While I applaud that there is conversation regarding Medicare for all, until details on how it would

[still_one]

work, the costs associated with it, how those costs would be paid for, and the fact that the Democrats do not have the majority in both houses, is it even possible?

Until those DETAILS are known, what does it mean?

Recall the Vermont legislature passed a Single Payer Plan, which the governor supported, until it arrived at his desk, and concluded they couldn't pay for it, so he didn't sign it.

The California legislature tried something similar, but the speaker put it on hold because there were no details on how it would be financed, how the services would be distributed, how much money would be available from the federal government, and a whole host of other issues.

We can state in principle that Medicare coverage should apply to everyone, but without necessary details, it is simply a statement of principle.

I await those details I mentioned above

[greatauntoftriplets]

1. Same here.

I'm on Medicare and have supplemental coverage. Yet I just got a $159 bill from a physician for an office visit. That hurts. My supplemental (which I've been told is great coverage) paid nothing.

[guillaumeb]

15. The misnamed "Medicare Advantage" plans are offered by private insurers.

An attempt by George W. Bush to weaken traditional Medicare.

[PoindexterOglethorpe]

16. I have one of those Advantage programs

and it's been great for me.

No copay for an office visit. No co-pay on common drugs. I don't happen to be taking anything exotic or expensive, lucky me. Oh, and I'm on a plan that I don't need to pay anything extra for.

And the Advantage or supplemental plans exist to close gaps in traditional Medicare, which only covers certain limited specific expenses.

[guillaumeb]

18. So if those gaps were closed,

would that improve Medicare?

It seems to me that the "gaps" are designed into the program. Like the drug gap that was designed in by the GOP.

[PoindexterOglethorpe]

29. Keep in mind that Medicare

was pretty much designed as a nearly bare-bones program for seniors. More to the point, it was designed at a time when the range of medical options, procedures, and medications was a tiny fraction of what it is now. Fifty years ago people weren't routinely on five or more different medications. Now a lot of people are. Things like knee and hip replacements didn't exist. Cataract surgery was relatively primitive. And so on.

I think there needs to be a basic level of medical services, drugs, etc, covered for all. Including well checkups and preventative stuff. Then there could be a series of "buy ups" that would cover more and more stuff.

I haven't exactly devoted a whole lot of time to this, and so my suggestion here is going to be highly flawed, I know. But there needs to be a starting point of some kind.

Oh, and the other thing to remember about the origins of Medicare is that since most people get their health care through their job, once people stopped working, they had no health care, and Medicare was intended simply to step in to cover that breach.

[guillaumeb]

30. Fewer people than ever get coverage through work.

And Medicare has a much lower overhead cost. So the savings are there.

[PoindexterOglethorpe]

33. So true.

In fact the extremely low overhead of Medicare is remarkable.

Put everyone into that system, no more insurance premiums unless you elect a buy up of some kind.

Also, I'm pretty sure that Medicare never concerned itself with pre-existing conditions, which is wonderful.

[Ninsianna]

63. Don't they have a lower cost because they don't cover everything?

People who are in the field say that Medicaid makes more sense to expand to everyone if considering a single payer plan based on ones that exist now.

[Hoyt]

55. As someone who paid for my mom's drugs up until 2005, Democrats really missed by not doing something

on prescription drugs that were not covered before 2005. The donut hole sucked, but it was better than what was before. Obama's ACA attempted to close the donut hole, but who knows where that stands.

[sprinkleeninow]

22. This is true. My mom was first covered by a supplemental,

then an advantage plan. She landed in the hospital w/a major stroke, then a nursing facility while on the advantage plan. She paid affordable non-covered expenses until she/we were forced to apply for Medicaid. Then there was a co-pay according to her s.s. income. The dang skilled nursing monthly cost was $12,000 if 30 calendar days and $12,400 if 31 calendar days!
Made ME ill!

[greatauntoftriplets]

37. I don't have a Medicare Advantage plan.

[Hoyt]

53. Well, one third of Medicare Beneficiaries prefer Medicare Advantage. They aren't made to take it.

It's voluntary. I had Kaiser MA until I decided to go back to work. It was a good plan, unless you are one of those who has to choose from every doctor. Personally, I like the way Kaiser -- a non-profit -- coordinated care and encouraged me to have colonoscopies and other preventive tests.

Some folks don't like it, then they can select traditional Medicare with no out-of-pocket cap on expenditures. You have to buy a supplemental unless you want to risk bankruptcy with one hospital admission. Some people like it, that's fine. Some don't know any difference.

Besides, if the OP has a supplemental policy, he/she doesn't have a Medicare Advantage Plan or they are wasting their money.

BTW -- I suspect the $159 bill is not a bill at all, but a statement.

[still_one]

26. F and I believe G offer the most comprehensive supplemental, but the premiums are more

The important point you have brought up is that Medicare premiums and possible out of pocket expenses can still occur

[greatauntoftriplets]

36. I have F.

And paid up the deductible months ago. Go figure.

[DURHAM D]

38. Looks like your office visit was not coded correctly. NT

[greatauntoftriplets]

42. That's very interesting.

Also, this is a visit that occurred last February!

[DURHAM D]

47. If you have plan F it should have been covered.

However, some states offer a Plan F with high deductibles. If you have regular F it looks like a mistake.

[greatauntoftriplets]

48. It's regular F.

Something's off.

[still_one]

40. If you have a supplemental F with a deductable, and you have already paid your deductable, I would

be curious why they charged you additional.

Part D can cost some out of pocket expenses, and I guess certain procedures which aren't approved can, but I am really surprised that they charged you additional

[greatauntoftriplets]

44. Another doctor is also sending me bills for office visits.

In that case, it's for multiple office visits and is less than 1/2 of the $159. I see her weekly (long story) for a pesky auto-immune disease that no one has ever heard of, but was surprised when I received the first invoice.

Think I'll call the $159 doctor tomorrow to ask about this. It just came yesterday and I haven't paid it yet.

[still_one]

45. Sounds like a good idea, you might also contact the insurance company. All the best

[greatauntoftriplets]

46. Thanks.

[Ninsianna]

64. Pardon my nosiness,

but which autoimmune disease? No need to go into details, but would you feel comfortable sharing the name?

[greatauntoftriplets]

70. Check your PM, please.

[beaglelover]

2. I agree. Let's see the details Bernie.

[WinstonSmith00]

3. Why we so worried about cost of health care?

Yet we never question the cost of War.

[Fresh_Start]

6. You might be lost

we always question the extreme expenditures on military spending.

In fact, most of would probably agree that military spending should be cut in half and the money spend on social programs like food, housing, education and healthcare

[WinstonSmith00]

11. Paying for health care is not a problem

With all the waste and embezzlement that goes on through our Government there should be more important things we talk about we cant afford. One thing we can afford to do is give health care to each and every person in this country and anyone who says we cant is a con out for the corporate interest.

[Stargazer99]

12. Europe seems to have found a way to take care of its people

Is American so dumb that it can't do the same...oh, I forgot those involved in medical care just might not get such a generous income
we must let some die and be disabled to keep the system going The value of a human life in the lower-income levels is cheap or not at all. My girl died over $3.00 being over the state of Washington limit for medical assistance. That tears up my soul, but as I see it the well-heeled really don't care about anyone but themselves. OH, yeah when she died she was EMPLOYED but the business did not have medical coverages. Talk about slavery being overcome

[DURHAM D]

39. "Europe"???

Each country has a different plan.

[GulfCoast66]

73. Many of the best systems look nothing like Medicare

Which is why I agree with the OP. Many of us are Stongly in favor of health coverage for 100% of Americans. But not necessarily in favor of an expansion of Medicare.

Have a nice evening

[guillaumeb]

14. Wars are even more profitable to the 1%.

[leftstreet]

41. +1

[MineralMan]

4. Proposals for Medicare for All right now are merely symbolic, frankly.

Since there is no possibility of any such thing passing or being implemented at this time, introducing such proposals is little more than symbolism.

It may create demand for such a system in the future, but no details are going to be provided, because that requires actual action that might actually be taken.

Celebrate the proposal, but don't expect it to be more than symbolic until we've replaced Republican control of all three branches of federal government with Democratic control.

Symbolism is important, but it is not even potentially realistic at this time.

[Fresh_Start]

8. +1 nt

nt

[KPN]

5. OK.

[maxsolomon]

7. the perfect is the enemy of the good

you're not going to see them for a while and you will have to accept that. this is positioning for the mid terms.

[NurseJackie]

9. Are the details KNOWN but secret? Or are there NO details at all? Is this grandstanding?

[HarmonyRockets]

49. Wait a minute

Hold on



The bill is being revealed tomorrow.

And also, I don't agree that we should be attacking Democrats like Kirsten Gillibrand and Kamala Harris by calling them grandstanders.

[NurseJackie]

50. I'm sorry, but that didn't answer my question...

The bill is being revealed tomorrow.

So I've heard. Have these individuals who are "signing on" actually READ the bill?

And also, I don't agree that we should be attacking Democrats like Kirsten Gillibrand and Kamala Harris by calling them grandstanders.

If they've actually read the bill and know the details of what they're attaching their name to, then they aren't.

So have they? Are they? Are they supporting an actual bill, with actual plans of how it's going to get done and how much it's going to cost and how long it will take to implement? Or are they just glomming on to a popular hashtag / bumper-sticker / slogan?

All I'm asking is how have they arrived at their decision? Did they read and analyze the details of this bill? Or is this just a "me-too, me-too" moment? That would be grandstanding, and that would be disappointing.

[HarmonyRockets]

51. I don't know

Try calling their offices and asking?

[NurseJackie]

52. I figured as much.

[Cary]

74. Why do you want to be obtuse?

You know that isn't what NurseJackie said.

She isn't Hollybaere.

[DURHAM D]

10. I don't know if BS has evolved but start here -

http://www.thepeoplesview.net/main/2016/1/18/bernies-new-health-care-plan-is-mathematically-challenged-flat-tax-gamble

[guillaumeb]

13. Medicare is paid for with premiums.

Medicare started in 1966.

The problem is solved on a national level, except for finding the political will to defy the Insurance companies. Coincidentally, the Insurance companies donate heavily to both major parties.

[WinstonSmith00]

17. Exactly it works like an Insurance Company

Without the corporate middleman exploiting us for profit. And instead of making the premiums based on age or risk factors or pre existing conditions. The premiums can be based on income ensuring everybody gets coverage they can afford.

[guillaumeb]

19. Yes, if there as the political will, this could very easily be done.

But those Insurance companies bribe politicians for a reason.

[sprinkleeninow]

23. 'Political will.' Money talks.... eom

[pnwmom]

20. Medicare is paid for with the Medicare tax that comes out of paychecks.

The optional Medicare supplement is paid for with premiums.

[guillaumeb]

21. True. So the system is already in place for funding.

I referred to premiums simply because the tax is a type of premium in the sense that it has a single purpose, insurance.

[pnwmom]

24. The system is in place but the amounts would be critical. For most people not already on Medicare

the tax would have to go up. Voters would have to be convinced that the tax increase would be worth it.

Unfortunately, voters have been trained over the decades to believe that taxes should never be raised, that whatever is needed should just be taken out of "wasteful" spending. And they've also been trained to believe that private industry does a better job. We'll have a big job convincing them otherwise.

[guillaumeb]

31. Agreed 100% on the success of GOP framing.

If the tax increase was less than current Insurance company subsidies, the benefits would be apparent.

[manicdem]

25. Effect on singles without a family?

I like the concept of a single payer program to lower the ever rising insurance costs, however I'm concerned on how it would affect a person like me. lower middle wage earner who is single and has no family. I have a feeling that my insurance rates would increase if a flat tax were implemented.

[bettyellen]

27. No throwing women's reproductive rights under the bus- or making them a footnote.

[SaschaHM]

34. This so much.

People seem to underestimate how central access to and funding of reproductive rights are going to be to any passage/defeat of a single payer system.

[bettyellen]

35. The economic toll on women, added to the expectation to this day that they should be primary care

Givers to children represents a remarkable extra economic burden on women. Dudes want sex, they want babies, they want women to foot the bill for all of it. It's a sickness to think that's fair.

[forthemiddle]

58. Just for clarification

Right now Medicare does not pay for Obstetrics or reproductive services. It also doesn't cover pediatrics. Now obviously, right now, it doesn't have to, but in order to add all of those services, there will be a cost.....

[LAS14]

28. Until it becomes a wide topic of conversation, those details....

... won't be well developed.

[Voltaire2]

32. The bill is available for your reading.

It includes details on costs and funding.
I assume those details will be insufficient as the point here is to spread FUD.

[still_one]

43. Are you referring to the John Conyers bill?

https://www.congress.gov/bill/115th-congress/house-bill/676?q=%7B

"The program is funded: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% of income earners, (3) by instituting a progressive excise tax on payroll and self-employment income, (4) by instituting a tax on unearned income, and (5) by instituting a tax on stock and bond transactions. Amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children's Health Insurance Program (CHIP), are transferred and appropriated to carry out this bill.
The program must give employment transition benefits and first priority in retraining and job placement to individuals whose jobs are eliminated due to reduced clerical and administrative work under this bill."

Because if that is NOT what you are referring to, do you have a link?

I guess you would characterize anything I say as spreading FUD, such as how the services would be distributed, and is the revenue in Conyers bill enough to cover that?

Sorry that I asked a question about costs. How dare I do that............

The only thing I have seen regarding Sanders' bill is that the federal government would create a new insurance plan that would supplant existing insurance plans, including the private coverage people get from employers, and to finance it people would pay new taxes instead of premiums, with government control over the nation's total healthcare budget, controlling fees for the providers and producers of medical care.

So provide a link if you have something handy

[tonyt53]

57. I think you are walking down the correct path. COSTS do matter, whether we like it or not.

Nothing is free, and should never be expected to be.

[Voltaire2]

69. We are paying far more per capita than any other nation.

And we are receiving mediocre health care in return. That is a pretty low bar. I'm sure we can do better.

[MichMan]

60. Conyers bill seems a little too good to be true

Everyone is immediately eligible

No co pays, deductibles, or premiums of any kind

Adds to current Medicare benefits by including vision, hearing, mental health, dental

Prohibits private physicians from participating unless they agree to be non profit

Any reason people can't just call an ambulance or go to the emergency room for everything since it never costs them even a dime?

Finally, is the medical industry even capable of handling all the new demands for all these services?

[clu]

54. allow people to opt into medicare

the money that my employer and I spend on healthplans then goes to medicare.

[still_one]

62. If they really wanted something like Medicare for All to work, it would have to be mandatory

Last edited Wed Sep 13, 2017, 12:42 AM - Edit history (1)

In other words everyone would be required to pay into it.

That is exactly what we all are doing now, except the benefit is only realized when one turns 65, and even then, additional premiums are required for Part B for most people, plus a good number of folks will require a supplemental premium to cover the costs not covered by Medicare, in addition to a drug plan, and perhaps a dental plan.

Another factor will be distribution of the services. Someone is going to need to determine what is the reasonable cost of services, otherwise you will either have more physicians opting out of accepting Medicare assignments, or getting paid too much for those services, which will put a burden on the system.

[tonyt53]

75. BINGO!!!!!

[NCDem777]

56. I have a way to pay for it

Y'know those billions we spend trying to get the varying factions of crazies in the Middle East to get along?

Take that money and use it over here. Israel, Palestine, Sunni, Shia, whatever. They've had half a century to hash it out and done nothing.

Take their welfare away.

[still_one]

66. As far as I am aware there are only two ways to pay for something like this. Increased taxes, and

cutting programs, and while your suggestion is certainly attractive, it is unlikely that will occur, so the only realistic option would be through increased taxes.

I remain skeptical that we have the votes for that, since the republicans are pushing for the failed Regan-nomic trickle down BS, and in case no one noticed, they have the majority in both the House and the Senate.

[marybourg]

59. The conversation has to take place before

the details can be known.

[still_one]

68. absolutely, but they should also have a rough estimate as to how much medical expenditures cost, and

how much taxes will need to be increased to cover those costs

The problem of course will be the republican majority, and their goal to "decrease" taxes, especially for the top 1 or 2%, which makes the Medicare for all, unlikely at this time.

We will be lucky if we can get the government to fund the ACA to stabilize it. We had 3 republican votes in the Senate which kept the ACA alive, but I do not think we can count on those republicans for a Medicare for All bill

[davekriss]

61. Fair question, but there are solutions

We pay substantially more for healthcare per capita than any other nation on earth. Why? Certainly not for results. On most macro-level measures we are at the bottom of the list. No, the wide variance funnels money from our hands and into the pockets of the wealthy crust that runs the show. Plus more of our money is spent on SG&A expenses in an effort to win our business while at the same time minimize what gets paid out for actual healthcare.

I recommend reading the FAQs page at the PNHP site: http://www.pnhp.org/facts/. H.R. 676, Rep. Conyer's "Medicare for all" bill proposed in 2015, comes close to meeting the ideals of the PNHP program. But it is a fair question to ask for details on all current single payer proposals.

[still_one]

65. It will be brought up tomorrow so we will see what results. At the same time there are Democrats in

Congress working to have the government continue funding the ACA

If nothing else, I certainly hope we are able to do that, because at this time it is doubtful we have the votes for either Conyers' bill or Sanders' bill, but we will see what develops

[Voltaire2]

67. by the way the Sanders bill is 179 pages of detail.

[Expecting Rain]

71. Please link to the text so we can read it.

[still_one]

72. I thought he was revealing the bill tomorrow, so I would like to see the link if it is available now

[stopbush]

76. Medicare is currently paid for by taxing 100% of working Americans.

Those tax dollars are barely enough to cover seniors on Medicare, who account for roughly 19% of the population.

So the question is: how much would payroll taxes need to increase to cover 100% of the population as opposed to the current 19%? The current tax rate is 1.45% for the employee and 1.45% for the employer, or a 2.9% total. 19% divides into 100% 5 times, so one assumes that one would need to raise the payroll tax five-fold to cover 100% of the population. That would mean that the employee would pay a tax of 7.25% as would the employer, equaling a tax of 14.5%.

Add into this the fact that current Medicare recipients pay monthly premiums of $109 on average, or $1308 a year.

So do the math: if you earn $50,000 a year, your Medicare tax would be $3625 at 7.25%. Add in your premiums of $1308, and you're paying just under $5,000 a year per person for Medicare for All. Sounds good.

But what if you are a family with a spouse who doesn't work and two young children who don't work? How are they covered in the Medicare for All scenario? Surely, there would be additional premium cost involved. They can't be covered free of charge. That $5000 per year mentioned above covers ONE working person, not their family members. Even if you waive the payroll tax deduction and charge only the average monthly premium per person (as Medicare currently does), you are looking at an additional $3900 per year to cover a non-working spouse and two children. That makes your cost around $9000 per year, and that is equal to 18% of that $50,000 income you are earning.

And, to cover all bases, let's not forget that you are currently paying 6.2% of your income in Social Security taxes. Add that into the mix, and your combined Medicare for All and SS expenses for that family of 4 with one bread winner described above would be over 25% of your income.

That's still a bargain when compared to the taxes paid in European nations, and it's the true cost of having a truly socialistic approach to things. It is what it is. Let's not downplay the realities involved.

I don't have the answers. I do know that while Medicare for All might well be the best and fairest approach we could take toward universal healthcare, it comes with real expenses and real costs to real people.

[Hoyt]

79. Excellent post. Not sure numbers are right, but it would take some serious analysis to refine that.

On the one hand, healthcare costs of elderly are much higher than those of younger folks. But, then, we'll be picking up cost of uninsured and stuff Medicare doesn't pay for.

My point is not to question your calculations -- which are excellent for this purpose -- but we really need a Congressional Buget Office analysis of what this thing will cost so we can lay it out to people.

[JCanete]

84. It should come with real costs to the richest people who have far far far more than they need

to live an amazingly privileged life, and who have, I'd be willing to bet in every instance, benefitted greater by our national infrastructure than the common American, and thus, there is no robbery in the works by making them pay more in taxes so that there will continue to be a great infrastructure not just for the commons, but for the next entrepreneurs and visionaries to benefit from. A healthy workforce is a far more productive workforce.

[stopbush]

87. Without providing an idea of how much you believe the rich need to pay

or how much it adds up to, you're engaging in hyperbole.

[JCanete]

88. on what level?...political reality or what is mathematically possible? It is neither

mathematically hyperbolic nor philosophically hyperbolic for me to say that the rich need to pay what it takes, and I'm pretty damn sure they'll have a fuck-load left on the other side of it.

If you want to suggest I'm being politically hyperbolic, politics is a shifting terrain.

[pnwmom]

85. Thanks for the reality check. The devil is always in the details. n/t

[applegrove]

77. This would be in the platform to come. Dems will likely win the House in 2018.

And if Trump makes it to 2020, there will be a Democratic stampede to the polls to vote him out then.

[still_one]

78. I hope you are right, but I am not as certain as you are about the midterms

[ZX86]

80. The love of my life has no insurance and an aggressive form of brain cancer....

but until details on how it would work, the costs associated with it, how those costs would be paid for I'll await those details. <sarcasm>

[still_one]

81. I am sorry for what you are going through

[ZX86]

82. That was sarcasm. My loved one does not have brain cancer.

But there are people in this country that are facing such scenarios and I care about what they are going through. I'm not going to quibble about the cost. The United States is the richest nation in the history of richest nations. We can afford single payer. What we can't afford is our fellow citizens suffering and dying needlessly.

[still_one]

86. Thank goodness for that. The fact is,Bernie knows perfectly well that Medicare for All does not

have a chance in this Congress. His point is most likely to initiate the discussion.

As for costs, whether you appreciate it or not, that will be an issue, because it is all dependent on distribution of services, and what price is reasonable for those services

[JCanete]

83. It means we have prominent Senators on record supporting a Medicare for All effort. I am not with

those who say this is meaningless, any more than I am with those few detractors who say that Booker et al. are doing this cynically to pander to the left vote while knowing that no such measure will pass. It matters that they are on record for this. It matters that the more Senators who sponsor this, the more it becomes a potential part of the Democratic identity. Generations inspired by these politicians have the potential to internalize this as a worthwhile fight, and may even decide that it is a position they come to expect of their representatives. Future representatives will be navigating far less in the dark by endorsing single-payer or medicare for all out the gate, because so many big name Senators have already paved the way, making it less and less of a third rail for mainstream politicians.