Sharpe
6133
Thing is, this is all relative. How does the overall private insurance market compare to Medicare in terms of efficiency? In terms of cost?
Medicare is far from perfect, but there are no perfect options for where we are now in terms of health care.
I continue to feel a Medicare Buy In strong public option French/German universal-coverage style system is the best choice, but a Canadian style single payer system is the second best choice. Sticking with what we have now is a very distant choice down the list.
Matt_W
6134
This is my sister’s entire job. And she definitely describes it as maddeningly complex and obtuse and infuriating. Although she has enough experience with it that she knows how to make it work and has helped my parents and other older relatives navigate Medicare. She also bills private insurance, which is equally complex, obtuse and infuriating in roughly the same ways, but with much higher premiums.
Also, my ex-wife’s mother was diagnosed with ALS. Medicare fast-tracked her enrollment (she was 60) and she was able to obtain tens of thousands of dollars of support equipment–special van with wheelchair lift, powered chair with chin controls, motorized bed, a sling hoist for lifting and moving her around, an eye-tracking computer with voice synthesis, periodic nurse visits, etc–for no extra cost and with very little hassle. It made an unrelentingly horrible experience slightly more bearable for her and her family. There is no way she could have gotten all that through private insurance. She’d have been bed ridden and locked in.
I have Medicare, via SSDI. It sucks, man. You pay about $140 a month for it and you can expect to pay 20% of literally everything if you don’t have a supplement/advantage plan, which are both nightmares of finance to navigate.
I still can’t get a supplement (the nice one that you pay another monthly premium for but covers everything that Medicare does not). Because states have the option to tell everyone under 65 to suck it.
Fortunately I found a reasonable advantage plan that takes effect in 2020 so I no longer have to pay $110 to see my doctor or $1200 for an abdominal ultrasound. ($5 and $125 instead, I can deal with these co-pays).
I haven’t had any options before this year that weren’t some sort of bloodsucking attempt to get me to pay more premiums (not sure what changed but I can’t complain).
I skipped out on a lot of doctor’s visits because $110 to me is a lot of damn money.
Straight Medicare sucks. Dealing with them when they suddenly decide not to pay for something has actually never happened to me (lucky). I’ve had it since 2007 and have had to save money whenever I start feeling ill. Just in case. So yeah, the phrase ‘Medicare for All’ is not accurate, imho. It would have to be something else.
Bro.
What exactly do you think is happening on the private markett?
Bro.
We pay ~$800/mo for a $3000 personal + $6000 family deductible HSA plan. So no co-pays, we just pay everything until we hit the limits.
I actually went to the trouble to download and search the 75-page document describing our “benefits” and the many things that are not covered and the many ways the insurer can screw us, but what the fuck. It’s not like we have a choice. Unsubsidized market plans are even worse. So we take the one shitty option we have that is at least paid for by my wife’s employer in part (about a third, IIRC) because it’s not like we get that money back if we don’t take the health plan.
We literally have the worst of all worlds. And I’ve had rather a lot of interactions with the healthcare system over the last five years in particular.
Single payer sounds real damn good to me.
It’s been a long time since I had private insurance but mine was crazy good. I don’t recall the prices but it wasn’t a logistical nightmare.
Yes I know that the private market sucks. Just saying Medicare isn’t the bomb-diggity-doo that some people think. That’s all.
Edit: I guess I’ll just stick to silly forum games, what was I thinking?
The private market has gotten steadily worse since 2007 to the point where your first paragraph made it sound like you were sarcastically bashing Medicare by describing how cheap it was.
The point of MFA is that Medicare itself will also improve because of its better negotiating power.
dtolman
6139
We can tell its been a long time. They haven’t had crazy good plans in decades.
Now its a nightmare of copays, the horrors of out-of-network doctors practicing at in-network hospitals, and endless arguing with bureaucrats over the finer points of medical coding. All this and more, for ever increasing fees - my last plan cost between what I paid, and my company - about 2800$ a month for a family of 4. Seven years earlier, a better incarnation of the same plan only cost 2200$ a month.
This is not sustainable.
I realize that. My monthly income after bills being paid is about $400.
Healthcare in the U.S. sucks. I apparently made a huge mistake posting. Won’t happen again.
Tim_N
6142
Mate, no posting mistake, that does suck. They are right, though, that the private insurance markets over there sucks even worse. It all sucks, is the point.
In Australia we have a public + private system. If you earn over a certain amount you get taxed a little more every year unless you take up private insurance. So, the only reason I take up private insurance in Australia is to avoid this extra taxation (which would amount to maybe $1000 USD a year).
I pay $80 USD a month, I have a relatively very small deductible, no copays that I know of, and the plan covers alot of stuff but the stuff it doesn’t will be covered under the public system for no extra money.
It’s really incredible sometimes to hear about health care in the US. If you were on the equivalent of the SSDI here in Australia, you would be paying nothing. I feel for you.
Sharpe
6143
Folks, let’s show a little tolerance to Knightsaber; I think his posts were missing key context but I don’t think he deserves vicious criticism. In his circumstances, being on Social Security Disability with a limited income and depending on Medicare can in fact be a tough situation. Unfortunately, without Medicare I believe he would be in a far worse, far tougher situation.
The problem with Knightsaber’s post is that criticized Medicare in a vacuum, but the reality is that the alternative to Medicare is a private health care system that would almost certainly be vastly worse for a person with the kind of health conditions that lead to being on Social Security Disability.
It’s fair to criticize Medicare which is an imperfect system; however in the context of the 2020 election and candidates’ positions on on health care you also have to look at what the alternatives are.
Most do it’s called Medicare advantage. Don’t get me wrong since it’s free Medicare is great deal for seniors, and when you couple with a Medicare Advantage program it is objectively good insurance. My mom, 94, has wracked up hundreds of thousands of medical expense and her copays have been very affordable.
There are significant disadvantages to Medicare, beside the issue with doctors not accepting it (which probably can be addressed). The one that you and @RothdaTheTruculent seem to be naive about is the belief that MFA will eliminate those evil insurance companies denying you and your loved one’s treatment. The reality is that Medicare is a laggard in agreeing to new, costly procedures.
If there is a new say cancer treatment, the first place to approve trails are the Mayo and Cleveland Clinics, or places like Stanford here on the West Coast. Then good insurance programs like executives and union members get. Then the regular insurance companies, and the finally (often years later), Medicare will agree to reimburse a procedure. There is a reason lots of people from place with universal healthcare come to the US for treatments.
There are about 45 million folks covered by Medicare, and its been going on for 50 years. So I would expect that most of all the benefits of eliminating the middle men etc. would have already occurred. We spend about $11,300/person for Medicare, a figure that doesn’t include the amount seniors pay for co-pays or Medicare Advantage premiums. The VA is a single payer, and mostly single provider spends about $13,000/person Now both senior, and veterans are going to have higher medical cost than the average American, but still neither of those numbers give me confidence that MFA will be cheaper than our existing (admittedly awful system). But I’d happy to be wrong, and if the public option /MFAWWI is cheaper and comparable in quality to my existing insurance I’ll gladly switch. But after the disaster rollout of the ACA, I think it is crazy to not recognize while MFA scares the shit out of many of us. Which is exactly the point Rahm is making.
Keep in mind, it’s not just higher costs, it’s extremely higher costs. Like 100 fold more expansive to cover a senior, rather then us young people. I mean, 90% of Medicare costs is end of life care, isn’t it. So, the larger the percentage of people that aren’t using end of life care, the lower the per person cost will be.
So, when you think about it, it makes sense that costs would go down. That’s just logic.
Enidigm
6146
I can get why Knightsaber is frustrated.
When i quit my job and was unemployed - and now suddenly the insurance market had changed from the last time i was self-insured - i tried ACA. They basically said it was 750$ a month without a subsidy. I asked them how i was supposed to receive a tax subsidy if i had no taxable income. They basically told me SOL then.
Because so much of the medical system is moving to “concierge”i fewer and fewer of the “good” doctors are still available to medicare users. And often to qualify for substantial discounts you have to basically have a net value of zero, being forced to sell effectively all you own.
That sucks. I had to go on the ACA when I lost my job, but since I was getting unemployment benefits, I could use that to get a lot of subsidies. And I out my kids on CHIP. I actually kept my kids on CHIP because getting them on my work insurance would be prohibitively expansive, but I do pay a monthly fee for them.
Matt_W
6148
Is this per year? TriCare is a better comparison: younger, mostly healthy people. Totally single payer. It spends about $5,700 per covered member, including active duty, reserves, retirees, and their familiies.
Nope.
From this paper
Health care reform debate in the United States is largely focused on the highly concentrated health care costs among a small proportion of the population and policy proposals to identify and target this “high-cost” group. To better understand this population, we conducted an analysis for the Institute of Medicine Committee on Approaching Death using existing national data sets, peer-reviewed literature, and published reports. We estimated that in 2011, among those with the highest costs, only 11% were in their last year of life, and approximately 13% of the $1.6 trillion spent on personal health care costs in the United States was devoted to care of individuals in their last year of life. Public health interventions to reduce health care costs should target those with long-term chronic conditions and functional limitations.
Remember also that ~30% of people die before they hit age of 65, and plenty of those die from chronic expensive diseases.
So yes it will be significantly less expensive to covered younger people than older but not 10x much less 100 fold.
I agree that’s probably a better comparison, but that’s not exactly cheap almost $500/month or $1,900 for a family of 4 about what you can get ACA coverage for. But in order to get in the military in the first place you have to be pretty healthy.
Matt_W
6151
Those are premiums and don’t include out-of-pocket spending: copays, deductibles, etc. (Which will be high for a plan that “only” costs $6,000 per year. My premiums, most of which are paid for by my employer, are more than twice that amount.) TriCare numbers are total spending.
Enidigm
6152
It was just a little shocking that the people who most need health insurance - those with no income - don’t really seem to have path to receive it. I’ve never taken any government assistance for anything so i can’t say from personal experience how one goes about even doing it in practice. But since there are now “windows” which you can subscribe for health insurance, it’s even more frustrating. I know my aunt who was unemployed before she died, in order to receive a lung transplant for her inherited illness, basically had to liquidate her entire estate to 0 so that she could qualify for assistance. Including selling her house, her car, and reducing all her bank accounts to 0.
Also the BXBS insurance i have now only pays about 50% of expenses. The dental insurance is only good for about 25%. That’s after copays.
