All of the studies, regardless of ideological orientation, showed that long-term cost savings were likely. Even the Mercatus Center, a right-wing think tank, recently found about $2 trillion in net savings over 10 years from a single-payer Medicare for All system.
The way I see it, healthcare is a tax without representation if you get it through your employer. If you don't like the insurance your employer provides, can you take that money as a lump sum that...
The way I see it, healthcare is a tax without representation if you get it through your employer.
If you don't like the insurance your employer provides, can you take that money as a lump sum that your employer would have spent and put it towards the plan of your choice? I have yet to hear of an employer that does this. If your employer gets a much worse plan, what are your options? Change jobs? That's not much of a choice for most people. Medicare for all means there is someone who is elected who (in theory) answers to you for the quality of your care. It's more representative than any employer-provided healthcare that currently exists.
Wasn't this supposed to be the point of health savings accounts? You can put some amount into it tax free, but it can only be used for medical stuff? It always seemed like the type of thing that...
Wasn't this supposed to be the point of health savings accounts? You can put some amount into it tax free, but it can only be used for medical stuff? It always seemed like the type of thing that sounds OK on paper, but when it came down to it you'd never be in a position to know if you were putting enough in ahead of time or not.
In the interest of transparency, the author of that study is apparently claiming that $2 trillion number is being misattributed by M4A proponents. Source
In the interest of transparency, the author of that study is apparently claiming that $2 trillion number is being misattributed by M4A proponents.
"Last year I published a study with the Mercatus Center projecting that enacting Medicare for All (M4A) would add at least $32.6 trillion to federal budget costs over the first 10 years. After the study was published, some advocates misattributed a finding to it, specifically that M4A would lower national healthcare costs by $2 trillion over that same time period. This misattribution has since been repeated in various press reports."
Thank you for the follow up and link, it's a good read. The only actual number quoted in the study is the $32.6T, so it's obvious to be the number that's used in reporting and for comparison. In...
Thank you for the follow up and link, it's a good read.
The only actual number quoted in the study is the $32.6T, so it's obvious to be the number that's used in reporting and for comparison. In the article you linked he made a point of giving an upper limit on the "cell phone bill", but didn't bother with such in the study. I am curious as to why he couldn't bother guessing at a high number...
The study only quotes increased utilization, but makes no mention that healthcare costs are high because people wait until the last minute to get treated when treatment will be more expensive in hopes that the issue would have gone away during the waiting period. Increased utilization results in less severe illnesses which means treatment is less severe and less costly. Example: An oseltamivir prescription ($56) at the start of flu symptoms is miles cheaper than a single visit to the ER ($600) let alone a ICU stay ($20k) after getting pneumonia because of the flu.
This is an interesting article, but it brought up some thoughts that I had around the utility of articles and studies like this. While it is certainly common knowledge and truth that a single...
This is an interesting article, but it brought up some thoughts that I had around the utility of articles and studies like this.
While it is certainly common knowledge and truth that a single payer system is superior to each other type of system, it's not really worthwhile to bring up to most of the people in the US who are against single payer systems. This comes back to a fundamental point, which is that you cannot reason someone out of a point of view that they did not reason themselves into.
The anti-single payer propaganda has directly linked the idea of medicare to "socialism" and to many people socialism is anti-freedom. There's not a lot of ways around it, unless someone in their family actually gets sick and dies, which is a terrible way to learn a lesson.
The other major stumbling block is that people who already have insurance see this as an assault on the hard work that they've done to ensure that they have insurance, and somehow forget that they would continue to still have insurance in the new system. Again, it's difficult to deal with this point of view, since it's not really a reasonable one. It's selfish, and shortsighted, and fundamentally unreasonable.
I'm not saying this to say that the article isn't interesting or that it isn't useful - it's both! - but that I'm just not quite sure how to bridge this gap between "people who already understand this" and "people who need to start understanding this".
That's a part of it, but not all of it. The right has done a great job of scaring people off of single payer healthcare via a number of other ways. I'll start by telling you that I'm a far-left...
The anti-single payer propaganda has directly linked the idea of medicare to "socialism" and to many people socialism is anti-freedom.
That's a part of it, but not all of it. The right has done a great job of scaring people off of single payer healthcare via a number of other ways.
I'll start by telling you that I'm a far-left liberal (at least as Americans go). I agree that we should be moving to a single-payer system for a variety of reasons. (One of which is that it gives you true freedom - the freedom to quit your job without worrying that you or your family will be without medical care until you find a new one.)
I work in an office that's about 40-50% immigrants, mostly from Canada and France. I've talked at length with some of them about the differences in our systems. One thing people in the US are concerned about is that if they have a serious condition they'll be stuck waiting weeks to see a doctor about it. That's not how it works in Canada, though. If you have a life-threatening problem, you see a doctor immediately. One coworker's father had a brain aneurism and they got him to a doctor (and I believe surgery) that day, just like would happen at an American ER. Meanwhile, I have very good insurance for an American, and I already have to wait weeks to see a specialist because they're all fully booked.
Another thing people are concerned about is being able to continue seeing the doctor they're currently seeing. When the ACA was being debated, President Obama promised that you'd be able to keep the same doctor you currently see. It then turned out that a lot of people weren't able to do that. So it's understandable that people don't trust the government when it comes to issues like this.
Finally, there's the question of what kind of treatment you can get. Coverage in the United States varies widely. If you have Kaiser as your health insurance company, they've done a good job of bringing down the costs of typical health care. If you go to a Kaiser doctor for a checkup and the doctor determines you need to see a specialist, you often get an appointment with the specialist that day in the same building. It saves you time and hassle. More and better health care keeps people healthier which lowers their costs and increases their profits. The problem is that as soon as you step outside the realm of "typical" it completely falls apart. Have a rare disease? You're boned. React oddly to the standard treatment for a normal issue? You're boned. They will fight tooth and nail to not give you the treatment you actually need because it doesn't fall into their model. Add to that the world many of us lived in for decades where things like pre-existing conditions excluded you from even being able to get insurance, and it's understandable that people get nervous about any change to their coverage.
It's likely that single-payer healthcare would solve a lot of these issues, but the public has fair reason to be skeptical about change. Unfortunately, that just makes it easier to spread lies about the system. And never underestimate the ability of our government to screw up something that works elsewhere (especially when you have a group of people actively working in the government to dismantle it as we do).
It comes down to the concept of "freedom" I think. Freedom is a fetishized word in the USA. People must be free to do the things that they want to do, and they end up having a lot of freedom......
It comes down to the concept of "freedom" I think.
Freedom is a fetishized word in the USA. People must be free to do the things that they want to do, and they end up having a lot of freedom... but most of their freedoms kind of suck. In this specific instance, Americans are "free" to make a decision for themselves on how to deal with their healthcare. This is one of those times where this idea of "freedom"is kind of a lie. It's better to have the "freedom" of having your healthcare stuff decided for you so that you don't have to experience crippling debt.
The USA has this interesting patina of "freedoms". For example, the freedom to own and operate a handgun, which is clearly an instrument intended only to murder humans, is juxtaposed with not having the freedom to smoke marijuana, which is mostly harmless. The same people who are rabidly pro-freedom are also usually rabidly anti-drug, and I have never been able to figure out how they can hold two very different ideas in their head at the same time.
Freedom also rarely extends to women's bodily autonomy, as well. The same people who would sooner actually die than allow you to take their guns, will literally kill you for allowing a woman the freedom to own and operate her own body.
Freedom in the USA is such bullshit. You are free to work or die. Everything else (including your birth and disposal of your body) has a price tag, and someone is usually profiting from it.
Freedom in the USA is such bullshit.
You are free to work or die. Everything else (including your birth and disposal of your body) has a price tag, and someone is usually profiting from it.
Even working has a price, and the cost of ones own death costs nothing to the person dying, but that price is passed to the next of kin (or spread to everyone if there is none, and the state foots...
Even working has a price, and the cost of ones own death costs nothing to the person dying, but that price is passed to the next of kin (or spread to everyone if there is none, and the state foots the bill).
A famous book which those people love to quote calls this "doublethink".
The same people who are rabidly pro-freedom are also usually rabidly anti-drug, and I have never been able to figure out how they can hold two very different ideas in their head at the same time.
A famous book which those people love to quote calls this "doublethink".
This article is about a new meta-analysis, but the article doesn't do a good job of summarizing it. Better to read the analysis or at least its abstract. From the abstract: In other words, the...
This article is about a new meta-analysis, but the article doesn't do a good job of summarizing it. Better to read the analysis or at least its abstract.
From the abstract:
We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administration and drug costs (R2 of 0.035, 0.43, and 0.62, respectively). Only drug cost savings remained significant in multivariate analysis. Included studies were heterogeneous in methods, which precluded us from conducting a formal meta-analysis.
In other words, the studies are so different that it isn't worth taking any kind of average, and so the authors of the meta-anlysis didn't pick any headline figure for the amount of savings.
The article picks one study that says $2 trillion savings over ten years, so let's go with that as an example. To put this in perspective, the health care sector is about $3.6 trillion per year, about 17.7% of GDP. At $200 billion per year that's a savings of about 6%. Another way to put look at is that per-capita, $3.6 trillion is $11k per person and the reduction predicted from this study is about $610 per person.
Saving $600 or so isn't nothing, but remember that it's just one study and the other studies predicted different results. So you should put high error bars on that.
It seems that medical care would still be a large and growing part of the US economy. The US would still be spending more than other countries on medical care. Reducing inequality and increasing financial security by spreading the burden more equitably (as insurance is supposed to do) might be better reasons to support Medicare for All than an uncertain amount of savings?
(Note, that's just picking out a few numbers. I'm not any kind of health care expert and have only skimmed the report, not read it.)
Agreed, here's my take on it: Even if it cost far more than current care, well over a third of the entire population would have far better access to good medical care. The fact that it also will...
Agreed, here's my take on it:
Even if it cost far more than current care, well over a third of the entire population would have far better access to good medical care.
The fact that it also will save money over the current system means that there is 0 legitimate reason to oppose it.
I am somewhere in the middle of the top 20% of wage earners, and I currently have pretty good health insurance. It is still terrible by any measure (Keep an eye out for a rant thread I'm going to start soonish). If Bernie's M4A gets implemented as-is, it will be 8% more cash in my pocket, after taxes....and I'm still paying way above anybody making less than me. I would be able switch employers far easier since my family's health care would be assured even if it took a bit to get back on my feet.
From Wikipedia List of countries by health insurance coverage List of countries by total health expenditure per capita World Health Organization ranking of health systems in 2000 America is one of...
Facts are irrelevant.
Obamacare still equals Death Panels in most peoples minds.
Which is ironic when health insurance companies have been death panels all along.
The way I see it, healthcare is a tax without representation if you get it through your employer.
If you don't like the insurance your employer provides, can you take that money as a lump sum that your employer would have spent and put it towards the plan of your choice? I have yet to hear of an employer that does this. If your employer gets a much worse plan, what are your options? Change jobs? That's not much of a choice for most people. Medicare for all means there is someone who is elected who (in theory) answers to you for the quality of your care. It's more representative than any employer-provided healthcare that currently exists.
Wasn't this supposed to be the point of health savings accounts? You can put some amount into it tax free, but it can only be used for medical stuff? It always seemed like the type of thing that sounds OK on paper, but when it came down to it you'd never be in a position to know if you were putting enough in ahead of time or not.
That's honestly what a lot of people seem to believe.
In the interest of transparency, the author of that study is apparently claiming that $2 trillion number is being misattributed by M4A proponents.
Source
Thank you for the follow up and link, it's a good read.
The only actual number quoted in the study is the $32.6T, so it's obvious to be the number that's used in reporting and for comparison. In the article you linked he made a point of giving an upper limit on the "cell phone bill", but didn't bother with such in the study. I am curious as to why he couldn't bother guessing at a high number...
The study only quotes increased utilization, but makes no mention that healthcare costs are high because people wait until the last minute to get treated when treatment will be more expensive in hopes that the issue would have gone away during the waiting period. Increased utilization results in less severe illnesses which means treatment is less severe and less costly. Example: An oseltamivir prescription ($56) at the start of flu symptoms is miles cheaper than a single visit to the ER ($600) let alone a ICU stay ($20k) after getting pneumonia because of the flu.
This sort of criticism is exactly what I was looking for by posting his response, thanks!
This is an interesting article, but it brought up some thoughts that I had around the utility of articles and studies like this.
While it is certainly common knowledge and truth that a single payer system is superior to each other type of system, it's not really worthwhile to bring up to most of the people in the US who are against single payer systems. This comes back to a fundamental point, which is that you cannot reason someone out of a point of view that they did not reason themselves into.
The anti-single payer propaganda has directly linked the idea of medicare to "socialism" and to many people socialism is anti-freedom. There's not a lot of ways around it, unless someone in their family actually gets sick and dies, which is a terrible way to learn a lesson.
The other major stumbling block is that people who already have insurance see this as an assault on the hard work that they've done to ensure that they have insurance, and somehow forget that they would continue to still have insurance in the new system. Again, it's difficult to deal with this point of view, since it's not really a reasonable one. It's selfish, and shortsighted, and fundamentally unreasonable.
I'm not saying this to say that the article isn't interesting or that it isn't useful - it's both! - but that I'm just not quite sure how to bridge this gap between "people who already understand this" and "people who need to start understanding this".
That's a part of it, but not all of it. The right has done a great job of scaring people off of single payer healthcare via a number of other ways.
I'll start by telling you that I'm a far-left liberal (at least as Americans go). I agree that we should be moving to a single-payer system for a variety of reasons. (One of which is that it gives you true freedom - the freedom to quit your job without worrying that you or your family will be without medical care until you find a new one.)
I work in an office that's about 40-50% immigrants, mostly from Canada and France. I've talked at length with some of them about the differences in our systems. One thing people in the US are concerned about is that if they have a serious condition they'll be stuck waiting weeks to see a doctor about it. That's not how it works in Canada, though. If you have a life-threatening problem, you see a doctor immediately. One coworker's father had a brain aneurism and they got him to a doctor (and I believe surgery) that day, just like would happen at an American ER. Meanwhile, I have very good insurance for an American, and I already have to wait weeks to see a specialist because they're all fully booked.
Another thing people are concerned about is being able to continue seeing the doctor they're currently seeing. When the ACA was being debated, President Obama promised that you'd be able to keep the same doctor you currently see. It then turned out that a lot of people weren't able to do that. So it's understandable that people don't trust the government when it comes to issues like this.
Finally, there's the question of what kind of treatment you can get. Coverage in the United States varies widely. If you have Kaiser as your health insurance company, they've done a good job of bringing down the costs of typical health care. If you go to a Kaiser doctor for a checkup and the doctor determines you need to see a specialist, you often get an appointment with the specialist that day in the same building. It saves you time and hassle. More and better health care keeps people healthier which lowers their costs and increases their profits. The problem is that as soon as you step outside the realm of "typical" it completely falls apart. Have a rare disease? You're boned. React oddly to the standard treatment for a normal issue? You're boned. They will fight tooth and nail to not give you the treatment you actually need because it doesn't fall into their model. Add to that the world many of us lived in for decades where things like pre-existing conditions excluded you from even being able to get insurance, and it's understandable that people get nervous about any change to their coverage.
It's likely that single-payer healthcare would solve a lot of these issues, but the public has fair reason to be skeptical about change. Unfortunately, that just makes it easier to spread lies about the system. And never underestimate the ability of our government to screw up something that works elsewhere (especially when you have a group of people actively working in the government to dismantle it as we do).
Only in America, the ruling elite was able to convince the common folk that healthcare for all is bad...
It comes down to the concept of "freedom" I think.
Freedom is a fetishized word in the USA. People must be free to do the things that they want to do, and they end up having a lot of freedom... but most of their freedoms kind of suck. In this specific instance, Americans are "free" to make a decision for themselves on how to deal with their healthcare. This is one of those times where this idea of "freedom"is kind of a lie. It's better to have the "freedom" of having your healthcare stuff decided for you so that you don't have to experience crippling debt.
The USA has this interesting patina of "freedoms". For example, the freedom to own and operate a handgun, which is clearly an instrument intended only to murder humans, is juxtaposed with not having the freedom to smoke marijuana, which is mostly harmless. The same people who are rabidly pro-freedom are also usually rabidly anti-drug, and I have never been able to figure out how they can hold two very different ideas in their head at the same time.
Freedom also rarely extends to women's bodily autonomy, as well. The same people who would sooner actually die than allow you to take their guns, will literally kill you for allowing a woman the freedom to own and operate her own body.
Freedom in the USA just doesn't mean anything.
Freedom in the USA is such bullshit.
You are free to work or die. Everything else (including your birth and disposal of your body) has a price tag, and someone is usually profiting from it.
Even working has a price, and the cost of ones own death costs nothing to the person dying, but that price is passed to the next of kin (or spread to everyone if there is none, and the state foots the bill).
Ain't no freedom at all.
A famous book which those people love to quote calls this "doublethink".
This article is about a new meta-analysis, but the article doesn't do a good job of summarizing it. Better to read the analysis or at least its abstract.
From the abstract:
In other words, the studies are so different that it isn't worth taking any kind of average, and so the authors of the meta-anlysis didn't pick any headline figure for the amount of savings.
The article picks one study that says $2 trillion savings over ten years, so let's go with that as an example. To put this in perspective, the health care sector is about $3.6 trillion per year, about 17.7% of GDP. At $200 billion per year that's a savings of about 6%. Another way to put look at is that per-capita, $3.6 trillion is $11k per person and the reduction predicted from this study is about $610 per person.
Saving $600 or so isn't nothing, but remember that it's just one study and the other studies predicted different results. So you should put high error bars on that.
It seems that medical care would still be a large and growing part of the US economy. The US would still be spending more than other countries on medical care. Reducing inequality and increasing financial security by spreading the burden more equitably (as insurance is supposed to do) might be better reasons to support Medicare for All than an uncertain amount of savings?
(Note, that's just picking out a few numbers. I'm not any kind of health care expert and have only skimmed the report, not read it.)
Agreed, here's my take on it:
Even if it cost far more than current care, well over a third of the entire population would have far better access to good medical care.
The fact that it also will save money over the current system means that there is 0 legitimate reason to oppose it.
I am somewhere in the middle of the top 20% of wage earners, and I currently have pretty good health insurance. It is still terrible by any measure (Keep an eye out for a rant thread I'm going to start soonish). If Bernie's M4A gets implemented as-is, it will be 8% more cash in my pocket, after taxes....and I'm still paying way above anybody making less than me. I would be able switch employers far easier since my family's health care would be assured even if it took a bit to get back on my feet.
From Wikipedia
America is one of the few OECD countries that tries to privatize healthcare, which apparently costs more and is less effective.