Reason.com

Free Minds & Free Markets

Are You Sure You Want Medicare for All?

Expanding existing government healthcare systems would also spread the reach of their already messy problems.

Senator Bernie Sanders (I-Vt.) plans to unveil his long-awaited "Medicare for all" proposal for government-controlled, single-payer health care. His colleague, Sen. Elizabeth Warren (D-Mass.), is all-in on the scheme. "Medicare for All is one way that we can give every single person in the country access to high quality health care," she writes. "Everyone is covered. Nobody goes broke paying a medical bill. Families don't have to bear the costs of heartbreaking medical disasters on their own."

And for starting us along the path to all of that high-quality care, she adds, "We owe a huge debt to President Obama."

Well, there is something there. Debt, that is. Huge, accumulating mounds of it, swamping everything in sight. In 2001, the Congressional Budget Office warned that spending on retirees—specifically Social Security and Medicare—"will consume…almost as much of the economic output in 2030 as does the entire federal government today."

"Notwithstanding recent favorable developments," the Medicare Trustees conceded in their report this year, "current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation." The report foresees that "the trust fund becomes depleted in 2029."

In actual dollar amounts, says Michael D. Tanner of the Cato Institute, "Medicare faces unfunded liabilities approaching $48 trillion. And, if we return to double digit health care inflation, we could see Medicare's liabilities swell to more than $88 trillion."

This is the regular Medicare system that we have now, targeted at the growing but limited population of retirees. Medicare for All would take this existing system's promises, costs, and unfunded liabilities, and apply them to the whole country.

Medicare is in the hole, by the way, even though it pays medical providers rather less than private insurance. "The government program typically pays only 80 percent of what private insurers do," CNN noted in 2014.

Red tape is also a huge burden for medical providers who accept Medicare. "A random survey of 1,000 practices found physicians and staff spend 15.1 hours engaged in quality measure reporting each week, at a cost of more than $40,000 per year for each doctor," according to FierceHealthCare.

Jumping through bureaucratic hurdles for the privilege of accepting substandard compensation isn't as attractive as it might seem. That may be why a growing number of physicians refuse to see Medicare patients, others limit the number they'll accept, and more balk all the time.

Under a single-payer system, options for medical providers may be more limited than they are now—there probably wouldn't be any better-paying private insurers to take by preference to the government system. But there also wouldn't be any private insurers to effectively subsidize Medicare patients. In the case of a single-payer transition, doctors who find the terms of Medicare for All unacceptable may switch entirely to private-pay (if that's still permitted), while some percentage will leave medicine entirely. Considering the potential for switching over to single-payer in The Atlantic, Olga Khazan predicts "Hospitals would shut down, and waits for major procedures would extend from a few weeks to several months."

Such delays and restricted access assume that Medicare for All means an actual attempt to replicate the sort of care currently provided by the retirement system, including its costs, writ large(r). If, instead, the U.S. were to expand existing government healthcare for the poor into Medicaid for All—a plan explicitly endorsed by Sen. Brian Schatz (D-Hawaii)—the plans offering's and costs would be rather different. That is, the program would offer less, and be pretty bare bones.

Medicaid "limits the drugs and treatments its beneficiaries can get," Khazan notes. "Americans would find it stingy compared to their employers' ultra-luxe PPO plans."

Medicaid, by the way, pays less than Medicare—about 61 percent of what the retiree medical program pays providers. "Focus-group participants estimated that the current Medicaid rates were covering roughly 50–70 percent of their costs of providing care for Medicaid patients," according to a HealthAffairs survey. Given that many providers lose money on every Medicaid patient seen, it's unsurprising that a lower percentage of physicians accepts such patients than takes Medicare patients.

Physicians have to chase the various state Medicaid plans for their pittance, even so. Illinois hasn't paid billions of dollars owed to providers for patients' medical bills—and ignored a court order to do so, leading to yet another order that the state may or may not take seriously. Connecticut isn't quite so far in the red, but also holds back payment to providers. And my wife, a pediatrician, isn't alone among providers in having to constantly treat our state's Medicaid system like a deadbeat that needs constant nagging before it offers a few dimes on the dollar for what it owes.

And, yes, Medicaid is rule-bound too, governed by most of the same red tape that ensnares Medicare.

Again, switching to Medicaid for All would limit providers' choices. They could take the plan, switch to private pay (if allowed) or leave medicine. But if each patient seen represents an actual loss, few providers would have the ability, let alone incentive, to knuckle-under and accept the new order. Many would be out of business—or politicians would be scrambling to find yet more money to make sure that the country maintained some sort of health care industry.

A big part of the problem, as Cato's Tanner pointed out earlier this year is that "Americans want widely contradictory things from health-care reform. They want the highest-quality care for everyone, with no wait, from the doctor of their choice. And they want it as cheap as possible, preferably for free."

Promising, as Sanders and Warren do, to give everybody high-quality health care without regard for ability to pay will always find an enthusiastic audience. But delivering on that promise is likely to give us not the illusion of Medicare for All, but rather its awful, unsustainable reality.

Photo Credit: Michael Vadon

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • Telcontar the Wanderer||

    "Red tape is also a huge burden for medical providers who accept Medicare. "A random survey of 1,000 practices found physicians and staff spend 15.1 hours engaged in quality measure reporting each week, at a cost of more than $40,000 per year for each doctor," according to FierceHealthCare."

    If only there were an economic system in which every exchange were regulated by an individual with skin in the game already present at it...

  • Unicorn Abattoir||

    The people promoting Medicare for all believe that the government owns your skin and therefore is present.

  • Hunthjof||

    What I am amazed it is even with all that red tape their fraud rate is insane and their rejection of payment is comparable to the rest of the industry.

  • DajjaI||

    "Medicare for all' means that you all will get sick and I will be the only one left to take care of everyone. I don't want to change your diapers and I'm pretty sure you don't want that either. (Or do you?? You people are SICK.)

    Jill Stein disavows this message.

  • Telcontar the Wanderer||

    Yes, the flipdiving community would be devastated by a disruption in availability of emergency services, I'm sure.

  • Rat on a train||

    Fast, inexpensive, high quality. Pick any two. Or, in the case of the government, pick one which may be denied.

  • DesigNate||

    Why? It's pretty accurate, at least in my field.

  • JWatts||

    Agreed, it's pretty accurate in mine too. Though it's a matter of degree. If you want really high quality, it will probably be both slow and expensive (think Military procurement), but in general you'll get decent effects if you pick two.

    Of course, some people try to ignore all three and then it just doesn't work.

  • Scarecrow Repair & Chippering||

    I wonder what the practical consequences would be, other than destroy health care in the US.

    1. Some Canadians cross the border for paid health care. No more!

    2. Any politician in a single-payer country caught going elsewhere for health care would probably be a lame duck; do they exempt themselves, or set up some special hospital for their care? I know Congress has done a lot of that, but what abut Britain and other single payers?

    3. Outlawing all private health care seems unlikely in the US for at least a while; they need to get the single payer option in place for a while to accrue the experience necessary to blame private care for its problems. I wonder how long that will take.

  • Scarecrow Repair & Chippering||

    Interesting. This original SUBMIT resulted in a long delay terminated by a 503. I resubmitted, so not a definite squirrel problem.

  • ThomasD||

    1. Some Canadians cross the border for paid health care. No more!

    The private pay system does not go away, it just loses any form of subsidy.

    Meaning private hospitals will be entirely private, and damn expensive.

  • Mark22||

    In the US, the private system subsidizes the public system, not the other way around.

  • Adam330||

    2. Of course they give themselves special privileges. http://www.dailymail.co.uk/new.....ients.html

    But note that "special privilege" here is that they get a private room! This is standard at most US hospitals, but its special treatment in the UK.

  • Tony||

    And in the US you can to happily leave that private hospital room with an $8000 bill.

  • Adam330||

    Your point? That nice stuff costs money?

  • some guy||

    His point is that someone else should have to pay for the goods and services he uses.

  • Incomprehensible Bitching||

    As an American, I have a God given right to embrace a diet exclusively of chicken wings, cigarettes, and beer, and I expect the American Health Care System to subsidize that and inject me with life-extending drugs which allow me to live a long, happy life of chicken wings, cigarettes, and beer.

    Because everyone needs medicine sometimes.

  • Red Rocks White Privilege||

    As an American, I have a God given right to embrace a diet exclusively of chicken wings, cigarettes, and beer

    Tony seems to believe that the goal of the American healthcare system is to allow poor people to stuff themselves with fried meats and carbs, then provide them with heroic medical treatment until they gracelessly expire.

  • mpercy||

    And speaking of chicken wings, cigarettes, and beer, I have a right to foodstamps which allow me to buy chicken wings, cigarettes, and beer. I may have to fudge the rules a bit to get the cigarettes and beer, but that's ok--I'll sell $100 worth of my foodstamps for $50 cash and use the cash for cigarettes and beer. And then I'll complain that I can't afford enough chicken wings as it's my right to!

  • some guy||

    Yeah, government regulations of the medical and insurance industries have really driven up costs. But, even so, if you didn't want to leave the hospital with an $8000 bill then you should have bought different insurance.

  • ||

    And? Are you consenting to this 'Animal Farm' Soviet Union style of privileges for one class of people?

    Happens in Canada too.

    I thought you hated 'let them eat cake' Tony. Then again, you'd be the one checking off the lists in the gulags, right?

  • BYODB||

    Some animals are more equal than others, comrade!

  • Zeb||

    You can get private insurance and/or use private hospitals in the UK. Though I expect most politicians would use NHS so it doesn't look bad.

  • Zeb||

    Care to elaborate? I can't find anything that contradicts what I said.

  • swampwiz||

    I remember when my father had heart-valve surgery, because my mother was around so much, he got moved to a nice private room, since the nurses did not have to be as attentive.

  • Hunthjof||

    "3. Outlawing all private health care seems unlikely in the US for at least a while; they need to get the single payer option in place for a while to accrue the experience necessary to blame private care for its problems. I wonder how long that will take."

    Actually depending on how the plan is written several of the Democrats single payer proposals would in fact do that. California's original plan would have prohibited any service covered under California Care from being purchased with private insurance and I believe even cash. If that had gone into place I would have expected a thriving healthcare business on the Mexican side of the California boarder and also in Yuma Arizona and places in Nevada.

  • tombstone||

    Some US citizens go to Canada for cheap health care (and no guaranties). They will kill hospitals with this. Canada and Great Britain do not allow patients to sue physicians, and the Affordable Care Act was targeted by the attorneys to keep tort reform out of it. Physicians (and increasingly RN's) pay plenty of money for malpractice insurance. If Physicians and nurses have to play this game, and there is no tort reform, there will be an exodus of qualified, skilled healthcare professionals from the industry. This will cripple hospitals.

  • Scarecrow Repair & Chippering||

    I wonder what the practical consequences would be, other than destroy health care in the US.

    1. Some Canadians cross the border for paid health care. No more!

    2. Any politician in a single-payer country caught going elsewhere for health care would probably be a lame duck; do they exempt themselves, or set up some special hospital for their care? I know Congress has done a lot of that, but what abut Britain and other single payers?

    3. Outlawing all private health care seems unlikely in the US for at least a while; they need to get the single payer option in place for a while to accrue the experience necessary to blame private care for its problems. I wonder how long that will take.

  • Mark22||

    2. Any politician in a single-payer country caught going elsewhere for health care would probably be a lame duck

    Yeah, just like politicians who promote public schools and send their kids to private schools. Just like that.

    3. Outlawing all private health care seems unlikely in the US for at least a while

    AFAIK, no major nationalized health care system "outlaws" private health care. The UK has a thriving supplemental private insurance and private provider market.

  • Zeb||

    I thought some provinces in Canada forbid private health care. I could be thinking of something else.

  • Brian.bs||

    In ALL OF CANADA private healthcare is forbidden. Of course Quebec has found a few loopholes. And yes, the politicians just head to the US for treatment. Not waiting in lines for them.

  • Mark22||

    You're right, Canada does. Although it hardly matters, given that most Canadians can always use the US system with a short drive and that private clinics often seem to ignore the law.

  • C. S. P. Schofield||

    Thought the Canadian Supreme Court had ruled that the State could not deny access to private healthcare on the grounds that a right to such was written into their Constitution, and the Canadian system routinely failed to provide. Sorry to hear it didn't stick.

  • Eric L||

    "The UK has a thriving supplemental private insurance and private provider market."

    Same in Japan. AFLAC insurance company does a thriving business in Japan providing supplemental health insurance of various kinds.

  • Leo Kovalensky||

    "Medicare is in the hole, by the way, even though it pays medical providers rather less than private insurance. "The government program typically pays only 80 percent of what private insurers do," CNN noted in 2014."

    What will happen to costs when private insurance is no longer around to subsidize Medicare?

  • TrickyVic (old school)||

    I'm not sure about Medicare part A, but part B requires you to pay 20%.

    What happens will people are going bankrupt trying to pay the 20% co-insurance?

    The Medicare for all is just a step in the direction they want to go. Once everyone gets it, then they will complain about it and try to "fix" the system.

  • Adam330||

    I always laugh when people tell me how awesome Medicare insurance is. They all seem to be blissfully unaware about that 20% co-insurance requirement. You think you're $2000 or whatever deductible is bad- try out 20% of your $150k heart bypass.

  • Adam330||

    A lot of that, including the doctors fee and anesthesiologist, are under part B, as is the follow-up rehab care.

  • JFree||

    try out 20% of your $150k heart bypass.

    Well maybe you should go to Thailand. At Bumrangrad hospital, a bypass will cost a bit more than $22k all in. Add a few thousand for the rehab/vacation on the beach. Or Singapore - for a cost of less than $30k.

    What Medicare should do is start playing hardball - and start covering those sorts of surgeries in any JCI-level hospital. You want to pay more - you pay more yourself. The cost difference (400-500% higher costs - and that ratio is comparable for near everything) is a hell of a lot for the government to pay for a middle-class and above welfare program.

  • JFree||

    Course if we had a primary-care driven system instead of a specialist-driven system, those incentives would already be in place. But we need to focus the entire discussion on 'insurance' so we can keep them poor people out and drive the costs up - cuz we're USAUSAUSA.

  • tommhan||

    Yep we have to get a hospital and prescription insurance plan to go with Medicare so we won't be bankrupted by the medicare after paying for it our whole lives. Retiring is scary because of worry over health care. I am planning on retiring in 2 years and I worry about what will be left after I pay for extra insurance and whether the prescription coverage will allow me to continue to receive the meds I need. Now people that never worked much and have nothing get all their meds free and vets get theirs free. Us? not so lucky.

  • John Donohue||

    Oh. You don't know about Medicare Advantage. That pays for the remaining 20%, in some cases with no increase in premium. I repeat, no increase in premium.

    SS takes $138 out of my check for Medicare A and B. I just contracted for a United Health Care Advantage plan that covers 100% of doctor and hospital, no matter what. Drugs, covered up to $3000/year. The only charges are for emergency ambulance $200, and $75 if you go to the emergency room or one of those corner clinics. Otherwise, I am totally covered, with no deductible, no copay.

    I did not have to take a medical exam or even respond to a list of ailments.

    When I heard about this astounding plan, I asked my broker...how can UHC make any money? He said "well, WE get your $138/mo, and if you have a big claim, the """government gets involved""" in compensation. I did not drill down on that.

    I am not making this up. I have this plan.

    Wouldn't you like "everyone" to have it??? [US --> bankrupt]

  • Ride 'Em||

    It depends on your income. Because my wife and I were savers before we retired, silly us, when we applied for Medicare this year we were notified our total premiums would be about a thousand a month. There is some income means testing in Medicare.

  • creech||

    What will happen? Why all the doctors and nurses speaking out against Obamacare repeal will be perfectly happy with their pay cuts.

  • Mitsima||

    "Keep 'em just satisfied enough so that they keep coming back for more." - every drug dealer, ever.

  • Leo Kovalensky||

    First they will be labeled as kulaks/wreckers. It's always people's selfish desires to improve their quality of life that wreck the whole Socialism thing. If only everyone cared as much as the central planner does.

  • tlapp||

    Per the government's own Trustee Report Medicare is 65% short of money needed to pay promised benefits. It is not insurance but insurance fraud. This proposal is to expand fraud to everyone.

  • loveconstitution1789||

    The goal is to destroy private health care markets and lock every American into this failing system. It is just shown that everyone suckling from government teats makes it harder to decommission said teats.

  • Mark22||

    I think talking about "suckling from government teats" is an unnecessary turn-on for heterosexual males. Why not refer to the orifice that the government shit actually comes out of by its proper name?

  • loveconstitution1789||

    Hm.. You might be right and labeling someone a felcher might embarrass more people to leave that shitty government welfare alone.

  • Jimothy||

    For me, government is personified by Nancy Pelosi, so the thought of sucking from its teat is anything but a turn on.

  • Mickey Rat||

    In doing so, eliminating the private insurance payments which are making up and hiding the fact that MediCare does not pay for the full cost of treatments. Is this intentional or are Sanders and Warren just that stupid?

  • Citizen X - #6||

    I've seen no evidence that either of those clowns isn't stupid.

  • Enjoy Every Sandwich||

    Does Bernie plan to "reveal" how he plans to pay for all of this "free" health care?

  • loveconstitution1789||

    Be assured holding and shaking taxpayers upside down will be involved.

  • Mark22||

    That's why blue collar workers wear coveralls

  • Citizen X - #6||

    By making sure "the rich" pay their "fair share," whatever those words mean.

  • Enjoy Every Sandwich||

    I know they'll say that. But if they spend whatever money they make off of that (heh if they make any at all), then where will they get the money for all of their other "free" goodies like "free" college education, "green" energy, etc etc?

  • Citizen X - #6||

    By making sure "the rich" pay their "fair share," dude. Because they're "the rich." Progressive policymaking isn't exactly rocket surgery.

  • sarcasmic||

    As long as the rich are rich, then they haven't paid their fair share. If they paid their fair share then they wouldn't be rich anymore.

    "The trouble with Socialism is that eventually you run out of other people's money." - Margaret Thatcher

  • Sir Chips Alot||

    if the "rich" are taxed at 100%, would it even cover the projected costs?

  • Enjoy Every Sandwich||

    I very much doubt it, even if the rich were stupid enough to keep producing after that level of taxation was established. Which they're not.

  • Mitsima||

    LoLz, you are thinking so one-dimensionally, economically speaking. Anyone who has ever run a shell game con knows that funded payouts are not how you (the dealer) play the game ...

  • Episteme||

    Bernie's going to use Tesla's machine from THE PRESTIGE to continuously liquidate kulaks.

  • loveconstitution1789||

    As someone who gets healthcare via the veterans health system, run away from Medicare for all as fast as is humanly possible.

    The USA would be better off returning to cash (no health insurance) for minor medical and catastrophic health insurance for hearth attacks and major stuff.

  • sarcasmic||

    Obamacare is kinda forcing that. The only insurance offered by my employer might as well be catastrophic. The deductibles are in the thousands. The problem though is that this insurance costs the same as the insurance that actually paid for stuff, and I've got to contribute a hundreds a month into the HSA for the cash part. Trying to get enough in the HSA to cover the deductible. So my health insurance costs have literally doubled since the Unaffordable Care Act.

  • Citizen X - #6||

    Same here, and my network has like two doctors in it, both of whom have retired.

  • Episteme||

    Under Berniecare, those two now have to fight in the arena!

  • Aloysious||

    I'm in the same boat.

    My doctors have stopped accepting new patients.

  • Billy Bones||

    Sarcasmic--Not to mention the risk you take of not using your full HSA, and forfeiting any unused amount. Every year it is a crap shot for me. If I put too much in, I end up not needing it and losing it. Too little, then I still have to come out of pocket. Apparently I need a new deck of tarot cards.

  • sarcasmic||

    I've got an HSA, not an HRA. The HRA is not your money. So it's use it or lose it. Had one, but they switched last year. The HSA is an actual bank account with a debit card, and the money is mine. It carries over and comes with me if I switch jobs.

  • loveconstitution1789||

    Not all HSAs have a calendar year use-or-lose-it period. Shop around as any HSA plan that I have heard of allows transfers to other HSA plans. The media almost refuses to provide in depth analysis about HSAs since they go directly against government socialist-care.

    I even throw extra money into my employee's HSA accounts if they use an iWatch or fitbit to record healthy habits. A little financial incentive to exercise on a weekly basis.

  • Fairbanks||

    By law unused HSA dollars rollover indefinitely, and you can even withdraw them (and pay taxes). You may be thinking of FSAs.

  • Mark22||

    Medicare/Medicaid account for about half of US medical spending. If Medicare/Medicaid managed to control costs at UK levels, we could extend them to every American with no increases in taxes/fees/etc. The trouble with single payer in the US is that the single payer system we have is so damned inefficient, and extending that inefficient system to the rest of the population makes things much, much worse. That's what dooms Medicare for all.

  • CatoTheChipper||

    It ain't gonna be Medicare for all; it's gonna be Medicaid for all.

  • loveconstitution1789||

    Its gonna be nothing but no frills medical care for all. This means long lines to see doctors for a few seconds with each doctors as they will have to really assembly line patients.

  • BYODB||

    Nah, what you'll end up seeing is that once the government is in control they'll actually loosen the requirements so that people like a basic Nurse has expanded abilities to see patients and prescribe med's as a full Doctor. (Partially because the incentives to become a Doctor in the first place disappear, so it will just cease being a thing beyond policy / administration. We already see this today with Nurse Practitioners and various other niche 'specialists' that aren't 'real' Doctors but emulate them in assorted ways that are too complex to get into with non-healthcare people.)

    I mean, sure, outcomes will get worse but you think the government will let you sue their employees? HAHAHA, no recourse you proles. Malpractice will cease being a thing once the government is regulating itself. This is something that idiots fail to even think about because, well, they have no clue how anything actually works.

  • Mark22||

    https://www.youtube.com/watch?v=tFfTludf0SU

    Doctor Lexus: "Right, kick ass. Well, don't want to sound like a dick or nothin', but, ah... it says on your chart that you're fucked up. Ah, you talk like a fag, and your shit's all retarded. What I'd do, is just like... like... you know, like, you know what I mean, like..."

  • Juice||

    If you're on Medicare, don't you still have to buy supplemental insurance?

  • BYODB||

    You don't have to, but it's stupid not to.

  • John Donohue||

    Yes. Get an Advantage or Supplemental plan. Seriously. Advantage window is coming up, starting Oct 10th. Prior conditions, not an issue with Advantage.

  • lap83||

    problem: Medicare patients can't find doctors who will see them and are getting worse care than uninsured

    solution: force everyone to get on Medicare!

    problem: doctors leave the profession in droves

    solution: enslave the doctors!

    problem: doctors offer health care on the black market to make money

    solution: arrest all the doctors!

    problem: everyone is ill or dying

    solution: construct Ministry of National Health and Wellness (aka national propaganda center to brainwash us into believing we have the best healthcare in the world)

    problem: doesn't work

    solution: start another war somewhere?

  • lap83||

    *Medicaid patients

  • Enjoy Every Sandwich||

    We've always been at war with The Whole Fucking World.

  • Citizen X - #6||

    Not to mention Mathematics and Biological Facts!

  • Mark22||

    solution: arrest all the doctors!

    problem: everyone is ill or dying

    Doctors are actually remarkably useless in improving life expectancy or overall health of a population; prevention and public health measures are much more effective.

    That's why the healthiest countries in the world spend about 1/3-1/4 per capita of what the US spends.

  • lap83||

    "public health measures" they'll take care of that in the Ministry of Health and Wellness, courtesy of your tax dollars

  • BYODB||

    So, your theory is that Doctor's improving the health outcomes of individuals doesn't translate into overall better health outcomes generally.

    Care to connect those dots?

  • Mark22||

    There are many aspects to that question.

    Doctors obviously extend life in some cases, but they also cause disease and death at a significant rate, through errors, side effects, and unnecessary procedures.

    Doctors are incentivized to treat symptoms, not causes, both because it lowers their costs and because it increases long term revenue.

    Many forms of medical care do not require doctors at all; they can be provided through self medication, apps, nurses, and other kinds of providers.

    Belief in the effectiveness of doctors causes people to take higher risks and live less healthy lifestyles.

    Producing doctors is an expensive investment of economic resources, and the question is not whether a doctor saves lives, but whether a doctor saves more lives than some other investment of those economic resources would have saved.

    Those are some of the reasons why more doctors (or more medical spending, for that matter) doesn't translate into longer life expectancy or more health. And that it doesn't is an empirical fact.

  • JFree||

    I tend to agree - but only re disease-based or bodypart-based specialists.

    Primary care doctors (or pediatricians/geriatricians) have a strong effect on life expectancy and better health - and they also tend to reduce overall medical spending costs. But a medical system has to have them - and pay them the right way. The US fails at both those.

  • Jerryskids||

    Medicaid/Medicare actually works pretty well for people in the program. Well, the people on the receiving end, people on the paying end not so much. M/M works pretty well - same as Social Security - as long as you've got many more people getting payroll deductions funding the system than people getting healthcare paid out. "Medicare For All" will work just fine as soon as we convince the Chinese to pay into the system with the stipulation that no Chinese will be eligible to receive any benefits from the system.

  • John Donohue||

    Ha! That's a great idea. The Chinese will fight to get covered however. They will force India to pay into the system without anyone from India collecting.

    I concur, M is great. I'm on it with a fabulous plan. Just like Ayn Rand, I have fought all my life against government intrusion into healthcare and retirement, but I am happy to take back some of the many many thousands taken from me over 40 years.

  • albo||

    Medicare for all will kill the ambulance industry, that's for sure. Our company gets reimbursed less than half our normal charge for a Medicare/Medicaid transport. And we can't balance bill the customer for the rest, like we can do with private insurance as a non-participating provider.

    Think about this, Bernie, when you have a cardiac event and you have to wait an extra half-hour for an ambulance.

  • Citizen X - #6||

    Bernie's nomenklatura, so he expects to have a full-time doctor on staff at his dacha.

  • CatoTheChipper||

    Komrade Bernie expects medical staff at each of his dachas.

  • Episteme||

    Komrade Bernie will guarantee full employment by building more dachas that need staffing!

  • John Donohue||

    My Medicare Advantage plan covers almost everything, but you have to pay $200 for ambulance. Is that all, half, or a fraction of your normal billing?

  • BYODB||


    "Olga Khazan predicts "Hospitals would shut down, and waits for major procedures would extend from a few weeks to several months."


    Don't worry, they'll just blame that on stingy Doctors. That's why they'll end up nationalizing all Doctor's. You know, because slavery is freedom! Prepare for never-ending tweaking to a failing system while we accumulate debt so fast your savings will evaporate before your very eyes! Oh, and if you're old you'll be left to die because you're no longer useful to society.

  • Enjoy Every Sandwich||

    Oh, and if you're old you'll be left to die because you're no longer useful to society.

    I strongly suspect if society gets to that state I will welcome death.

  • BYODB||

    It's inevitable when you start dealing with rationing. The elderly don't contribute to society anymore, thus their utility is less than younger people who still work. It's the inevitable result of a nationalized system combined with an increasingly scarce good. It's what happens when you go with utilitarianism.

  • CatoTheChipper||

    One of the architects of ObamaCare, Rahm Emmanuel's brother Zeke, has actually worked out the utilitarian formula to determine who should receive medical services and who should be denied:

    Principles for death panels allocation of scarce medical interventions

  • ||

    Or they're spend endless amounts of time, money and energy trying to improve those issues. I know. It's a topic that consumes Canadians. How to improve the system!?

    It never occurs to them - we've been so indoctrinated to think only government can provide health - that privatization is the only path; or at least one that can help alleviate the problems not to mention giving a chance to innovate.

    Oh, what you say about private care catering to only to the rich? At least in a private system it doesn't discriminate and everyone has a shot at it. In the public system special privileges exist even when it's NOT SUPPOSED to according to the 'value' system of fairness it's supposed to be hinged on.

  • ||

    Or 'they will'.

  • Unicorn Abattoir||

    That's why they'll end up nationalizing all Doctor's. You know, because slavery is freedom!

    You don't think we've been pulling those statues down for nothing, do you?

  • Sevo||

    "Are You Sure You Want Medicare for All?"

    Absolutely not.
    As O-care showed, as badly as the medical system was, the greedy hand of gov't made it far worse.

  • Tony||

    How did Obamacare make the system worse. Be specific and please cite your work.

  • Diane Reynolds (Paul.)||

    o It forced millions off of plans they were happy with
    o At best, it's failed utterly in controlling the costs of healthcare and at worst, made them go up faster.
    o It forced people by rule of law to purchase products they either didn't want or didn't need.

    These are but a few small examples.

  • Sir Chips Alot||

    how can you progtards be so stupid and low IQ?

  • Sir Chips Alot||

    how can you progtards be so stupid and low IQ?

  • sarcasmic||

    In my personal case it has literally doubled my out of pocket healthcare expenses. I spend almost as much on my health insurance and HSA as I do on my mortgage. Health insurance and HSA cost me more than cable, internet, electricity, cell phone, and student loans, combined.

  • BYODB||

    We've been giving you specifics for years now, Tony. It's a waste of time giving you facts, because you willfully ignore them.

    If rising premium costs were a problem, the ACA doubled down since of the states who report premium increases, they have gone up by as much, or more, than 200% since the ACA was enacted. No state at all has seen premium's go down. Not a single one.

  • CatoTheChipper||

    Under Obamacare I pay about 80% more for medical insurance and, instead of getting a good PPO plan, I get a crappy HMO operated by the same outfit that provides Medicaid to others for free. But my sixty-something wife and I do get free contraceptives.

    Obamacare sucks.

  • Hunthjof||

    "But my sixty-something wife and I do get free contraceptives."

    I always love when progs say oh in single payer there won't be politics involved in my healthcare. Cause yes military spending and which bases are kept open or are closed is based totally on military needs and not the power of the Senator or Representative where the factory or base is located. Same with Highway and transportation spending. What you describe was a direct political payout to Planned Parenthood, NARAL and NOW. Where resources are shifted and what is or is not covered will totally be determined by the political need at the time. Need Florida Senior care will get a boost sorry allergy sufferers. Soccer Moms pediatric care sorry Grandma. Gender Transition Surgery will no doubt get priority over that New heart drug.

  • loveconstitution1789||

    Tony|9.12.17 @ 11:50AM|#
    How did Obamacare make the system worse. Be specific and please cite your work.


    How did ObamaCare make the health/health insurance system better. Be specific and please cite your work.

    Typical lefty knows how bad ObamaCare is but wants other people to waste their time re-explaining it to the lefty as if they lefty will ever be convinced.

  • swampwiz||

    A lot of previously uninsured folks now have coverage. Folks who had been blackballed from private insurance like Yours Truly (cancer).

    YOU HAVE BEEN PWNED!

  • Suckin' Seed||

    "Blackballed" ? WTF is that? Insurance is hedging risk of loss. Sorry your risk for medical care is so high but insuring against a certainty will never make sense. Are you suggesting it's correct that someone else should be FORCED to pay a majority of the bill? This will not lower the cost, just the portion YOU pay. yadayadayada

    Why is the cost so high that it has become a problem?

  • I am the 0.000000013%||

    Do you honestly believe that if a majority of people had significantly benefited from the ACA there would be so much hatred of it.

    In my case my personal costs have more than doubled, and my insurance is no longer usable. The same is true of everyone else at my company. The ACA is the worst thing that has ever happened in most people's lives. Yep, it gave crap insurance to a small minority, of which an even smaller of minority of which probably couldn't have gotten insurance any other way.

    Not exactly wonderful, but it gets democrats re-elected.

  • ||

    Not exactly wonderful, but it gets democrats re-elected.

    Jury's still out on that . . .

  • BYODB||

    Yeah, from where most of America is setting they were more or less crushed by Republicans over the ACA specifically.


    Then, it turned out Republicans pulled a bait and switch. This next go around should tell us how angry their base is about that, but of course by then Democrats will have another massive entitlement we'll be fighting. Probably something that originates with Republicans given the Trump administrations fondness for family leave, but that will be peanuts next to the Democrat plan to nationalize Healthcare or give everyone free Unicorns.

  • DesigNate||

    Well my wife and I are without insurance for the first time in our adult lives. Oh, and I get to be taxed for choosing between a place to live and health insurance.

    ANYONE that supports this law can go get spitroasted by a giant pineapple and a porcupine.

  • Diane Reynolds (Paul.)||

    And for starting us along the path to all of that high-quality care, she adds, "We owe a huge debt to President Obama."

    Well at least they're finally admitting the truth.

  • Pariah30||

    The healthcare system, or should is say the healthcare "insurance" system was broken long before Obamacare came around. Premiums were rising rapidly at an unsustainable rate. It's not the government that is making healthcare bad and getting worse, it's capitalism where it doesn't belong. Another factor in out out of control healthcare problem is our out of control diets. Over consumption of sugar, alcohol, processed foods, sweet drinks etc. isn't helping, especially when you sit all day and never exercise. The foundation of overhauling our healthcare has to be based on prevention of disease. Making people more healthy will lower the cost of healthcare more than any other plan that could be implemented. It can work if you want it to.

  • Sir Chips Alot||

    what kind of stupid are you talking? Which part of the 15+ hours a week of form filling doctors have to do falls on capitalism? The reason health care is so expensive is the government. Get the government out of healthcare entirely and let the markets work.

  • Pariah30||

    Anarchy in healthcare is genius.

  • ||

    What chaos do you fear, exactly, if the government were to get out of healthcare, and why?

  • Priscilla King||

    Where is that "like" button? Dittos to you, Sir Chips Alot.

  • Suckin' Seed||

    @Pariah30 - you are making an argument in favor of capitalism and don't even know it. Allowing insurance companies to offer discounts for lower risk clients is what you are suggesting. I think "government" just outlawed that idea. Not helpful.

  • sarcasmic||

    Making people more healthy will lower the cost of healthcare more than any other plan that could be implemented. It can work if you want it to.

    You're right! We need food police! And exercise police! We need inspectors to go through homes and make sure people have the correct food! Send them to education camps if they don't! Take away their children if they don't feed them properly! We should make being overweight an arrestable offence! Take fat kids away from their parents! Send fatties to prison! Starve them! Force them to exercise! We should do group calisthenics like they do in North Korea! Force everyone to be healthy! Be healthy or firing squad!

    You're a genius!

  • BYODB||

    I hear forced labor camps are a great way to get trim for Bikini season!

  • Enjoy Every Sandwich||

    Our Socialist commissars have a far more efficient system than that, comrade! They'll just totally fuck up the economy. When there is no food to be had, no matter how much worthless currency you have in your pocket, we'll see how fat everybody gets!

    Except for our Dear Leaders of course! They NEED to be fat. Otherwise we won't have our Socialist worker's utopia!

  • sarcasmic||

    Everyone will be equally poor, which is so much better than being unequally rich. Because equality.

  • Fuck you, Shikha (Nunya)||

    I finally understand Stalin! The demise of the kulaks was for the benefit of the population by reducing their dietary intake so much to the point to make them healthy. I hear it worked out great.

  • Pariah30||

    Food police? I was talking education, like teachers. If intentionally making yourself sick and expecting the treatment to be affordable is your kind of intelligence, then own it man. It's all yours.

  • ||

    If intentionally making yourself sick and expecting the treatment to be affordable is your kind of intelligence, then own it man. It's all yours.

    So, would you then agree with the following statement?

    People who blow up into fat balloons through their own bad choices should pay through the nose for health insurance, while those who don't should have miniscule premiums.
  • Suckin' Seed||

    BOOM!

  • sarcasmic||

    How will your ideas be enforced? What if people ignore their education? What if they eat what they want instead of what the government tells them to eat? What if they don't get as much exercise as demanded by the government?

    Someone must enforce your ideas. That requires police. Men with guns who kill people who don't obey.

    Eat right or die! Exercise or die! Motherfuckers!

  • BestUsedCarSales||

  • sarcasmic||

    Jello is one strange motherfucker.

  • The Laissez-Ferret||

    Yeah because people have no idea that eating fried foods and junk is worse than a grilled piece of chicken and veggies. It's not like it's half the stories we see on the news, talk shows, internet and magazine articles, and I don't know, common sense tells people that. But I'm sure if we had more information out there, people would change their behaviors.

  • Longtobefree||

    Eating fried food is not necessarily worse than grilled chicken and veggies.
    It depends on the serving sizes and frequency. And how clean the grill was before the chicken was put on it. And how well the veggies were washed. And a whole lot of stuff related to an individual, not a government funded study that predictably reaches the conclusion that funds more government studies.

  • Red Rocks White Privilege||

    It's not the government that is making healthcare bad and getting worse, it's capitalism where it doesn't belong

    Oh, bullshit. You really think it's a coincidence that healthcare costs started rising at an exponential rate after Medicare and Medicaid were established? These programs were passed after LBJ and his cronies promised that they would lower the overall cost of healthcare. They're a complete failure in that regard.

    And what we have isn't "capitalism," since that would require medical providers to list the cost of their services. What we have is a government-protected monopoly that exploits public and private insurance plans as a pool of "free money" for the purpose of practicing price discrimination.

    Another factor in out out of control healthcare problem is our out of control diets. Over consumption of sugar, alcohol, processed foods, sweet drinks etc. isn't helping, especially when you sit all day and never exercise.

    Well, guess what? People who blow up into fat balloons through their own bad choices should pay through the nose for health insurance, while those who don't should have miniscule premiums. That sound fair to you?

  • Citizen X - #6||

    Well, you made it two whole sentences before departing reality, so you're still a more honest commentator than Tony.

  • BYODB||

    This has a ring of Poe's Law to it, something tells me with a name like Pariah30 this person is 'unserious'.

  • Libertymike||

    Tell him socialism sucks, Huzzah.

  • Unicorn Abattoir||

    Uh huh. Government should control all. People should be forced.

    Get up off of your knees, if you still can.

  • DesigNate||

    MEDICAL CARE IS NOT A FUCKING RIGHT.

    Fuck off, slaver.

  • Ariki||

    "it's capitalism where it doesn't belong"

    Your stupidity is palpable.

  • C. S. P. Schofield||

    Does anybody actually know what was wrong with the American network of health care before the government started to "fix" it?

  • BYODB||

    Price inflation and rising premiums, which the ACA predictably exacerbated. The ACA had literally the exact opposite effect of it's stated goal, but that's likely because Democrats were lying through their teeth about said goal. They even lied about the reason, as the entitlements they previously passed were largely to blame for those cost increases.

    The goal was collapsing private insurance to pave the way for the State to be involved in every aspect of people's everyday lives. Once they control your healthcare, and people's lifestyles can be said to directly impact every other citizens pocketbook, they can legislate behavior like never before while also effectively nationalizing a massive swath of the economy into direct government control.

  • CE||

    Ya think?

  • BYODB||

    The first paragraph is a fact, the second is mostly supposition.

  • Libertymike||

    No, the second paragraph is fact as well.

  • Unicorn Abattoir||

    The soda taxes appearing an assorted cities strongly support your supposition.

  • BYODB||

    Yes, I believe that will be a predictable outcome but I can't say for a fact it was an actual goal at the time of it's passage. It's just that progressives are super predictable, even while there isn't any argument that will stop their roll. The slippery slope fallacy is not an actual fallacy when dealing with Progressives, I've found.

    I'm willing to consider that this is because I'm being intellectually lazy, but I very much doubt it when looking at the last century of American history.

  • C. S. P. Schofield||

    No, no, I mean WAYYYY back. I was born in 1961. So far as I can determine, the government has been 'fixing' the the health care economy for almost as long as I've been alive. Arguably longer. Certainly Medicare was begin in the mid-1960's, so presumably there was a perceived need.

    I guess my point is; how much of the current mess is the consequence of previous attempts to 'fix' matters?

  • sarcasmic||

    Before Medicare the poor had to go to charity hospitals and such, which was demeaning. It hurt their self esteem to ask for help from religious organizations. So the government stepped in to pay for it, and remove the shame of asking for charity.

  • loveconstitution1789||

    That and WWII had wage controls (government intervention), so employees could only offer health insurance as an incentive to work at their business. After WWII, many employers dropped health insurance and most Americans went back to cash for minor medical stuff and some had catastrophic health insurance plans to cover major medical stuff.

  • sarcasmic||

    The third party payer system is what drove up prices. Can you imagine what an oil change would cost if it was covered by car insurance? Probably a couple hundred bucks. But you wouldn't know or care. You just hand them your insurance card and the insurance company pays for it. As long as insurance pays the mechanic, and you pay the insurance, the mechanic can charge whatever they want.

  • loveconstitution1789||

    Yup. You never hear people haggle over medical care costs like you would with a car price.

  • sarcasmic||

    There's no price to haggle over. Nobody knows what anything will cost until after billing gets done.

  • BYODB||

    It's been fucked since wage and price controls under FDR if memory serves, so yes far longer than you or I have been alive. I believe 1942 is the year the shit really started rolling although some people will try and put the figure at 1912 or so although that's not really true in my view. That's just when the conversation started up.

  • Libertymike||

    1912 - the election of Woodrow Wilson, a first ballot entry into the Progressive HOF.

  • BYODB||

    Yes, fuck Wilson and fuck Teddy Roosevelt. We went from 'bad' to 'worse'.

  • Zeb||

    It is a bit difficult to compare 1942 to today, though. In 1942, there was a lot less that doctors could actually do for you. Most of the complicated surgeries and expensive drugs that we take for granted now just didn't exist. So overall costs are hard to compare.

  • loveconstitution1789||

    That is true to some degree but for routine minor stuff that is similar treatment to medical treatment in 1942 is more expensive too. Casting a broken limb is fairly similar. Doctors also used to make house calls.

    One reason is that in 1942, a doctor told you to take antibiotics and either the doctor had it or you could get a pharmacist to mix some up for you. On that note, good medicine research costs money and those costs need to be passed along to customers.

  • BYODB||

    I wasn't comparing then to now, I was indicating when the government got involved. Everything since then has been ever increasing market distortions.

  • JFree||

    No actually 1939 is the year medical care became distorted. That's when employers got to take a tax deduction for providing health insurance to employees. That was almost entirely a cronyist decision to favor the donor class (since unemployment was still 18% - so this merely provided a tax deduction for the executives/managers). They had taken huge tax deductions to build private hospitals with their name on the plate somewhere. And while those hospitals were non-profit charities, the reality is that they were mostly empty (roughly 50% capacity) because regular folks couldn't afford them and they strictly limited their pro-bono cases. Which is why municipal hospitals had been built in the 1920's/1930's - and were full to the gills (90% utilization). The thought was that providing a tax deduction would encourage companies to provide insurance which would in turn lead to some hospital switching from munis to private.

    It didn't however actually do anything. Employers required a second dose of cronyist legislation in 1942 - to favor benefits over direct pay with the WW2 price controls - which AGAIN mostly benefited the donor class since the younger male employees were in the Army and Rosie Riveter didn't use benefits (unless she was pregnant).

  • TJ_ExMachina||

    The Revenue Act of 1939 excluded payments received from insurance from Gross Income. Sec 22 (b) 5.

    Companies got a deduction for providing health insurance in the Revenue Act of 1942.

  • Suckin' Seed||

    1973 - HMO act - gov't started subsidizing expensive procedures. Not like an oil change, more like detailing.

  • Priscilla King||

    For those too young to remember...the health care system worked well before insurance butted in. When I was a minimum-hourly-wage worker I could pay cash for medical tests. And pay rent, buy groceries (no food stamps!), and buy a big stereo, in the same month.

  • Citizen X - #6||

    You're referring to Congress making health insurance a pre-tax employment benefit around the end of World War II, yes? Because that was the beginning of the fuckupery.

  • BYODB||

    Yeah, you would need to go back almost a hundred years to find a system free of government fuck ups. People tend to forget that law makers have been meddling with healthcare for so long that no one remembers a system without them involved. And no, they didn't get involved to help. They got involved because they fucked up with wage controls.

  • C. S. P. Schofield||

    This is pretty much what I've thought for a while; that the present system in a mass on band-aids, one on top of another, and we no longer even know that the patient beneath looks like.

  • BYODB||

    Exactly. It's the literal model of an over-regulated market. The fact no one see's that is because they're too stupid to realize that it's just another market, no matter how they 'feel' about it.

  • BestUsedCarSales||

    Or even more so, that markets are objects that can be bent to the will of a power that is great enough.

  • Diane Reynolds (Paul.)||

    It wasn't free enough.

  • CE||

    I'm sure I don't want Medicare for all. Why not just sign everyone up for the VA health system?

    Medicare should be completely voluntary, and forced to compete with unregulated private health insurance.

    Keep Medicaid as a safety net for the truly needy (for now). Medicare (and Social Security) subsidize wealthy older people who don't work on the backs of younger, poorer people who do.

  • Longtobefree||

    Used to be a good idea.
    But what happened instead is that the feds restricted the insurance plans that can be sold, and put in price controls.
    Hence shortages all over the place.

  • SteveDDD||

    The prime example of GOVERNMENT RUN health care is the Veterans' Administration, which is part of the U.S. Department of Veterans' Affairs. You're for that? Medicare is an INSURANCE PROGRAM. It takes the place of private insurance. Who paid into SS/Medicare and subsidized (just wealthy, what?) older people for the previous 40-50 years? Today's SS/Medicare recipients! Libertarians claim to hate money printing (federal deficit spending), even though private banks do the majority of deficit spending by issuing LOAN dollars/credit out of thin air...why the disconnect//misunderstanding concerning "money printing?" Federal govt can't run out of its own sovereign currency, the US dollar-because the US govt created the dollar and all the laws for the US dollar. The US dollar is a LEGAL concept-not a physical one. Increased spending on health care by the federal govt initially will lead to bottlenecks in the supply chain (inflation) but those will be smoothed out as time goes by. Medical price inflation would actually grow GDP and the federal govt (via the Fed) has the unique ability to CONTROL the value of the US dollar by using interest rates. Medicare-for-all is a win for ALL, incl. greedy , self-absorbed libertarians.

  • Brandybuck||

    Medicare was designed for old people, with young working people paying for it. It's expensive now because we have too many retired old people and not enough employed young people. Putting EVERYONE onto the plan will only destroy the budget.

    What's the point of "free" healthcare if everyone's taxes are so high that they exceed the cost of private paid healthcare? It would be cheaper for everyone to just flush a trillion dollars down the toilet.

    If the goal of this is to help the poor, then let's only spend money needed to help the poor. Give them premium vouchers or something like that. Shoving everyone onto the system only breaks the system.

  • C. S. P. Schofield||

    It ain't gonna work. No matter how we allow our self-nominated 'betters' to meddle, the results will not be the utopia they promise. Britain couldn't make it work. Canada couldn't make it work. The Swedes (who are some of the most law abiding and relentlessly nice people on earth) couldn't make it work.

    Delivering health care requires the kind of subtlety, sensitivity to feedback, and ability to change to meet demand that Governments are peculiarly unsuited to. Oddly, that kind of responsiveness is the hallmark of the reasonably free market, and in my experience every attempt to 'regulate' said market inevitably makes it less responsive.

  • BYODB||

    The goal isn't what they say it is, for one.

    What people are basically saying is that the only ethical deliverer of goods is the government. That is their belief. Anything private, or even remotely capitalist and/or free market, is evil by definition whereas government action is good by definition.

    That is the type of viewpoint we're dealing with. No evidence, and there is a whole shit ton of it, will sway someone until they end up being personally fucked by the government. Even then, they blame it on the opposition party rather than the federal leviathan of bureaucracy that does basically whatever the fuck it wants.

    Your point about Medicare is right on, though. What they're essentially suggesting is keeping a popular name and transforming it into something completely different since what it is would explode overnight if they got their way.

    Fortunately, very few people are as stupid as Warren and Sanders. Warren and Sanders biggest fault is that they actually seem to believe the shit they say, whereas their party just says it to win and have no intention of doing what they say. They're kind of like Republicans in that way.

  • Diane Reynolds (Paul.)||

    If the goal of this is to help the poor, then let's only spend money needed to help the poor.

    that's kind of where this whole mess got started.

  • Suckin' Seed||

    The goal was to shift spending off the gov't ledger and onto someone else AND be something Dem voters would go to the polls for. SUCCESS, sort of.

  • Eric L||

    What is to stop the government in the future from retroactively seizing assets from estates in an attempt to cover the deficit in this expanded Medicare?

    For example, grandma falls and breaks her hip. Government program pays for all costs. Several years later grandma dies; the government sends a bill to grandma's estate to recover some or all of her medical costs. Her home, any savings and the few municipal bonds she had planned to leave to her children are instead taken by the government.

    I know many on the left do not like the idea of inheritance so maybe that's a good feature not a problem for them.

  • sarcasmic||

    That is actually happening. Lots of people these days are inheriting nothing when their boomer parents die because all their assets are used up paying for end-of-life medical and hospice care.

  • BYODB||

    This has already happened with the NHS, although as I recall there was some outcry at the 'conservative' government going after people in this way. Of course, no mention that the reason why they're trying it is because their preferred type of healthcare is fiscally impossible to sustain on 'preferred' legislation because, as it turns out, unicorns don't fucking exist.

  • NotAnotherSkippy||

    Already the case for Medicaid. That's why there's such a thriving biz for lawyers to shield wealth.

  • Hunthjof||

    Yup. But don't think that they will stop at healthcare. There are already politicians proposing seizing all 401k's outlawing private pensions and making Social Security the only pensions system. Then whatever money you have left over after you die doesn't go to your estate but is property of good old Uncle Sam.

  • BYODB||

    Once you've acknowledged that your body is wholly owned by the government, do you really have any particular leg to stand on once they come for your 401K?

  • BestUsedCarSales||

    Real question. Why is the rejection rate so high for people going into medical school? It seems like the threshold is kept artificially low, and I wonder if there is a law or something else that might explain why this is so.

  • BYODB||

    It's more complicated than that in regards of number of physicians. The AMA had misguided policy for years, and there are a limited number of residency slots in teaching hospitals which is a required step on the path to becoming a doctor. Those are just two reasons off the top of my head, but there are many others.

  • BestUsedCarSales||

    But why is the latter true? It seems like if there is a bottleneck on number of teaching slots that over time things would adapt to allow more in, but that does not seem to be true. Because this doesn't seem to be an issue of a lack of qualified applicants even.

  • NotAnotherSkippy||

    Because residencies are paid for by medicare/aid in teaching hospitals and so the government plays yet anothet role in fucking up the market.

  • BYODB||

    Indeed, although also consider it's in the AMA's interest to keep the number of graduating doctors low (hence their previous bad policies that kept numbers artificially low). Gatekeepers are usually not a good thing for an industry, overall, and they work with the government to keep themselves in power over their own industry. Conflicts of interest are obvious.

    Classic case of rent seeking, and the AMA has it's own interests that aren't necessarily the same interests as the public.

  • NotAnotherSkippy||

    AMA interests aren't necessarily coincident with the providers either. The medical schools have no reason to restrict their class sizes, just look at the law schools. It's really the residencies that bottleneck everything. Now a good question would be why don't more private hospitals increase their residencies. I don't know the reason for that.

  • BYODB||

    Lots of reasons, liability costs and opportunity costs just to name two.

  • Longtobefree||

    Well, it used to be that so few could speak Latin - - - - - -
    But now it is just like any other union job.
    Too many doctors, and the pay goes down. Gotta pay those student loans, you know.
    It is almost like the doctor union was in bed with the feds to keep the money in a tight loop.

    (Irrelevant computer terms:
    loop = the working part of a noose.
    tight loop = the working part of a noose three days after the deadline)

  • Longtobefree||

    Well, you need have to have at least a room temperature IQ; and now you have have to have a good enough credit score to fund a dozen years of living expenses and tuition.

  • Longtobefree||

    As a medicare patient, who had no say in the deduction of "premiums" during 45 years of employment, and who has no say in what "networks" are used, and no say in what doctors are allowed of denied in those networks, and no say in what treatment is approved (regardless of effectiveness, or its lack), I can say that it will never work "for all'.
    Yes, I use it; because I could not use the deducted money, or the equal amount paid by my employers, to purchase the insurance policies that would have suited my needs. So now I have little choice, because it is illegal to sell the type of policy I would prefer. The least offensive economic policy is to take what Medicare deals out, and hope for the best. But it is not good insurance, and it is not good medicine, and it most certainly is not good policy.

  • loveconstitution1789||

    You could have voted against Social security and medicare programs but many/most Boomers never did.

  • NotAnotherSkippy||

    That's hardly limited to a single generation, although the millenials may be especially stupid.

  • Longtobefree||

    I could have (and did), but I am sure you will be shocked, shocked, to learn that I was ignored.

  • Hunthjof||

    "Medicare for All is one way that we can give every single person in the country access to high quality health care," warren would go on to say/. "Of course you can guarantee we will exempt ourselves from the system and continue to provide us Golden plans cause you think I am waiting 2 months to see a specialist and waiting in a waiting room with you peasants you're kidding.

  • zombietimeshare||

    I expect what they really mean is Medicare for you, and a sweet deal for them and government employees—and a few rich donors.

  • John Donohue||

    "...In 2001, the Congressional Budget Office warned that spending on retirees—specifically Social Security and Medicare—"will consume…almost as much of the economic output in 2030 as does the entire federal government today."

    Well, in the 16 years since 2001, we've gone most of the way there. Social Services = 69% of Fed Spending.

    http://mil14.com

    Military = 14%

  • Robert Arvanitis||

    Multiple failures.
    * Government does nothing to PROVIDE healthcare.
    * Government abuses monopsony power to drive down its payments, but that merely shifts costs. Squeeze the balloon here, it expands there.
    * Therefore government's abuse of the the market creates crises, which spawn new "fixes," for further crises. Hippo gets in the tub. Water everywhere. Hippo declares state of emergency and nationalizes all the towels.
    * Government is 10% insurance, 90% financing. Infantalizes citizens, destroys incentives to innovation. Nothing more than a "Christmas Club" for routine, budgetable expenses. Prepaid. More than you need SO might as well use it...
    * Government pays, government decides. Unjustifiable power over life and death.
    * Mandarin class comes to feel it SHOULD decide.

  • orthohawk1026@gmail.com||

    Just wait till all those who aren't on Medicare find out just what "Medicare for all" really means: only 80% of your bill is paid (assuming everything you had done is covered), and 15% of your pay will be taken to pay for it all.

  • TJJ2000||

    ONCE UPON A TIME.... Doctors would come to your house; preform their work; and send a small bill that even broke households could pay.

    THEN CAME..... Government monopoly forces. Now NO ONE can pay for a doctor. Even the fairly rich cannot pay the doctor.

    THEN CAME.... ACA ( Obamacare ). Now NO ONE can afford insurance

    Some people never learn - EVERYTHING and I mean EVERYTHING the monopoly forces of government touches is the MOST expensive and generally UN-AFFORDABLE items in the universe. There are NO EXCEPTIONS.

  • sarcasmic||

    "Everything government touches turns to crap."
    -Ringo Starr

  • John B. Egan||

    I lived in many foreign countries which had National Health. I never found any of them to be any worse than what we pay through the nose for here. Now, at 68, I've been on Medicare for 3 years. Medicare is no worse than what i was paying $900 a month for my personal policy before I went without for a couple of years because I couldn't afford the 30% increases. Our country as a whole could cut our $3.2 Trillion a year medical bill by about 1/2 if we chose to go Single Payer...we would cover everybody and we would end medical bankruptcies. I don't see the downside. When people argue to keep our present system, it's like insisting on paying $50,000 for a $25,000 new car...but only if it won't run 2 days out of 7, and guarantees that it will break down periodically, leaving you will massive repair bills. The 'logic' blows me away.

    This is from 2013: https://www.cnbc.com/id/100840148

  • BYODB||

    So...were you a citizen of those countries while using their nationalized health system? Or were you always an American in their systems?

    If you believe that the argument is to keep the present system, I think you fundamentally misunderstand all together.

  • DirkT||

    "nationalized" isn't the best word to use. there are plenty of healthcare systems in the world that deliver affordable and efficient health services that aren't "nationalized."

  • NotAnotherSkippy||

    So you like the swiss model. Well then don't expect to cut your bills in half.

  • NotAnotherSkippy||

    About that nerdwallet crap...

    David Himmelstein and colleagues recently contended that medical problems contribute to 54.5 percent of personal bankruptcies and threaten the solvency of solidly middle-class Americans. They propose comprehensive national health insurance as a solution. A reexamination of their data suggests that medical bills are a contributing factor in just 17 percent of personal bankruptcies and that those affected tend to have incomes closer to poverty level than to middle class. Moreover, for national health insurance to have an impact, it would have to define "medical" expenses in a much broader way than is now typical of either private or government-funded plans.

    (emphasis mine)

    But don't let me interrupt your narrative.

  • jjjjj||

    If we completely deregulate private healthcare at the federal level...

    Nope. Still no.

  • DirkT||

    Those of us who have lived and worked abroad and received medical care while there then returned to the USA don't understand what the fuss is about. No, those systems aren't perfect, but they are, by and large, preferable to what America has.

  • DesigNate||

    Did any of those countries consist of 330MM people of different socioeconomic, ethnic, and cultural backgrounds?
    What was the top income tax rate? What was the average person paying in taxes?

    Did you, or the liberal geniuses like you, take into account that most Eurpoean countries are able to give their citizens such awesome benefits thanks in no small part to the outsized US military that you all always complain about? (I tend to agree with that, but it's fucking rich to complain about us spending more on the military than all of NATO combined and then lauding those same countries for giving out free, if mediocre, goodies.)

    Why did I just channel Judge Napolitano and will I be able to stop?

  • DirkT||

    Back in the 1990's Israel, Switzerland and Taiwan all massive enacted health care reform by looking the world over for what worked and what didn't and each country devised reasonably priced, efficient systems - all different from one another. Had they begun with your defeatist attitude nothing would have gotten done.

  • eyedocac||

    Why do liberals think healthcare for all = high quality care? Cool idea but inaccurate. I guess associating the two is a good buzzword.

  • DirkT||

    Why are so many Americans defeatists around this subject?

  • jerbigge||

    Seems to me that repeal of all health care legislation back to 1789 performed by the federal government is a better solution. No where in the Constitution have I seen anything giving the federal government the power to regulate health care or drugs. Note that states license physicians, not the federal government. The repeal of all legislation giving the professions a legal monopoly would also be Constitutional since the result of such legislation does nothing but increase costs to the consumer of professional services. In effect all professional organizations are "labor unions" under a different name and also like labor unions, require the use of force to get their way.

  • IrishEddieOHara||

    Wait a minute, asshat!!!! SPENDING on Social Security???? You make it sound like we SS recipients are acting like the illegal aliens and the other moochers in our country.

    We paid into that fund in good faith and trust that it would be returned to us. So don't write that line as if WE are the problem. If the fund has a problem, it is because the thieves in DC have raided the treasury and looted SS.

    IT AIN'T OUR FAULT!!!!

  • DesigNate||

    You didn't pay anywhere near what you are going to take out of it.

    (not sure if sarcasm, should probably get my meter recalibrated.)

  • Rockabilly||

    NO, I'm not a marxist. I'd rather die than be a commie rat.

  • macsnafu||

    Why do Senators Bernie Sanders and Elizabeth Warren hate Americans? What did we ever do to them?

  • Myk||

    Medicare OPTION for all. Single payer OPTION. Why is it Reason always leaves out that very important part of the equation that even Canada ruled had to be allowed? Oh yeah, not the spin you want to put on your fear mongering of healthcare that works better in the majority of countries than the former or present US system works and for less money. The failure of our system is the free market with some insurance protectionism thrown in. Get sick, insurance cancels when it's time to pay, pass the costs on to everyone else. That's how your free market works when those who need the most from those sworn to help them have the least to pay for it. Someone else will always pay.

    What a Medicare for all option would do is get those out of public healthcare who saw it as a way to get rich. They are rarely Drs who actually care about making you better. Sometimes they are, the specialty clinics. And with an option for supplemental insurance and private practices they would remain.

  • NotAnotherSkippy||

    VA option for all. That's the closest model to the NHS/Canada which you love. You should have no trouble accepting that.

  • Will Nonya||

    because it isnt actually being presented as an option....

  • American Veteran Patroit||

    Balderdash, especially coming from BS, now that fits perfectly!

  • Jacks61||

    Even with the govt robbing the SS Trust starting in the 80's, they are still outspending it. ALL of them are doing it. They ALL want a piece of the pie. If they had left the trust alone at the time, the program would have never ran out of funding. Leave it to greed to carry the day.

    Trillions spent or stolen since our involvement in the middle east. Billions spent fighting the "war on drugs". Both are far WORSE. But holy shit, taking care of our sick, hell no we can't do that without people losing their minds.

    $20 Trillion in debt and Trump wants to CUT taxes, yet increase the military budget. What am I missing here? Oh yea, the IMC wants more f'ing money.

  • Mark22||

    $20 Trillion in debt and Trump wants to CUT taxes

    Yes, it's obviously far better to adopt the plan of the Democrats, which is to tax people even more to throw it into the maws of politically connected corporations! Sorry, until the federal government manages to balance its budgets, there should be no new taxes.

    yet increase the military budget

    The alternative being Hillary, who would have started a few more wars by now, nominally cut the military budget, but vastly increased military spending through "emergency spending".

  • tommhan||

    If anyone ever looked at Medicare deductibles and co pays I don't think they would want that program as their health insurance. Private insurance costs are inexpensive compared to Medicare. When you retire you have to have another insurance back up and a prescription plan to keep from being bankrupted by the government.

  • Priscilla King||

    I've always been sure I wanted a cash-based, patient-controlled medical care system.

  • DirkT||

    You can afford to pay cash for that seven figure bill for that rare cancer you will be diagnosed with in 15 years?

  • XM||

    The seniors won't tolerate the rest of the country (millions of healthy young people) taking large slices of the pie that once belonged to them. Oh, and some things that single payer nations do to keep cost down will be either unconstitutional or yugely unpopular here. And white progressives who run big business will tell Bernie the same thing they told CA. Sorry.

    But you know, the democrats a bunch of insulated people, despite their diverse base. They got their asses kicked when Obamacare passed, which now "popular" to the tune of 45-50% approval rating. And it took a polarizing figure like Donald Trump to even make that happen.

    But they want to go through another round of punishment because their echo chamber demands it, even after 2 blue states shot down the idea. Any attempt to pass single payer will mobilize the center right in general, including the nominal "NeverTrump".

    No society on earth can provide total access to all healthcare while not sacrificing quality. Some libertarians like the French model, but even the NYT admits that people there are taxed to the heavens. These places don't have meaningful economic growth.

  • Will Nonya||

    Once upon a time i was able to go to my dr and more often than not get seen the same day or at worst the following day. I have a reason to go for the first time in a long time but because I havent gone for every sniffle "my" dr considers me a new patient so i have to wait till December to be seen. current patients get seen today presumably because they have less paperwork to complete and they've helped pay his green fees more recently. best I can do is go to a nurse practitioner, urgent care or wait months to have a non-critical auto accident injury looked at.

    Apparently we have the downsides of socialized medicine without the higher taxes. This is approaching my experience with the Military and VA healthcare systems neither of which are anything I'd wish on a loved one.

    Why people think that more government in a system that's been repeatedly distorted by government action will make things better is beyond me. Only transparency and competition will improve our system.

GET REASON MAGAZINE

Get Reason's print or digital edition before it’s posted online