Medicare-E(veryone) is a great slogan.
I think it is a good animating vision for a desired end point.
It is not serious policy yet.
Medicare-E instead of managed competition is a debate about means. I want to assume that I share the same desired end of most Medicare-E/single payer advocates (namely making sure everyone in this country has access to affordable, competent and effective health care.) I am assuming that is a shared end goal. But I have a hard time seeing how the end goal is achieved by an attractive slogan that has minimal policy back-up support.
I understand the desire to use Medicare as the basic structure of a national single payer system as it is a pre-exisiting program whose skeleton is strong enough to build on. However that skeleton has some odd deformities to it, and a lot of trade-offs have been built into Medicare that would need to be re-examined if we were to massively expand Medicare’s scope. I have a big series of questions that Medicare-E advocates would need to answer to transform a slogan into a policy program as Medicare E is not a matter of simply printing up new ID cards and mailing them to everyone in the country with a start date three months from the mail date.
- Why Medicare-E when there are numerous other examples of universal or near universal coverage that are provided by non-single payer systems (Netherlands, Germany, Switzerland as relevant examples)?
- We are currently closer to the Swiss model of managed competition than single payer. How do we managed the transition?
- If Medicare-E was an easy sell, we should have seen Vermont go forward with a single payer plan. Please explain why Vermont decided that it would not apply for a Section 1332 Waiver to transition the PPACA programs into single payer?
- How should we treat people whose current insurance has an actuarial value (AV) in the high 80s or better (Medicaid, CHIP, Cost sharing Silver 1st and 2nd Tier, Platinum, good union deals etc)? Do we transition everyone to Medicare’s 81/82% acturial value and tell people with good, high AV insurance to suck it? Do we keep high AV plans? If we keep high AV plans, how do we prevent massive cost dumping of sick people from private pools into public pools.
- How do we treat Medicare Supplemental policies to increase AV?
- As we’ve talked about in the rest of the series, Medicare is a good insurance program but it is not a perfect insurance program. The biggest problem with Medicare from a beneficiary point of view is that it does not limit maximum annual exposure to costs nor does it do well with extreme outliers of care. As we’ve seen, Medicare Part B has a 20% co-insurance rate with no out of limit cap. Medicare Part D has a 5% co-insurance rate with no annual cap. Medicare Part A limits annual and lifetime hospital days covered. An individual with Hep-C and cancer is far better off on a PPACA compliant Bronze exchange policy than they would be in Medicare.
- What benefits are covered (most private insurance will cover elective abortions, Medicare via Hyde is prevented from doing that)
- Is private pay for services allowed or is private pay outlawed?
- What do we do with Medicare Part C?Do we place limits on lifetime and annual individual exposure? If so, how do we pay for the increased AV?
- How much do individuals pay?
- Does everyone pay the same amount, or are individual contributions keyed to income/assets? If they are keyed, how?
- Does everyone pay the same deductible or does that vary based on ability to pay? (Same deductible for Bill Gates and the 31 year old with 3 kids working at an $11.00/hour job? Or do they face different cost sharing?)
- Do we use a single national risk pool and contracting model, or regional models (the New York versus North Dakota problem)
- What do we pay providers?
- Is Medicare-E allowed to negoatiate for drugs?
- HOW DO WE GET 218-51-1-5?
I have a much harder time seeing how that end is achieved if Medicare-E advocates don’t start answering the hundreds of policy implementation and management questions that Medicare-E would entail. The biggest problem with Medicare-E is how to finance it from people who will be made significantly worse off. People with high incomes are highly likely to already have better than Medicare insurance through either work or the Exchange. Not pissing this group of people off is critical to building a winning political/legislature coalition. Not pissing this group of people off will either involve unicorns shitting bricks of gold out of their ass, or some seriously odd plumbing. A simple slogan does not address this critical blocking problem.
What is the solution?
Betty Cracker
The main value I see in ditching managed competition that covers everyone in favor of a government-run single payer program is that it takes the profit, obscene executive salaries and operational redundancies out of the system. No more kowtowing to shareholders at the expense of delivering optimal medical care to members, no more $10M+ CEO compensation and no need for dozens of claims processing platforms, etc.
Aren’t people in countries that have single payer such as Canada allowed to buy private insurance if they want it?
Chyron HR
Jeez, what part of “I CAN COUNT TO SIXTYYYYYYYYYYYYY HE SOLD US OUUUUUUUUT” do you not understand?
SP
It’s 218-60-1-5, isn’t it?
Just for fun I googled yours since I wondered if anyone else commonly uses that shorthand, and what came up was a bible verse that seemed appropriate for the US political process:
“Have mercy upon me, O God, according to thy loving kindness: according unto the multitude of thy tender mercies blot out my transgressions.”
Freemark
I see ‘Medicare for Everyone’ more as a general salespitch for single payer. It explains what single payer is in a way Americans understand as a built in defense against it being ‘Communist’ medicine. It doesn’t mean it wouldm’t be changed in some way to fix problems with it.
MazeDancer
These are all excellent questions. And show how getting ObamaCare passed was a miracle. Alas, keeping profit in medicine was part of how ObamaCare got passed.
lymie
@SP: Sorry to be dim, but what does this mean? I’m usually pretty aware of the healthcare debate….
Davis X. Machina
What is the solution?
Leaders. Who know how lead, with leadership.
Kylroy
@lymie: It’s not a healthcare term. It’s the 218 representatives, 60 senators,1 President, and 5 Supreme Court members we’ll need behind it to enact any policy.
GHayduke (formerly lojasmo)
Medicare recipients in Minnesota have private supplemental insurance to cover part, if not all the additional 18-19% it seems to work okay.
Crab
ICYMI, this is a really good account of Vermont’s failed quest for single-payer. Some of the difficulties were specific to the fact that VT is a small state, but there are still some issues highlighted here that would apply for nationwide adoption:
http://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin
Richard, one of the age-old arguments for single payer is that if medical providers had just one insurer to interface with we’d save tons of money currently wasted on administrative overhead. Do you think this argument is oversold? (I’m thinking in particular that this was more true in the days of typewriters, carbon copies and snail mail, but I could be wrong.) Do you think it would be feasible and worthwhile for the govt to develop some kind of common billing portal the exchanges?
Richard Mayhew
@SP: I was feeling generous so I dropped it to 50, but yes, 60 is more probable.
@lymie: Exactly what @Kylroy: said.
218 Reps, 50 Senators (+ a friendly VP) or 60 Senators to beat a filibuster, 1 President and 5 Supreme Court justices are the minimal winning coalition for any law. How do we assemble that for a much more massive transformation of the US health care system than PPACA which with the most liberal Congress since at least 1965 was barely able to assemble 218-60-1-5
Richard Mayhew
@GHayduke (formerly lojasmo): That is a viable plan.
Question though — should someone who is making 102% FPL and is age 64 be subsidized to buy up so their actuarial value of coverage is 97% to 99%? Currently under Medicaid expansion, they are getting 97% AV coverage and they sure as hell can’t afford a $50/month supplemental policy that can be medically underwritten if they missed the initial enrollment period.
It works, but these types of details need to be worked out.
msdc
@SP:
This. And it’s the most important question of all.
lymie
@Richard Mayhew: Aha, thank you, Richard and Kylroy. Dope slap.
218 Reps, 50 Senators (+ a friendly VP) or 60 Senators to beat a filibuster, 1 President and 5 Supreme Court justices are the minimal winning coalition for any law.
Aaron Morrow
If Medicare wasn’t so much more politically popular as a universal program, would it be smarter policy to gradually expand Medicaid until everyone is covered?
(To answer at least one question, I would require Medicaid estate recovery to change from a regressive funding stream into an economically progressive one, so that would be funded (in part) by a progressive asset tax.)
Richard Mayhew
@Aaron Morrow: Yep,
that is definately a possibility, Year 1 make eligibility age 64, year 2 make eligiblity age 63 etc.
Problem with that is once we get into the mid-50s, private insurers don’t mind covering working people at that age, as they are still relatively healthy. People with good insurance (acturial value at or above 90%) through work won’t want to go to Medicare as they still get a great deal at work.
How do we manage that transition so Medicare-E for the 53 year old cohort is not a massive risk dump from the private sector to the public sector? Or are we okay with a massive risk dump?
Kerry Reid
@Davis X. Machina: Also some sort of furniture with ecclesiastical connotations, from whence they can bully.
GHayduke (formerly lojasmo)
@Richard Mayhew:
Damn it, jim, I’m a nurse, not an insurance underwriter!
Seriously, I have no idea what you’re talking about.
japa21
Oh Richard, don’t you realize a few ponies and unicorns will solve the whole thing.
On a more serious note, even before you get to the 218-50 (60)- 1 -5 part of the equation, you have brought up many other very valid questions. It is called being practical and realistic. Unfortunately, that is something many on both the kleft and right have difficulty understanding. I mean, there are still people complaining about not getting the public option, even though it was obvious fairly early on that there was no way that could be achieved.
And the biggest issue is probably, as you point out, how to make it work so that people don’t lose coverage they currently have and how to pay for it all.
NCSteve
Policy management questions blah blah blah! Magic unicorn fart sparkle dust fixes everything! “Policy” is just what corporatists say when they want to impede the great clash of symbols that is both the means and the end, the tactic and the objective of politics!
Thoughtful Today
!
Universal health care has been achieved by Europe, Canada, and Japan.
I understand corporate insurance salespeople like Richard want to make it sound impossible. But that’s somewhere between insulting and childish.
Thoughtful Today
Richard has repeatedly engaged in what might be called ‘distraction through obfuscation’.
He thinks the convoluted predatory insurance schemes are the only possible way to go. He rejects both history and reality.
Realistically, universal health care has been achieved by nearly every industrialized nation on earth. Richard rejects that historical reality with a wave of his hand and then goes into a Rube Goldberg description of why those historical realities aren’t possible.
superfly
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
Upton Sinclair
Mnemosyne (iPhone)
@Thoughtful Today:
Yes, but each of those places has a different system than each other. Japan’s system is a series of private non-profits that are strictly regulated by the government, and most people have employer-based insurance. Germany and Switzerland are similar to Japan. France has a public insurance fund that is used to pay private but tightly regulated doctors and hospitals. Great Britain has the NHS, which directly employs the doctors and hospitals. Etc.
Every country has a slightly different system, and a lot of them aren’t actually “single payer” at all, much less “single provider” like the UK. But they have all figured out how to rein in insurance companies and healthcare providers to get universal coverage.
Richard Mayhew
@Thoughtful Today:
There are multiple paths to universal or near universal coverage. Single payer (Canada) or Single Payer/Single Provider (UK NHS) are a minority position.
The Germans don’t use single payer.
The French don’t use single payer.
The Japanese don’t use single payer.
The Dutch don’t use single payer.
The Taiwanese don’t use single payer.
The Italians don’t use single payer.
Right now the US is moving down the path of universal coverage through a combination of programs including a large component of regulated private insurance that is partially subsidized (implicitly or explictly). The US will have near universal coverage through multi-payer systems.
Single payer is a means to an end, it is not an end in and of itself.
If you don’t see the truth in that statement, we’ll never have a productive discussion. I value the end (universal access to affordable and effective health care) far more than I value any mean that gets us either there or at least closer to that end point.
Thoughtful Today
To repeat myself:
I’ve personally seen Britain’s socialized medicine system in action, it was fast, effective, and compared to our Rube Goldberg profiteering system, far more efficient.
It was amazing, I was taking a walk with British friends in a London park, one of them started having respiration problems and called for an Ambulance.
A British Ambulance showed up in the middle of the park faster than any pizza delivery I’ve ever ordered.
Afterwards I expressed worry that it was going to cost a fortune and the Brit looked at me like I was from Mars and said (paraphrasing), ‘I already paid for that with my taxes.’
It’s not that complicated.
Mnemosyne (iPhone)
@Thoughtful Today:
Right, but the UK’s system is not the only way to go, and there’s a good chance that it works best for a small, geographically bound population.
Single provider is not the only way to go. It may not even be the best way to go depending on the country.
Thoughtful Today
!
To be clear:
Family values for me and millions of other Americans means providing health care to every American.
It’s why I love Bernie, he shares my values.
https://BernieSanders.com
For specifics on where Bernie Sanders stands on healthcare issues:
http://feelthebern.org/bernie-sanders-on-healthcare
Richard Mayhew
@Thoughtful Today:
Okay, HOW…
And again, if single payer is so obviously superior within the historical American context, why did Vermont pull its single payer application waiver.
Vermont should be one of the easier cases (Hawaii/Alaska are probably the easiest cases) for a successful single payer experiment in the United States.
Massachusetts elected to go the managed competition route. I assume there was a decent reason for that (ie quite a few unions have 95% or higher actuarial value insurance with no network restrictions and their members don’t want to give that up to move to an 83% AV plan)
Mnemosyne (iPhone)
@Thoughtful Today:
South Korea is considered a modern miracle of universal healthcare because it only took them 12 years to go from a private for-profit system to universal coverage:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447690/
Sanders can start the transition to Medicare for All, but he can’t hand-wave away the practical issues and problems with our current system that will need to be solved that Richard outlined above, so it will take TIME. Your pony-unicorn hybrid will not arrive tomorrow.
Richard Mayhew
@Thoughtful Today: Do you value the means (single payer/Medicare for All) that is highly unlikely to get 218 votes in the House much like 60 in the Senate more than the ends of using previously built structures and rejiggering them to increase coverage?
Thoughtful Today
Please send me a solid informational link if I’m wrong but as I understand it:
The Germans provide health care for all their Citizens.
The French provide health care for all their Citizens.
The Japanese provide health care for all their Citizens.
The Dutch provide health care for all their Citizens.
The Taiwanese provide health care for all their Citizens.
The Italians provide health care for all their Citizens.
America does NOT provide health for all our Citizens.
My values, along with millions of my American neighbors, demand health care for all Americans.
Bernie shares my values:
Unless you’re https://BernieSanders.com
Bernie Sanders health care stand should be a core Democratic Party value:
http://feelthebern.org/bernie-sanders-on-healthcare
Richard Mayhew
@Thoughtful Today: It is not complicated as long as the plan that works is well thought out before hand.
Single payer is neither necessary nor sufficient for your scenario to come true.
Hell, if I have a heart attack while walking back from lunch today, I’m in an ambulance within 5 minutes and at a major academic medical center ER in 8 minutes. And from my private insurance my out of pocket exposure will be less than a day’s pay plus however much parking and coffee costs my wife.
What you want (and I agree with completely) is high actuarial value coverage that buys cost effective healthcare services while probably also shaping society so that we don’t need to use as much healthcare as going to the doctor/hospital sucks. Single payer is neither necessary nor sufficient for that goal to be achieved.
Richard Mayhew
@Thoughtful Today:
So let’s say we get President Bernie… How do you get to 218-60? And when?
Thoughtful Today
You remember those regular flights from the war zones of Afghanistan and Iraq to Germany, Richard?
American soldiers were flown in emergency aircraft to Germany in order to save their lives.
That level of complexity, international flights from a war zone to hospitals in Germany didn’t include any of your 27b/6 corporate insurance nonsense.
Americans needed healthcare, the US government made sure they got world class healthcare across international borders.
I get you find that ‘unpossible’. I find that small minded thinking offensive.
Richard Mayhew
@Thoughtful Today:
The Germans provider healthcare to all of their citizens through a variety of local insurance councils, employer sponsored social welfare groups and federal level reinsurance. Not single payer.
The French provide health insurance to all of their citizens through several seperate national programs plus individual level buy-up policies. Not single payer.
The Swiss provide health insurance to all of their citizens through private insurance that is tightly regulated like public utilities plus individual buy-up policies. Not single payer.
I agree with your goals.
I disagree with the assessment that Medicare-E is a) the only viable way to expand coverage from 90% of the population to 97% or more of the population AND B) that Medicare-E is politically feasiable enough to disregard other methods. My assessment/judgement is that if the most liberal Congress since 1965 could not get 218 votes\
Here is a decent overview of how different countries cover their populations. it is a little old (2008, but decent enough)
http://www.itup.org/Reports/Fresh%20Thinking/Health_Care_Systems_Around_World.pdf
Thoughtful Today
I get that we don’t share the same values Richard.
I support universal health care for every American.
You support 27b/6 insurance “high actuarial value coverage”.
Until you understand it’s not the same thing, you are correct, this isn’t going to be a very productive conversation.
Richard Mayhew
@Thoughtful Today:
I find it telling that you are either unwilling or unable to actually answer two simple questions.
1) Why did Vermont scrap its single payer waiver?
2) How do you propose to get to 218-60-1-5?
Richard Mayhew
@Thoughtful Today: go fuck yourself then…
Thoughtful Today
Erm…
Richard is using the same offensive stalling tactics successfully used by climate deniers: Obfuscation, misdirection, and demanding that their ridiculous questions be endlessly answered while the planet burns.
In Richards case, he’s got more complicated question about %$!^%@#$ insurance than were on my Anatomy & Physiology final exam (which I assure you he’d fail as he clearly knows nothing about health care).
Betty Cracker
@Richard Mayhew:I fully understand why it made sense to expand coverage through the private insurance system rather than attempting to burn it all down and adopt single payer in the short term, but I see two big drawbacks to continuing a private system for the long haul:
1) The current system leans heavily on employment-based insurance, which may not remain viable in the long term because of shifting employment patterns. More and more people are freelancers and contract employees these days. They can buy insurance through exchanges, and they’re certainly better off under Obamacare than they were under the old system, but they still get screwed if they don’t qualify for subsidies compared to people who get employer contributions.
2) It’s great that Obamacare compels insurance companies to spend 85% of every dollar on actual healthcare, but there are still shareholder dividends, absurdly high executive salaries and multiple operational redundancies in the private system that a government-run, single-payer model would theoretically drive out.
End note — I really appreciate the time you spend giving your take and answering questions. Thanks!
El Cruzado
I dunno. Everyone gets a bronze plan, you can buy yourself (or your employer can) buy up to Silver and Gold.
Thoughtful Today
One questions for Richard:
What year will every American Citizen have health care?
2025? 2045? Never?
Currently 30 MILLION Americans don’t have health care under Richard’s Republican insurance scheme (see: Nixon, Dole, Romney, et. al.)
I support what should be a core Democratic Party value: Universal health care for every American.
Which is why I support Bernie, he supports my values: Health care for every American Citizen.
http://feelthebern.org/bernie-sanders-on-healthcare
NonyNony
@Thoughtful Today:
Wow – we’ve got a new troll around here and it’s a Bernie troll!
Awesome – we haven’t had any good left-wing trolls around here since, oh man, Bob?
Welcome aboard, trollish one. I hope you learn how to troll better soon – the folks around here will eventually learn to ignore this kind of childish propaganda flinging schtick if you don’t learn how to actually engage with people instead of cut-n-pasting propaganda at them.
BubbaDave
@Thoughtful Today:
1) I assume you picked that nym long ago and haven’t bothered to change it as it got more and more out of date.
2) The fact that you think repeating the same slogans only louder is a substitute for policy discussions does not add to the discussion
3) Every time you post here I become slightly more likely to vote for Hillary in the primary
Thoughtful Today
A lot of free-lancers and contractors that work for Uber mensch type centralized e-commerce companies that outsource liabilities to contractors and customers find it difficult to get the ‘group plans’ that require “insurance companies to spend 85% of every dollar on actual healthcare”.
It’s only 80% for those individually contracting for health insurance.
Medicare has only a 5% overhead (~3% by some measures). That means 95% goes into healthcare.
Assuming a corporation is more efficient at reducing overhead, that means corporate insurers are guaranteed a whopping 10% to 15% in [cough] criminal [/cough] profiteering.
Mnemosyne (iPhone)
@Thoughtful Today:
Richard answered your questions with links and information, and you responded with empty slogans and campaign websites. Why are we supposed to take you seriously again?
Mnemosyne (iPhone)
@Betty Cracker:
FWIW, past global experience in other countries (like my idol South Korea) seems to show that an existing for-profit system doesn’t have to be a barrier to getting to a nonprofit or single payer system. It’s possible to transform that for-profit system. So it’s probably not necessary to dump PPACA in favor of Medicare For All — we can take the best elements of Medicare and add them to PPACA to make a nonprofit system. It will take time and there would be some intermediate kludges, but we don’t have to go back to scratch. We just have to keep moving forward and push the for-profits out.
Richard mayhew
@El Cruzado: so the French system
Richard mayhew
@Mnemosyne (iPhone): agreed. Incremental, marginal learning by doing changes with the occasional massive SNAFu in a two or three state experiment will be how the system and our society changes.
Thoughtful Today
!
I vote for whoever the Dem is in the General Election. And if Hillary reflects your values, you should vote for her in the Primary, Bubba. However…
Bernie supports my values and advocates for policies I believe in. Health care for every American is one of my core values and Bernie shares it. And I know he doesn’t waiver from his firmly held beliefs unless there’s serious evidence to sway them.
Where Bernie stands on issues: https://BernieSanders.com/issues
More on Bernie’s stands on issues: http://FeelTheBern.org
Richard mayhew
@Thoughtful Today: have you ever read an insurance company’s financials? My company just closed our fiscal year books with a combined/blended mer north of 90 and an operating margin of 2.3%. And that was an amazing year
Richard mayhew
@Thoughtful Today: please better trolling… Who wants pie?
JGabriel
Richard Mayhew:
Yeah, this is a sticking point for me too. I think we would need to significantly improve Medicare to a roughly 90%-95% AV, either in advance of implementing single-payer, or as part of the implementation.
(Edited to Add: Obviously, none of those improvements can be accomplished until today’s GOP is knocked down to 33%, or less, in both branches of Congress, or until the GOP moderates, or until the GOP implodes and is replaced by a more moderate party. In other words, not this decade and probably not the next either.)
JGabriel
@Me:
Oops. Was thinking in terms of veto. Would only need to knock down GOP to less than 50% in House, and 40% in Senate with a Dem president. Still not likely to happen this decade though.
Thoughtful Today
Perhaps I’m misunderstanding.
What’s the insurance company you’re working for, Richard?
How much did the CEO make in toto (stock options, benefits, etc.)? What’s the median of the total earnings of the top 20% of your companies employees?
Don’t add in the minimum wage employees fielding the phones, I’m talking about just the top 20% of your companies best paid employees.
How much has your insurance stock gone up in the last ten years?
Is your companies financials entirely transparent? Or is it a private company that can do tricks like increasing executive pay, do buy backs of stock, and other tricks to reduce reported ‘profit’?
Richard mayhew
@Thoughtful Today: non profit, everything is available on the 990 via guidestar
Thoughtful Today
Heh, I was just trying to remember “990 guidestar” yesterday.
For that reminder, thank you, Richard.
MazeDancer
Richard, As one of the original petitioners asking for your wisdom in illuminating the morass of Medicare for currently living humans who could one day be enjoying same – or have friends and loved ones about to do so – thank you for your kind efforts. Clear info is vital to currently existing people, and separate from the one day hope we all have for a better way.
And “218-51-1-5” pretty much, uh, trumps all considerations of how do we one day join the civilized world in healthcare for all. (Which is different than health insurance for all.)
Had no idea such generosity as you bring to your posts – for which you get absolutely nothing except gratitude – would lead into you receiving the pies meant for all insurance companies and medical profit makers everywhere.
Please know your wisdom is always appreciated. And, yes, as you’ve demonstrated, you can handle all comers yourself. But, really, today has gone wacky. Full of typed angst. In more than this thread.
OT – Among the wonderful things about BJ has been it’s – most of the time – not the sink hole of “No, I’m right” into which DailyKos has spiraled. May that always be so.
Richard mayhew
@MazeDancer: thank you… And I like pie
MazeDancer
@Richard mayhew:
Well, then, you are in the right place. Enjoy! And thanks for the laugh. (Also, as ever, the info)
Thoughtful Today
“218-51/60-1-5″ is another reason I appreciate Bernie. I lived in Arizona, briefly, and it sure felt abandoned by the Democratic Party.
Watching 11,000 supporters of Bernie in Phoenix, the red heart of a red state, was amazing.
So to answer the question: ‘How is “218-51/60-1-5″ achieved?’
Answer: A 50 state strategy. Bernie has one:
https://duckduckgo.com/?t=lm&q=Bernie+Sanders+50+state+strategy
Thoughtful Today
re: Bernie’s 50 State Strategy details:
https://www.reddit.com/r/SandersForPresident
Bernie’s in Iowa tomorrow, Saturday, August 15:
Boone, Iowa, Boone Town Meeting @ 10:30 AM
Des Moines, Iowa’s State Fair @ 2:00 PM
Iowa, Sunday August 16:
Eldridge, Iowa, Scott County Democrats Picnic @ 1:00 PM
Dubuque, Iowa, Dubuque Town Meeting @ 6:00 PM
NEW: Reno, Nevada stop on August 18 @ 7:00 PM
South Carolina Friday, August 21:
Greenville Rally @ 11:00 AM
Columbia Town Meeting @ 7:00 PM
South Carolina Saturday, August 22:
Sumter Town Meeting @ 11:00 AM
Charlston Rally @ 7:00 PM
TBD for August: Mississippi, Alabama
[copy & paste at will]
mclaren
Once again, Richard Mayhew is lying to you. When the ACA blocked the familiar scams and ripoffs used by greedy corrupt doctors and greedy corrupt hospitals and greedy corrupt health insurers and greedy corrupt medical devicemakers and greedy corrupt imaging and blood testing labs, they merely invented new scams and ripoffs.
The latest scams?
Drive-by doctoring. Doctors who bill patients for a consult when they don’t actually see the patient, but are in the building (this is legal, by the way, though it’s obviously criminal fraud). And the very latest greatest ripoff confected by the relentlessly greed-crazed American medical system?
Your hospital is in-network, but your doctor isn’t.
Source: “Surprise! When your hospital is in-network but your doctor isn’t ,” Newsworks, 13 August 2015.
Keith
Hello Richard:
If it isn’t too late I’d like to try and put into context some of the challenge questions you pose.
Vermont, it might be fair to say, put the cart (political process for Single Payer) well ahead of the horse (the actual plan that would move VT to Single Payer).
Lacking a coherent plan design at the outset, VT had no workable framework of reference; beyond Medicare, or something like it. That left the state prey to entrenched interests to an unhelpful extent. As a result, there were a significant number of compromises made, all of which moved Gov. Shumlin and the VT legislature away from true Single Payer, moved them to leave on the table savings from pharmaceutical purchases, administrative cost reductions and truly central control or regulation of fees for service. GMC simply ceded the field early on to private concerns – the precise opposite of a real single payer program.
In other words, it is a falsity (not yours per se) to suggest that when Sumlin backtracked in December 2014, he did so because the Single Payer (GMC) plan was too expensive. GMC was more expensive, but GMC (now a horse designed by several committees) was no longer Single Payer. Unsurprisingly, this significantly increased the projected costs for the now abandoned hybrid program.
Perhaps the more carefully thought out ColoradoCares approach will prove sufficiently robust to survive inevitable political sniping and attempts to mae a dromedary from a perfectly fine paint horse – I hold out the hope that they do. It would give us a better test, with a larger population, of a real Single Payer plan.
Personally, I think such tests (the waivers made available under ACA) are critical to guiding the nation to fully optimized economy of scale in our provision of and payment for healthcare. That Vermont’s effort fell into a combined political and cost-burden ditch should never be taken as a wholesale repudiation of Single Payer (whether as Medicare E, or in some other manner). It should be taken a lesson on how much needs to be carefully planned before a system is subject to political approval.