The link:
http://www.democraticunderground.com/10027306302The OP:
Recursion (42,267 posts)
Medicare for all would cost more than what we are paying now. We need to stop avoiding this fact.
Looking at 2013 (the last year we have full data for), 168 million Americans have private health insurance of some form, while 47 million have Medicare and 41 million have no insurance (Kaiser, below). 50 million of the people with private insurance cannot actually get medical care because they cannot make their copays or deductibles (Commonwealth). The 168 million pay $916 billion in premiums to receive $801 billion in treatments for an overhead rate of 12.5% (CMS; the next two sentences too). Medicare, meanwhile, receives $585 billion in revenues to deliver $550 billion in treatments, for an overhead rate of 6%. So, a 6.5% savings off of $916 billion yields $60 billion dollars saved if we do nothing but migrate everyone on private insurance to the Medicare model.
Medicare has another advantage: it pays doctors, drug companies, etc. less than private insurance, on average 20% less (CNN). If that's a good guide, we would be saving an additional $160 billion, and the 168 million people currently with private insurance would be paying $680 billion for $640 billion in treatments, and we'll be saving $220 billion dollars. All well and good. But now let's look at the uninsured and underinsured. Remember: all we've done so far is take the exact same treatments people are getting today and find a cheaper way to pay for them. We haven't addressed the 50 million insured people skipping treatments, or the 40 million with no insurance. That's 90 million people who will now be getting health care under Medicare For All that aren't now.
The 118 million people who currently actually get treatment through private insurance would in this plan be costing on average $5700 per year (680 billion divided by 118 million). If the underinsured and uninsured start using medical care at the same rate as those 118 million, that will be an additional $513 billion in expenditures, meaning instead of paying $220 billion less, we'd be paying $293 billion more in total than we are now.
But what's worse is that we probably wouldn't spend that, because if we simply literally expand Medicare to everyone, they would have a $1200 deductible, a 20% copay for all treatments, no out of pocket maximum, and a $550 / month deductible, assuming the non-Senior Medicare enrollees would not get a premium subsidy from the Trust Fund like Seniors do. (And if we want the plan to be more generous than the current Medicare system then we have to increase the baseline cost we're talking about by that much more.) So it's not clear that that's actually going to help the underinsured at all (it sounds like exactly the sort of plan that isn't helping them now). But it really does to me illustrate the fact that if our actual goal is to make the $513 billion dollars in foregone health care actually happen, we're going to have to pay $513 billion dollars one way or another.
Single Payer may be a great idea (though very few countries actually do it; most achieve universal health care some other way), but the notion that it's going to cost less than our current "strategy" of simply not treating people is just a fantasy. It's going to cost a whole lot of money. And we really need to be up-front about that.
As an idea of the scale we're talking about here, $293 billion is about 80% of the entire defense budget, or a 12% payroll levy, or a 16% corporate tax (on top of our current levies and taxes), or a 20% VAT (depending one what we exclude).
https://www.cms.gov/Research-Statistics-Data-and-systems/Statistics-Trends-and-reports/NationalHealthExpendData/index.html
http://kff.org/other/state-indicator/total-population/
http://www.commonwealthfund.org/publications/press-releases/2015/may/underinsurance-brief-release
http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/
Now this is a large bonfire. And awaaay we go:
elehhhhna (29,287 posts)
1. Dgaf. Take it from the military budget.
Or vote for a war liking status quo 1%ers lady.
Cause when war comes to our shores the chinese will be happy to give you free health care. A bullet to the head.
Recursion (42,267 posts)
8. That's $300 billion per year. That's 80% of the defense budget (nt)
Facts?
Igel (22,757 posts)
18. That's the facile solution.
Do that and suddenly you have a lot of high-school graduate men with no additional training looking for jobs.
Suddenly a huge number of 22-year-olds no longer qualify for the GI bill.
Suddenly a large number of manufacturing jobs--munitions are built in the US, for the most part--vanish.
The military has a large civilian workforce. They'd be fired.
The innovation and engineering jobs that the military also provides for vanishes.
The pension funds and retirement funds that rely on stocks from defense-related contractors (and that can be toilet paper vendors) are weakened. When we hear about how much of the wealth in America is owned by the top 1% or 2% that's restricted (tacitly, because nobody wants all the details) to wealth held by households and individuals. Not pension funds, whether state or corporate.
Don't think of the DOD as "the war machine." Think of it as a $500 billion/year stimulus package that helps working class high-school graduates and the engineering/manufacturing sector.
Scuba (48,062 posts)
32. And you have lots of new job openings for nurse, medical technicians, etc. Seems you ...
... folks who want us to think of DOD as something other than a "war machine" always overlook the alternative jobs that would be created with that money. And those new jobs would benefit humanity, unlike your war machine jobs.
Really?
librechik (26,937 posts)
40. foreign bases in Butt****istan?
We could cut the military to pay for healthcare. And do all the other sensible things grownups around the world do to care for their citizens. That we don't.
Like the russian and the chinese?
Doubledee (48 posts)
64. Not quite
Money spent on defense does not return to the economy anywhere near as much as does money spent on infrastructure and public assistance. Further, cost overruns, waste, corruption, black budgets, et al, all contribute to our economic woes not, as you suggest, to a thriving economy.
So the military procurement process has waste and corruption and medicare for all won't?
Recursion (42,267 posts)
98. Really? Because I'm pretty sure we're conversing on the Internet, funded originally by DARPA
The D in DARPA stands for "Defense".
Alert!!!!
Then 1 weak ebony pansy weighs in:
1StrongBlackMan (24,268 posts)
106. As someone that lives in a community where it's largest private ...
employer is a defense contractor, and there is a military base ... I've had this discussion a million times.
Idealist: "... and we can pay for it by ending military spending!"
Me: "Okay. But what do we do about the 5,500 unemployed missile designers/builders and the other 5,000 that support their work ... and what about the 34,000 civil workers that work on the base ... not to mention the Billions dollars the put into the economy?"
Idealist: "Well ... we just convert them to Green Tech and infrastructure repair."
Me: "You do know that building a missile is a different skill set than what is needed to fix a build. Right?"
Translation: Don't take my communities federal dollars!!!
I suspect that 1 weak ebony pansy's job is directly related to those fed dollars.
CurtEastPoint (6,055 posts)
2. What value do health insurers add? Zero. What do they do? Make profit.
Remove that from the equation, then let's talk.
What value does medicaid add? It subsidizes losers healthcare so they can breed more thus taking more dollars from the fed budget.
A big conversation ensues about costs which I won't bring over.
Scuba (48,062 posts)
34. Please cite your source for the claim that "Medicare pays 80% of what private insurance pays."
In my not small experience, private insurance companies were negotiating prices comparable to, sometimes lower than, what Medicare was paying.
Prove it or shut up!!!
SickOfTheOnePct (3,312 posts)
44. CNN link
http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/
Umm damn. What do I say now? I know...
Scuba (48,062 posts)
60. Doctors represent only a small part of healthcare reimbursement.
Clue bat slams the underwater breathing apparatus dummie:
Recursion (42,267 posts)
65. No, it's a very large part
<pie chart>
Here's "stuff" (drugs and devices) vs. "overhead" vs. "services". Notice how "services" is like Pac-Man there.
Here's the breakdown of "services":
<pie chart>
Note that "hospitals" will include a lot of payments to physicians also.
So the dummie scuba got his ass handed to him. Can a dummie ever admit they were wrong?
Scuba (48,062 posts)
79. Yep, just over a quarter of services, which is about 3/4 of everything.
And 30% of 75% is less than a quarter of all healthcare costs. Not a big part of the overall cost picture.
Facts intrude:
Recursion (42,267 posts)
80. Much bigger than, say, "profits", which is the usual boogeyman here (nt)
Dummie scuba triples down:
Scuba (48,062 posts)
87. Still disproves the claim that Medicare only pays 80% of healthcare costs.
BTW, this thread hasn't even ventured into the esoteric world of healthcare costs vs. charges. As we used to say in the business, healthcare information management isn't rocket science; it's much more complicated than that.
The reply?
Recursion (42,267 posts)
90. Medicare pays 80% of a given person's treatment. That's the limit
That's not a "claim", that's just what Medicare pays.
http://www.webmd.com/health-insurance/insurance-basics/medicare-part-b-doctor-costs-and-lab-tests
Medicare Part B pays 80% of most doctor's services, outpatient treatments, and durable medical equipment (like oxygen or wheelchairs). You pay the other 20%. Medicare also pays for mental health care costs.
<bunch of pie charts>
OUCH!!!! Will Dummie scuba surrender?
Scuba (48,062 posts)
107. As I said, the thread hasn't ventured into costs vs. charges, nor into DRG's. Nor into ...
... the arcane world of insurance/provider negotiations and reimbursement.
This is not nearly as easy to dissect as your pie charts suggest.
Translation: LALALALALALA I CAN"T HEAR YOU!!!
That is all I will bring over. Well worth the read.
