He was the Sarah Palin of the times.
You not paying attention.
Thread score biggestal99 1 Weedhopper 0
I never believed the Russian collusion lie, did you and why would you trust criminals like Obama and Hillary?
My post wasnt about russian collusion but Trump special relationship with Putin.
You mean the special relationship you were lied to about by Traitors?
Where the* ■■■■ did you get the idea that Obamacare is “ raiding ” *Medicare and this is causing it to run out of money? That article doesn’t say anything of the sort. Instead, the report says, like Social Security, due to changes in demographics and increased health care costs, the trust fund will be depleted by 2026 and then payroll taxes will cover 90% of costs. That doesn’t make it insolvent. That makes it a tax policy issue. Crazy idea here, increase the payroll tax by a faction of a percent to solve the gap. Allow Medicare to negotiate drug prices. Allow for a global health care budget so that billing and insurance related costs are reduced significantly rather than fee-for-service based payments. This would also reduce costs by encouraging more effective care rather than lucrative care.
Ok, I would take back ‘based on raid’ by Obamacare, but it didn’t help.
Obamacare mandates $716 billion in Medicare payment reductions from 2013 to 2022. However, contrary to the way they are often portrayed, these cuts are not aimed at specific instances of waste, fraud, and abuse. Instead, they are across-the-board changes in Medicare payment formulas for a variety of Medicare providers, including hospitals, nursing homes, home health agencies, and hospice agencies.
Despite the constant political rhetoric that Medicare payment reductions affect only providers and not beneficiaries, funding cuts for Medicare services will directly affect those who depend on those services. If Obamacare’s major reductions are implemented by Congress over the coming decade, seniors’ ability to access Medicare services will surely diminish.
https://www.cbo.gov/sites/default/files/43471-hr6079_0.pdf letter from the cbo, figures are shown on page 14
Now, 2026 Medicare is insolvent, regardless if there is a dispute on the above, and that won’t be my main issue going forward. Democrats don’t want to deal with it, and Trump doesn’t either, Republicans, like Paul Ryan, get demagogued on this issue whenever they try to propose solutions. Social Security will be insolvent by 2034 I believe.
Sanders wants to add dental coverage to Medicare. Democrats I haven’t seen anything where they proposed what you did, they say nothing except for increasing the cap on the amount that can be taxed for social security, but not to increase the amount for those whose cap went up but, to use it as a welfare plan for others. Now, for Medicare, really for Social Security too, there needs to be a phase in where the percentage goes up maybe phased in of about 2 years before you can collect, for both Social Security and Medicare. Starting not for people who are about to reach it now, but for people who are about 55 now and below, not effecting those 56 and up right now. Marco Rubio proposed something like that and he got hammered. Democrats usually demagogue this stuff without offering solutions.
Benefits have to be adjusted in some such way for younger people, with the aging pollution, living longer than when these programs envisioned, especially with abortion on demand reducing the amount of workers necessary to sustain it. Payroll tax for all, including the Social Security part plus the Medicare part of it need to go up, phased in. The idiotic Obama payroll cut a few years ago (supported by some Republicans) obviously didn’t help a few years ago. Why cut the payroll tax when these programs eventually were going insolvent? Since Medicare insolvency is more immediate than Social Security, then the Payroll part that goes to medicare needs to go up, possibly in increments, and also deal with Social Security to get it in better standing, that needs to go up, the amount and quickness needs to be faced. Of course the cap on the amount needs to go up some as well, but everybody is going to have to pay. Will it go up 1 percent or 2 percent, in increments of quarter or half percent, needs to be dealt with so neither medicare or social security will become insolvent phased in a few years, and without things like the temporary payroll cut of a few years ago that hurt social security and medicare.
The charts that you give exactly show what I was talking about. In reference to emergency visits, US did better than UK, Sweden and Canada, three Universal Health Care places. More than 4 hours Canada by far the worst.
The US leads the pack for waiting less than a month, although Switzerland and Australia are right on our heels. When looking at four months or less, France and Germany edge out the US with Switzerland, Netherlands and Australia following closely.
Who gets elective surgery in less than a month. 61 percent in the US and 59 percent Switzerland #1 &2. both majority private health care. Who is at the bottom? Canada at 35%. Also significantly worse is 37 percent Sweden, 47 UK. What about who has to wait more than 4 months? USA 3.6, Switzerland 3.5, 18 percent Canada , 12 & 12, UK & Sweden. So those with predominant private insurance, have to wait much less than with the single payer plan. Now, this is where you have the problems that I pointed to earlier.
A Fraser Institute report, meanwhile, showed wait times for surgical and other therapeutic treatments across the country rose last year to an average of 18.2 weeks c ompared with 17.7 the year before. The total wait time in 2013 was 95 per cent longer than in 1993.
Table 2 indicates that a significant number of Canadians—an estimated 52,513 people— received treatment outside of the country in 2014. This is a considerable increase from the estimated 41,838 who travelled abroad in 2013
In 2016, an estimated 63,459 Canadians received non-emergency medical treatment outside Canada.
So a pattern, it goes up every year where they have to leave the country to get taken care of, mostly in the US.
What about UK?
ONDO (XINHUA) - Thousands of elderly people in Britain are left to go blind because of rationing of eye surgery in the National Health Service (NHS), a report revealed on Saturday (April 6).
The Times newspaper said a survey by the Royal College of Ophthalmologists (RCO) found tens of thousands of elderly people are left struggling to see because of an NHS cost-cutting drive that relies on them dying before they can qualify for cataract surgery.
The survey has found that the NHS has ignored instructions to end cataract treatment rationing in defiance of official guidance two years ago.
The RCO said its survey has found 62 per cent of eye units retain policies that require people’s vision to have deteriorated below a certain point before surgery is funded.
Now your tables showed Switzerland performs the best, with Germany coming in 2nd and the US in third. Ok, Switzerland private insurance, Germany, for the most part private insurance, and the US. For specialist. 69 73 & 71 percent able to get it done. UK 48 percent and Canada, and Sweden at the bottom, Canada, full socialized medicine. UK by the way does have a private care for about 10% of the population, mostly wealthy, they probably don’t go blind.
Holy crap. Over 21% of Americans who had a medical problem in the past 12 months did not visit a doctor because of the cost. This is over THREE TIMES the median.
Okay, sure, that is why Obamacare’s skyrocketing deductibles. Many officially have health care but because of huge deductibles, they don’t go, because of huge deductibles, the exact result of Obamacare. Many of those technically insured, have such high deductibles that they don’t want to get it. If people had plans before Obamacare came, there were deductibles that were reasonable, how about going back to Catastrophic insurance available for young people, or scaled to what people actually need, which would be more economical. The Obamacare thing where all these minimal things which must be met, even if there is no way in the world that person will need it, that makes it more expensive. The overwhelming things that have added to the cost, in fact make it more cost prohibitive. Also, give where true competition is, where it is not employer based, would make it a lot better. Switzerland does a lot better than us.
*Now to address the VA. Let’s look at the scope of the wait-list scandal that came out in 2014. First, while the faking of wait-list data was unacceptable, it did not lead to widespread deaths. It was particularly an issue with the Phoenix VA and possibly the Los Angeles VA. The IG report into the Phoenix VA found that 6 patients died due to “clinically significant delays in care associated with access to care or patient scheduling.”  The report into the LA VA 1 found that two patients who experienced delayed consults died. The first patient was a 70-year old man with history of heart disease and “a timely consultation by a CT surgeon would not likely have prevented his death because he was receiving appropriate care from the cardiologist.” The report concluded that the second patient in his late 60s had “severe multi-organ disease” and “a history of poor attendance at his cardiology appointments, including ‘no show’ to a heart failure consultation in month 9.”
You are trying to swat a fly, and not seeing the mountain, got the terminology wrong for sure. It is not merely talking about a few places in Phoenix. Here is a CNN report back I 2015
Hundreds of thousands of veterans listed in the Department of Veterans Affairs enrollment system died before their applications for care were processed , according to a report issued Wednesday Here is the report https://www.va.gov/oig/pubs/VAOIG-14-01792-510.pdf
The VA’s inspector general found that out of about 800,000 records stalled in the agency’s system for managing health care enrollment , there were more than 307,000 records that belonged to veterans who had died months or years in the past . The inspector general said due to limitations in the system’s data, the number of records did not necessarily represent veterans actively seeking enrollment in VA health care.
Now, it is over years, and not just in one year, but that is horrible government bureaucracy. The way to relieve this is to make private care available for these veterans, not just adding more government money to an inefficient system.
Now, going back to your reference to Phoenix VA shortly after the report in 2014 still some serious issues were going on just two years after
Two years after they first sounded the alarm about secret waiting lists leaving veterans struggling for care at the Phoenix VA, investigators said some services have improved, and they cleared the clinic of allegations that top officials ordered staff to cancel appointments.
But confusion and bureaucratic bungling are still prevalent, some veterans are waiting a half-year or longer for treatment, and staff are still canceling appointments for questionable reasons.
More than 200 veterans died while waiting for appointments in 2015 , and investigators said at least one veteran would likely have been saved if the clinic had gone ahead with his consultation.
A new report by the VA inspector general shows 43 percent of the 225 patients who died between October 2014 and August 2015 at the Los Angeles VA were waiting for appointments or needed tests they never got. However, the report does not conclude these patients "died as a result of delayed consults.
That is almost 100.
Now, in reference to the cost being higher than the other countries. Let’s go over some factors:
We do much more preventive maintenance, and that preventive maintenance is more expensive. We spend a lot of money on mris and mammograms that are not done in other countries, our mris are more expensive than other countries. Those procedures are good and generally can be done immediately.
As noted the US has way more mris and uses that, as preventive maintenance, Canada for example doesn’t spend nearly the same money on mris:
Canada has one of the lowest rates of MRI scanning machines per capita in the developed world, with 8.8 MRI scanners per million people, compared to 46.9 in Japan, 14.4 in Switzerland and 35.5 in the United States, in Canada. Pittsburgh alone has more MRI machines than all of Canada. UK, single payer only has 6.9
27.5 million mri exams are done, and mris are more expensive in the US.
Mammograms are another factor, we do a lot more mammograms as well Why Do Other Rich Nations Spend So Much Less on Healthcare? - The Atlantic
Compared with the average OECD country, the U.S. delivers (population adjusted) almost three times as many mammograms , two-and-a-half times the number of MRI scans, and 31 percent more C-sections.
As pbs confirms:
Our data suggests that the U.S. does do more tests than other OECD countries. The U.S. did 100 MRI tests and 265 CT tests for every 1000 people in 2010 — more than twice the average in other OECD countries. It does more tonsillectomies and more knee replacements than any other OECD country. It also has more Caesarean sections and coronary bypass procedures than in most other countries.
So, a significant reason is because we do a lot more tests in the US rather than other countries. I guess our costs would go way down if we drastically reduce the number of mris and mammograms, is that what you are suggesting? Has absolutely nothing to do with single payer. Unless it is because government has a set amount of money, and the government figures it is too expensive to do them, and that is why Pittsburgh Pennsylvania has more mri machines than the whole country of Canada. Oh, also, who is at the bottom, even worse than Canada, oh UK, another single payer country, at 6.9. Japan, at the top in mris are very effective, they have great results, but they are not single payer.
Are we overdoing mris and mammograms? Perhaps, but that is a big factor. Mri exams are also more expensive than in other countries.
There are a couple of other factors that are present in the US, not present in other countries that make it more likely to be more expensive and get worse results. #1, the US has fat people. Overweightness, Obesity is much worse in the US as compared to other countries. Our addiction to fast food and sitting on the couch, and sedentary lifestyle would not get better if we got socialized medicine.
The analysis showed that the United States is home to the highest number of overweight and obese people in the world. In the U.S., 70.9 percent of men and 61.9 percent of women are overweight or obese, compared to 38 percent of men and 36.9 percent of women worldwide.
Perhaps most frighteningly, the study shows that being overweight or obese caused 3.4 million deaths worldwide in 2010, accounting for 3.9 percent of years of life lost and 3.8 percent of disability-adjusted life-years.
In comparison, People get fat, costs go up, and people die. Socialist health care won’t make people exercise and stop eating junk food.
In reference to people who are heavy, the top 10, Germany is there, but that is more private insurance, so the European single payer countries don’t start off in a deficit. We have fatter people, we are going to eventually spend a lot more money on them with people having multiple problems. Heart issues, back issues, etc. No matter our system we are going to spend a lot of money on health care because we have fat people.
Next, we have in the US, we spend two to three more times other countries spend on malpractice, that has run some doctors out of business. Health care costs have to take into account that. Not a huge amount but still a contributing factor. We spend 55$ billion a year on malpractice, other countries spend nowhere near the amount, some countries you are not allowed malpractice suits at all.
Now in reference to what is more effective in the US private or public health insurance, which is more cost effective?
Who spends more money per patient?
The AHPI study found that employers spent $3,430 on health care per person in 2012. By contrast, government programs spent $9,130.
The study makes clear that some of the spending difference is due to the fact that Medicare, Medicaid, and the Veterans Health Administration tend to serve older, sicker, or special-needs populations.
When it is apples to apples some say that Medicare and Medicaid is more effective and when numbers are shown, they will say that, but that is not taking into account some relevant factors:
This is from an analysis in Forbes: Employer Health Insurance: A Bargain Compared to Government-Sponsored Coverage
Often studies which show when comparing apples to apples, public is cheaper, it leaves out some important factors. That article goes over some, but I want to highlight some
Unfortunately, some of the steps taken to keep Medicaid costs from rising over the past ten years have simply shifted the actual costs of the program to private payers. According to a recent study by the Kaiser Family Foundation, data suggest that both Medicare and Medicaid payments are significantly less than actual hospital costs, while private insurance payments exceed hospital costs by over 30 percent.16 In 2013, the value of this difference, as well as uncompensated care from uninsured people, amounted to a shift of $21.1 billion to private payers. This cost shifting effectively added $111 per covered life to employer-sponsored and household health care costs and makes it more difficult for employers to control their costs in the black box that is the U.S. health care system.1 7 However, cost-shifting may no longer be a viable strategy in the future.18 At a minimum, there is a limit to the cost shifting that employers and households can bear. Further, improper Medicare and Medicaid payments, including fraud, were estimated to be $64.8 billion in fiscal year 2011,19 or 6.8 percent of all Medicare and Medicaid spending. Improper Medicare payments were estimated at $42.9 billion, or an average $863 per covered life, while improper payments by Medicaid amounted to $21.9 billion, or $392 per covered life. The Medicare improper payments were primarily due to medically unnecessary services and insufficient documentation, while the improper payments in Medicaid were primarily due to ineligible or indeterminable beneficiary eligibility status.
The conclusion of this AHPI study says:
The data demonstrate that for a variety of reasons employers pay significantly lower health care costs per covered life than government programs. This stems not only from the differences in the age and health status of the populations covered by employers and the government, but it also comes in part from the significant amount of improper payments that are still made by Medicare and Medicaid. For example, the $21.9 billion in improper payments in Medicaid accounts for 15.5 percent of the difference in the program’s cost per covered life compared to large employers. At the same time, large employers spend considerable time and resources studying trends within their health care plans and taking a variety of actions to address the underlying causes of what is driving their cost increases. One question is whether those same types of incentives to control costs are present in such government systems as Medicare and Medicaid, or whether costs are controlled by the government simply capping what it will pay for particular procedures, forcing private payers to pay those unreimbursed costs. Although both employers and the government have taken steps to “bend” their health care cost curves, they have taken significantly different approaches. Large employers have adopted a consumer oriented approach that more actively engages their employees to seek out high quality, low cost health care. Medicaid, in contrast, has mandated reductions in provider reimbursements and shifted costs to both employers and Medicare, which has effectively enabled the program to reduce its cost per covered life by 2.8 percent from 2003 to 2012 (see chart below). However, these kinds of reductions in provider payments can have negative consequences on the availability of providers and the quality of care.
The federal government also caps payments to doctors who treat Medicaid patients. Nationwide, the average Medicaid payment was 61 percent of the average Medicare payment in 2011. The average Medicare payment, meanwhile, was 80 percent of the average private-insurance payment.
Those low payments yield a predictable consequence – Medicaid patients can’t get appointments. A Health Affairs study last summer found that one-third of doctors refused new Medicaid patients in 2012. Only 70 percent of doctors nationwide participated in the program.
Here the efficiency of Medicare is even worse when they try to ‘control the costs by underpaying hospitals. This is noted by Pipes in that same article:
Medicare and Medicaid, for example, pay below-market rates to healthcare providers. In 2012, the two programs underpaid hospitals by $56 billion.
Providers respond by charging those with private insurance more. Kaiser found, for example, that private insurers’ payments to hospitals are 30 percent greater than hospitals’ costs.
Such cost-shifting adds more than $1,500 annually to the private insurance premium for a family of four. Without it, the gap between the cost of government coverage and employer coverage would be even greater.
Kaiser notes the following:
Another notable change in Medicare spending in the past 10 years is the increase in payments to Medicare Advantage plans, which are private health plans that cover all Part A and Part B benefits, and typically also Part D benefits. As a share of total Medicare benefit spending, payments for Part A and Part B benefits covered by Medicare Advantage plans nearly doubled between 2007 and 2017, from 18 percent ($78 billion) to 30 percent ($210 billion), as private plan enrollment grew steadily over these years (Figure 3) . In 2017, 33 percent of Medicare beneficiaries were enrolled in Medicare Advantage plans, up from 19 percent in 2007.
In addition to all the above, many people must use private health care plans to supplement Medicare, which Harris and Sanders would abolish, leaving people destitute and unable to get care:
Waiting list for Medicaid has gone worse with Medicaid expansion:
In states that have expanded Medicaid, at least 21,904 of these individuals have died on these waiting lists before ever getting the care that they needed," says Nic Horton, FGA research director and author of the report.
If you go to page 6, it shows Maryland has 8495 people dying after Medicaid expansion, dying on waiting list,
Finding was that waiting list has 650,000 people on Medicaid waiting list.
As a commentator notes Medicaid expansion has lost its focus: Study: Americans dying waiting for Medicaid help
“You’ve got these individuals with developmental disabilities, intellectual disabilities, traumatic brain injuries, frail, elderly seniors in some cases, who are on these waiting lists,” reports Horton. "And they need services. They need in-home care. They need therapy. They need these home and community-based services.
“It’s being spent on the wrong people,” he warns. “It’s being targeted to people who don’t have disabilities, who are working age, who need to be working and contributing.”
What about illegals cost to the US. Remember Obamacare was supposed to not fund illegal access to health care. In one sense that is true, but there is plenty of evidence that illegals do use our health care.
Illegal immigrants get about $18.6 billion a year in health care costs, as documented here. Yes, Obamacare is supposed to stop them, but also provides other, workaround ways for them to get access to it.
Here is a summary by the author of this examination of the issue, you can look at such details:
Current federal policy is to prohibit federal tax funding of health care to unauthorized immigrants through either Medicaid or Obamacare. Nevertheless, rough estimates suggest that the nation’s 3.9 million uninsured immigrants who are unauthorized likely receive about $4.6 billion in health services paid for by federal taxes, $2.8 billion in health services financed by state and local taxpayers, another $3.0 bankrolled through “cost-shifting” i.e., higher payments by insured patients to cover hospital uncompensated care losses, and roughly $1.5 billion in physician charity care. In addition to these amounts, unauthorized immigrants likely benefit from at least $0.9 billion in implicit federal subsidies due to the tax exemption for nonprofit hospitals and another $5.7 billion in tax expenditures from the employer tax exclusion.
All told, Americans cross-subsidize health care for unauthorized immigrants to the tune of $18.5 billion a year . Of this total, federal taxpayers provided $11.2 billion in subsidized care to unauthorized immigrants in 2016 .
The documentation for such detail is in the article. Now, we know that is going way up since New York City itself offered health care for illegal immigrants.
New York, by itself wants to spend $500 million on health care for illegal aliens. New NY health care law might spend over $500M on illegal immigrants We know that Governor Newsome is pushing for free health care for illegal aliens in California.
Joe Biden in appealing to the left wing, wants health care to go to illegals, and he even said he wanted to get clinics for illegals. We know Bernie Sanders wants to expand health care to illegals, in the sense, it is more efficient to treat them.
“Look, I think that anyone who is in a situation where they are in need of health care, regardless of whether they are documented or undocumented, we have an obligation to see that they are cared for,” Biden said in response to whether illegal immigrants “should be entitled to federal benefits like Medicare, Medicaid.”
Finally, the idea that we’d spend a lot more money than other countries only because we have private insurance, and one tries to imply that if it was all public it would be cheaper and more effective is baloney. The Public health care spends money on Medicaid, Medicare, Children’s health insurance program, public employees plan, the public spending by itself is 1.6 Billion or so, 1.9 billion the private sector.
The chart at the bottom of the link shows of that 3.5 trillion the breakdown.
So when one says we pay all this much more money, two to three times higher than other developed countries and its all because of private sector greed or whatever is false. That is because the public sector in the US spends the equivalent to the others all the cost of the other countries per capita just by itself. The US public sector almost spends as much money as the private sector right now, using the government programs right now as much as the rest of the countries both private and public sector combined. The private sector spends 1.9 billion giving health care to 170 to 180 billion, and to imagine that the public sector will insure the 170-180 billion for no cost to make it equivalent is not on anybody’s horizon. If you make all of it public and it goes to 3.2 trillion a year, the cost would be two to three times other countries as well. Most likely that would be an underestimate. So the railing about the cost is ludicrous since the alternative won’t be cheaper, it would more likely more expensive that what it is right now and less effective. The wait times, the inefficiencies as experienced will increase if it goes to one size fits all with no competition.
Now, how can we change it so it is cheaper with where we are at. We can do Switzerland like where it is not employer based. We have car insurance, property insurance, life insurance, we go from job to job, not effected, we can just shop. Having competition is effective. Employers are paying right now that goes to a specific health insurance program, they decide what program that you will get. I’d say whatever the amount of money that businesses contribute to the health insurance companies on behalf of an employee, they do not do that, but they change that into the form of a voucher, and that voucher can only go to health insurance. And then you use some of your own money to help pay.
However, it should be left in all the hands of the consumer. Of course there is a market place now under the federal government, but it should be open market. Anybody should be able to tailor to what they exactly need. Sure a certain amount of minimum provisions necessary but that is it, but more plans that were previous to it. Younger healthier people should be able to get catastrophic insurance, they are not diabetic or something, they can get a cheap insurance for themselves, may be a high deductible, but wouldn’t be bankrupt if something inexpensive happen to them. If it is not tethered to who your employer chooses, one has a totally free market. They have an incentive to not be lazy, and be fraudulent, because if you waste money, you will lose because you have competition, which is not found in the public sector. It becomes portable, and you get to decide and truly shop. Car, life, property insurance, they can compete, so can the health insurance truly compete. Go across state lines, which something we can not do currently. To put the medicare for all, or the VA for all would be the inefficiencies multiplied.
All of this is ridiculous. Taxes may have to go up, but that’s simply a shift in how payments are made. Overall, costs go down. Every other developed nation demonstrates this. Maybe an employer’s payroll taxes go up, but their overall contributions would go down because they wouldn’t be paying as much towards premiums. Becase math. And there is no “true competition” in the overall health care market. There’s inelastic demand for people who need insulin. When you have a heart attack, people aren’t fighting for your business. They’re fighting for your life. Get that Ayn Rand ■■■■■■■■ out of here.
This is idiotic. Costs are not going to go down overall. All the inefficiencies noted, people going blind in the UK, huge waiting lists, people dying because of waiting lists are not only apparent in other countries, it happens right here in the US, in the public systems you are wanting to apply to the rest of the country. Every other developed country does not mean that they have to go to an inefficient idiotic system, we know if it went to socialized medicine, we’d have many issues, because we know in the US inefficiencies are present, and more expensive, in this inefficient system you are trying to change everybody to.
Costs will not go down because we are right now, almost paying the same amount in public as private, and the public is not insuring 180 million people. If it then starts to insure another 180 or so million people, why do you think all the problems now, that they sluff off to the private insurance to take care of, will have no private system to sluff off the problem to resolve, and all will get hurt. UK and Sweden sluff off their problems to private insurers to try to resolve some of the problems that their single payer system can’t solve. Switzerland, Japan, Germany, many other countries do not have a single payer program, have universal coverage, and are more efficient than us, I’d draw ideas from them. I’d rather draw ideas not only from what is good in our system, but in the areas that the US system is weak from these other countries, not from UK, Sweden, and Canada, with all the documented problems in their system. If you have more efficiency in this system that we have now, you can get people to treat that heart attack better.
Before we go any further, I just want to say I truly appreciate you taking the time to respond to all of my points, especially given the scope of our posts. I respect that you’re responding with evidence of your own to back up your position. This is more and more rare around here and I think these posts deserve a thread of their own to continue this discussion, but alas, we’ll have to manage with this thread
Ah, I see what you’re saying. Yes, the democrats, in an effort to compromise with the GOP during the forming of the ACA, included cuts to the Medicare fee schedule. Other compromises were dropping the public option, adopting the individual mandate (a Heritage Foundation idea), and adding over 200 GOP amendments during committee in the bill. I’m not a huge fan of the ACA for some of these reasons and more, but we’ll get back to that.
I’ll cede your point that no one wants to deal with it. But it doesn’t have to be dealt with with cuts. Social Security can easily be solved by eliminating the cap on the payroll tax and then adding a progressive tax rate on incomes above 300,000. Add the progressive tax rate for the Medicare tax, switch to a global budget for hospitals and providers and boom, Medicare problem solved as well.
I have no problem with phasing up taxes on incomes above a certain threshold.
I would hope, for consistency’s sake, you think the Trump tax cuts are “idiotic” as well.
You’re cherry picking information. In almost all of the cases, the US is the median. And we pay twice as much as most other countries. And what does Germany and Switzerland (whose statutory insurance companies are non-profit and funded largely by the government) being private have to do with provider wait times? Switching to a medicare for all wouldn’t make our providers public. We’re talking about a funding mechanism here.
And I’ll cede this point right now, so please don’t bother bringing it up any more and I’m going to snip any relevant responses: Canada’s wait times are pretty bad, but there are several other countries that perform similarly or better than the US, so I don’t give a crap about Canada. It’s not relevant to the point that several other countries, who pay a fraction of what we do, get similar or better results.
So, the UK, who pays about 40% less than us, cut funding for cataract surgery which led to some blindess. That sucks. As a policy position, I’d be in favor of increasing NHS funding to solve that. You know, because they have thousands of dollars more per capita to work with compared to the US. We are spending 2.5 times more than them and 20,000 - 40,000 people die a year from lack of health insurance coverage. Hundreds of thousands go bankrupt. Who knows the amount of people that have other complications like this that are both insured and uninsured.
Tens of thousands die per year from a lack of coverage and we pay over twice as much per capita as they do. I’m going to keep hammering that in any time these datapoints come up.
Again, our health care providers would still largely be public. We’re talking about a funding mechanism. And those private insurance companies are non-profit, way more regulated than our insurance companies, and are largely funded by their governments. But, at the same time, I’d be happy to switch to any of their systems.
“Going back to what we had” is not a viable solution. No matter how you spin it, people were overall worse off because insurance could choose to drop coverage or deny coverage. The rate of increase in health care expenditures has actually gone down since 2010 compared to any decade before it. You bring up the essential health benefits required by the ACA, but every single one of these other countries are going to have the same thing in place. It’s kind of amusing that anyone would think that any of these other countries have fewer regulations overall on their health insurance companies. I mean, for the love of god, they can’t even be for-profit.
sigh I knew you’d bring up the record-keeping report. That wasn’t a testament to the VA health care system, that was a crticism of their record keeping. The conclusion wasn’t that hundreds of thousands died as a result of waiting for care. It doesn’t give a cause. Hell, in some cases, people on the list “waiting for care” were people who died before the record keeping system was even implemented. Read the last sentence in the quote you provided.
No, it’s not almost 100. I’ve read both the Phoenix VA and the LA VA IG reports. As the last sentence in your quote says, they did not die as a result of the delayed consults. In many of these cases, patients were old, had chronic health problems, and died from a cause unrelated to what they were even seeking care for. What I originally said was true—only a handful died as a result of the delayed care between the two VA centers.
Tens of thousands die per year from a lack of coverage. If you’re pissed off from the VA, surely you’re pissed at our for-profit, rent seeking system that allows for this.
Are all of those tests more effective? When looking at 5-year survival rates on multiple types of cancers, there are other OECD nations that have similar or better results than us. For example, out of 18 different types of cancers, Canada has better results in 7. They are within a few percentage points in all of the rest. Other countries have similar profiles as well. If we’re paying over twice as much as another country, shouldn’t our results be twice as good? And, you know, cover everyone and not allow hundreds of thousands to go bankrupt?
Let’s actually look at the numbers here. Here are the obesity rates of OECD nations:
|United Kingdom of Great Britain and Northern Ireland||27.8|
As you said, we are the most obese nation of all developed countries. The median country is 38% less obese than we are. We could estimate how much this factors in to our inflated health care costs by finding out what we pay on obesity related health care costs and then subtracting out that 38% difference. According to a few different estimates, we spend between $147 billion in 2008 dollars and $342 billion on health care expenditures related to obesity. Using that more conservative estimate of $342 billion, if we reduced our obesity related costs by that 38% figure to get in line with median obesity rates, that would reduce our costs down to $212 billion. That’s a per capita reduction of $400, which wouldn’t even bring our current total expenditures below the $10,000 mark. While a significant amount, it doesn’t even translate to 4% of our total spending. And that’s using as conservative as an estimate as possible.
So most of that $55 is on preventative medicine. Only about $7 billion is on actual tort costs. However, we could eliminate the entire $55 billion and that’d only come out to be a per capita cost of $170. Combined with the obesity cost reduction, we’re still above $10,000 per capita. Still not really moving the needle much.
Hi Adroit, I will respond a little to your comments tomorrow, but there is one other thing that we have that is worse than other countries, independent of private vs. public insurance, that I left out, that factors the costs. Now I don’t have the equivalent in money, or cost per capita for other countries, but a huge amount of expense that we have that would far exceed other locations is our substance abuse problem. The Surgeon General in December 2016 reported the loss of 442 $ billion in expenses dealing with our addictions.
Now, I couldn’t find the equivalent per capita for the other countries we have been comparing to, but the comparisons of the US to other countries, US is either at the top, or near the top, per capita in things not only cannabis, but the opioid we far exceed prescription stimulants, etc. A chart shows that here: https://recoverybrands.com/drug-treatment-trends/
I am sure other countries also spend money on this as well, but since we are at or near the top on these things, and most of those countries that we are comparing to, I didn’t see them at or near the top in these categories, our expenses will far exceed the other countries, and 442$ billion is a huge amount. Now how much that is per capita, compared to other countries would have to be determined, but since we are at or near the top of most of those things per capita, that is another factor that makes us more expensive than other countries that we are comparing to.
I put a lot of work in my original response, and I just want to respond briefly to your comments, if I did point by point, this thing would be a book. First, on medicare, since it will go insolvent in 7 years, I think the idea of the medicare portion of the payroll tax needs to go up some for everybody, plus increasing the cap, but also, since people are living longer for people 55 and younger, the age at what people can collect on it will have to increase by 2 years. We are getting too many candidates who are ignoring the future 2026 insolvency and want to add benefits to medicare right now, which is ridiculous, since it is now on the brink of insolvency. Well, here we are talking about medicare for now, the Trump tax cut is another issue in reference to the overall economy, not directly impacting the medicare, social security fund (though if you are getting more people making money, people are paying more payroll tax will help, though others will argue that it hurts, but that is another debate) whereas the payroll tax cut specifically brought in less money to those funds that are on the brink of insolvency.
Now, in reference to the wait times, yes emergency same day, US is in the middle of the pack, that is not what I want to emphasize., remember USA was number three on waiting to see a specialist. The three countries that were the best included the US, but the two above them, Switzerland and Germany, are for the most part private. Elective surgery, US was at the top. You also said well there are other countries have better wait times for other things, but the three such as UK, Sweden, and Canada that I’ve focusted on, that are single payer, are at the bottom of the list. It is not a coincidence. And also remember, the ones that are single payer, two of them have private insurance outlets, UK & Sweden, for example, Canada doesn’t but their outlet is 60,000 plus coming to get their help in the United States.
Next, sure I don’t want to have people to go bankrupt to get health care. One has to have the ability to go back to having catastrophic insurance, relatively high deductibles but they won’t go bankrupt. The minimal standards right now are still too much to be required. ‘If you want to keep your plan, you can do it period.’ Why can’t for some people go back to that promise that President Obama himself made!
Tweak the system somewhat borrowing ideas from Japan, Switzerland, other countries, to get the right mix, I’m not exactly sure, but I don’t want people to go bankrupt, but that does not entail, having to go to single payer, to address the issue. I think the single payer system has that, underfunding becomes a problem, older people will not get things done for them. Sure, try to find the right mix,
I think the problems of rationing, long waits, (fraud and waste in the public in the US as well, not sure If those countries have those problems) , are inherent in the single payer as experienced in single payer countries. As noted by me, right now, in the US, the public insurance, is undercharging medicare and Medicaid, and overcharging the private insurance. It makes it seem like the private insurance is ineffective but it ends up medicare and Medicaid is ineffective, if there is no private insurance outlet, the problems will be worse. Medicaid 30% are not taking them because of experience of underpaymet. Why would I want this country to go that, if there is no private insurance around, that would be catastrophic to people on medicare right now, and the hospitals who depend on those private insurance payments to make up for public underpayment.
Aetna, Cigna and others are out there in Switzerland, I somehow doubt that they are profit here, but non-profit there. Most likely they do it for some profit, I never heard of Aetna and Cigna being nonprofit. Japan is private insurance, I doubt it is all nonprofit. Sure there are regulations.
On the VA wait time sure we are not sure on why many of those people died, some may have died because of old age. I didn’t say, or meant to say that 307,000 died because of this issue. They don’t know why the 307,000 people died in the first study, however that just shows how inefficient the VA is. Many, some or few, could have died because of waiting, or something totally different, I don’t think the benefit of the doubt automatically goes to the inefficient VA that can’t even track that. Those problems persisted in both LA and Phoenix two years after the original study. Those waiting lists 2 years after people died, sure they can’t say they know why 200 people died in one place died almost 100 died in LA, if they can’t tell us why, why would I want to turn over our health care to such a limited population to such an inefficient program for the whole United States, I imagine, those problems would multiply.
Also, as noted we already at 1.6 inefficient billion dollar in the public sphere right now, much more expensive per capita than the 1.9 billion spent in the private sphere.
Look, you said you’d be happy to switch over to one of those other countries that have universal health care like Switzerland or Japan, so I’d be good with that, but I just don’t think single payer is the solution because of the reasons given. Tweak the current system, a lot if necessary. I think the market and competition would do fine for most people who are employed, give them incentives to get insured if necessary, those who are unable to work, give them help for sure. If you want to give a last say, by all means give it, I’m kind of worn out on this thread. If I do respond again, it’ll be a one or two sentence thing (so much for my brief response).
Take him to 7/11 for a Slurpee and let him freely talk.
I totally understand and I meant it when I said I appreciated your effort in this discussion. It is exhausting. I’ve been working on a blog post series on this topic and I’m almost at 20,000 words over 7 posts. I haven’t published a single one because…reasons. But I get it. Just the idea of having to respond to the replies I know are coming. The research it takes. The fact that someone will always be able to find a particular data point to back their position.
I disagree about the fact that the wait times are a function of the payment mode. That’s a function of health care providers. All else being equal, Doctors getting paid from a different source isn’t going to change how many patients they can see. Hospitals getting paid from a different source isn’t going to change how many beds they have. However, what will change is the fact that Doctors will have to spend less time on billing issues themselves (and yes, I can point to a study showing the average number of minutes a day a doctor spends on billing/insurance related issues rather than their staff). A doctor would have to hire less admin staff to work with insurance if there’s a global budget or a set fee schedule rather than dealing with networks and different companies that pay differently. A hospital wouldn’t have to spend 25% of its costs on administration (double what places like Canada and the UK spend) if there was a global budget. That money could then be spent on CapEx like additional wings, beds, medical equipment. And the 60,000 figure from Canada is from 1) elective procedures, and 2) a survey of doctors of their estimates on how many of their patients seek care in the US. That’s hardly indicative or authoritative of health care outcomes.
It’s not that Medicare and Medicaid are undercharging. Because of the feedback loop of hospitals and providers charging more to private insurance because private insurance doesn’t care because they can just raise premiums, deny claims, etc, hospitals and providers have raked in increased profits and wages at a vastly higher rate than inflation. Have outcomes justified these increased profits and wages? No. The various players have been leeching off the nature of our system and then when we want to put an end to it, people cry about the golden good being taken away. Our outcomes do not justify the lucrative windfall that hospitals, providers and pharmaceuticals have all received.
The statutory insurance in places like Switzerland, Netherlands and Germany are non-profit. It is illegal for profits to be distributed to shareholders. In Japan, the “Statutory health insurance system, with >3,400 noncompeting public, quasi-public, and employer-based insurers. National government sets provider fees, subsidizes local governments, insurers, and providers, and supervises insurers and providers.” Over 84% of Japans system is publicly funded. While you have these entities managing the insurance, it might as well be a “single-payer” with that kind of public financing.
And again, the VA “300,000” figure has no bearing on the efficiency of the VA. As the IG report showed, it was a record keeping issue based on legacy data. And we do know why those 200 people died at Phoenix VA and 100 died at LA. The IG report determined that only a handful was due to the wait times scandals.
Again, we spend over twice as much as most other developed countries. TWICE AS MUCH. We don’t cover tens of millions. Tens of thousands die a year for lack of coverage. Hundreds of thousands go bankrupt. And most of the data points that are used to argue against single payers in other countries basically pale in comparison to these figures. We don’t have anywhere near the outcomes that justify our costs. That’s the bottom line.
Hence the desire to secure the border!
Well done on debunking the folly of single payer!!
Yeah, because that $18 billion a year—which amounts to $55 per capita of our total $10,700 per capita health care expenditures—is really breaking the bank.
So what? Biden won’t be the nominee, it will be a far leftist. After 14 or so drop out, all their voters will turn to the far leftist still standing. Ten Biden will be out. He loses every time he runs for the nomination, & will again this time. The dems know he’s kooky.
Gees Matt, do you think anybody read all of that?
The ghost of Trip?
You were ahead of the curve.