Corner cases and off the mean clusters are where policies need to be thought through on how they really work and why they do what they do and to whom. In US healthcare policy, the median individual is barely touched by the medical system in a given year. Anything that is straightforward and cheap works for someone who is retrospectively running up $300 in claims for the year.
This applies to Health Savings Accounts for only those who can afford a new tax sheltered savings account and it applies to Medicare for All sloganeering:
Out of curiosity, what do all y'all Medicare-For-All folks suggest happens to me? SSI = $750/month. Traditional Medicare has no out of pocket maximum. Part C plans 1) charge premiums and 2) have an out-of-pocket max of $6,700. Leaving me with *checks calculator* no money to live.
— MedicaidMatt, Esq. ⚖ (@mattbc) May 28, 2018
We need to think about cases like Matt’s. We need to think about cases like the $1 million a month man in Iowa.
These are the cases where we really need to think about our values and what we actually prioritize as these are catastrophic costs and risks borne by individuals or society. Medicare for All without a whole lot more scaffolding fails.
We need to keep this in mind when we think about the future — what do the tough cases look like under our musings and desires?
Chyron HR
“They understand that they’re doing this for the country.” –
Donald TrumpNina Turner, probablyYutsano
Part C is Medicare Advantage. At his income level, that shouldn’t even be a consideration. My concern would be how much Medicare premiums would go up after the expansions and should they be redistributive based on income. And if that’s feasible.
MomSense
If we are going to do Medicare for all we have to bring the costs down. I don’t see how we can bring the costs down without dealing with the cost of medical education and the limited slots available for specialists.
Barbara
People do not understand how Medicare works. Many people who see Medicare for all as aspirational do not understand the high percentage of Medicare beneficiaries who are either covered by supplemental retiree plans or buy their own privately issued supplemental plan. Someone who is currently eligible for both Medicare and Medicaid is a dual eligible. They broadly fall into three categories: under 65 and totally disabled; over 65 and living in a nursing home (ran out of money and are using Medicaid for LTC); or categorically indigent individuals who “age in” to the Medicare program. There are Part C plans that are specifically geared to people with disabilities or in long term care so nothing is absolute, but Part C plans tend not to be useful for dual eligibles because Medicaid picks up cost sharing otherwise imposed by Medicare. Right now, the government is funding demonstration projects to allow dual eligibles to obtain benefits through an integrated Medicare/Medicaid contractor to lessen the complexity for beneficiaries while still having a capitated plan providing benefits.
stinger
People who have $300 in annual medical costs should be so grateful for their good health and good luck that they’d gladly pay slightly higher taxes to prevent MedicaidMatt and the $12 million man from a) dying needlessly young and b) losing their home to medical costs. The 1% should pay more than “slightly” higher taxes. And/or we could shift some taxpayer money from Congressional slush funds for sexual assault payoffs into health care.
Charles Gaba
RELATED: All-Payer bill dies…in California. Which has a Democratic Governor, a Democratic Assembly and a Democratic supermajority in the state Senate:
http://acasignups.net/18/05/29/california-crud-all-payer-bill-dies-i-even-got-around-writing-about-it
Barbara
@Chyron HR: With respect to this person’s specific condition, Part D plans have an elaborate structure to eliminate most cost sharing for “LIS” beneficiaries (“Low income supplement”). There would likely be similar cost sharing waivers for individuals who are on SSI in any version of Medicare for all.
Roger Moore
My gut feeling is that “Medicare For All” is a wonderful slogan but a seriously flawed policy. The ideal response would be to use creating “Medicare For All” as an opportunity not just to expand insurance coverage but to seriously revamp Medicare in ways that eliminate its biggest problems.
FlipYrWhig
@MomSense: My pet idea, and I say this fully aware that I know nothing, would be for the federal government to take over primary care for everyone, as a sort of “VA for all” model. I feel like there are a lot of people who could be “coached up” into GPs and nurse practitioners.
rikyrah
Medicare for All is not a one size fits all solution. We must think of those who it won’t fit
rikyrah
Medicare is a true relief for people like my sister: a double breast cancer survivor who pays the equivalent of a luxury car note for health insurance and is counting down the days to when Medicare,plus a supplement policy will still be Less than half of what she pays now.?
rm
Thank god for the out-of-pocket maximum on my employer-sponsored insurance plan. And for the ACA and whatever other laws prevent them from dropping us. My wife last year spent 6 months in a hospital with 3 weeks in ICU. This year is shaping up to be a similar cost. Whatever system we put in place has to deal with the high tail of health care consumers. If I could manage moving to Canada, or re-learning French and moving to France, I would say fuck y’all shitgibbon-voting stupid USians and get the hell out of this fucked up bullshit to somewhere more civilized.
Also, fuck “balance billing,” which is legal in my state, and which renders copays and out-of-pocket maximums worthless. Luckily public hospitals don’t seem to engage in that practice.
Barbara
@rikyrah: The point in all of this is that the reason why Medicare is “so low” for your sister is because current taxpayers (which would include your sister) are basically paying 2/3 of Medicare expenditures on a pay-go basis. The average person contributes over their working life no more than 1/3 of the cost of what will be paid out in benefit expenses under the Medicare program on their behalf, as opposed to Social Security, which is close to 1:1, and with some tweaks could clearly be solvent for a long time. This is not in any way to blame your sister for her own health problems or suggest she isn’t deserving, just to state that there is a big structural problem that will make it very hard to expand Medicare to cover more and more people at a younger age as the program is currently structured.
gene108
I think a lot of folks, who don’t have Medicare think it’s a straight forward thing. There are a lot of options in Medicare, which can be overwhelming.
I think “Medicare for All” can be effective, if it is linked to a broader policy objective, such as decoupling insurance from employment or providing a minimum guaranteed level of coverage to everybody.
I don’t think “Medicare for All” will fix everything, but it can be used to fix one or two glaring weaknesses in our current system.
@Roger Moore:
Fixing problems costs money. How big a tax hike will be required and how politically feasible is it? Those are the main issues facing us, when it comes to fixing Medicare.
hilts
OT
Every goddamn day that Donald Trump serves as President is a fucking crime against humanity.
h/t https://www.buzzfeed.com/nidhiprakash/puerto-rico-death-toll-harvard-study?utm_term=.qgYzNOQQz#.mcXPnMGGP
I'll be Frank
I’m wondering how the Japanese do this. They’ve had single payor and an aging population for some time.
VeniceRiley
Medicaid for all. As for increased taxes, I wonder if what employers and self employed spend now for their plans is more than what the tax increase would roughly equal? Or maybe even less, since there would be so much streamlining and simplification?
However some other countries do it that makes it cost so much less and work better is what I am for. I don’t even know what that would look like. I’m leaving it up to the brainiacs.
Alex
@Roger Moore: Yeah, I think most of the people backing “Medicare for All” really want a benefit design closer to “Medicaid for All,” but they don’t say that because either they don’t know the difference or they think Medicaid is too stigmatized by its association with the poor. The big advantage of Medicare expansion is that it’s all federal, with less chance for red states to sabotage it, but I doubt that’s why the slogan has settled on it.
The Other Chuck
Here’s a solution: tax the fucking rich and stop throwing our treasure away on wars fought to prop up the fucking rich.
Shinobi
I had always assumed that “medicare for all” was more a “see, medicare, we already do this, it isn’t that scary, what if we just made this kind of support available to everyone” type slogan, than a literal policy proposal.
The structure of the medical field in the US would need to change. Cost structures, profitability, education & training, so many things really would need to be adapted for us to move to a more progressive model of care. I always thought of it more as “something like medicare but that will be unrecognizable compared to medicare by the time we actually overhaul the system.:
But that’s never going to happen because politicians like money.
ruemara
@Charles Gaba: And, unsurprising as usual. It’s a lot harder than it looks.
@Shinobi: For many who don’t know what medicare is, they literally mean Medicare as a global health services program. The details have escaped them.
Ohio Mom
@ruemara: I’ve met a number of under-65 yo’s who think Medicare is free. I wonder if that misconception isn’t fueling some of the enthusiasm for Medicare for All.
Bob Hertz
America today has about 330 million residents.
Assume that 60 million are on Medicare and 70 million are on Medicaid, or in prison, or Indians, or in the military, and that leaves us 200 million for single payer.
At $6,000 each, the cost would be $1.2 trillion.
That is an impossible tax increase, but remember that employers currently pay about $950 billion in health premiums.
So in a sense the money is already there. But there is a huge problem.
Some employers pay at least 20% of payroll on health insurance and other employers pay next to zero. (think General Motors vs. Dunkin Donuts)
I cannot come up with a tax system that would work here for single payor.
The employers who pay nothing will resist wildly, as they did vs. the Clinton plan.
Even some wealthier employers will use ERISA to fight single payor taxes. I do not know how we could bring this off