What happened to Medicare for All? (M4A)

[MorkandMindy]

In 2018 M4A was very popular:

A Reuters-Ipsos poll released in August 2018 found that 70 percent of Americans supported "Medicare for all."

An American Barometer survey conducted by Hill.TV and the HarrisX polling company, found that 42 percent of respondents said they "strongly" supported the proposal, while 28 percent said they "somewhat" supported it.

Again, 70%.

 

[MorkandMindy]

It works

Countries with single payer would not trade it in for the US for-profit system.

Because on average the US 'system' is 70% more expensive than the single payer systems as a percentage of GDP.

And that is a fairly consistent figure for the average, most countries pay similar amounts for healthcare as a percentage of GDP, and the US is an outlier, getting robbed by the health insurance companies.

Single payer is a pretty obvious choice

 

[PloverWing]

I don't think anything's happened to it. There are still a lot of people who think health care financing needs to be improved, and a single payer option is still one of the viable options.

There are just other things ahead of it in Washington's priorities at the moment. COVID is still a high priority. Aside from COVID, most of Congress' energy right now seems to be directed toward the infrastructure bill, which is also worthy of having high priority.

Given the current makeup of the Senate, it's probably not practical to try to get health care reform done right now. The current batch of Republicans won't vote for a single-payer health care system (and moderate Democrats might not either), but they probably can be persuaded to vote for repairing bridges, so it makes practical sense to start with something that Senators can agree on.

 

[hedrick]

What happened is a Senate that would never pass it. Biden is concentrating on things he has a reasonable chance of doing.

in the US context it would also be challenging to implement. The first are
Republican Congress would lower funding to the point where it doesn’t work. This has been an issue in the UK as well. It would also be hard to get a bill passed that didn’t ha e enough political compromises to seriously weaken it, I’m afraid this will have to wait a generation.

 

[MorkandMindy]

So what went wrong?

The backers (owners?) of the DNC rejected it and it died.

And it was killed off:

Elizabeth Warren claimed it would cost 52 Trillion dollars over ten years and that pretty much killed it. I downloaded her platform statement on M4A and she provided no argument for why it would cost more rather than less than the existing system, and in her statement she compared 8 different healthcare plans that didn't cost as much, and then left her own out.

oh, we all posted at once... great posts!

 

[MorkandMindy]

I don't think anything's happened to it. There are still a lot of people who think health care financing needs to be improved, and a single payer option is still one of the viable options.

There are just other things ahead of it in Washington's priorities at the moment. COVID is still a high priority. Aside from COVID, most of Congress' energy right now seems to be directed toward the infrastructure bill, which is also worthy of having high priority.

Given the current makeup of the Senate, it's probably not practical to try to get health care reform done right now. The current batch of Republicans won't vote for a single-payer health care system (and moderate Democrats might not either), but they probably can be persuaded to vote for repairing bridges, so it makes practical sense to start with something that Senators can agree on.

The existing wealth care system costs a bundle, 17.7% of GDP, and dwarfs all other issues.

Just the amount of profiteering in the existing healthcare system is bigger than the entire military budget.

 

[MorkandMindy]

What happened is a Senate that would never pass it. Biden is concentrating on things he has a reasonable chance of doing.

in the US context it would also be challenging to implement. The first are
Republican Congress would lower funding to the point where it doesn’t work. This has been an issue in the UK as well. It would also be hard to get a bill passed that didn’t ha e enough political compromises to seriously weaken it, I’m afraid this will have to wait a generation.

I saw in Britain that politicians who played it safe and didn't upset anything were eventually voted out for being useless, it happened maybe once.

 

[ArmenianJohn]

In 2018 M4A was very popular:

A Reuters-Ipsos poll released in August 2018 found that 70 percent of Americans supported "Medicare for all."

An American Barometer survey conducted by Hill.TV and the HarrisX polling company, found that 42 percent of respondents said they "strongly" supported the proposal, while 28 percent said they "somewhat" supported it.

Again, 70%.

It died with Bernie Sanders' presidential campaign.

The Republicans and Democrats don't believe in it because they are paid by the health insurance industry.

 

[ArmenianJohn]

What happened is a Senate that would never pass it. Biden is concentrating on things he has a reasonable chance of doing.

in the US context it would also be challenging to implement. The first are
Republican Congress would lower funding to the point where it doesn’t work. This has been an issue in the UK as well. It would also be hard to get a bill passed that didn’t ha e enough political compromises to seriously weaken it, I’m afraid this will have to wait a generation.

It wouldn't be hard to implement. Medicare already exists and is proven to work and that is for the population with the most health problems. Expansion to include younger and healthier participants into the pool would only drive down expenses for Medicare.

It would be wise to implement it by expanding Medicare slowly but steadily. Lower it to be for those 60 and over, then 55 then 50, then 40, then to all. Do this over 5 to 10 years, if that.

A compromise would be to allow for competition for the supplemental insurance, but at least Medicare would protect all people from complete financial ruin in the face of a serious injury or illness. Right now, even with all my insurance coverages (including extra insurance for catastrophic injuries and illnesses) I can still be financially destroyed with just one serious enough health problem.

There is nothing difficult about implementing it, other than negative attitudes that are based on politics and emotions and not logic.

 

[jayem]

Elizabeth Warren claimed it would cost 52 Trillion dollars over ten years and that pretty much killed it. I downloaded her platform statement on M4A and she provided no argument for why it would cost more rather than less than the existing system, and in her statement she compared 8 different healthcare plans that didn't cost as much, and then left her own out.

oh, we all posted at once... great posts!

$52T over 10 years would be a bargain compared to the current cost of health care.

The most recent data I could find on health care spending was from 2019. Total spending was $3.8T. A 4.6% increase from a year earlier. That's been about the average yearly increase for quite a while.

Historical | CMS

This was the year before Covid. To be very conservative, let's estimate 2020's health care spending increased 6%. We'll round it down to $4T. That's our starting cost. And we'll stay on the low side and estimate spending increases 4.5% every year for 10 years. Plugging those numbers into a future value calculator (that accounts for compounding over a decade) the total cost of our current system of health care spending over 10 years will be $62T. If a Medicare-for-all system will cost $52T, we're saving $10 trillion.

 

[Fantine]

We pay more per person for our patchwork system with many un and underinsured than other countries pay for everyone. Insurance costs eat up 20% or more of our premiums.

Who cares if we buy insurance from the government instead of an insurance company if it's cheaper and more inclusive.

 

[MorkandMindy]

$52T over 10 years would be a bargain compared to the current cost of health care.

The most recent data I could find on health care spending was from 2019. Total spending was $3.8T. A 4.6% increase from a year earlier. That's been about the average yearly increase for quite a while...

Why are healthcare costs increasing more than inflation?
Are they paying staff more?


Not from what I've seen.
But the health insurance companies are making much bigger profits

In the Fortune 500 United Health is number 5. It is well ahead of Exon Mobil at number 10. That's a lot of profit to make off premiums

And CVS Health makes a lot off premiums too and it is number 4 in the Fortune 500.

Health Insurance is more profitable than piracy used to be.

 

[MorkandMindy]

The M4A supporters I met were saying we presently don't cover the healthcare costs of 8% of the population. Some do eventually get indigent care, often to late, but in terms of hard finance the amount of the costs left uncovered is maybe 5%.

And the M4A supporters were claiming we could cover the remaining 5% or whatever little bit it is by cutting the military.

As you can see I am an M4A supporter and there are a good number of good people on here who are, but we do have do get out to the M4A crowd that they are making a fundamental mistake in believing the added cover will add cost.

That extra 70% the US healthcare costs is because of the added complexity in filtering out the 5% who don't pay anything and charging others more so they go bankrupt.

Covering 100% would cost a lot less in total owing to simplified accounting and elimination of the health insurance companies.

Even the M4A supporters don't know that.

 

[MorkandMindy]

To be more exact, the US government funds 1.2 Trillion directly and 0.234 Trillion in healthcare related tax breaks. That comes to 1.434 Trillion and with single payer the US total healthcare expenditure would be expected to be around 2 Trillion dollars, so there's about another 566 Billion to find.

Which isn't really a lot for a couple of reasons.

Total healthcare costs including health insurance company profits and huge pharma markups at present comes out at 3.5 Trillion dollars.

Subtract the 2 Trillion it should cost and that's 1.5 Trillion of waste at present. All we need to do is recoup 0.566 Trillion of that and that covers the whole thing.

 

[MorkandMindy]

I have wasted hundreds of hours in comparing different forms of cover and understanding the multitudes of inclusions and exclusions from health insurance.

Another form of loss is that employers paying healthcare prices them out of hiring employees in the US.

And if they do hire in the US the added costs have to be added to the products making US products less competitive World-wide.

Dumping for-profit healthcare is the most important issue facing the US in terms of humane practices and in terms of economics.

But there is a certain irony in that vast waste to us is vast profits to the ones who own the government, so the bigger the waste the more impossible it is to reduce it.

 

[mark46]

Would the government back Medicare contributions with interest to those over 65? Or would there be different rates for each age group?

 

[hedrick]

Why are healthcare costs increasing more than inflation?
Are they paying staff more?

A lot of it is drug costs. At the moment we have no way to control costs. Most payments are by insurance companies. Despite occasionally denying people, they can't really refuse standard treatments without getting sued. So doctors can invent exotic and expensive treatments, and there can be new drugs with no limit on cost.

Unfortunately there's no way to control costs without telling someone no, and that is equally hard politically whether we have the current system or a single-payer system. Remember all the pushback over "death panels," and that was over simply trying to inform people of alternatives. I don't know what the answer is, but at some point we really do have to start saying no. The recent alzheimer's drug would have been a good starting point.

I suspect we'd have to do something about lobbying, but the Supreme Court won't allow that.

 

[DaisyDay]

So what went wrong?

The backers (owners?) of the DNC rejected it and it died.

And it was killed off:

Elizabeth Warren claimed it would cost 52 Trillion dollars over ten years and that pretty much killed it. I downloaded her platform statement on M4A and she provided no argument for why it would cost more rather than less than the existing system, and in her statement she compared 8 different healthcare plans that didn't cost as much, and then left her own out.

oh, we all posted at once... great posts!

Elizabeth Warren was/is a strong proponent of MC4A. The estimated cost of 52 T dollars still cost less than the current 10 projection of government spending on healthcare and she claims that it would put 11 T dollars back in the pockets of taxpayers.

Plans | Elizabeth Warren

 

[jayem]

Why are healthcare costs increasing more than inflation?

It's a confluence of several factors:

1) Economically, health care is inelastic. Meaning rising costs do not lower demand.

2) Okay, Boomer. You're part of the problem (myself included.) The population is aging. We 65 and older folks grew faster in number than any other age group. And I've read that sometime in the 2030s, senior adults will outnumber children. Obviously, this translates to a greater demand, and more spending, for health care.

65 and Older Population Grows Rapidly as Baby Boomers Age

3) As was noted, our prescription drug prices are the highest among all advanced countries. American consumers are paying for drug development--especially the costly clinical trials. And--to make matters worse--Medicare cannot, by law, negotiate favorable drug prices for Part D coverage with pharmaceutical companies.

4) We are incapable of doing what every 1st world nation does to keep health care costs down. Which is to establish a system of medical price controls. We have too many payers. Half of us get health coverage as a job benefit. Smaller businesses buy policies from a plethora of insurance carriers. Most all large employers are self-insured. (But they hire insurance companies as TPAs.) Then there's the individual market with many insurers selling policies on the ACA exchanges. Having so many different buyers of a high-demand product (which is medical care) means prices stay elevated. It's just basic economics. And it points out the great advantage of a single-payer system. When there's only one buyer for a product, prices drop. It's the buying power of a monopsony. Medicare does this to a degree. It sets MACs (maximum allowable charges) for covered services and procedures. But to really control costs, it must be done on the larger scale. That being said, we can't go overboard with price controls. Medicaid has fee schedules also. But in some states, reimbursements are so low, that providers won't see Medicaid patients. There's a sweet spot, and we have to find it.

 

[Nithavela]

If those 70% of americans want medicare so much, they should pony up the neccessary money to out-bribe the pharma and insurance industry.