Since everyone seems to be excited about Medicare for All, here's the full text of the bill.

[HerbChestnut]

https://www.congress.gov/bill/116th-congress/senate-bill/1129/text

Enjoy.

[lapfog_1]

1. and here is the problem with this

In General.—Beginning on the effective date described in section 106(a), it shall be unlawful for—

(1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or

(2) an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.


Many unions have fought long and hard to get decent health care for their members. Many employers of non-union exempt employees offer "better then average" and "better than Medicare" insurance as part of the package deal to entice employees. Adopting this MFA bill kills those plans.

I'm not defending the blood sucking insurance companies... just pointing out that a lot of people aren't going to like this version of universal health care.

[HerbChestnut]

2. Insurance companies are free to provide insurance for anything that isn't covered in M4A.

So if a person feels they need more coverage than what Medicare would offer under this bill they are free to purchase that supplemental insurance. Likewise, employers are free to offer supplemental insurance as an employee benefit.

[marylandblue]

16. Sanders said that M4A will cover "everything" with no copays or deductables,

So what exactly would be left for private insurance to do?

[HerbChestnut]

17. Optional cosmetic surgery is one example.

Here's the full text of the bill with what it covers.

https://www.congress.gov/bill/116th-congress/senate-bill/1129/text

[marylandblue]

22. There is no such thing as "insurance" for optional anything.

Insurance is to mitigate the risk of financial or physical loss such as from fire, theft or sickness. By definition, if it's optional, it's not a loss, it's just another expense, like a car. Nobody will insure you for the future purchase of a car, they will only insure for the loss of your existing car.

This is not arguable. It's insurance 101.

[HerbChestnut]

25. Look through the bill.

It talks about what's covered.

[marylandblue]

27. I did, and it does cover "everything" which is my point.

It's in fact, by far, the most comprehensive coverage in the world and it seems health insurers are going to be limited to insuring against losses due to ugly faces and missed spa visits.

Please excuse me now, I need an emergency massage. Good thing I'm covered for that.

[Nanjeanne]

47. Perhaps there is no such thing in this country but there's plenty in other countries.

Example - Germany: Germans can purchase a policy from any private health insurance company, German or international; for instance if you would like access to and reimbursement of costs for a private doctor and a private room in hospital, homeopathy and other alternative treatment or higher dental reimbursements.

In Canada - some employers offer supplemental insurance that covers decreased wait time for things like MRIs that are not deemed medically urgent. For example, my girlfriend had a pain in her shoulder. An xray did not show anything. Dr. did not deem it medically urgent and she was given an MRI appointment for 5 weeks later. She chose to use her supplemental to get an MRI within 5 days. Fortunately, her pain was just rotator cuff tendinitis.

In France people buy supplemental insurance for items like chiropractor or for overages for some specialists where 70% is covered by mandatory public insurance. For seniors 100% is covered. But for a psychiatrist consultation - in 2017 the fee was 37 euro and the government plan paid 70% and patient would pay 11.10 euro. A root canal is 70% covered - at 93.99 euro and patient pays 28.20 euro.

I could go on country by country but you get the gist.

[marylandblue]

49. I mean there is no such thing as "optional cosmetic surgery insurance."

The reason there is no such thing anywhere is that it is optional. If I will never want cosmetic surgery, I won't buy it. If I think I will want it someday, I'll wait until I want it, buy the insurance, get the surgery, then cancel. Even if there is a waiting period of one year, I'll just buy it a year in advance and then do it. So how can any insurance possibly make money this way?

For chiropractors, psychiatrists and dentists that all seems to be fully covered under Sanders plan.

For overages, Sanders plan has no overages. It pays 100 per cent, not 70%, so there will never be an overage.


For getting in fast for an MRI, that can be insured around. But our healthcare system is actually already well providing rapid testing and procedures in most cases. Sanders plans covers MRIs and accordingly, a private insurer would not be allowed to provide MRI coverage.

Another suggestions was getting insurance for private rooms and extra spongebaths. Alright, I suppose you can insure around that, but seriously, how many people are actually going to want that at all, but if they did, why would I need insurance for it? Why not just buy an extra spongebath as needed?

For psychiatrists, US psychiatrists charge $200 to $300 per session and most don't take any insurance now, so there is no chance they will join Medicare. It's not clear from Sanders' bill if you could get private insurance for psychiatrists, since M4A would cover that. Even if you could many psychiatric illnesses are lifelong, so people who need it most would be excluded for having a pre-existing condition.

And the whole point of this subthread was that supporters of M4A raised the almost inconsequential point that private insurance would still be allowed for things nobody actually needs. I have no idea why this is important. All it tells me is that Sanders doesn't understand insurance.

[CTyankee]

63. you might need "cosmetic" surgery if you are a burn victim or have disfigurement due to some

kind of accident. Those are technically cosmetic but not comparable to such things as tummy tucks and facelifts.

[thesquanderer]

65. re: "For chiropractors, psychiatrists and dentists that all seems to be fully covered"

"Fully covered" is an ambiguous phrase.

I had something that required physical therapy, it was fully covered... for x sessions. If you think you could benefit from more, that's on your dime. There's no exact right amount of treatments that will always be right, but there will always be an exact amount insurance will cover for a certain condition. One could want more coverage than that.

Psychiatric care falls into a similar category.

Some "cosmetic area" can be a gray area. If you need a tooth removed, dental insurance should cover that. But there are different kinds of "replacement teeth" and you choose in part based on what you can afford. I wouldn't expect a medicare equivalent to pay for the most desirable option.

The point is, no public plan will really cover everything someone could reasonably want. And in fact, what ultimately gets passed, even IF an MFA plan comes to fruition, will almost certainly fall short of the theoretical ideal its advocates are campaigning on, which will then open up further possibilities for private supplemental.

Honestly, I may have a preference about some aspects of some health care proposals over others, but none are going to be passed exactly as claimed, and all will be improvements on what we have so far. I am not going to choose my candidate based on which fictional good healthcare plan they prefer, though it does provide one piece of a puzzle that tells you how they think problems should be addressed.

[Hassin Bin Sober]

21. Private room? Cosmetic surgery? Extra sponge baths? Basically anything an ins company wants to offer

[marylandblue]

23. See number 22.

[Hassin Bin Sober]

30. Number 22 is nonsense. Call it what you want. Prepaid benefit? It can still be offered as a...

... benefit in an insurance package. And yes, a private room can still be a “loss” - if I don’t get sick I don’t need a private room.

[marylandblue]

36. Like I said, this is insurance 101 and not arguable.

If you wish to argue it, please take a course in risk management or principles of insurance first. It's a big enough deal that M4A will help protect my precious body. Let's not pretend that anyone is going to cover my ugly face. There is a reason optional cosmetic surgery insurance doesn't exist anywhere in the world. It's impossible to make money on it. If you don't understand why, you don't understand insurance.

PLEASE don't take my word for it. Not when I am providing undisputed information that you can verify for yourself from reputable sources.

[zaj]

51. Well then union members would see a rise in quality of coverage

Right?

[lapfog_1]

55. the issue isn't the "things" that are covered

it's the quality of the things that are covered.

the time spent by a doctor on your illness or condition, the treatment that MIGHT have been ordered from the beginning if "cost was no object". The follow ups. The ordering of more diagnostics.

And should MFA be the new law of the land (and private insurance is relegated to plastic surgery or some such nonsense) the assembly line medical practice will be all you get... and if anyone here thinks that employers are going to give you a big fat raise because they no longer have to pay for private insurance, thus providing you with more money to contribute to the taxes needed to pay for MFA... ha! I've got a bridge in Brooklyn I can sell you.

[Autumn]

6. Why? I don't know of one person who doesn't like Medicare. We buy supplemental plans now

so can they. That's not going to change.

[lapfog_1]

20. you haven't talked to many people my age have you?

I am getting close to Medicare Age... and just a whole lot of people that I know who are retirees on Medicare hate the fucking system... you are often palmed off on some snot nosed kid (PA or something) who spends a total of 10 min with you... doesn't really listen, orders a blood test or Xray and proscribes something.

In the biz... it's known as 3Ps... Pills, Prayers, and Postmortems.

I do NOT relish the idea of retiring and going on Medicare.

Yes, it is certainly better than NO health care...

In the current system of health care ranked by quality of care

private on call doctors (for the very very wealthy)
"Cadillac" PPOs (for the executives and other wealthy people)
PPOs
HMOs
Medicare
Medicaid
ER - which you can't use until you are really sick and is the most expensive
nothing

[Hassin Bin Sober]

24. That's a crock of malarkey. My parents were on Medicare and they had doctors fighting for their...

... business.

And you think private insurance doesn’t get you pawned off on a PA? Sorry, but that is the way things are now. And rightfully so - I have friends that are PAs and friends that are ER DOCS. It doesn’t make sense to tie up a doc with mundane stuff like sniffles or stitches.

[Autumn]

26. I've talked to a lot of people who actually are on Medicare. They like it and in

the time I've been on Medicare I have never had to see any snot-nosed kid (PA or something). I see my Doc, have never had to wait 2 days for an appointment and if I have an issue I call and talk to the receptionist and she relays to the doc and if it's of concerned they will call back and have me go right in. I also spend time with my Dr, discussing my health issues and other things, I've never been time-limited.

[Bradshaw3]

28. total nonsense

I'm on Medicare and so are most of the people I know and none of us would trade it for the crappy private insurance we had before. The only thing that comes close was an HMO offered when I worked for the state, but even that had high out-of-pocket expenses for certain things that Medicare and supplemental covers.

One of the main reasons Obama won in 2008 was people were sick of getting sucked dry by private insurers and millions signed up for Obamacare because of that. Medicare works great and there is no such thing as going to a "snot-nosed kid." I have access to many more doctors than I did with a PPO. That is big insurance and RW propaganda that has no place here. Your "list" is an outright lie. I will take Medicare and supplemental over what you listed, definitely over PPOs, which have cause millions to go bankrupt. Simpy put your propaganda shows you don't know what you are talking about.

[Autumn]

52. Old people not liking Medicare is another RW talking point. I see a lot of those here now .nt

[SouthernProgressive]

32. "you haven't talked to many people my age have you?"

Or many people at all, for that matter. Some of the claims are just amazing. Really show how small of a circle some develop their worldview from.

[Nanjeanne]

48. Really - hate the fucking system? WOW. I was thrilled when I finally got on Medicare and it has

saved my husband's life. Literally. Fucking literally. He has an incurable but "manageable" blood cancer. He has been alive for the last six years because of Medicare and because they paid for his stem cell treatment, his constant infusions (at a cost of $180,000 per infusion. He gets them now once a month by the way.).

We have never been palmed off to any snot nosed kid and we haven't met a single person who has. I saw three breast surgeons at three different highly regarded teaching hospitals before settling on the one who would handle my breast cancer diagnosis. My husband is treated at Yale for his myeloma and sees the top myeloma specialist at Dana Farber for advice and guidance on his treatment.

My primary care physician is fabulous and has never palmed me off to anyone. I do see a PA in my gynocologist's office by my choice because I can get an appointment with her much easier - I only go once a year and I get to spend more time with her. And I've never seen snot falling from her nose.

I am deeply saddened by the whole lot of people that you know who are retirees who have such horrible experiences. It must be hell where you live.

[DeminPennswoods]

59. That's baloney

Both parents were on Medicare Advantage private insurance. They had doctor visit and specialist co-pays, ER co-pay and the occassional denials of coverage. Last year, switched to Medicare with a supplement. It was cheaper overall and with Medicare being the first payer, have not even had specialist co-pays since the doctors have accepted Medicare reimbursement.

[George II]

7. That is a HUGE problem. Plus, unless I missed it, the bill still doesn't address....

....how the plan would be administered, who would handle claims, etc., etc.

This bill appears to assume that Social Security Administration does all of that now, but it doesn't. That's handled in a big part by the big bad "private insurance industry".

Plus, if there are all the savings touted, that means that a lot of people will lose their jobs. It doesn't address what to do with them.

Sadly, this is also based on the misnomer that the healthcare industry and healthcare insurance industry are rolling in dough and gouging the American people, when in fact the net profit margin of both industries is less than 5%. I defy anyone to run a business based on a profit margin of less than 5%. They go belly up in short order.

https://www.macrotrends.net/stocks/charts/HCSG/healthcare-services/profit-margins

https://www.verywellhealth.com/health-insurance-companies-unreasonable-profits-1738941

[Hassin Bin Sober]

34. That slim margin and the constraints placed on the insurance companies by the ACA gives the ...

.... insurance companies incentive to pay higher prices when all they have to do is make predictions from year to year and pass on the costs to the policy holders when costs eventually skyrocket.

5% of a $Billion dollars is better than 5% of a $million dollars. And the numbers are closer to 10% for the big name vultures that dominate the business.

The insurance company that supposedly is negotiating on your behalf has no incentive to keep costs down other than the deals they negotiate from year to year. As long as they get their cut based on their predictions, they are good.

https://www.npr.org/sections/health-shots/2018/05/25/613685732/why-your-health-insurer-doesnt-care-about-your-big-bills



Why Your Health Insurer Doesn't Care About Your Big Bills


Higher prices can boost profits

You would think that health insurers would make money, in part, by reducing how much they spend.

Turns out, insurers don't have to decrease spending to make money. They just have to accurately predict how much the people they insure will cost. That way they can set premiums to cover those costs — adding about 20 percent for their administration and profit. If they're right, they make money. If they're wrong, they lose money. But, they aren't too worried if they guess wrong. They can usually cover losses by raising rates the following year.

Frank suspects he got dinged for costing Aetna too much with his surgery. The company raised the rates on his small group policy — the plan just includes him and his partner — by 18.75 percent the following year.

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That's good in theory, but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here's how: Let's say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

It's as if a mom told her son he could have 3 percent of a bowl of ice cream. A clever child would say, "Make it a bigger bowl."

Wonks call this a "perverse incentive."

[Voltaire2]

37. The employer based system was a terrible mistake.

You get seriously sick and your insurance is tied to your employer you are seriously fucked.

Unions will survive. A majority of union workers are represented by unions that have endorsed Medicare for All. Because unions are generally progressive center left social democrats politically and have no interest in propping the corrupt private health insurance system.

[Demsrule86]

40. Not true...that can be controlled ...hubs had two spinal surgeries in six months...he was put on

company disability...and we kept our employers subsidized insurance...I am against MFA which would cost me a fortune...it will never become law anyway.

[Voltaire2]

42. I'm so glad you are privileged to have

super good benefits. Most everyone else doesn’t, which is why the number one reason for personal bankruptcies is medical expenses.

Doesn’t everyone deserve the same freedom from healthcare cost anxiety that you have?

[Demsrule86]

61. I don't like MFA...it won't work and will cause us to lose the electiion...what I have is way closer

to the ACA than MFA.

[Voltaire2]

64. Not what you described, nowhere near it.

At best, people might be enrolled in a long term disability program, but they generally will not retain health insurance. So in the scenario where a serious illness has pushed a person into ltd, they are now existing on some fraction of their prior income and have to pay individual premiums, deductibles, copays, mystery out of network bills and the rest of the crappy private system costs on their own. If they don’t have ltd they are just basically fucked.

It is a crappy system. Why we want to retain it is a mystery best understood by insurance ceos and their lobbyists.

[KentuckyWoman]

60. Your experience is extremely rare.

Most people do not have either short or long term disability benefits. FMLA says your employer CAN terminate you on the 91st day. Many companies do. Some hold out until long term disability kicks in. They you lose your benefits and your job.

COBRA costs far more than the disability check .. if you are lucky enough to have it. Most disability insurers require a person to apply for SSDI at 5 months. If approved, it takes 2 years to be eligible for Medicare. COBRA maxes out at 18 months. Meaning a sick person has a gap of 6 - 12 months of looking for coverage on the open market.

No job. Little income... a lot of medical care needs... and ridiculously unaffordable insurance.

It happens every day, all over the country... you were lucky. Very lucky. Throw in all the people sticking in a job they don't want because of medical insurance. Throw in all the people who would retire a little early and open a spot for someone younger, but Medicare doesn't kick in till 65 - so they stay.

We HAVE to unhook medical insurance and employment. We have to. ACA tried to turn it into a private purchase system much like auto or home insurance, but that can't work. We can control how we drive. There is way too much about health we can't control. Bad shit happens.

We are way past time to join the rest of the developed world. It doesn't matter if it will pass THIS time. We have keep on it and keep fighting... it is the right thing to do.

[Demsrule86]

62. Single payer is not the rule but the exception...most countries have hybridized version...and in

UK they are busy cutting it...so no, I don't want MFA...and neither do most Americans if it means getting rid of workplace insurance.

[Voltaire2]

66. Most developed countries start with a base universal system.

It covers everyone and is not tied to employment. After that they might also have supplemental systems. The French system for example covers everyone with a basic program, and then almost all workers are enrolled in a supplemental program. The supplemental eliminates almost all fees, the basic pays 75-100% depending on your circumstances.

None of them have the crapfest of corruption and economic hardship that is our private system.

[Buzz cook]

54. Those points keep people from getting ripped off.

Insurers can't charge you money for something you and they can get for free.

Employers can't use as compensation things that they and their workers get for free.

Unions worked hard to get benefits. They didn't work hard to be given stuff their employer got foree while pretending it was compensation.

[DeminPennswoods]

58. Do you realize just how much Medicare covers?

It is amazingly comprehensive, but if you need more, there are supplements available to cover it. Supplements would be available under the M4A bill, too.

We've seen that employer-provided health insurance isn't necessarily a lifetime thing what with companies cutting retirees health insurance off completely or raising premiums or freezing benefits for current employees. In today's rush to keep labor costs low, employer-provided health insurance isn't and isn't going to be a sustainable business model. There is no guarantee you'll be able to "keep what you have".

IMHO, people "want to keep what they have" precisely because they are worried they won't be able to get health insurance otherwise. It's also what keeps people from changing jobs or taking a job simply because it offers health insurance.

M4A would reduce business' labor costs, it would simplify paperwork and payments for hospitals and doctors, it would give workers the ability to maximize their earning potential by untethering health insurance and work and it would allow unions to concentrate on negotiationg better pay, working conditions and retirement benefits.

[Autumn]

3. Nothing in this section shall preclude an individual from choosing a Medicare Advantage

plan or a prescription drug plan which requires the individual to pay an additional amount (because of supplemental benefits or because it is a more expensive plan). In such case the individual would be responsible for the increased monthly premium.


As it is now. That Republican talking point bites the dust.

[HerbChestnut]

4. Many talking points bite the dust once people actually read the bill.

[Autumn]

8. Yes they do,it looks like some good parts of the ACA have been incorporated and employers

can offer it to their employees.

[NYMinute]

10. Not only that the existing objections don't dissolve

but new objections to this unworkable and expensive pie in the sky boondoggle crop up inevitably.

[Autumn]

14. Yes and Bidens tweaks of the ACA and his "massive new subsidies "will be workable?

If it's Biden's expensive pie in the sky boondoggle it will work?

[DeminPennswoods]

5. It looks pretty comprehensive

not just some "pie-in-the-sky" idea that hasn't been thought out.

[NYMinute]

9. This bill will not get out of the committee

Just a publicity stunt.

Some people should stick to what works -- like naming post offices.

[left-of-center2012]

11. "everyone seems to be excited about Medicare for All"

Really?

[HerbChestnut]

12. It's getting a lot of attention on this forum lately.

I figured it would be a good idea for everyone to see the actual bill so we could have an informed discussion on it. Here's hoping...

[Thekaspervote]

31. Agree!!

[Uncle Joe]

13. Kicked and recommended

Thanks for the thread HerbChestnut.

[Hoyt]

15. Maybe someday someone will tell us what each age and income group will pay in

premiums or taxes to fully fund all healthcare costs implicit in this plan.

[Voltaire2]

38. The funding details are tbd but it will

include an increase in payroll taxes for both employers and employees, and that increase will, for the vast majority, be significantly lower than current premiums, and vastly lower than current average total out of pocket expenses.

There are no premiums, deductibles, or copays, except for prescriptions, in the senate bill. So the rest of your question makes no sense. Everyone is covered.

[Demsrule86]

41. I don't believe it will be lower...and I don't want to start over and lose the next election...we

have the ACA ...let's use that.

[Voltaire2]

43. I understand you are opposed to MfA

and so you have to reject all the reasons why it makes sense.

[Hoyt]

46. Would you like to bet? Not that I'm opposed to paying more if

everyone is covered.

[Everyman Jackal]

18. If Medicare for All charges a monthly premium or there is any deductible or copay for anything

then I am against it. For the last 24 years, I have been covered by the VA. In those 24 years, I have not spent a dime on my healthcare. In fact, I even get a travel allowance every time I go to a doctor or hospital. This is what everyone should have, nothing less.

[HerbChestnut]

19. Your VA healthcare is funded through taxpayer dollars. The same would be true for M4A.

Instead of people paying into a private insurance pool they would pay into a public one. It's really that simple. Also, the VA would be kept as a separate entity, meaning your healthcare wouldn't change.

[Voltaire2]

39. How about we all get covered like that?

I know, we could call it VA for All.

Read the bill. That is what it does.

[Nanjeanne]

53. Because the VA is like the NHS in UK. Doctors are government employees. That is not like

Medicare or Medicare For All. What Medicare does is basically what insurance companies do - pays the bills to

[lapucelle]

29. How is it being funded? N/T

[Thekaspervote]

33. The Brits went with ntl' health care post WWII, we missed the boat

Yes, we need affordable health care. IMHO most people seem to think it will be free...there’s nothing free.

[HerbChestnut]

35. Good thing M4A isn't the same as the British system.

Check out the bill.

[Autumn]

57. The only people I've ever seen talk about it being free are those who don't

want it implemented or don't want affordable health care for all, the "I have mine and I pay for it" set and if course the "you just want free things, people".

[Kaleva]

44. A lot of vets love their VA health care. Is this similiar?

I'm babysitting and don't have much time here to read the text.

[HerbChestnut]

45. The VA would be kept as a separate entity from M4A.

M4A is public health insurance that would cover any health expenses most people would realistically need and would cap the amount of money people spend per year on prescription drugs. I'm not familiar enough with the VA to make a direct comparison between the two.

[ismnotwasm]

50. This is an outline

Not a comprehensive plan, but it’s not as bad as I expected.

[Voltaire2]

56. Why did you expect it to be bad?