprees? Not that the would need to do that but our tax dollars are being abused to all hell.

[yurbud]

16. The rest of the world doesn't want to fight us. We could reduce defense spending to actual defense

not world economic hegemony with bases in places most Americans don't even know exist like Uzbekistan.

[Hoyt]

18. Exactly, there's a big pot of money -- bloated military budget -- that can be

used to fund much of a new healthcare system and other needed programs.

[yurbud]

20. we're freaking out about China & Russia, both of which have military budgets a fraction of ours

though they seem to spend it in smarter ways than us.

[area51]

24. This group has done research.

PNHP

[yurbud]

25. great FAQ! I would actually prefer something like Britain's system

I belong to Kaiser now, which is insurance and healthcare provider rolled into one and it's infinitely simpler to use than my wife's Blue Cross, which in spite of being the largest insurer doesn't include everyone in it's network, so it's always a scramble to see if a particular doctor is covered.

In one case, she was getting evaluated at a clinic at a university hospital, which Blue Cross told us was covered. Then we got a bill for the full cost because they didn't cover the ONE doctor in the clinic who was assigned to do my wife's consult.

[Hoyt]

29. Before went back to work, had Kaiser. Liked it. Problem is, too many folks who want Medicare for all

aren't willing to make any compromises to make the system affordable. I should say, "one problem," because obviously there are other opponents. You start restricting choices of physicians, facilities, drugs, etc., and the very folks who want Medicare-for-all start complaining, even people who currently have the toughest rationed healthcare because they aren't insured.

I really liked Kaiser, and think a coordinated system like that funded by the government will be the least costly and provide the best care.

But I guarantee you, if Obama had announced Medicare-for-all with restrictions on physicians, hospitals, drugs, etc., to ensure the system is sustained long-term, he would have been renounced. That is one reason that I think legislators are afraid to get too involved in healthcare delivery because they don't want to be criticized -- by patients for providers -- for doing what is necessary to make it truly affordable system.

[yurbud]

32. The restrictions wouldn't be necessary--providers should be required to accept it

and Medicare for all could negotiate drug prices rather than pay through the nose for them.

That was a sore spot with both Obamacare and Bush's Medicare Part D.

They were too concerned about offending pharma, and weakened the effectiveness of their own policies by doing so.

[Hoyt]

35. The vast majority of providers already participate in Medicare. 30+% of beneficiaries choose

Medicare Advantage Plans over traditional Medicare. I think even under Medicare-for-all, those plans will still be there. Too many people like them.

As to drug prices, there is only one way to make negotiations work, you have to be willing to say, "Nope, too much, we are not going to cover your overpriced drugs." While government officials are fine telling poor people they aren't covered, they don't want to be telling the mass of voters that they can't get certain drugs, etc.

In any event, if you lowered prescription drug prices to what Canada or Britain pays, you'd save, at best, 1 - 3%
or so of healthcare costs and that assumes that it doesn't impede innovation for drugs that save a lot in hospital, doctor and other costs. 1 - 3% is still a lot and worth doing, but it isn't going to transform the system.

[yurbud]

37. Does the VA negotiate that way? If we know about what the cost of the drug is...

and offer a reasonable profit on it, it would be tough for a drug maker to turn down 330+ million customers.

[Hoyt]

38. Good luck. I do agree some means of deciding on a fair

price is necessary, but the VA isn’t getting such a good deal.

[greymattermom]

26. Ask Putin

Russia has universal health care. Maybe not the best, but they have it. Also ask Trump why we don't do what Russia does.

[yurbud]

33. That would be a great way to get it! "President Trump, is there anything wrong with Russia's

health insurance system? No? Okay, please sign this bill that gives us one just like theirs."

[Access Geek]

28. Force all policies to convert to single-payer

There is absolutely no reason why we need individual medical policies for any reason. All medical procedures should be relegated to a single-payer system where everybody is equal. Furthermore, if we have to Institute a major wealth tax on all people who have money, it should be confiscated from them to pay for this very needed policy. Nothing else will work.

[yurbud]

34. "confiscate wealth"? That's an odd way to describe taxes.

When you produce wealth for your employer and only get a fraction of it in wages, are they "confiscating" your wealth too?

Or when they break unions, so you can't effectively bargain for a greater cut of the wealth you make for them?

[Celerity]

36. All medical procedures should be relegated to a single-payer system

Not every procedure, elective surgery should not be covered. Zero chance people will sign onto a system that includes breast jobs and tummy tucks, etc.

[fleabiscuit]

40. That's a broad brush. Reconstructive surgery denied is a Republican idea. Don't play Dr.

[Celerity]

41. I said elective surgery, reconstructive would not fall under any sort of blockage I envision

I even listed examples, so please don't project things onto me that I didn't say.

[fleabiscuit]

45. Disregarding emergencies, all surgery is elective. nt

[Celerity]

46. you seem live in a different reality than I do & I think you are simply being pedantic,

but to each his own

[fleabiscuit]

47. Welcome to DU. nt

[Celerity]

48. thank you

[GulfCoast66]

39. There is more than one way to skin a cat.

Medicare for all is definitely better than what we have now.

But we should carefully study other county and see what works best.

I do not want to emulate Britain and their system. France and Germany both have systems ranked among the best in the world. They are different from each other and from my reading I think a system like France has may be our best option. Insurance companies are generally nonprofit and residents have a variety of options to choose. But one constant is that the government covers the insurance cost for those who cannot and no for profit corporation has an incentive to deny care to increase profit.

We could use the ACA as the frame to build up to such a system. It does not totally remove the employer from the mix which will make it easier to sell. The largest resistance we face is the good number of Americans who are satisfied with their employer based system. Well that and too many Americans do not feel that people who look like them are deserving of benefits.

Don’t get me wrong. Health care should be a right all democrats support. The way we get there will take lots of work and comprise.

But who knew, health care is complicated!

[yurbud]

42. As I've seen in the education "reform" movement, there's still room for abuse

when using "non-profit" insurance companies, such as inflated executive salaries and subcontracting to for-profit companies.

If it can be done by a non-profit, it should just be done by the government, so we have some say in funding and decision-making.

If any private entity is involved, there is room for corruption.

[GulfCoast66]

44. So often on DU we get in fights over the smallest of details

I agree about the potential for salary inflation. But I am not as sanguine as you about the efficiency of government employees over nonprofit.

And I realize neither of our ideas is one election away.

If we determine that a the top marginal tax rate is 70% or more then salary abuse becomes less of a problem. Especially if we go back to pre 1980 law where stock options are illegal. Of course if nonprofits stock is not an issue. Just bringing another of my pet peeves!

But this is what I want to see...open discussion of the various options. Not fighting over Symantec’s.

Have a great evening

[yurbud]

49. most of the time, the "downside" of using gov't employees is wages & unions

using contractors of any kind usually only saves money if it all because the contractors shortchange their workers unless they are using the "cost plus" scam, in which case, paying workers more increases their profits (but so does intentionally breaking & wasting stuff like burning trucks with flat tires in Iraq).

[GulfCoast66]

50. Oh I disagree that government employees are more expensive

Well, the workers get more wages. But business does not.

The whole Outsourcing of government was only about lining the profits of republican sugar daddies. And cost reducing is only the result of reduced services.

One huge scam.

But that does not mean I think all the nations healthcare should be handled by a single agency. Make insurance nonprofit, allow different models and agencies tightly regulated. Charge the well off enough to cover the cost of those with few resources.

[yurbud]

53. if they were as tightly regulated as they needed to be, no one would want to do it.

[GulfCoast66]

54. You may be right. But I don't think so.

It works in other nations. And they would still provide good jobs. Granted no one would invest because they are non profit but there are models that work such as nonprofit hospitals. I do not think putting all that in one single government agency is either doable or desirable in the long term.

That said, there are so many models better than what we have now.

[roamer65]

43. Just model it after OHIP, the single payor system in Ontario, Canada.

That blueprint will get 90 pct of the job done.

[Turbineguy]

51. The current system is like people who steal car radios.

They get a cut, it's true, but support the employment of a legion of others.

[PoliticAverse]

52. "or legion of customer "service" operators to deny claims." -about 10% of Medicare claims are denied

actually.