
Jayapal and Sanders Medicare for All Bills: One Is a Lot Better Than the Other - howard941
https://thedeductible.com/2019/04/23/rep-jayapal-and-sen-sanders-have-introduced-medicare-for-all-bills-one-is-a-lot-better-than-the-other/
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sanderjd
> _S 1129 contains the clause that every true single-payer bill contains – a
> clause stating that on a certain date after the bill becomes law insurance
> companies may not sell policies that duplicate the coverage of the Medicare
> For All program._

I'm a single payer noob. Can someone explain to me why such a clause is
necessary? If people are already paying for health care coverage from a
federal system through taxes, why would they pay more to purchase a plan that
duplicates that coverage from a private insurer? And if nobody is paying for
that duplicate coverage, why is it necessary to outlaw it (rather than just
letting insurance companies decide it doesn't make sense to sell it anymore)?

It makes me suspicious that they need to outlaw something that would appear to
be unnecessary under the rest of the system they're creating. It makes me
think the outlawed coverage might actually be useful for some reason, in which
case it would be a bummer for it to be outlawed.

~~~
Youden
> Can someone explain to me why such a clause is necessary?

Because legally, such a plan offers you literally nothing and there is no
rational reason why you should purchase it. To purchase it would be irrational
and likely a result of someone trying to swindle you out of your money.

> why would they pay more to purchase a plan that duplicates that coverage
> from a private insurer?

A few reasons I can think of:

\- They're continuing a plan they've had for years and would rather keep
paying for it than accept change.

\- Marketing tricks them into it despite it being a stupid idea (see
timeshares for evidence this happens in reality).

\- Because it comes as an add-on to a larger package with something that
_does_ have value.

~~~
cosmie
It also prevents some of the anticipated benefits of the single-payer system.

\- Providers don't realize the anticipated reductions in administrative
overhead, since they may still need to retain the same complexity in billing
but just with a radically different distribution of claims.

\- Consumers may still end up having issues with providers accepting plans.
Especially if you leave a loophole that allows providers to decline the
single-payer option but accept the private versions that cover the same
service.

\- Consumer confusion can come into play related to covered services. One
potential draw of the private version would be lax qualification standards for
a specific coverage item. But if they decline coverage and the consumer tries
to fallback on the single payer system, they may not have gotten the proper
approvals or step therapy to have the procedure covered. The private company
will have a marketing department to ensure negative consumer sentiment ends up
falling on the lap of the single payer system.

\- Economies of scale. The single payer system has market power specifically
explicitly because of the fact that they own the whole consumer pool. If you
allow it to remain fragmented, it lowers the single payer's negotiating power.

\- Risk pool. The private company is more likely to skim off the healthiest
consumers from the risk pool, and leaving the unhealthiest. This causes all
kinds of issues from a political standpoint. The private companies can offer
more attractive "perks" (like covering the same procedure, but streamlining
the qualification process) because their risk pool is less likely to actually
need that procedure. This would incentivize the top end of the market to
purchase the plans (or offer as employee benefits, such as now), who would
then feel negatively about the single-payer option because they're being
forced to pay into that while not actively using it since it appears "worse"
(even though it covers the same things).

At the end of the day, the clause isn't strictly necessary for a single payer
system. But without that clause, you introduce quite a few failure modes and
unnecessary friction points that can be completely avoided by simply
disallowing duplicative private policies from being sold.

~~~
sanderjd
All of your points except the first one seem more relevant to the debate
between single payer vs. multi payer. But I'm specifically asking, assuming
single payer (ie. without a loophole that makes it multi payer), why is it
necessary to proactively outlaw other plans rather than let them die?

I think your first point kind of gets at the crux of it though: you want
providers to only have to support a single payer in order to reap the
administrative efficiencies, so you either need to make a law that says that
providers must only accept payments from the single national plan, or that
insurers can't offer plans that pay separately. Those two options seem
equivalent to me, but the first one (forcing providers to only accept payments
from the national plan) seems more intuitive than the second to me.

~~~
cosmie
For sure, the first point is pretty critical to ensure market viability of a
single payer system. The potential reductions in administrative overhead
absorbs some of the expected reductions in reimbursement amounts that'd come
with a single payer system.

But even if you can make it work out from an economics standpoint, it can
ultimately fail from a political standpoint if people _feel_ like it's a
failure. And there are a lot of entrenched interests that would benefit from a
failed single payer experiment. My other points were geared towards that
component. Letting the multi-payer environment die out organically leaves a
grey area with potential consumer confusion and frustration during the
transition period, and also leaves the infrastructure in place to easily roll
back the single payer plan if you adequately exploit that frustration.
Forcefully cutting over to a single payer system allows a clean break so both
the consumer and provider side of the market has the opportunity to validate
if the claims in the single vs. multi payer debate can be realized, without
creating a giant attack surface for political and market shenanigans that
could kill it before it really got going. It also raises the level of effort
required to roll back the single payer system, since the infrastructure and
and staffing to support it is reduced more rapidly than if taking a "let them
die on their own" stance.

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gok
Where "better" here means "allows doctors to continue to earn much more money
than they do in other countries for performing the same services".

~~~
influx
How much should they be allowed to earn?

~~~
gok
However much they can get someone to pay them! So long as they're aren't also
using their cartel power to reduce the availability of medical care. Which
they are.

~~~
charliesharding
How would they get anyone to pay anything if their services are being offered
by the government as a basic human right? They lose all bargaining power if
they can't refuse their services.

~~~
zaroth
If the government offers too little money, the supply drops and you get
quotas, waiting lists, and denied treatments.

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maxxxxx
Let’s not make this into another stupid polarized fight. Sanders is a
pragmatic guy who I am pretty sure would entertain other thoughts if they
really addressed the real problems unlike most republican proposals.

~~~
toomuchtodo
The crux is hospitals and doctors don’t want their pay cut, when it should be
cut (Sanders’ bill does this). This is the result of the AMA attempting to
keep wages high through quotas (as well as bloated hospital admins), and the
resulting policy required to fix cost inflation.

Healthcare is a utility, not a profit center, of course we’re going to
compress unnecessarily high wages (or cut unnecessary non-provider jobs
ruthlessly).

~~~
charliesharding
Compressing "unnecessarily" high wages will inevitably cause less people to
want to assume large amounts of debt for the necessary education and training
to become doctors. The doctors that I know chose their career explicitly
because of the salary and status that comes with being a doctor. Remove the
incentive and you will diminish the supply. Diminishing the supply while also
promising free care to all (increasing demand greatly) will result in very
long wait times and diminished quality of care.

~~~
toomuchtodo
Those folks can depart the system and we’ll put an express lane visa in for
doctors who want to immigrate to the US. Lots of highly educated healthcare
professionals in the world who would want to immigrate to the US and aren’t
anchored to unreasonably high wages.

Those doctors you mention picked the wrong career for fat cash and prestige.
We can’t allow a broken system to continue because of previously made bad
decisions.

~~~
zaroth
Ah yes, the best of both worlds; socialized medicine provided at rock bottom
prices through mass immigration undercutting the salaries of US citizens that
are paying billions towards non-dischargable loans taken in good faith.

Sarcasm of course. In my opinion, these are two great ideas for getting Trump
re-elected.

~~~
toomuchtodo
You can always count on America to do the right thing after having exhausted
all other options.

