It’s not your imagination – the economy is rigged, and has been since 1980. {{ LOL }}
{{ A helpful starting point would be to address benefit cliffs — income eligibility cutoffs built into certain benefits programs. As households earn more money, they can make themselves suddenly ineligible for benefits that would let them build up enough wealth to no longer need any government support. In Kansas, for example, a family of four remains eligible for Medicaid as long as it earns under $39,900. A single dollar in additional income results in the loss of health care coverage — and an alternative will certainly not cost only a buck. }}
Absolutely! When someone moves from Medicaid to the “dignity” of a for-profit health plan with the 20% skim rate to the Obamacare insurer, they trade first dollar coverage for large deductibles and big out-of -pocket costs (for 2024, max of $9,450 for an individual and $18,900 for a family.) It’s a financial catastrophe.
And if you live in one of the 12 craphole states that have failed to do the Obamacare Medicaid expansion, you don’t even get the refundable tax credit when you move to the for-profit health plan.
The Medical Industry would mostly be thrilled (Insurance companies much less so), but the crux move is away from USAian idiot big medicine doctor visit health care to systematic a PUBLIC HEALTH system as practiced in most of the rest of the advanced world. Much higher quality and better outcomes for less money.
Not enough to pay for Medicare for All, absent a significant (and politically infeasible IMHO) reduction in compensation for medical providers. You can’t convert to a single-payer government system without either significantly increasing what most people end up paying for health insurance or without slashing costs (or both).
Competitive pricing in health care (we’re paying double what other countries pay). 2) End the tax break for employer provided health insurance. ($350 Billion cost to Gov’t in 2022).
I don’t think it’s doctor’s salaries. It’s the obscene amount of money being sucked out of the health care system by insurance companies (15%-20% skim rate) and Private Equity-owned firms in price gouging for out -of -network care. That’s still a thing despite the new Federal law on surprise billing.
The “skim rate” just isn’t all that big. In 2022, we spent about $4.5 trillion on health care expenditures. Of that, only about $1.3 trillion (less than 30%) constituted private health insurance spending. Even if all of that had a skim rate of 15%-20% (it doesn’t, since employer-funded plans and not-for-profit systems have lower administrative loads), it would still be only 4-6% of national health care expenditures.
It’s a big figure in absolute terms, but it’s only a few percentage points of total costs.
Ask the various insurance companies to bid to provide a per capita cost for Universal Health Care for everyone–mandatory coverage. This is already done for private employers offering group health care plans, so it is NOT new or innovative to anyone (who is paying attention, anyway).
They can’t bid to provide a per capita cost for everyone without having negotiated their rates with providers and established what level of insurance they would be providing under the service. An insurance contract that provided the average coverage of employer-provided health care, and the reimbursement rates of employer-provided networks, would be astronomically large. An insurance contract that provided coverage equal to what Medicaid provides, at rates that Medicaid pays, would be cheaper - but no one would be happy with it, and providers would not agree to join that network.
At the end of the day, a certain proportion of the population is uninsured, a proportion is uninsured, a proportion gets “discount” public insurance with limited providers (Medicaid), a very large proportion gets “somewhat discount” public insurance with a broad but not universal set of providers (Medicare), and the rest get a wide range of private insurance. All of those programs differ wildly in coverage, reimbursement levels, provider networks, and (where applicable) premiums.
Since most of the country’s health care is reimbursed at a volume negotiated discount (Medicare and Medicaid), and a fair number of people are uninsured or underinsured, switching to a single-payer system will dramatically increase the amount of money we have to pay out for health care if we’re going to give everyone the equivalent of a workplace policy at workplace rates. And if we don’t do that, then all the beneficiaries who go from workplace policies to the new policy will be very upset, while the providers won’t participate.
Not for profit systems are price gouging as much as the for-profit ones. I get most of my health care from Providence Health which was founded by Catholic nuns (sisters). I believe the last nun CEO they had was drawing a salary of about $35,000/yr in the 1980’s. Today the CEO is getting $13 million/yr and Providence recently paid a $158 million settlement in a lawsuit where they weren’t providing the level of charity care their tax exempt status required.
On the employer-funded health plans side, the Chamber of Commerce in Indiana hired a health care consultant to look at what their members were paying for hospital costs. Instead of getting a bulk discount for providing the largest volume of business to the hospitals, they were actually paying the highest prices.
American business thrives on skim, scam and fraud. And that ethic is on overdrive in the health care industry.
It’s not just the insurance company 15%-20% skim. They’re not acting as your agent in getting the best prices. All the big insurers today own captive Pharmacy Benefit Managers (PBM)s and the profit from that operation is regarded as a Medical Expense to the health plan rather than part of the 15% to 20% limit on profit & overhead. Why do Medicare Advantage Plans offer “free drug plans”? Because there is no limit on how much the can price gouge and must Americans are too dumb to do comparison shopping.
Like the executives who destroyed Boeing, it’s all about Executive Compensation rather than patient health.
Essentially that’s the way Medicare Advantage operates. Humana bids a fixed price to cover a big group of Medicare patients and then increases Humana profits by delaying and frustrating their access to care.
The problem is that the financial interest of the for-profit insurance company is directly opposed to that of the patient. And with the bipartisan level of political corruption in Washington, there is no one looking out for the patient’s interests.
Do well planned roll out of free easily accessible and available Public Health Education and testing, which done properly pays for itself both in better results and in much lower long term costs. And yes, that is why the AMA, anti birth control fanatics, “venereal diseases are the WILL of our RIGHTEOUS GOD”, and also “that is too disgusting for polite society to acknowledge exists” fanatics, and most importantly “people like me should not have to rub shoulders with scum like those in public health clinics” have opposed such programs for over a century.
Do a long term transition whereby doctors can pay their own way through education and then charge whatever they can get, or are trained on national dime and pay that back in lower salaries etc.
Provide medical tourism programs, especially for procedures and recoveries that require a lot of time and care, to go to Mexico India Bulgaria and whereever else quality care is available for less money.
More would be needed, but it would not be a bad start.
Easily. Require their pricing–on a per capita basis–to be “not more than” some specified figure that is readily determinable. It is not an immediate number. It is a 5-yr goal figure they need to show AND how they get to it.
For example: US pricing for per capita health care is (say) $25k/yr. Yet Canada and France have per capita health care costs that are far lower–and rated far higher–than US health care. Say Canada is at $17k/yr and France is at $13k/yr. Split the difference(s) and all bids must fall to $20k (or less) per capita/yr by the end of 5 yrs. Then repeat the process with lower per capita target amounts (decreasing the differences) as time goes on. As the US is a much larger market, US costs should be lower (based on what the “JCs” claim, right? “Buy more, get a lower price per unit.”). So trap them in their own arguments. Having medical tourism is perfectly acceptable–as long as the insurance company pays for it. US companies have already been doing it for years because I posted that information a long time ago on the TMF boards. Plus, the NHS also did medical tourism to India for its patients when it was cost and time effective.
In addition, the “high cost” patients are now averaged over 300+million people, not just the multiple 2-20 million individuals within a single insurance company times multiple insurance companies. Which brings the average for those patients to within a manageable level for that group size.
With this system, everyone is insured–even if they don’t want it or use it. Their choice to use or not. But there is a problem for them: Any other insurance they want to buy will require participation in the national system. That is how they keep their prices low. Actually, they are just ripping off their customers because every pysical medical condition is covered.
But why would medical providers (doctors and hospitals and outpatient clinics and diagnostic centers and everyone up and down the line) agree to participate in such a system? If actual health care expenditures are falling by 20%, then all the people and institutions that make up that industry will have to receive 20% less compensation for their services. Why would any of them sign up for this new program?
And more to the point, why on earth would you expect the federal government to even attempt this? When they tried to throttle back Medicare reimbursement rates, Congress enacted 17 separate “doc fix” measures that prevented the provider reimbursement cuts from taking effect - before killing that measure altogether. The health care sector is an enormous part of our economy, more than 10% of GDP, and probably a similar proportion of jobs - including scads of good middle-class jobs. The regional hospital network probably isn’t the largest employer in each congressional district, but it probably is in the top 10 or 20.
That’s why single-payer proposals die. You can’t pay for it unless you impose a massive reduction in reimbursement rates or raise the amount of money that the average person who currently has private insurance has to pay. Neither of which has a political chance. Which is why neither Vermont nor California has been able to pull it off…
The goal I’d envision is to have a national health care service that directly employs doctors, nurses, aides, office staff, and the like, PLUS directly owns and operates hospitals, clinics, imaging centers (possibly co-located), with all of the associated equipment. That’s what the VA does. (More or less - yes some things are probably still contracted out, but the majority of the care is done by VA doctors and nurses employed by the government and working in VA owned hospitals and clinics.)
In my mind, the key isn’t providing everyone with health insurance, it’s providing everyone with basic (and possibly beyond just basic) health care.
Getting from where we are to the place I am thinking of is not easy. You can’t snap your fingers and make this happen overnight (or even in a year). It will take a 10 to 15 year plan to get there.
I wouldn’t outlaw or remove private for-profit clinics or hospitals or doctors or even health insurance. But I would provide at least a basic level of care (emphasis on CARE and not insurance) that is available to everyone in the country.