http://www.democraticunderground.com/10027197977 Thu Sep 24, 2015, 07:00 AM
Star Member Recursion (41,228 posts)
Do you really want Medicare For All?
I really feel like people are ignoring how Medicare actually works when they ask for that.
Medicare is divided into 4 parts, A, B, C, and D.
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
Medicare Part A covers hospital care. Inpatient hospital care has a $1260 deductible. After that, you will pay $0 for the first 2 months, $315 per day for the third month, and $630 per day for any stay beyond 90 days.
Medicare Part A covers skilled nursing facilities (in some circumstances). You will pay $0 for the first 20 days, $157.50 per day for days 21 through 100, and all costs beyond day 100.
Medicare Part A is not cheap. The premiums are $407 per month. Most retirees have their premium paid by the Medicare Trust Fund and pay nothing themselves, but remember that expanding Medicare to everyone means that the Trust Fund could not pay for everyone. In fact, workers would have to continue donating to the trust fund while also paying ~$400 / month simply for this basic insurance.
Medicare Part B covers most other medical services. It has a $147 / year deductible (this seems reasonable), but after that it only covers 80% of costs; you (or your private insurance) are responsible for the remaining 20%.
Medicare Part B's full premium cost is $335.70 / month. Most retirees have some of that subsidized by the Trust Fund, but the same issue as above applies: if we expand it, the trust fund can't cover everyone, so everyone will be paying that (while also still contributing to the Trust Fund).
Medicare Part C is a system in which a private insurer can provide Medicare Part A and B-like benefits to retirees with a subsidy from the Trust Fund. It's not even clear what this would mean in a Medicare-for-all system, so I'm not sure what to do with it.
Medicare Part D covers prescription drug costs. The benefits vary by plan, but the deductible cannot be more than $360. The copayment varies by drug; sometimes you are charged a flat copay (say, $10 per refill) and other times you are charged a percent of the cost.
Medicare Part D's unsubsidized premium is $72.90 / month (again, same point and reservation about the Trust Fund).
In addition to the Trust Fund, there is another source of subsidies for seniors: many are dual-eligible for Medicare and Medicaid. And this is, to me, where the plan really falls apart. Because the people who should be on Medicaid but aren't because their states didn't expand it are exactly the people who still need the most help right now.
So, we have a plan that all told:
Costs $815 per person per month,
Has a $1260 deductible for hospital care, and
Has a $147 deductible for other care but only offers 80% coinsurance after that
If you think ACA was a political loser, that's nothing compared to what telling people that would have to go on that would be like. Now, you can wave your hands all you want about the premiums coming down, but nobody's made a convincing case of how much they would come down. But let's say they do, and let me turn that into a question: how much would they have to come down for this mandatory public insurance to be politically palatable?
I think there's a reason very few countries use a single payer system to deliver universal health care; even Canada (which is probably the closest) doesn't do it nationally but by province. We need to come up with a better idea, because I don't think this is a good one.
Fair questions that require some intelligence and thought.
Oh wait a minute,you are asking something like that at the DUmp?
Response to Recursion (Original post)
Thu Sep 24, 2015, 07:05 AM
Star Member Hortensis (836 posts)
1. Single payer modified to fit the needs and means of the larger population.
Or "I have no clue but it everything should be FREEEEEE!!!!"
Response to Hortensis (Reply #1)
Thu Sep 24, 2015, 07:07 AM
Star Member Recursion (41,228 posts)
2. OK, modified in what ways?
This is what I'm talking about. "Medicare for all" is a nice slogan but it doesn't tell me what someone is actually for. How would you modify a single payer regime to work for our larger population?
Nice try.
Response to Recursion (Reply #2)
Thu Sep 24, 2015, 07:36 AM
Star Member Hortensis (836 posts)
6. Well, 1% of all Medicare dollars go to non-patient-care overhead.
6% for those who purchase Medicare Advantage. That is opposed to a cap of 20% for the healthcare administration (no longer insurance) companies selling on the exchanges. That's a lot of money just for paper shuffling.
Exactly what modifications would be needed are beyond me. I assume there would be literally thousands. However, shifting all those wasted premium dollars into paying for, say, a 6% system would pay for a bunch of them. And that's the end of this one for me.
Click your heels together 3 times and say skittles and unicorns.
Response to Recursion (Original post)
Thu Sep 24, 2015, 07:32 AM
Star Member Warren Stupidity (44,517 posts)
4. Well that is dishonest.
Medicare part A premiums are 0 if you paid into medicare. Expanding medicare to everyone would continue that. Yes the horrible drug 'benefit' badly needs reform. Yes nursing home care doesn't exist. It should. Are you aware of the deductibles that most private insurance plans before and after ACA come with? They are far worse than medicare.
Just tell me it is free,who cares what someone else has to pay for me to get it.
Response to Recursion (Reply #9)
Thu Sep 24, 2015, 07:43 AM
Star Member yardwork (38,895 posts)
12. We can expand it any way we choose.
It's ridiculously dishonest to imply that Medicare would stay exactly the same if it was expanded to universal coverage.
Just make it FREEEEEEEEEEEEEE!!!!!!!!!
Response to yardwork (Reply #12)
Thu Sep 24, 2015, 07:45 AM
Star Member Recursion (41,228 posts)
13. I agree, so people who want to expand it need to talk about what that would actually mean
We could all pay much higher Medicare levies into a larger trust fund that pays everybody's premiums.
We could all directly pay Medicare premiums, with or without a mandate to do so.
We could do some combination of the two.
But those aren't neutral decisions, and it's kind of silly to talk about being "for" Medicare For All without saying which one of those paths you want to go down, because they're very very different.
See my comment above.
Response to Recursion (Reply #9)
Thu Sep 24, 2015, 07:54 AM
Star Member Warren Stupidity (44,517 posts)
16. So your theory is that a change to medicare to cover everyone would have
to work just like the current system that doesn't cover everyone?
As I said, a totally dishonest op.
Response to Warren Stupidity (Reply #16)
Thu Sep 24, 2015, 07:56 AM
Star Member Recursion (41,228 posts)
17. No, it would just cost a whole lot
Like, around $800 per person per month.
In your plan to expand Medicare, what do you do with someone who doesn't pay the premiums? Or are there premiums at all? (And if not, how are you paying for it?)
Psssst,he doesn`t want to pay a damn thing.
Response to Recursion (Reply #17)
Thu Sep 24, 2015, 07:59 AM
Star Member Warren Stupidity (44,517 posts)
18. No. It. Wouldn't.
Please take a little time to educate yourself. Our current system is ridiculously expensive. We have the most expensive healthcare system on the planet and we deliver remarkably mediocre healthcare from that system. Every other modern industrial democracy that has implemented a universal public system has far lower per capita costs and they deliver better healthcare. I guess we are just too stupid to do that here. Or something.
Well you picked your name correctly.
Response to Recursion (Original post)
Thu Sep 24, 2015, 07:41 AM
mwooldri (6,632 posts)
10. Personally I'd like a service that's free at the point of delivery.
"Medicare for all" is a good start IMO.
At least you are honest.
Response to Recursion (Original post)
Thu Sep 24, 2015, 08:11 AM
KentuckyWoman (674 posts)
20. Yes I do want medicare for all
It's not that hard to tweek the system we already have.... no need to remake the wheel.
Require everyone to pay into medicare. A 1.5% tax on ALL earnings - corporate and private - straight off the top - will easily get the job done. Demand more from the people at the top to shore up the trust fund. Demand responsible charges from providers and quality BASIC care.
I have no problem with giving all people the exact same choice seniors get now. I can choose "traditional" 80/20 insurance where I can see any doctor that takes medicare without any referrals OR I can choose a medicare HMO that limits my costs and my choices. If I want more choice I can minimize my risk for high costs by buying a supplemental policy.
I'd kill off medicaid and put the dollars into national medicare. Give people who gross under 400% of the poverty level coverage in a medicare HMO plan with no copays, deductables, or coinsurance.
Cover long term care. Cover home care. Offer a stipend to a family member who quits works to full time caregive and therefore save money out of the system.
The system works pretty damn good now for seniors. Generally we old farts are much healthier and living longer than our counterparts of the past. It works.
Expand it.
Response to Hoppy (Reply #21)
Thu Sep 24, 2015, 09:01 AM
Star Member Recursion (41,228 posts)
24. Currently we spend $3 trillion on health care per year
If we run with the notion that Medicare cuts costs by 20%, we would be spending $2.7 trillion on health care without getting people who currently can't afford treatment treated.
Kaiser estimates 12% of the population is uninsured. If they start using medical services at the rate most people do (which is probably optimistic; they will probably need more care than people who have had insurance), then immediately we are adding 13.6% to the costs (that's 12 divided by 88), meaning the total cost is just over $3 trillion... which is exactly where we are now. And that's not counting the people who have insurance but can't afford the copays and so are skipping treatments...
I think it's irresponsible to say that extending health care to the entire country is going to save money. We have so many people currently going without health care that the costs are going to go up.
Give it up,you are talking about a credit card bill to 5 year olds on Christmas morning.
