RichVR
6112
I would think, cheaper for people who have lower income?
I think @Alstein means the cost of a public option should be percentage of income, rather than a flat amount, so it’s affordable at any income level. In practice, this likely means there will be a balance point somewhere in the upper-middle-class range where a private plan is actually cheaper than the public option. You could deal with that via some kind of cap, if you think it’s a problem, though I tend to think it’s actually a nice competition-encouraging feature.
I think the way Mayor Pete described it is when you go to Healthcare.gov. in addition to the United Health Care Bronze, Silver and Gold, and the Kaiser Bronze Silver, and Gold, you’ll have the Medicare option. The price of all those plans will be reduced if your income is below 400% of the poverty level ofr$97,000 for a family of 4. I just want to make sure that price they offer Medicare for a 55 year old is the actual price it cost the government to deliver it and the subsidies are the same.
I just want someone to close the family loop holes that the ACA created.
Dems: “Here’s our carefully crafted position just to the left of the middle of the Overton window”
GOP: “Let’s dismantle all entitlements”
Dems: “Shit, need to run over there to get back in the middle, or people will think we broke a campaign promise and will stop voting for us!”
He also starts out with a dumb frame (though it comes midway through the article), where tries to use “90% have coverage” to imply that healthcare is a low priority issue that we should be happy to get a small win or two on. But it’s the highest priority issue among Dems other than defeating Trump, according to the polls I’ve seen.
That, plus ‘they have insurance’ is a pretty low bar. What’s the premium? What’s the deductible? The last exchange plan I was on had a $26k-per-year family deductible, $13k-per person. Premium was $8k per year. I could deal with that, but most people don’t have twenty grand a year to pay out of pocket.
SlyFrog
6120
Part of the insurance issue is that we have a hard-on for doctors and healthcare providers, and have a false viewpoint that they are somehow these shining angels of mercy who will do nothing wrong.
No one wants to go after doctors. It’s much easier to go after the big evil insurance companies, whoooooo, boogie boogie booooo, the evil insurance companies.
Never mind that it’s not the fucking insurance company that is charging staggering amounts of money for health care. It’s the greedy fucking doctors and actual health care providers and institutions.
But again, the average American’s knowledge of health care comes from watching someone on Grey’s Anatomy save the life of a 3 year old girl with super-cancer, and all doctors, while they may fuck a lot and be saucy and sassy, are fundamentally good people saving the world.
It’s the same issue with “educators” with respect to universities, etc. All them damn greedy student loan companies. It’s never the people and institutions who actually took the massive amount of money that created the indebtedness.
Sharpe
6121
No industry is either pure good or pure evil; every group is subject to human nature. I’m not saying doctors or educators are worse than any other group, but when it comes to the filthy lucre, they are as subject to greed, rationalization of greed, and self-dealing as any other group.
There’s a deeper issue here in that our society relies on market forces to balance out these human frailties, and it’s not a coincidence that the two industries mentioned, health care and higher education, both have significant market imperfections which cause market forces to be less than perfect on balancing pricing issues. In both industries, you have a problem of inelasticity. Healthy markets rely on flexible supply and demand as a necessary mechanism. In health care, demand is not elastic (unlike other industries, walking away from a bad deal or a high price CAN kill you); and in higher education, supply (specifically the supply of slots in “elite” universities) is not elastic. Because we have put a “prestige premium” on certain colleges, our society has created an inelastic market for higher education. In both scenarios, the inelasticity means that supplies/providers can jack up the prices far beyond the standard rate of inflation, and that the normal market mechanisms (like just walking away from an overpriced supplier) cannot and do not counterbalance the pricing.
So I agree with Slyfrog on the character issue here but I also think character is a bit of a detour; the real issue is being honest about the limitations of a purely free market and identifying portions of the market where government intervention is required. As an example, higher education was much less expensive decades ago during the era when states were building and financing high quality but low cost state universities; now that many states are unwilling to fund those schools at a healthy level, the market imperfections are reigning supreme.
This is all underscores my core economic philosophy: I’m not a socialist who believes in 100% government control with central planning, and yet I’m not a believer in the fairly tale of 100% self-regulating “free” markets; the overwhelming evidence is that balanced, regulated markets, with reasonable government intervention where necessary, is the best economic policy. Basically, the type of economic policy what was common from the 30s to the 60s in the US, and that started to erode during the 70s, accelerating in subsequent decades.
That’s why, although I don’t agree with Warren on every single issue, overall she is strongly my preference for the 2020 Presidential nomination.
SlyFrog
6122
I think that is incredibly well said, and I tend to agree with your outlook as well. The funny thing is, I think even real conservatives would agree with you, but the formerly conservative party has been hijacked by idiots.
The reality is, to my understanding, that even conservative economists, who are being honest and true to the profession, recognize that there are situations where free markets essentially do not work to the benefit of the greater part of the population. For example, price gouging situations due to natural disasters or other resource bottlenecks (which as you essentially reference, is a scarcity issue). Free markets and free exchange essentially break down in certain circumstances, but too many Republicans (and libertarians, being honest) just refuse to recognize that. (I have a separate theory that a lot of libertarians secretly get erect at the thought they they might be able to control people by having limited resources those people need, but that’s just my own bit of armchair social psychology).
I recognize that no industry is pure good or pure evil, and I agree with your point on that. My point, however, is that most industries do not have some sort of “shield” where their members are falsely deemed to be these paragons of virtue. No one ignores the giant upswing in legal costs because attorneys are some noble paragons of virtue who would never be greedy, they just want to help people.
Yet that’s what we do with educators and doctors. They have this halo that is quite frankly unwarranted. It doesn’t mean they’re all bad. But they are greedy, and they want to make a lot of money and live really well just like a lot of other people do. I think we have given them a bit of a pass because we’re not supposed to question them, because of the nature of what they do. And I also think their representatives are very adept at using that to try to focus blame to other entities, when much of the blame lies squarely with them.
I agree with this, and think we will ultimately have to regulate medical service fees and charges; or, alternatively, have a single payer negotiate them, which amounts to the same thing.
That said, while it isn’t the insurance company setting the high fees, it is the insurance company routinely denying your coverage and claim as matter of policy. There is a reason people hate insurance companies. The industry does not exactly have a strong reputation for integrity.
They are, however, setting the reimbursement rate (yes, I know its a result of a negotiation between the provider and payor). Which may or may not have a rational relationship to the original high fee. Opaque pricing from the patient point-of-view is yet another problem with healthcare. Not that you’re going to be price-shopping while bleeding out from a gunshot (or other emergent medical crisis).
Alstein
6125
That, plus a guarantee that the out-of-pocket expenses for approved medical procedures (basically everything under the ACA now) cannot exceed x% of your income above poverty level (thinking 12.5%+2.5% per dependent capped at 20% total)
That amount would be your premiums, deductible, drug expenses.
Someone needs to say it: Rahm should eat shit.
If Rahm was being remotely honest he would admit MFA isn’t good just because it expands coverage and saves tens of thousands of American lives each year. It’s also good because it removes vast inefficiencies and helps untangle the Rat King of American health care so that we can get closer to the heath care costs of the rest of the industrialized world.
More specifically, with MFA you no longer have:
- People needing to learn Advanced Squad Leader level of rules when they come of age, just so that they can interact with our byzantine insurance system at a basic level of competence
- People stuck on the phone with their insurance companies, trying to push back against false charges
- Out of network fees
- essentially random fees that you get when using health care
- the Kafka-esque process of trying to find out how much medical care will cost before you actually get the medical care
- People having to deal with the thorny interface of their insurance, medical bills, and taxes
- People having to look up a new insurance plan each year
- The game of musical chairs that gets played each year as doctors and patients get re-assigned to each other, and doctor’s and hospitals completely lose the institutional knowledge they have built up on that patient
- The respect that patients lose for doctors, when they realize that they are unlikely to see this doctor more than 2-3 times before they are shuffled off to another one
- Each hospital needing lawyers and negotiators to deal with each of the insurance companies
- Each hospital needing a platoon of medical coders to deal with each of the insurance company’s billing systems
- The money that insurance company’s bleed off in profits, overhead, and lobbying
- the emotional suffering that people go through, when at their most difficult moments in life they are also trying to parse insurance company small print and think through the financial shit wave that is coming their way because they made use of the US medical system
- the people who die or are injured or suffer without need because they are afraid to use the medical system.
Those factors are just off the top of my head. I’m sure there a dozen more that I’ve missed. By removing these factors, we take a big chunk out of the 1 Trillion dollars per year that we lose to health system inefficiencies.
Dude do you actually know anybody on Medicare? Every helped anybody fill out a Medicare form? Ever tried to figure out the maddeningly complex rules to see what Medicare will cover? Ever try to appeal a treatment Medicare has refused?.
I’ve done all but the last, and spent plenty of meals in my mom’s senior living home listening to Medicare horror stories from her friends.
The healthcare you describe sounds really marvelous, it also has absolutely no resemblance to the actual Medicare system that exist today.
Finally lets not forget, the medicare reimbursement rates are low enough that many doctors refuse to take Medicare patients.
The thing is, you can decline Medicare (Part B) and rely solely on private insurance. But basically no one does. So maybe, you know, it ain’t so bad? Maybe it’s better than relying on private insurance…
@Strollen is right, Medicare is nothing like that now and MFA won’t be either. But hey, if you can figure out an actual system that removes all that bad stuff…Rothda for President! :)
Why don’t they buy private insurance?
No, MFAWWI won’t be like that, because it doesn’t do anything to control costs and requires all sorts of Byzantine BS to make sure that wrong people don’t get to benefit from it. MFA means that everyone benefits automatically and costs and weird network effects are controlled by the single payer and the fact that all doctors will accept it. Go to whoever you want, have better coverage, pay less. It’s only possible with a single payer system.
Nesrie
6131
Someone claiming Medicare is efficient… Thinking they have little to no experience with Medicare from either end. It’s right up there with people saying Medicare is free.
Yeah, my Mom is on Medicare, and I just spent the weekend with her. She has no complaints about it, and her positive experience with it is one of the ways I try to nudge her into seeing that maybe other people should get the same level and type of health care that she is getting.
In the previous report on the financial impact of MFA, they went with the assumption of paying out 140% of current Medicare rates. Finally, let’s not forget, there are cost savings for both providers and customers by cutting out a layer of unneeded middlemen. That’s kind of what started this conversation.
