Medicare for all

[lyman]

Great Lyman, if you work for large employer. If self employed, it's a different deal in this country than say in Canada France or Germany--all places where people wouldn't swap their system for ours in a hundred years.

your comments were directed towards Walmart ,,, not the local burger joint,,



my wife works for a small law firm,
she pays just like I did when I was in the grocery business,
partial, the firm pays partial, administered by an insurance group,

and yes, not all small companies can do that,

re canada et al

those folks have been conditioned to the lifestyle and tax burden,

we are not, yet,

[togor]

Important: in the other countries, the markup is less for treatment. Our market based system here doesn't deliver broad value for consumers for the simple reason: if you're really sick, how much will you spend to get better? All of it. Job #1 in controlling health care costs in this country is to make it less profitable. Not unprofitable, just less profitable. For the Ambulance-chasers too. Everyone knows this is true but few are willing to say it publicly.

[lyman]

Important: in the other countries, the markup is less for treatment. Our market based system here doesn't deliver broad value for consumers for the simple reason: if you're really sick, how much will you spend to get better? All of it. Job #1 in controlling health care costs in this country is to make it less profitable. Not unprofitable, just less profitable. For the Ambulance-chasers too. Everyone knows this is true but few are willing to say it publicly.

no doubt

insurance , while necessary, is also scam,

[Vern Humphrey]

Job number one in this country is to reduce the paperwork, which accounts for from 1/3 to 1/2 of all medical costs. We can do that by going a true free market system.

Medical Savings Accounts

The fundamental principle behind Medical Savings Accounts (MSA) is that it allows people to pay for medical care with tax-free dollars, and to roll any unused dollars over at the end of each year into their IRAs. Under this proposal, each individual would buy a low-cost Catastrophic Health Insurance policy – with a high deductible. He would then save an amount equal to the deductible. When the deductible in the MSA is spent, the Catastrophic Health Insurance policy would cover additional costs.

Any money unspent at the end of the year would roll over into their IRAs – so people would use the same dollars for both health insurance and retirement savings.

The institution holding their MSA would issue a credit card, and this card would be used to pay for health care. This would have several important impacts:

1. Paperwork makes up from one-third (in private health plans) to one-half (in government programs) of the total cost of health care. The use of this credit card approach would dramatically reduce the paperwork and result in lower costs.

2. The current systems of paying for health care have long delays built in. No small businessman could ever survive in the slow-pay environment of the health care industry. How do health care givers survive? By raising prices!! The pay-on-the-spot approach would allow care providers to further lower costs.

3. Under the current system, there is no incentive for people to bargain for health care – because the insurance company pays the costs. Similarly, there is no incentive for providers to lower their charges, because the insurance rates are known. But when people spend their own money (and know they can keep all they save), they have an incentive to bargain for better rates.

4. Similarly, there is no incentive to avoid over-consumption of medical care under the present system. Many people feel, ”I pay the insurance premium. I should get my money’s worth!” But if people know that by staying in bed, drinking lots of fluid and taking an aspirin, they will get to roll over the money saved into their IRAs, they have an incentive not to over-consume.

For those who cannot save the deductible can apply for support by submit their current tax return. Based on your declared income, you will receive a certain percentage of assistance. But each time you went to the doctor, SOME of the money paid him would be YOUR money – so all the incentives still apply.

[gwp]

Job number one in this country is to reduce the paperwork, which accounts for from 1/3 to 1/2 of all medical costs. We can do that by going a true free market system.

Medical Savings Accounts

The fundamental principle behind Medical Savings Accounts (MSA) is that it allows people to pay for medical care with tax-free dollars, and to roll any unused dollars over at the end of each year into their IRAs. Under this proposal, each individual would buy a low-cost Catastrophic Health Insurance policy – with a high deductible. He would then save an amount equal to the deductible. When the deductible in the MSA is spent, the Catastrophic Health Insurance policy would cover additional costs.

Any money unspent at the end of the year would roll over into their IRAs – so people would use the same dollars for both health insurance and retirement savings.

The institution holding their MSA would issue a credit card, and this card would be used to pay for health care. This would have several important impacts:

1. Paperwork makes up from one-third (in private health plans) to one-half (in government programs) of the total cost of health care. The use of this credit card approach would dramatically reduce the paperwork and result in lower costs.

2. The current systems of paying for health care have long delays built in. No small businessman could ever survive in the slow-pay environment of the health care industry. How do health care givers survive? By raising prices!! The pay-on-the-spot approach would allow care providers to further lower costs.

3. Under the current system, there is no incentive for people to bargain for health care – because the insurance company pays the costs. Similarly, there is no incentive for providers to lower their charges, because the insurance rates are known. But when people spend their own money (and know they can keep all they save), they have an incentive to bargain for better rates.

4. Similarly, there is no incentive to avoid over-consumption of medical care under the present system. Many people feel, ”I pay the insurance premium. I should get my money’s worth!” But if people know that by staying in bed, drinking lots of fluid and taking an aspirin, they will get to roll over the money saved into their IRAs, they have an incentive not to over-consume.

For those who cannot save the deductible can apply for support by submit their current tax return. Based on your declared income, you will receive a certain percentage of assistance. But each time you went to the doctor, SOME of the money paid him would be YOUR money – so all the incentives still apply.

Sounds like a well thought out plan.

[togor]

Sounds like a well thought out plan.

Well easy to refute many pieces of it, but no one here wants to hear it. One thing I will point out: 80 and 90 year olds generally will be in no shape physically or mentally to haggle effectively with insurance companies. This should be obvious but maybe not.

[lyman]

Well easy to refute many pieces of it, but no one here wants to hear it. One thing I will point out: 80 and 90 year olds generally will be in no shape physically or mentally to haggle effectively with insurance companies. This should be obvious but maybe not.

refute away, I am interested, surely some others are,

[S.A. Boggs]

refute away, I am interested, surely some others are,

+1
Sam

[togor]

Medical Savings Accounts

The fundamental principle behind Medical Savings Accounts (MSA) is that it allows people to pay for medical care with tax-free dollars, and to roll any unused dollars over at the end of each year into their IRAs. Under this proposal, each individual would buy a low-cost Catastrophic Health Insurance policy – with a high deductible. He would then save an amount equal to the deductible. When the deductible in the MSA is spent, the Catastrophic Health Insurance policy would cover additional costs.

Any money unspent at the end of the year would roll over into their IRAs – so people would use the same dollars for both health insurance and retirement savings.

The institution holding their MSA would issue a credit card, and this card would be used to pay for health care. This would have several important impacts:

1. Paperwork makes up from one-third (in private health plans) to one-half (in government programs) of the total cost of health care. The use of this credit card approach would dramatically reduce the paperwork and result in lower costs.

2. The current systems of paying for health care have long delays built in. No small businessman could ever survive in the slow-pay environment of the health care industry. How do health care givers survive? By raising prices!! The pay-on-the-spot approach would allow care providers to further lower costs.

3. Under the current system, there is no incentive for people to bargain for health care – because the insurance company pays the costs. Similarly, there is no incentive for providers to lower their charges, because the insurance rates are known. But when people spend their own money (and know they can keep all they save), they have an incentive to bargain for better rates.

4. Similarly, there is no incentive to avoid over-consumption of medical care under the present system. Many people feel, ”I pay the insurance premium. I should get my money’s worth!” But if people know that by staying in bed, drinking lots of fluid and taking an aspirin, they will get to roll over the money saved into their IRAs, they have an incentive not to over-consume.

For those who cannot save the deductible can apply for support by submit their current tax return. Based on your declared income, you will receive a certain percentage of assistance. But each time you went to the doctor, SOME of the money paid him would be YOUR money – so all the incentives still apply.

Commenting because I was asked.

Years ago I was working for a consulting company active in the wholesale electricity business. This at a pre-911 time when electricity at the transmission level was being deregulated. Thus in theory a smelting plant in the service area for some regional utility could buy its juice from a merchant plant 3 states away, and somehow the transmission of that electricity would get sorted out in both grid ops and the market. I remember talking to an old time guy in this business, and he said "inefficiency is where the profit it". He was right.

Paperwork exists in the health insurance industry because it more than pays for itself in reduced treatement. From the insurance consumer's point of view, as Vern articulates, it's needless overhead. But to the insurance companies, all of that administration serves to reduce the amount of actual benefits that get paid out. This goes hand-in-hand with the basic logic of competition in private insurance markets: companies aren't competing to reduce the costs of delivering products (unlike manufacturer's always looking to reduce production costs). Rather, companies compete for the healthiest patients, the ones who won't need the insurance.

Interestingly enough, the ACA did move in the direction that Vern suggests, eliminating some of the paperwork by requiring policies be sold that cover somethings. Did it work? Well people who dislike the ACA say that it did not, because the policies were more expensive (because they were required to cover things). One could always eliminate administrative bottlenecks in private insurance, by making it easy for companies to just deny almost everything they want with no appeals process (sort of going the opposite direction that the ACA did). Sure, cheap policies that don't cover anything.

As for long delays.....raising prices....it doesn't follow. I know people who are in private consulting. Everyone would love to be paid net-30, but sometimes when you get a large organization as a customer, they may tell you that they're going to pay you net-90, take-it-or-leave-it. But eventually you get paid. Sometimes you get a start-up for a customer and they're at net-120 or something. It sucks, but raising prices on everyone else isn't the logical response. One just has to have a line of credit, or a built-in cushion, or something to ride out the ebb-and-flow of accounts receivable.

I could go on, and will if necessary, but the basic reality is that someone making $10, $12, or $15/hour with no health insurance is not in any position to go out and buy good health insurance, and save for a house, and save for retirement, and do a good job of raising their kids, etc. We could do better in this country encouraging good long-term financial decision-making, but for people at the bottom, the #1 thing is that there just isn't enough money to get it done for people at the bottom of the wage scale.

[S.A. Boggs]

Commenting because I was asked.

Years ago I was working for a consulting company active in the wholesale electricity business. This at a pre-911 time when electricity at the transmission level was being deregulated. Thus in theory a smelting plant in the service area for some regional utility could buy its juice from a merchant plant 3 states away, and somehow the transmission of that electricity would get sorted out in both grid ops and the market. I remember talking to an old time guy in this business, and he said "inefficiency is where the profit it". He was right.

Paperwork exists in the health insurance industry because it more than pays for itself in reduced treatement. From the insurance consumer's point of view, as Vern articulates, it's needless overhead. But to the insurance companies, all of that administration serves to reduce the amount of actual benefits that get paid out. This goes hand-in-hand with the basic logic of competition in private insurance markets: companies aren't competing to reduce the costs of delivering products (unlike manufacturer's always looking to reduce production costs). Rather, companies compete for the healthiest patients, the ones who won't need the insurance.

Interestingly enough, the ACA did move in the direction that Vern suggests, eliminating some of the paperwork by requiring policies be sold that cover somethings. Did it work? Well people who dislike the ACA say that it did not, because the policies were more expensive (because they were required to cover things). One could always eliminate administrative bottlenecks in private insurance, by making it easy for companies to just deny almost everything they want with no appeals process (sort of going the opposite direction that the ACA did). Sure, cheap policies that don't cover anything.

As for long delays.....raising prices....it doesn't follow. I know people who are in private consulting. Everyone would love to be paid net-30, but sometimes when you get a large organization as a customer, they may tell you that they're going to pay you net-90, take-it-or-leave-it. But eventually you get paid. Sometimes you get a start-up for a customer and they're at net-120 or something. It sucks, but raising prices on everyone else isn't the logical response. One just has to have a line of credit, or a built-in cushion, or something to ride out the ebb-and-flow of accounts receivable.

I could go on, and will if necessary, but the basic reality is that someone making $10, $12, or $15/hour with no health insurance is not in any position to go out and buy good health insurance, and save for a house, and save for retirement, and do a good job of raising their kids, etc. We could do better in this country encouraging good long-term financial decision-making, but for people at the bottom, the #1 thing is that there just isn't enough money to get it done for people at the bottom of the wage scale.

People at the bottom of the wage scale are always in this position. Many of the people that I went to school with and didn't do much with their life except party, smoke, dope now what full coverage from the government. I dealt with people who did the same thing and then demanded treatment. No one and I mean no one makes great life style choices, too much alcohol, food, too fast in a car...you get the picture.
On the other hand are physicians who charge outrageous fortunes due to having to carry expensive malpractice insurance. Idiots who do it to self and then want to sue the Dr. for an imaginary reason and some fool lawyer will take the case. If lawyers could be taken out of medicine some of the cost could come down, the other end is Corporation Medicine. Medicine for profit and not the well being of the patient. Hospitals regularly pad their bills for insurance/private people to pay. As one who has been ill and used their services, I do believe that if Government insurance was run like my Wal-Mart insurance things could improve. We got outstanding coverage for a modest and affordable cost, I can't say enough about the care I got and am still getting from our insurance.
Sam

[togor]

Paul Krugman weighs in on the subject. A liberal economist to be sure, but the comparison of health care between Tennessee and Kentucky shouldn't be hard to independently perform. Kentucky of course expanded Medicaid under the ACA, whereas Tennessee did not.

https://www.nytimes.com/2019/06/24/o...alth-care.html

[Vern Humphrey]

People at the bottom of the wage scale are always in this position. Many of the people that I went to school with and didn't do much with their life except party, smoke, dope now what full coverage from the government. I dealt with people who did the same thing and then demanded treatment. No one and I mean no one makes great life style choices, too much alcohol, food, too fast in a car...you get the picture.
On the other hand are physicians who charge outrageous fortunes due to having to carry expensive malpractice insurance. Idiots who do it to self and then want to sue the Dr. for an imaginary reason and some fool lawyer will take the case. If lawyers could be taken out of medicine some of the cost could come down, the other end is Corporation Medicine. Medicine for profit and not the well being of the patient. Hospitals regularly pad their bills for insurance/private people to pay. As one who has been ill and used their services, I do believe that if Government insurance was run like my Wal-Mart insurance things could improve. We got outstanding coverage for a modest and affordable cost, I can't say enough about the care I got and am still getting from our insurance.
Sam

Let me get this straight -- our resident "expert" says true medical savings accounts won't work because he assumes the existing system will somehow infect it.

And for people with low income, the system I advocate has a built-in remedy for them -- submit your income tax return, and you will get a portion of your medical expenses covered -- at NO cost to you.

[togor]

Let me get this straight -- our resident "expert" says true medical savings accounts won't work because he assumes the existing system will somehow infect it.

And for people with low income, the system I advocate has a built-in remedy for them -- submit your income tax return, and you will get a portion of your medical expenses covered -- at NO cost to you.

Built-in remedy? Wait for your tax return to be made partially whole for medical bills put on the credit card? Remember one of your reforms is to keep prices low by requiring prompt payment of medical bills.

Medical savings accounts are no substitute for insurance if anything major hits. A young couple has a premature baby requiring hundreds of thousands of dollars of medical care. What is a health savings account supposed to do about that?

[lyman]

the health savings account I have from a previous employer was used to cover deductibles, meds etc
I put a percentage in the account, and paid into the fund

my deductible was a bit high compared to a hmo, but I still put money into a HSA account to cover it,

major medical like you mentioned was still covered by your plan, your deductible may be higher (esp on the 20% or 30% out of network)

if you are talking about the savings accounts you can use for medical, or the FSA you can use for childcare etc, , that is a different process,
you simply put in the amount you think you will use that year, tax free of course

[S.A. Boggs]

I use our HSA to pay for meds that are OTC that my insurance won't cover...anti-acid in particular.
Sam