While the United States has the best health care money can buy, it is also fraught with problems. One of the most obvious problem is that many Americans cannot afford to buy that health care—many lack health insurance and others lack adequate insurance despite Obamacare. This lack of insurance has at least two major negative impacts: the health of the uninsured is at risk and health care institutions suffer financially. Another effect is that of medical bankruptcy; though probably not as widespread as the left claims it is still worthy of concern. Because of these problems, it is hardly surprising that some Democrats and others on the left have proposed expanding Medicare to cover all Americans.
On the positive side, such an expansion would provide everyone with health insurance. This would benefit those without insurance and would also help health care institutions financially since medical services would eb paid for. Also, since the system already exists, it would not need to be created from scratch: the state would mostly just need to scale up the existing system. As would be suspected, such a system is also ideologically appealing to the left. While there are clear advantages to expanding Medicare to cover everyone, a rational assessment requires looking beyond just the positive aspects and, as much as possible, without the glasses of ideology.
Perhaps the most obvious concern is the cost of such a program. Those who already pay for insurance would, presumably, not feel any financial impact from the switch—unless the cost of Medicare for all was significantly higher than what they already pay for insurance. Which it might well be. There are numerous plans for paying for the expansion, but it seems fair to say that many of them are distorted by ideological concerns and wishful thinking. Such an expansion would obviously be expensive—but also obviously not beyond the ability of people to pay for it. As always, the main issue is who will be footing the bill. The cost could have various negative impacts on the economy and individuals, and these need proper consideration.
A second concern is the impact on the health insurance industry. While some might be tempted to think that only the fat cats of the industry would lose out, the fact is that the insurance industry is made up of a range of people who depend on their job to survive. Switching to Medicare for all would effectively eliminate the private health insurance industry and put many people out of work through the direct and indirect effect of this elimination. It is also worth considering the other economic aspects of this elimination, such as on the stock market. While it should not be assumed that this cost will be too high relative to the benefits, this cost needs to be properly considered.
A third concern is fraud. While fraud does occur with private health insurance, Medicare has proven to be a cash cow for fraudsters. In 2014 about 10% of Medicare’s total budget was lost to fraud. Expanding Medicare to everyone would turn the cash cow into a cash herd—which is something to be worried about. Fraud could and should be addressed even if Medicare is not expanded, but the cost of fraud must be included in the calculations used to assess the merits of expanding Medicare.
A fourth concern is usually advanced by conservatives, namely that the elimination of the for-profit motivation and providing care to all will somehow ruin the quality of health care with socialism. One reply is to note that health care will remain for-profit: Medicare for all does not nationalize health care institutions, just the insurance industry. That said, it could be argued that with one entity paying all the bills costs will increase and quality will decrease—but what is needed is evidence for these claims. If they are true, then this would be a problem.
While Medicare for all is a popular idea, it would be unwise to let its appeal blind people to a rational assessment of the costs and benefits of such a plan. It might turn out to be a good idea, but that is not a matter to be settled by political slogans or ideological posturing.
How doe Medicare-for-all work with open borders?
How does Medicare-for-all work with open borders?
I don’t think anyone serious is seriously proposing open borders and Medicare for everyone within the borders.
So when Dems say they want to “abolish ICE” they are not asking for open borders?
ICE has only existed since 2003. The US did not have open borders before then, so ICE is not necessary for closed borders.
Mostly not; but there are no doubt some who are. For any position, there is a non-zero chance someone holds it. What I have seen is the proposal to get rid of ICE but not to just open the borders.
I guess it would be kind of like the way federal immigration law is enforced in sanctuary cities.
Mike(s):
So what will change when ICE is abolished?
Perhaps nothing. Policy and practice are what matter, rather than what the organization is called. While “abolish ICE” makes for a good bumper sticker or hashtag, without an actual set of proposed policies and practices it is worse than meaningless.
A lot of the concerns mentioned could be dealt with by looking at the much more equitable and mature healthcare systems in other advanced Western democracies which deliver better outcomes at lower costs to the community. The US is hung up on the appearance of socialism when most of its allies have heavily socialised healthcare and other community support systems. So much US political rhetoric seems to be tied up with emulating countries that the US is ostensibly in conflict with rather than those with historical shared values.
There is a lot of confusion between a big welfare state and actual socialism. I have no problem with a big welfare state if the people are willing to pay for it with high taxes.
I don’t like it when pols claim that everybody can get a bunch of free stuff and we can pay for it by taxing the “rich.” They will talk about “millionaires and billionaires” but the, at the end of the day, the “rich” will turn out to be those earning $100,000.
Does your dog get better treatment when he’s sick than you do? Dr. Sarah Boston thinks so. During a year in which she underwent treatment for thyroid cancer, the Canadian veterinarian couldn’t help but compare her experience with those of her own patients. The result is Lucky Dog, a new book that is more than a cancer memoir in that it brings up issues that frustrate many Canadians about our health care system: Long waits for everything from initial diagnosis to treatment, a sense of profound powerlessness, poor communication and a lack of choice.
https://www.huffingtonpost.ca/marilyn-linton/canada-health-care_b_5434980.html
You missed one major concern – waste. Medicare loses a significant amount of money due to fraud, but fraud implies criminal intent. Waste is caused by redundancy of services, paying for unnecessary services, paying too much for services, and simply having an excess of personnel doing the tasks that can be done by fewer people – just to name a few. And the cost of waste in the current Medicare system far outpaces that of fraud.
The government is grossly inefficient, and in my opinion, completely incapable of handling so massive an undertaking as “Medicare for All”. They have nearly bankrupted “Medicare for Some”; it seems highly unlikely that they would do anything but the same, on a larger scale, if they undertook to create a single-payer system like M4A.
There are reasons behind this inefficiency, and they all seem to boil down to politics. And usually, the politics don’t go much farther than “Funding”, which is the government approach to just about any problem. They don’t have to worry about efficiency or quality, because they aren’t competing for business; they don’t have to worry about profit because they have their taxing authority.
Ask any successful business person about how they became successful, and they will tell you that they hired the best people they could find and kept them happy, they stayed open to new ideas and adapted to new situations, and they provided an excellent product or service to their customers at a reasonable price. In the case of health insurers, one of these metrics is the negotiated fees they pay the healthcare providers. Too little means a limited network of providers both in number and in quality, which means that fewer individuals and companies will buy your product.
The government, of course, does none of that. There is a pretty good reason why physicians in private practice limit Medicare patients, or won’t accept new ones – because Medicare payouts are not competitive with those required of private industry, and claims are exponentially more difficult to process.
“A fourth concern is usually advanced by conservatives, namely that the elimination of the for-profit motivation and providing care to all will somehow ruin the quality of health care with socialism. One reply is to note that health care will remain for-profit: Medicare for all does not nationalize health care institutions, just the insurance industry.
It is true, healthcare will remain for profit and that M4A is nationalization of the insurance industry, not the healthcare industry, or so we are being told. But consider the model of what is happening with Medicare today. There will be no “negotiated fee schedule”, because the government will hold all the cards. If Medicare is all a doctor has in order to make a living, and no longer has the option of limiting the number of medicare patients, more existing practitioners will leave the field of medicine for more profitable enterprise, and fewer people will choose to go into medicine in the first place. If the government is who pays for your services, and doesn’t have to even negotiate those payments, then what you have is a government job. Worse, in fact, because you are likely to be saddled with debt from student loans and setting up in private practice, you are bearing all the risks associated with any business, and you are likely to be carrying a HUGE amount of liability insurance as a buffer protecting you from all the litigators waiting outside your door.
So you have all the costs, debt, and and risk of any entrepreneur, PLUS you have spent far more time in school working toward this goal – only to end up as the equivalent of a GS-12?
From where I sit, there’s little reason for anyone to go into medicine unless they were a true altruist, willing to work long hours for little pay simply for the good of mankind.
The optimism behind M4A isn’t much different from the optimism surrounding Obamacare – that if people are able to see their doctors for free for regular checkups, then we would have a healthcare system based on prevention. The problem with that mentality, of course, is that for that to happen patients would actually have to participate in their own care – they would have to quit smoking and limit alcohol because their doctor tells them to – they would have to limit their consumption of fats and sodas, they’d have to eat more vegetables and get more exercise – they’d not only be able to visit their doctor yearly for a checkup, but they’d actually have to listen to what they are told and act on it.
“the United States has the best health care money can buy…”
And look where the focus is, where those dollars are being spent. Heart disease. Diabetes. Stroke. Cancer. A hugely preventable array of diseases – but the American entitlement mentality says that not only is healthcare a right, but we also have the right to not listen, to demand a pill instead of being forced to take action ourselves, and when we do develop some chronic, long term, expensive illness, we have the right to not be blamed for it, and to just get our free meds and a little scooter to drive up and down the aisles of Walmart.
When the government shows that they can actually develop a system that will encourage the best and brightest to go into medicine, that will compensate them for their skill and expertise, and when the government shows that they have even the slightest interest in a competitive, efficient system that rewards merit and weeds out dead-wood, that focuses on performance rather than entitlement, for which the doctrines of “diversity” and “fairness” are applied after having read the resume and analyzed the qualifications for the job, then I will listen.
But when a politician like Kamala Harris establishes a platform that includes M4A and a $3 Trillion middle class tax cut, how are we to believe that these politicians have any idea what they are talking about?
When a president like Barack Obama force-feeds us Obamacare with the promise that our premiums will go down, that we can keep our doctors, and that the individual mandate is not a tax – and every single one of those points turns out to be a lie (defined NOT by the fact that he was wrong about them, but the fact that he knew that they would happen and made the promises anyway) how can we believe any of the promises for better care, more accessibility to quality doctors, lower cost, and no impact on our taxes?
And all they can say about the current state of Medicare is, “Well, it won’t be like that. We promise”.
I got as far as “waste” the root of which is the entire problem with government run anything. A business has customers who voluntarily purchase services. So long as there is no monopoly or virtual monopoly, the customer has the choice to select the provider who offers the best value for the lowest cost. Thus the incentive to eliminate waste is on the provider. In government run or other monopoly conditions, the customer has no choice and thus without competition the provider has little incentive to reduce waste. On top of that, those that work for the monopolistic provider have incentive to build bureaucratic empires. It’s their only opportunity to grow their “market share”, for lack of a better term. True that health insurance is a bit more complicated than other forms of insurance or other businesses for that matter, but health care itself does not have near as many of those complications. The merging and confusing of health care with health insurance is a huge part of the problem as well.
Many of the comments here reflect the US approach to delivering these services, which is not emulated in other countries providing healthcare to all its citizenry. The problems are not necessarily a reflection of “government run anything” but perhaps of the power of commercial interests in Washington.
The sad thing is that rather than looking for lessons to emulate, US lobbyists are frequently active in trying to get other countries’ healthcare services shutdown via clauses in international agreements.
MikeW, what makes you think that there are citizens in the US that are not receiving health care?
There’s “healthcare” and there’s “adequate healthcare”. Having lived in Australia, USA, UK and France, I would say that USA comes in about 7th place out of 4 for even routine healthcare. I’ve had better free healthcare in countries I’ve visited briefly than in the US as a tax-paying, highly-insured resident.
https://www.ncbi.nlm.nih.gov/books/NBK235885/
https://abcnews.go.com/Health/Healthday/story?id=4509618&page=1
https://www.cdc.gov/nchs/fastats/access-to-health-care.htm
https://www.nytimes.com/2016/10/25/upshot/why-the-us-still-trails-many-wealthy-nations-in-access-to-care.html
https://www.theguardian.com/us-news/2017/jun/24/us-healthcare-republican-bill-no-coverage-death
https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/
The far higher rates of mortality at all life stages for Americans compared to other Western nations also suggests that either everyone is receiving appalling healthcare or a certain proportion are receiving none.
Emergency rooms cannot refuse patients; so technically everyone has access to health care. But, there are people who lack insurance and the resources to access non-emergency health care-which is one reason people end up in the emergency room for conditions that could have been prevented if they had regular health care access.
So all the insurance subsidies provided for by the ACA accomplished nothing?
There’s “healthcare” and there’s “adequate healthcare”. Having lived in Australia, USA, UK and France, I would say that USA comes in about 7th place out of 4 for even routine healthcare. I’ve had better free healthcare in countries I’ve visited briefly than in the US as a tax-paying, highly-insured resident.
And here it is. “Free”. Nothing in this world is free. Anytime anyone gets something for free, it can only be because someone else paid for it. The “Affordable Care Act” here in the US works great. For some people. Meanwhile, saps like me have to pay $1700/month for the “privilege” of a $15,800 deductible for each of us. That means in a worst case scenario, and worst case limited to staying in network, I could spend between half and three-quarters of what I make in a year on health care. In what sense is that “insurance”? This partly because where I live I had only ONE choice. And this in an area where the cost of living is average. Where there are options, taking into account cost of living in those areas, costs are cheaper. Limiting people’s choices is simply wrong. It is bad policy. It is bad for quality. It is bad for costs. It is bad economics.
I can’t speak to French or Oz healthcare but the UK’s NHS is constantly running out of money. And depending on where you are, the service is quite terrible partly because, AIUI, it’s pretty damn hard to fire those people. There’s a lot of ruin in a nation. Eventually you run out of other people’s money.
So if that is your degree of understanding, that may explain this…
The sad thing is that rather than looking for lessons to emulate, US lobbyists are frequently active in trying to get other countries’ healthcare services shutdown via clauses in international agreements.
Yes. That is what these lobbyists are doing. Someone (who?) is paying them good money to run around the world and shut down healthcare services in other countries. Makes perfect sense. Because they are just that mean. Or perhaps underpants gnomes or something. What is sad is that pablum like this gets repeated in leftist echo chambers often enough that people simply believe it. Because everyone says so.
You’re referring to other nations’ legislative bodies as “leftist echo chambers”.
US lobbyists don’t like other countries healthcare systems because they provide a centralised negotiation point rather than the mess of 50 states that they’re used to exploiting.
Since you have no experience of other national systems, you could stop disparaging them or assuming that they’re subject to the same selfish excesses as exist in the US environment.
OK, it’s quite apparent to me that you have a reading comprehension problem. There isn’t enough time left in the universe to argue what you, intentionally or not, misinterpret and improperly infer.
True, I did neglect waste. It would seem to make more sense to return to the pre-insurance model of healthcare as a normal business with healthy, but not absurd, profit margins. Insurance companies also make a profit, so we essentially get double billed for everything.
…”A June 2012 survey of 36,000 doctors in active clinical practice by the Doctors and Patients Medical Association found 90 percent of doctors believe the medical system is “on the wrong track” and 83 percent are thinking about quitting. Another 85 percent said “the medical profession is in a tailspin.” 65 percent say that “government involvement is most to blame for current problems.” In addition, 2 out of 3 physicians surveyed in private clinical practice stated they were “just squeaking by or in the red financially.”
A separate survey of 2,218 physicians, conducted online by the national health care recruiter Jackson Healthcare, found that 34 percent of physicians plan to leave the field over the next decade. What’s more, 16 percent said they would retire or move to part-time in 2012. “Of those physicians who said they plan to retire or leave medicine this year,” the study noted, “56% cited economic factors and 51% cited health reform as among the major factors. Of those physicians who said they are strongly considering leaving medicine in 2012, 55% or 97 physicians, were under age 55.”
Interestingly, these surveys were completed two years after a pre-ObamaCare survey reported in The New England Journal of Medicine found 46.3 percent of primary care physicians stated passage of the new health law would “either force them out of medicine or make them want to leave medicine.”
Of course, opinion is not fact, and the above excerpt is from an opinion piece titled “How Government Killed the Medical Profession” published by the Cato institute. And I am not ignorant of the fact that a pretty big chunk of the population of this country would dismiss this article along with anything published by the Cato institute on the basis of their reputation as a “right-wing think-tank”, but there certainly is a lot in this article to digest.
https://www.cato.org/publications/commentary/how-government-killed-medical-profession
Yes. See above about care vs. insurance. Lies at the root of many medical professionals’ complaints. Problem is, it’s rather hard to get highly educated people to understand that there are things outside of their expertise that they don’t understand. Especially those of the memorizing classes as opposed to the thinking/problem solving classes. I’ve found a high percentage of doctors and other medical professionals can’t accept an answer they haven’t arrived at from their own analysis.
Something else Ive learned about doctors is the worst thing you can do when dealing with a health issue is give any indication that you might know what your own problem is. I’ve learned that it is much more effective and time saving to lead the doctor in the proper direction via a judicious injection of symptoms such that they think they’ve arrived at the diagnosis themselves. One must of course be open to and make the greatest use of their expertise as one’s self diagnosis can very well be wrong. But most of all, never give the impression that you yourself are capable of understanding the great mysteries of their pseudoscience. Of course there are exceptions, as with every piece of advice. But that’s the way to bet.