
Medicare for All Would Abolish Private Insurance. ‘There’s No Precedent’ - pseudolus
https://www.nytimes.com/2019/03/23/health/private-health-insurance-medicare-for-all-bernie-sanders.html
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ag56
I'm British, but moved to California 10 years ago. I have obviously had many
conversations with my American colleagues and friends over the years.

And I am (still) baffled that the starting viewpoint from the American side is
that with single payer health care private insurance would be 'abolished' or
otherwise become unavailable and/or illegal. Huh? Of course not. It's simply a
base level of care given to everyone. If you have the money and desire then
why wouldn't you pay for private insurance, or cash out of pocket for a
private hospital?

And better yet, that private insurance will become cheaper: it can exclude the
rare, chronic and expensive diseases you probably won't get. (As if you ever
do, you could rely on the base single payer coverage.)

~~~
cylinder
The intellectual level of understanding the concepts behind all of this is
basically a generation behind the rest of the oecd in America due to lack of
experience and lack of curiosity about other countries. This goes both ways.
Many people think everything will be free and boundless on single payer and
they can keep using fancy sparkling public hospitals and have free specialist
Consultation without even a GP referral all they want...

~~~
ykevinator
America has a unique patriotic bias that keeps us from having nice things like
health care and safe children.

~~~
scarface74
It’s not patriotic. There were many people who were against it because it was
championed by a “non American Secret Muslim who wanted to impose Sharia law”.
If Romney had proposed or Trump they would have been all for it.

It’s amazing how many states are passing laws that are pro Medicare expansion
now that it doesn’t mean supporting Obama.

On top of that, they don’t want “them” to have health insurance.

Let’s call “patriotic” what it is - racism.

~~~
oblongx
Let’s call “patriotic” what it is - racism.

    
    
        Seriously?

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drpixie
"There’s no precedent in _American history_ ".

Plenty of precedent in the rest of the world ... In fact, you'll have to go
looking to find western countries that _don 't_ have universal public
healthcare.

~~~
techbio
The quote _in the headline_ appeared to mean what you responded to, but a few
paragraphs into the article it was plain they were talking about the
unprecedented scale of the private health insurance industry, at about
$1,000,000,000,000/yr revenues (a trillion, a lot bigger than the defense
budget), largely owned by institutional investors and mutual funds, ie. people
with retirement plans. I would tend to believe unprecedented is the correct
term for nationalizing an industry of this scale. Of course, it is also
unprecedented to spend this much on health care.

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fubar392
Australia has medicare and a public health care system to go with it. And it
also has multiple private health insurers and a private health care system to
go with it. In a way they compete with each other. The private health care
system has better hospitals and equipment. But the public health system has
lower costs. If the private system gets too expensive, you would just go
public. If you can afford the insurance, you go private (also there are some
tax incentives for higher earners to stop them just using the public system).
Private system provides the best in care. Public system provides a base level
of care for everyone. It actually works very well.

An American friend told me that the US health care system will never be fixed.
There is no way it can. That there are too many people with too much power
getting filthy rich through it.

~~~
dvfjsdhgfv
> That there are too many people with too much power getting filthy rich
> through it.

That's the key point. Of course there are many precedents, all over the world,
and especially in all Western countries other than the US: the public and
private healthcare systems happily coexist. But in the US there is so much
money to be made on all components of the current complex system it's simply
impossible the people involved give up without fight and agree to make it sane
like everywhere else in the civilized world.

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millstone
"Medicare for All" is an umbrella political slogan, backed by many different
interpretations, timelines, and concrete policy proposals.

This article is about the Sanders plan, which is radical (in the non-
judgmental sense). It is more generous/costly than typical non-US single-payer
systems, such as Canada's. Even Medicare itself incorporates private
insurance, via "Medicare Plus".

So "abolish private insurance" is actually an outlier position among the
Democratic field and is not implied by a naive interpretation of "Medicare for
All".

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skookumchuck
Obamacare has resulted in only one insurance provider in my county, which is
my only choice.

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brylie
In Finland, we have Kela, which provides many services including health and
wellbeing support for all residents:

[https://www.kela.fi/](https://www.kela.fi/)

[https://en.m.wikipedia.org/wiki/Kela_(Finnish_institution)](https://en.m.wikipedia.org/wiki/Kela_\(Finnish_institution\))

I am an expat from the U.S. living in Finland on a work permit and still
qualify for Kela support.

Voluntary health insurance does exist here, e.g. employee health benefit, but
plays a small role compared with the National Health Insurance.

More info:

[https://www.infofinland.fi/en/living-in-
finland/health/healt...](https://www.infofinland.fi/en/living-in-
finland/health/health-services-in-finland)

------
car
[https://www.pbs.org/newshour/health/health-july-
dec09-insura...](https://www.pbs.org/newshour/health/health-july-
dec09-insurance_10-06)

[https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...](https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html)

[https://synapse.ucsf.edu/articles/2014/05/15/comparing-
healt...](https://synapse.ucsf.edu/articles/2014/05/15/comparing-health-
systems-around-world)

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bitforger
> Many supporters of this approach see elimination of private insurance as a
> key feature, not a bug...

Is this common vernacular now, or is the author letting their hacker show?

~~~
tupshin
This is common (enough) vernacular.

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apengwin
Abolishing private insurance is kind of the point here though.

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adventured
> Unlike Obamacare, emerging plans would sweep away the private health
> insurance system. What would that mean for the companies’ workers, the stock
> market and the cost of care?

The US spends around $3.6 trillion per year on healthcare now (approximately
18% of GDP). Matching with other elite, developed nation healthcare
expenditures, it should be closer to $2.3 trillion. Even after accounting for
the higher US wages. 10% to 12% of the economy going to healthcare should
produce a system that is competitive with the top dozen systems (whether
France, Canada, Britain or Switzerland).

What would cutting $1.3 trillion from the system do for the the US? It'd be a
boon for unleashing an extraordinary amount of capital for productive use.
Capital that's currently being vaporized as the greatest worker welfare
subsidy in world history, exceeding the over-spending on the military
industrial complex by a laughable sum ($200b-$250b in over-spending on
military, versus $1.3 trillion in over-spending on the healthcare industrial
complex).

At the center of all of the problems with US healtchare, including doing a
proper socialized system, is cost. No matter the angle, no matter the
argument, it's all back to the problem of how much the US spends per capita on
healthcare. There is no scenario where the US can implement a universal /
socialized medicine approach without dramatically cutting spending. The
question is: who's going to take the hits (on higher taxes, and lost jobs /
lost income). The US middle class pays very low effective income tax rates.
Other developed nations tend to have far higher tax rates on their middle
classes, which goes to pay for healthcare and other social safety nets.
Somebody has to tell the middle class their tax rates are going to double at a
minimum.

Doctors, nurses, admin, scientists, pharma reps, insurance industry employees,
etc. Overwhelmingly people in the top 40% of the economic bracket. That's
where that $1.3 trillion in welfare subsidies is going. Instead, it should be
going toward expanding the economy, funding business formation, investing into
productive companies, boosting household savings (including dramatically
reducing bankruptcies), and so on. I find that nobody ever wants to talk about
how so many people in the US healthcare system will need to take a huge pay
cut to get our costs down to sane levels. US doctors and nurses are
considerably overpaid versus other comparable nations (as one example, compare
what US radiologists make versus France or Germany, it's typically two to four
times higher depending on the market).

People often think the over-cost in the system is all in pharma + insurance,
which isn't the case. The over-cost in pharma is about $100 to $125 billion
per year, it's less than 10% of the cost problem in the US healthcare system.

Doctors at my local ER, in a rural market, charge about $1400+ per hour for
their time. Step foot into that ER for any reason, and it's $500+ as a minimum
charge from the hospital (doesn't count the physician fee). Doctors here
commonly earn ~$300,000 to ~$500,000 depending on specialty. Roughly 11 to 17
times the median income.

That all has to be wiped out, it's entirely non-functional and non-
sustainable. It's one of the great economically exploitive systems ever
invented, fiercely protected by very powerful guilds.

If we make our healthcare cost effective, you can increase taxation on
business (a tax to help pay for universal coverage) at zero net additional
cost to the businesses versus what they're paying now to cover employees with
health insurance. Each dollar directed at the healthcare system ends up going
a lot further in other words.

Short term there would be considerable pain for anyone working in healthcare,
unless it's phased in quite slowly. Even if it's phased in slowly, there will
be massive strikes and protests as wages either stagnate at a minimum or are
slashed. Every nurse in America will go on strike if you freeze their wages
for even a few years, forget about cutting their wages by 1/4 as should occur
to bring them into line with other developed nations.

~~~
cylinder
It's true. ER doctor which is just a small step above GP can earn 500k plus in
Wyoming or similar. These communities should be allowed to import physicians
from other countries and pay them 150k instead. This is sheer lunacy. If those
people decide to make that trade off that's up to them (they could not only
get good Indian and African doctors but they could likely still attract
European doctors at that rate!)

