
Paying for Medicare for All - js2
https://medium.com/@teamwarren/ending-the-stranglehold-of-health-care-costs-on-american-families-bf8286b13086
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simonblack
Americans will have to change the way the system gets paid, removing the
billions paid to the 'leeches' on the system.

Australia has a very good system, with everybody covered by a single-payer and
also the choice available to pay 'extra' to gain things like a preferred
doctor or surgeon when in hospital. Cost of triple-bypass cardiac surgery to
me was zilch, nada, 'nuttin'.

This cover for all works out to costing the Federal Government roughly $7400
per person per year. Extrapolating the Australian population size to the US
population size, that would total a mere 2.6 trillion per year. Nowhere near
the 20 to 30 trillion dollar figures that have been bandied about.

On the other hand, if you accept the 30 trillion dollar figure, it just means
that Americans are paying 10 times more for health care than they might be
otherwise.

~~~
js2
The 20-30T is over 10 years. The US currently spends 3.5T annually. About half
of that is private spending (employer-sponsored, out-of-pocket, etc) and the
other half is government spending (Medicare, Medicaid, VA, and government
employees).

The only way we can possibly contain costs is to legislate it via negotiation
between shareholders. There's simply no free market to control cost of health
care.

I'm ambivalent if single-payer is the best option. On the one hand, the
Federal government has shown it can supply it for those 65+ (Medicare).
Satisfaction with Medicare is better than satisfaction with private insurance.
And Medicare has 2% administration costs vs something like 14% for private
insurance. OTOH, our existing system is much closer to a Bismarck-style multi-
payer system like Germany, Japan, etc.

I'm also ambivalent about trying to convert to single-payer in one fell swoop,
vs a slower transition like making Medicare a public option with subsidies.

Currently, 160M Americans are covered by employer sponsored coverage. I can
imagine it's scary for many of them telling them they'll be put onto Medicare.
Loss aversion and all that. Americans seem to like the illusion of choice and
control.

I say illusion because what choice, really, do I have over provider if it's
employer-sponsored? In my career, I've only ever been offered 2-3 choices
picked by the employer that are varying degrees of suck.

Regardless, this will not be a simple transition:

[https://www.cbo.gov/publication/55150](https://www.cbo.gov/publication/55150)

~~~
simonblack
The greatest drawback, as I see it, to the US system is this: _Currently, 160M
Americans are covered by employer sponsored coverage._

The people most in need of 'single-payer' are the unfortunates who don't have
employer-sponsored health cover (160M is less than half the US population);
those out of work, whether 'retired' or 'not employed just right now'; those
who are physically unable to work because of bad health or past injuries; etc.

Single-payer covers everybody, and removes the cause of bankruptcies because
of tens (or hundreds) of thousands of dollar hospital debts. There's no way I
could have afforded my triple bypass surgery including 2 days in ICU on my
22-hours-a-week employment classified as 'casual work' if I was under the US
health scheme. That surgery came with a mere two-week warning, I went to have
an angiogram 'just to check things' and was told "We're not sure if we'll let
you go home today!"

~~~
js2
That 160M is vulnerable to having a health issue crop up which prevents them
from working, then they lose their job, 18 months later lose their COBRA
coverage (if they could afford it in the first place), then go bankrupt at
which point they can qualify for Medicaid. It's terrible and it happens.

BTW, a big point in favor of single-payer even for those 160M is that it
_increases_ consumer choice of provider since you no longer have to worry
about provider networks. In theory anyway.

There's just so much inertia and powerful vested interests behind the current
system, it's really hard to change. This isn't a new fight:

[https://www.healthcare-now.org/legislation/national-
timeline...](https://www.healthcare-now.org/legislation/national-timeline/)

------
samstave
I'm really curious about the following:

We talk about Medicare, Healthcare (in general) constantly.

I have built quite a few hospitals, healthcare software, and commissioned
several hospitals as well. My brother is the head of the VA for the entire
state of Alaska.

Healthcare is a wedge issue every single election cycle.

Yet here we are. Again talking about "medicare for all" (again) and ironically
enough, we seem (IMO) to be addressing the symptom and never the cause.

Costs are out of control across the board - and rather than addressing
insurance and pharma (actually addressing, not lip service to injustice) - we
try to apply a bandaid via medical subsidies.

I find it really ironic that 'Healthcare' in the united states is a malignant
tumor which keeps metastasizing as the decades progress.

/rant

