
Medicare for All: Leaving No One Behind - fosco
https://live-berniesanders-com.pantheonsite.io/issues/medicare-for-all/
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aceon48
To call our healthcare a market system is laughable. There so many protections
and regulations and distortions. In addition, when your house is in fire, you
don't shop fire departments.

In a life or death scenario, you certainly aren't shopping hospitals. And so
they can gouge you hundreds of $$ for even simple things like ice packs and
Tylenol. Our system is a scam. One hour in the ER should not cost $5000

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methodover
But what about when it isn't an immediate emergency? There are plenty of
healthcare needs where you totally do have time to shop around and find the
best bang for your buck, if the system let you do that. (There could be a
startup idea in there, even. A simple website to help find the most effective,
cheapest endoscopy or wisdom tooth extraction or STI test or mole check or
whatever.)

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slamdance
That is the underlying problem though. There is no "shopping around". Either
your plan allows it, or does not. If you need a procedure, your choices are
effectively limited to who is on your coverage list.

FWIW, I live in an area where there is ONE healthcare option
(Racketeering/monopoly). I (as an independent consultant) pay $1640/mo for a
$5,000 family deductible. So basically, I pay over $19,000/year for the
PRIVILEGE of paying another $5,000 and that's assuming I only go to the
doctors "they allow" me to go to. (it was $800/mo for a $1500 family
deductible prior to ACA). Obama can EABOD.

The only people who like the ACA are the people who don't have to pay for it.

Edit: Also I was in an MVA in July, the Emergency Dept. didn't accept my
insurance at all - so who gets the bill? I do. The MVA wasn't my fault, but
that bill is still my responsibility.

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wombatpm
The auto insurance company. That is why you have medical on your policy. Of
course you may have to sue someone to get it.

That's another crazy part of our system. Medical coverage is baked into your
health insurance, your auto insurance, your property insurance, workman's comp
insurance. A medicare for all plan, should require comensurate decreases in
all of those policy areas.

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slamdance
Yeah, it _will_ take a lawsuit, and that, I am told will take ~18 months +/-.
I'm on the hook until then. So far, with lost work, PT and imaging, I'm
already out almost $20k

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mc32
If I had a say, I'd like to see universal coverage for all Americans (and
market rate buy in for workers on visas) but provide it at several levels.

Everyone working or non-working gets some kind of base coverage --to which
they can buy a ala carte additional coverage/perqs. At the base level people
who behave healthy (but not necessarily healthy) get breaks (premium perqs)
for trying to be healthy in terms of diet and activity (activity monitors,
etc.)

In addition to some base coverage, people can opt in to more premium coverage
with shorter wait times, additional non-essential care, opt out of lifestyle
monitoring, etc.[1]

That way the system can be streamlined to be efficient in handling 80-90% of
cases and then have the second, premium system available for those who want or
need less ordinary medicine.

If you can keep 80-90% of your pop healthy efficiently and then you get the
rest to pay extra for their added needs, I think that could make the economy
more effective, overall.

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pg_bot
I own a medical clinic with my brother who is a physician. He has opted out of
medicare and medicaid because of the increased overhead and cashflow issues
that are incurred when dealing with the government. Instead we charge $50 per
month for a base membership to the practice and bill patients slightly above
cost for labs, and supplies. I think this will be the model for most Americans
in the future. Most medical costs are not emergency related and people just
need someone to give a quick medical opinion when they are concerned. For
people with a chronic condition like COPD or diabetes they get a monthly visit
have their vitals checked and can come back next month without paying crazy
high fees. For emergencies, people usually also carry a high deductible plan
so they are only using insurance for costs that can't be paid out of pocket.

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methodover
The primary mechanism by which money is saved is price controls, under a
single payer system. This should be extremely scary. And I'm saying this as
someone who voted for Obama in 08, 12 and HRC in 16.

Healthcare products are complicated. Getting the price right is a very hard
problem. Markets, generally speaking, have proven to be a fairly effective way
of settling on price. This is basic economics.

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maxxxxx
From my experience the US health care market is not a functioning market. No
price transparency, widely variable prices for the same thing, huge and
inefficient bureaucracy.

It would be interesting to see if there was regulation for open pricing,
billing standards and others. If that doesn't happen, Medicare for all is
definitely a good option.

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methodover
I totally agree with everything you said except that last sentence. Insurance
seems to be something of a failure as is. That said, MFA seems like just
another insurance system. Except customers can never opt out of it, never
develop a competing system, and are now bound to its inefficiencies forever.

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slamdance
Medicare & Medicaid has always been an option for everyone - its just that if
you made too much money, then you didn't qualify. It was a safety net for the
poorest people. It was not meant for students just out of school (who
presumably had skills to get a job with benefits) or people who are perfectly
happy not progressing or producing in their lives (which is fine, just don't
demand that "society" pays for everything).

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elihu
Who is pantheonsite.io, and why isn't this linking straight to
[https://berniesanders.com/issues/medicare-for-
all/](https://berniesanders.com/issues/medicare-for-all/)?

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neilwilson
The only moral way of providing healthcare is based upon need not ability to
pay.

If you introduce any pay structure into healthcare you are saying that those
with money can reserve scarce resources ahead of those without.

You are saying rich people are more important than the poor and the poor
should die more quickly to get them out of the way.

If you live in a society that takes that view, how long before you become the
poor?

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gremlinsinc
I'm a Bernie supporter.. and like the single-payer idea... but if that can't
get passed--how about we get rid of Insurers--and make HOSPITALS provide
insurance.

You pay your local hospital $x per month based on income... something like
4-6% of your income if you earn > $30k.

The hospital might get some gov't subsidies based on # of insured patients it
carries.

When you travel your hospital covers the bills at other hospitals. Since each
hospital = insurer they will work/negotiate with other hospitals for faired
deals than they would w/ insurance companies.

This also will do away with some of the billing requirements and could
streamline that process a bit.

A good startup might be creating the billing systems that manage all of this,
and centralizes everything between different hospitals.

No HMOs, Networks, etc... Hospitals could choose what extras they might cover
like infertility/etc... as a bonus so patients might pick a different local
hospital that has better coverage..

The boon for the hospital: Monthly recurring income from all it's patients -
past, present, and future.

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kapauldo
Happy to see this. Free market health care has failed, glad there is a
critical mass of people willing to get something new.

