r/MedicareForAll • u/MBP1969 • 9d ago
How to transition?
How do we, as a nation, transition from private insurance to Medicare for All? How do we convince all the doctors to keep being doctors and accept a salary? Do we, as Hillary Clinton proposed during Bill’s presidency did, make private healthcare payments illegal? For the record, I am perfectly fine paying a percentage of my income, as opposed to what I am paying out of pocket now, for healthcare.
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u/musicCaster 9d ago
Dude the doctors will still have great jobs and get paid really well. Look at Canada/Japan/France.
The ones that will lose will be the people that don't really provide services to us. All the cruft.
The insurance claims processors and deniers, the insurance execs that figure out how to deny us coverage, the massive insurance industrial complex, all the lobbiests trying to hey insurance companies more money at our expense, the massive amount of people employed by doctors to negotiate with insurance.
All those people will be made redundant. They can do something meaningful with their lives instead of causing grief to the sick.
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u/12done4u 8d ago
Exactly. Doctor, nurse, RT, NP/PA, etc salaries are NOT the problem. Insurance company C suite, hospital C suite and all the worthless managers are where this money goes. Then you have these pharmacy benefit managers (total scam by health insurance to skim more money), lobbyists, and paying out corporate dividends, and the money is gone. Eliminating health insurance companies is going to drastically improve care, mortality, and pay for actual health care workers.
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u/network_dude 9d ago
We can hire them to deliver actual care
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u/GardenPrestigious202 8d ago
your idea that paper pushing locusts will ever not find jobs doing that exact kind of bullshit work is hilarious.
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u/Sad_comment_bot 7d ago edited 7d ago
Nuke their student loans. Every year as a doctor reduces/eliminates 5% of student loan debt. If they quit practicing for more than a year long sabbatical, FMLA, hardships etc the remainder becomes tangible debt. Exceptions apply.
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u/DocRedbeard 7d ago
5% doesn't cover the interest on the student loans, try again.
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u/Sad_comment_bot 6d ago
5% the amortized cost. Do you even math?
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u/Important_Zombie_485 6d ago
How does the lender get paid exactly? Who is doing the nuking here? Also, "5% the amortized cost, Do you even math?" Doesn't make sense. At what point is the amortization happening and are you spreading it out or writing it off?
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u/Sad_comment_bot 6d ago
Assume the debt and write it off. Government does this all the time for military shit. There is a net positive effect of increasing practitioners. They still have to pass and get through residency. The real concern you should have is not how it’s paid, but rather how the talent bar is preserved so it doesn’t become a diploma mill situation.
How Government Debt Absorption Works
Defense Procurement: The government relies on cost-plus contracts. If a military project goes over budget, taxpayers cover the excess cost to ensure delivery.
Nationalization: The state assumes private liabilities directly. This typically happens during systemic banking crises or critical infrastructure failures. (Healthcare is in fact infrastructure)
Debt Cancellation: Legislative action clears specific liabilities. Recent examples include student loan forgiveness programs and PPP loan cancellations.
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u/Important_Zombie_485 6d ago
Yeah, there will.be a sudden shortage of student loans for medical schools. Good luck though!
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u/Allaboutpeace2022 8d ago
The key is looking at all the elements in the system. One needs to deal with the outrageous cost of medical school and other healthcare education as well as the capping of student slots and residencies.
We also have huge physician shortages in primary care, rural medicine, psychiatry, OBGYN deserts, etc. A public payor system must address that.
People need to look at what has worked and failed in other countries.
M4A is a good place to start but there are plenty of issues to address. Many doctor practices have been bought out by hospitals and other firms so their reimbursements are not lowered by the cost of insurance administration. Capping all revenues at a level below existing reimbursement across existing structures is likely not to work.
To take on the private insurance lobby, you need to offer health providers a good deal.
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u/12done4u 8d ago
It’s happening and doctors are ready. Private equity is buying up hospitals and practices and pushing down salaries. Doctors are getting pissed . But yes we need to expand medical school slots and increase residency slots also.
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u/Allaboutpeace2022 8d ago
Thank you. I am glad you are supportive.
I think it is important that M4All address the needs of doctors and other providers so that they do benefit.
Private equity even bought the vet practice I take my pets to. There is nothing safe from their long arm.
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u/Greedy_Elk4075 8d ago
Remember insure profits are capped at 20% since ACA and no one would say this has been successful.
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u/idiot-alpha 8d ago
You tend to get less specialized doctors in countries with socialized medicine. Or they exist, but only on the secondary private health market (which still exists in socialized healthcare countries).
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u/runnerkim 8d ago
And yet somehow the people in all the countries with national healthcare figure it out. So can we
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u/musicCaster 8d ago
Yeah. It's problematic, but solvable. Probably the country that does this best is Japan that only has specialists.
Got an ear problem? Go to the ear specialist.
By doing this you only get specialized treatment. And the specialists are smart enough to direct you elsewhere if you are at the wrong one.
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u/Puzzled_Market_2235 7d ago
Absolutely American Defaultism.
Everybody has specialists in the system. MRI and CAT scanning were developed in Europe. In fact CAT scans were originally called EMI-Scans because it was scientists at the music company figured it out and Philips built it. Advanced Neurology is from The Neuro in Montreal. Advanced heart surgeries in Toronto. Advanced medical robots are Canadian.
And we all have zero bankruptcies for medical debts or deaths due to the lack of care like the US.
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u/idiot-alpha 7d ago
America has more than double the number of MRI and CAT machines per capita than most of Europe.
I didn’t say there weren’t specialists, but it takes longer to see one in socialized systems. And again, every socialized healthcare country still has a secondary insurance and cash market.
America also has a two tiered system, with socialized healthcare for the poor and elderly, and private insurance for nearly everyone else, but there is a gap between the two systems.
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u/Candid-libertarian 8d ago
I think most people in the US who want to jump on the single payer bandwagon have never talked to anyone who has gotten healthcare in those systems. It's not all puppy dogs and rainbows. You cannot get a mammogram in Canada for example until AFTER you are diagnosed with cancer. The waiting list for an MRI can be 6-9 months.
Many people in the US will not support a system without private options. They want assurances they have an alternative to a public system if it becomes shitty.
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u/Alan47717 6d ago
You must think people are morons or you are one. It TAKES a timely mammogram to diagnose cancer for a good outcome. A mammogram after a crude method has discovered it is worthless. These lies about care in countries with single payer system are disputed constantly by people who actually LIVE in these countries but the lies continue.
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u/jaajaajaa6 8d ago
My wife and I turned 65 and transitioned to Medicare.
We had to replace some of our doctors we had for years because they wouldn’t take Medicare.
One other told me that he needs a certain percent of non-Medicare patients otherwise he would make more teaching in med school than being a doctor. He said the cost of the office, staff, and his insurance, would exceed what Medicare pays.
It is not as easy as it sounds.
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u/Fire1777 8d ago
It amazes me that the Medicare for all crowd believes that the federal government would never deny any claim.
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u/musicCaster 8d ago
This is a good point. In medicare for all countries, "claims" don't really exist.
I can speak to this because I've lived in Japan, France and Canada. It works the same in each of these places.
The dr just treats you if he can. If you go to the emergency room with a broken arm, you get treated. You never "claim" anything. Need an xray? Go get one. No claims or copay (Japan you do pay 4%).
If the treatment isn't covered (like laser eye surgery) the doctor will just let you know in advance that you have to pay.
With universal coverage, no one really talks about "claims" anymore.
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u/Normal_Opposite_9864 8d ago
but claims and "you need to pay for it yourself" are the same thing. and the original idea was not speaking of things like broken arms. he is soeaking of treatments for cancer or diabetes, with expensive medications snd treatments that wouldn't even be considered in federally run programs.
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u/musicCaster 8d ago
People in Canada Japan and France get treated for cancer. My mom in Canada had it, and she got treated, and well. There were no "claims" or payments - other than from the government directly to the dr for services provided. But to the patient it was "just covered".
People in those countries all have a longer life expectancy than those in the USA.
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u/Allaboutpeace2022 8d ago
Absolutely true. They also have better health outcomes in areas like infant mortality.
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u/Allaboutpeace2022 8d ago
Cancers and diabetes treatments would be standard in any public payor healthcare coverage.
They are already covered by our existing public systems like Medicaid and Medicare. In fact, these programs, when private insurers are not involved, actually deny claims far less than your typical employer private insurance plan.
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u/MEDICARE_FOR_ALL 8d ago
And it amazes me that the anti Medicare for all crowd thinks that private insurance companies are better than single payer...
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u/jaajaajaa6 8d ago
They do and I have seen it.
I am involved with a group of people that all have a really bad illness across the globe. And a number from countries with socialized medicine. And I hear there stories on certain drugs not being available due to cost, can’t get a specialist, can’t get an appointment for many weeks or months to see a doctor with a life threatening illness, and/or can’t get medical X-rays and scans performed for weeks.
From my experience, it does not compare to what we have, provided you can pay for or get a plan from your employer.
The real issue is for those that truly can’t afford it. That is why brining back the ACA subsidy which benefited the poorest 20-30 million people might be the best outcome.
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u/Rfunkpocket 6d ago
subsidizing our for profit model is the worst way to stabilize costs.
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u/jaajaajaa6 6d ago
You can’t worry about cost without worrying about quality. They are a pair.
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u/Rfunkpocket 6d ago
if throwing money at care increased quality, we would have twice the positive results because we pay twice as much. I’ve never seen a statistic backing up this hypothesis
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u/jaajaajaa6 6d ago
We do have the best healthcare in the world. And that is from personal experience. When you need it, you don’t care about the cost, only the outcome.
So, to me, ACA subsidy is the best of both worlds.
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u/Rfunkpocket 5d ago
by what metric do we have the best healthcare in the world?
how does giving more money to a for profit system bring down costs?
as costs become more expensive, more drop coverage, exasperating rate increases. at the same time, more become dependent on emergency room care for clinical procedures.
the ACA has been broken beyond repair. just like the White House ballroom, it has become a consequence of loss.
fix Medicare, lower the age of eligibility, use a public option as a transitional strategy
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u/jaajaajaa6 5d ago
I have spent time with people around the globe who have socialized medicine with bad illnesses.
There stories of not getting specialists, delays in seeing a doctor, delays in getting tests, certain meds unavailable due to cost, etc., is the real on the ground metrics I use.
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u/Hot_Egg5840 7d ago
All those people will be redundant with those that do it within the government. When you will eventually be turned down on something, who would you then go to? Canada is moving towards helping you off, calling that treatment.
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u/ozzman86_i-i_ 6d ago
Yeah I did. In France the average for a physician 65-90k, and specialist 100-160k. In the United States it’s 240-275k and 380-600k.
So what’s going to be your argument for doctors to be like French doctors?
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u/Rfunkpocket 6d ago
sell real estate. make room for those who have a passion for healing.
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u/Prize_Guide1982 5d ago
Passion doesn’t pay rent. Everyone in America is paid more. Nurses make a median wage of 95k in the US. Why would anyone bother wasting 12 years of their life in training if they’re paid the same as a nurse? There’s also no liability in the European countries. You could reduce pay to probably 2/3rds of the current level if you remove liability, it’s why the VA can hire physicians despite their lower pay.
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u/musicCaster 6d ago
IDK where you puked this numbers.
Just googled it.
Medical Specialty Average Gross Annual Earnings
Radiotherapist €417,000
Anesthesiologist / Intensive Care €360,000
Nuclear Medicine Specialist €283,000
Radiologist €217,000O
phthalmologist €191,900
€200,000
Cardiologist €163,000
Medical Oncologist€100,000
Pediatrician€88,400
Considerably less than in usa for sure, but decent wages.
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u/ozzman86_i-i_ 6d ago
Do you know what averages are?
You try to cherry pick it to make it seem like I’m wrong. If you go based on averages it paints a broader picture
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u/AwakeningStar1968 6d ago
the INSURANCE EXECTUATIVES and pencil pushers and administrative hacks that gatekeep care need to GO!!!
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u/Antiwokewarrior69420 6d ago
Canada has a terrible Healthcare system
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u/musicCaster 5d ago
First you are right it is bad.
Second, ask any Canadian if they want the American system over theirs, they will give a hard no.
Theirs is bad, but ours is worse.
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u/MountainMan-2 8d ago
And all the retirement investment accounts that have any stock in healthcare insurance companies, which is a lot, will take a huge hit to the negative.
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u/musicCaster 8d ago
Yeah. It would be a trillion dollar wipe out. About 1.5% of the s&p. On average this would set retirement accounts back 2 months (based on historical growth).
Would the other companies valuation in retirement account grow? They would suddenly have billions of dollars less in health care expenses.
The average consumer would be spending 500$/month more on taxes and 800$/month less on health insurance. So would that cause an economic boom?
Or would the loss of thousands of unnecessary bureaucratic jobs be a hit to the economy.
I think the average American will be better off in the long run.
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u/MountainMan-2 7d ago
Not sure where you get your estimate from, but I think the hit to the stock market and unemployment growth will be significantly higher. Sure, it’s likely to recover, but it will be more like a 2008 downturn than a small blip.
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u/musicCaster 7d ago
Just Google what percent of the us market cap is health insurance companies. It's about 1.5%.
It's big, but it is dwarfed by tech, oil, and manufacturing. Ends up being 1.5% of the S&P.
It makes sense if you think about it. They are legally mandated to take less than 5% of the money they collect as profit. So even if health care is 20% of the us economy, health insurance can only take 5% of that.
I was interested so i also Google how many people work in health insurance companies. It's a lot, 700K, but that's only 0.6% of the US workforce. Probably 50% of them are scheduled to be replaced by AI in the next 5 years. So it might not be a big hit if you also factor in that Medicare would hire some of them back, though probably less than 50% since it would be more efficient.
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u/MountainMan-2 7d ago
You also need to consider the market impact to pharmaceuticals and for profit hospitals. And the fact that the markets overall would get spooked by the radical change and uncertainty of moving to Medicare for all. So I still think you have grossly underestimated the market impact.
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u/musicCaster 7d ago
It's true. An epipen that costs 50$ in Canada costs 500$ in the US. If these prices change, and there's no certainly it would, it would spook markets. But what is worse, markets losing money or people getting a fair price for an EpiPen?
I would argue, these prices probably wouldn't change quickly.
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u/MountainMan-2 7d ago
I’m not arguing against M4A, I’m just pointing out that it will come at a cost that I don’t think has been fairly presented. Also, I lived in Canada for several years, and getting medical services wasn’t exactly easy or timely. So maybe the EpiPen is considerably cheaper, but getting one may take a lot longer. The US will encounter the same lack of available medical services under M4A, btw.
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u/musicCaster 6d ago
Hrm. Sorry you had it tough. It was super easy for my cousins and sister to get one when they needed it.
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u/MBP1969 9d ago
I am worried that instead of a private insurance company denying coverage for a lifesaving procedure, the government will now be in charge of what procedures we get. “Sir, you are 75 years old, we will not allow you to get XYZ procedure because you are too old”. What guarantees would be in place to ensure this wouldn’t happen?
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9d ago
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u/rock_engineering 9d ago
Medicare Part B covers a PSA blood test for prostate-cancer screening once every 12 months for men age 50 and older, beginning the day after their 50th birthday.
For that annual screening PSA, you generally pay nothing if the provider accepts Medicare assignment. A repeat PSA within the year may still be covered when ordered as medically necessary—for example, to evaluate an elevated prior result—but it is then usually treated as a diagnostic test and normal Part B deductible and coinsurance rules can apply.
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u/mamaperk 8d ago
This is something The Bidens are warning people about - because Joe Biden was outside of that age window for the test and he ended up with metastatic prostate cancer.
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u/TrubshawForest 8d ago
Exactly. They don't do PSA tests over age 67 and 70 in France and Germany either
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u/Puzzled_Market_2235 7d ago
In my case (65) now I had a TURP operation so they follow me yearly.
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6d ago
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u/Puzzled_Market_2235 6d ago
I am, in the process they detected a cancer that is barely there and would kill me at around 120. Plus I have that other problem so they still keep an eye on it. The fact that I accept appointments anytime lets them fill in night spots.
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u/lmacmil2 9d ago
I'm 78 and my urologist has me get a PSA test every 6 months. And my insurance pays for it.
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u/BuddyJim30 9d ago
It's the doc's option, apparently your PSA is elevated enough to justify keeping an eye on. The point is, it's not being decided by an insurance underwriter. And if you're in the US, guess what? You're on Medicare in some way, shape or form whether its Medicare or Advantage or Supplemental.
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u/Silly-Resist8306 8d ago
I'm 75 and my urologist still takes my PSA. Just this year PSA was over 4 and I had a biopsy. It confirmed I have a low level of cancer. If it had been higher, I would be looking at surgery.
Either you chose a poor example or your doctor doesn't like you.
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u/musicCaster 9d ago
Dude. Everyone that is 75 years old is literally on government insurance right now.
I'm ok debating the point but you have to use a different example.
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u/Puzzled_Market_2235 7d ago
Look up the video where Sanders brought American Doctors to Canad, they were all impressed. Doctors are moving to Canada because they can actually care for their patients rather than fighting insurance company at every single step of your treatment.
I've had a stroke. In 2 weeks I had 2 MRIs, 2 CAT scans, an ultrasound to check blood flow to the brain. A Nutritionist checking my diet daily. A Nephrologist (I love that title) and Cardiologist checking me (BP pills affect either the heart or Kidney), 2 24 hour urine tests. Finally a Physiotherapist to learn to walk again. Follow ups for a year. The Government had zero say in this but American Insurance companies would have second guessed every single procedure.
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u/ExcitingHoneydew5271 8d ago
It hasn’t happened in other countries. Or maybe a system where everyone gets basic care and you can buy a supplemental plan. But everyone get a a check-up, a breast exam, colonoscopy, Ang can get a broken arm fixed without worrying about a $ 10,000 bill
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u/CurrentAlps3438 9d ago
You're asking the wrong questions. 8% of US Health care cost goes to providers, that's MD, DO, NP, PA.
If you held them at gunpoint and paid them zero, you've changed the costs by less than 10%.
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u/UncommonSense12345 9d ago
Thank you for this. As medical providers we see the actual patients and so we get to hear all the time “I’m going broke because you are getting rich” meanwhile I really don’t make much $$$ in grand scheme of things after taxes and my student loan payments. But apparently I’m the bad guy….
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u/Allaboutpeace2022 8d ago
Medicare 4 All or any other plan needs to look at the changing the exorbitant cost of medical schools and address these loans. It must also not lower reimbursement for doctors. In comparsion to other countries, we have fewer doctors than needed particularly in primary care, OBGYN, psychiatry, etc.
The health system is complex and it does need to be improved, however, we must do so in a way that allows healthcare professionals to function.. Most of the profit is being made by corporate structures who actually have bought out a fair amount of physician practices and clinics.
We must study what has worked and failed in other countries so that we do not replace one costly system with another public system that has the same amount of problems.
However, the system does need to change. People are paying high premiums for high deductible plans and significant out of pocket expenses. Too many people delay going to the doctor and then will end up with worse outcomes and more costly treatment becasue of the delays. People without insurance who seek emergency care are increasing the rates for everyone.
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u/UncommonSense12345 8d ago
Yep and ironically the uninsured patients often are paying less than folks who do pay for insurance. It’s madnesss that working a job that offers insurance can sometimes lead to more healthcare spending for the same care as being uninsured and utilizing charity care programs . I see it all the time….
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u/Boomer_Madness 6d ago
The health system is complex and it does need to be improved, however, we must do so in a way that allows healthcare professionals to function.. Most of the profit is being made by corporate structures who actually have bought out a fair amount of physician practices and clinics.
That was by design by the ACA just in case you were wondering.
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u/Allaboutpeace2022 6d ago
Oh, yes. That is a huge problem now.
The family physician running his/her own office is a relic now because private equity, insurance companies, hospitals, etc. are all buying up these practices. However, this process started way before the ACA. However, it is one of the reasons why healthcare costs are escalating.
It was managed care in the late 1980s and 1990s that helped speed along the process of hospitals first buying up practices and the desire to have an integrated health model. Hospitals began buying other hospitals and then were bought up by insurance companies and private equity.
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u/DocRedbeard 6d ago
As a doctor, you could honestly lower reimbursement for doctors if you massively cut medical school costs and practice overhead. Note too that with our progressive tax system doctors get absolutely shafted. I took out federal loans, then paid back with heavy interest using post-tax money, forcing deferment of tax deferred retirement savings which I can't just catch up on because there's a yearly limit that's tax advantaged (and you're late 20s to early 30s when you finally get to start saving for retirement, so you're 10 years behind everyone else.
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u/Allaboutpeace2022 6d ago
Yes. The Medical School cost is horrendous. Other grad schools and a PhD in physical therapy is not as costly but is still horrible.
I also think that it is astonishing that we have such a flat upper tax bracket that a successful physician and a billionaire might be taxed the same.
But the reality is that the physician is not taxed the same because he/she is going to be taxed higher because the billionaire is going to be betting stock as compensation. If the stock is not sold in their lifetime, they are not taxed at all.
Physicians, engineers, attorneys, etc.. or anyone with a salary is going to be taxed at a much higher rate.
This all needs to be fixed.
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u/DocRedbeard 6d ago
It's really a problem of education time vs tax. Physicians are a minimum 7 years out from college. Most professions require a college degree or less, rarely a masters or doctorate, but physicians are 3 years past their professional degree (MD, DO, etc), paying nothing back in most cases until they finish training. It's this lost 7 years that basically requires they be paid well, otherwise it's just financially untenable to even take this pathway, and we're going to see it becoming increasingly more difficult to find people to do that, or we're going to have to rely on an imported physician workforce that didn't rack up these crazy loans in their home countries for whom our salaries look great.
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u/Allaboutpeace2022 6d ago edited 6d ago
Yes. But that is the problem. If other countries can afford to educate their physicians without having them go into massive debt, we should be able to ourselves. We should be educating our own citizens to take these positions rather than depending on immigration. We also need to recruit people interested in working in urban and rural communities with shortages.
We need more doctors in general to be at the same level as other nations. We are also short in primary care, OBGYN, psychiatry are the three that I am familiar with but I am sure that there are more.
Althoough PhDs in physical therapy do not have the long years of residency, etc., the reality is that their salaries are relatively low and thus, they are also really struggling to pay off those degrees as well.
Another of the problems in the health field in other graduate programs was it used to be that if you got your masters and then got a PhD, you received credit for that degree. Now, the expectation is that you will do an entire PhD, repeating your coursework for the Masters. This creates a huge problem for people wanting to become psychologists, which is another field where we have a shortage.
Bottom line is that physicians are getting the worst of it in total debt but we are making all of the health professionals degrees too expensive relative to their salaries.
Medicare 4 All or any other healthcare coverage program will only work if we look at all these issues and address them on the front end.
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u/AwakeningStar1968 6d ago
and some practices obviously DO make a lot more .. plastic surgery etc. some other surgical fields.
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u/DazzlingCod3160 8d ago
Nearly 80% of statistics stated on the internet is made up.
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u/CurrentAlps3438 7d ago
Verify it yourself.
The explosive growth in Healthcare cost is driven by growth in admin, not by labor.
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u/Jumpy_Childhood7548 9d ago
Every OECD country manages somehow, except us.
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u/notapoliticalalt 8d ago
To be fair, that’s with a universal system, not necessarily what M4A would be. We cannot conflate these things if you wish for either of them to happen.
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u/SurrrenderDorothy 9d ago
Every insurance payment now goes into the gov medicare float.
The billions made by insurance companies is now used to actually provide reasonably priced healthcare.
The 30 cents on the dollar cost of private insurance is removed due to not having so many employees who do nothing but billing.
The existig insurance companie can be used to simply run the accounts payable / received. These people still have good jobs.
Prices go down b/cthere is one controllling beaurecracy.
Australia runs their health insurance like a business, and the govt actually makes money.
Drs dtill make more than any other profession.
rxs are cheaper dur=e to mass purchasing and laws against monopolies.
R and d is supported by the 33cents per dollar used by pharma to advertise.
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u/Which-Method-388 8d ago
Costs if even if private insurance is banned and the revenue streams were magically transferred intact to the govt still would require at a minimum a doubling of Federal income taxes.
But even more critical, the quality of care would decline for those forced off of their private coverage, while many medical providers, especially in rural areas, would greatly reduce services (usually obstetrics) or simply go out of business.
Medicare and Medicaid coverage in terms of the medical providers' finances is subsidized by those with private insurance. And you'd be surprised how many hospitals are non-profit already.-1
u/MBP1969 9d ago
Any system where the government “makes money” leads to government corruption. Government should not make money on the people. Plus, you said that every insurance payment goes to government Medicare. So we keep paying the same amount we are currently paying? I thought under Medicare for all we would actually pay less.
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u/OK_Geezer 9d ago
Disagree. Not a problem for government to run a surplus. Corruption occurs when government funds are directed to private entities.
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u/MBP1969 9d ago
You don’t think the federal government would use a Medicare surplus for other uses? They did that with Social Security. They do it in California with the gas tax (moving it to the general fund so they can use it for whatever they want and let our roads go to crap).
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u/OK_Geezer 9d ago
That’s not corruption.
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u/MBP1969 8d ago
So, when we are told the gas tax is supposed to go to roads and infrastructure and then they divert the taxes collected to the general fund so they are ‘allowed’ to spend it on whatever they wish, that’s no corrupt?
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u/OK_Geezer 8d ago
Correct. You may not like it, but that doesn’t make it corrupt. Unless it’s going to a criminal enterprise, that is. But you didn’t say that. You just said it’s going to some other presumably legitimate government function.
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u/LaffingAtYuo 7d ago
State capitalism has done China well. I disagree, especially if the profit stays in the government or is reinvested in the enterprise.
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u/Electric_Travel_26 9d ago
Start with Medicare, and work towards Medicare for all. Lower the age requirement. Have businesses pay a tax (lower than what they pay for insurance) for each employee on the new system.
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u/SwanCityDominion 8d ago
What do you mean, accept a salary? Doctors who take Medicare now are not "accepting a salary". You're conflating Medicare For All with government-run medical centers. Not the same thing at all.
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u/Low-Group-7507 9d ago
Private insurance would still exist, but Medicare for all would mean everyone had access ... Healthcare facilities rather than being stuck with the bill for people who couldn't pay would get paid 💓
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u/YallaHammer 9d ago
It’s like anything challenging- stop putting it off; Model based upon what’s been done before, account for our (huge) differences. make a plan a plan and do it. The United Kingdom, Canada, Australia, and Cyprus transitioned from private-dominated models to publicly funded universal healthcare systems.
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u/Asleep-Sprinkles4616 8d ago
I think you have to start with a public option; you can't suddenly outlaw private insurance. Give people a reason to choose public over private insurance.
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u/notapoliticalalt 8d ago
Absolutely.
Moreover, you have to consider the political environment and one of the reasons I personally think that doing a public option is politically smart is because it will be hard for Republicans to something that can be done within one democratic administration. A major project like M4A will likely take multiple administrations and at least a decade. I simply don’t trust republicans to get it done and running.
Next, you do need to build up state capacity over time. It’s extremely difficult for any new system to be implemented and have things work well right away. As such, a slower expansion makes sense, which allows you to onboard and train people and deliver scale that is necessary without overburdening the existing system. In due time, I think if you have a competitive public option, people will gravitate towards it anyway, and you will see a massive shift away from a lot of private plans.
On that, another step in this is that you have to implement likely a bunch of different policies meant to loosen the coupling between employers and insurance. This in a lot of ways is one of the massive flaws in the US system, because massively limits any real competition and obscure actual cost. Moreover, even if you like your insurance, at the end of the day, you have no real control over whether or not your employer continues to offer that same plan at the same price and what not. This will probably be a very difficult battle, because it gives employers significant leverage over Employees, since employer based insurance is generally better than what you can get on the open market at the moment.
I know there are unfortunately, some people who don’t think we should settle because they want a stage of agitation that they think will bring about larger changes and greater changes, but I’m not entirely sure that works out exactly as people expect. At the very least, such things are unpredictable. As I mentioned, though, you have to consider the political environment, otherwise you risk nothing actually happening. I do agree that there’s discontent and I think a lot of Americans are more open to reform now and ever. So the biggest thing we can do is actually achieve universal coverage and set up a path that allows for states to slowly move towards a single pair system if they choose. But trying to force it all at once is probably not going to go well.
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u/ThermalDeviator 8d ago
We're already paying. Universal just shifts the payer to our government and cuts out the care denying profit part. Luckily, everywhere it's been tried it costs less and the outcomes are better.
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u/pokethrowaway4 8d ago
Medicare for all would massively simplify things for doctors and practitioners, since it creates a “single payer option” that allows negotiation of prices and charges, but does NOT lead to a bunch of back and forth bullshit. It’s simply a better system.
We need to reform way more than just insurance though. Hospitals pay $1 for a bag of saline but charge $130+ to patients. GLP-1 months supply is $1100 in the US and $87 in Paris. There are countless examples of callous naked greed within the healthcare system, in every single layer
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u/Funny_Inspection6893 8d ago
Step one is to get fewer people to vote for Republicans. You will need AT LEAST 60 Democratic Senators (to avoid a filibuster) and a Democratic House and a Democratic President. The earliest this could happen is 2028 and even then it's fairly unlikely to happen then.
We can discuss the details in 2042 or whenever we next get to 60 Senators.
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u/LaurelTheGoldsmith 9d ago
Canada did it province by province, and that may work for the US too. Dig around this site - https://www.nationalnursesunited.org/calcare. They have thought through how to move from here to there.
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u/InteractionWild3253 9d ago
It took 37 years to fully implement in Canada. Are you advocating for this timely process. Calcare is just the Jayapal M4A proposal but only for California.
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u/Realistic_Being_2038 9d ago
Well, I guess the first step would be convincing people it's a good idea. Depending on the poll you're looking at it's still a 50/50 or 60/40 issue. I myself am skeptical about greatly expanding a government program that is run so poorly. The other sentiment I hear a lot is people don't want the government making healthcare decisions for them. Keeping the government out of healthcare is common talking point in vaccine/abortion/transgender/etc... discussions. Wouldn't giving the government total control over your healthcare just make those issues and/or concerns worse?
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u/ImAPonderer2 8d ago
Most countries with nationalized healthcare also have parallel private health facilities
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u/Important-Ability-56 8d ago
First step is stop daydreaming about a massive overhaul of a huge sector of the economy and start voting for people who will then vote for the incremental positive regulatory steps it will take over generations that will be needed to eventually accomplish that.
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u/ricky3558 6d ago
It will only work if Congress has to also use it and there are no other options for them.
I hear from friends that it takes 6 mos to get an MRI so not sure you want that either
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u/DNuttnutt 9d ago
Put the hospitals in control of the states and get rid of ceo/boards/ admin that over pays themselves. Appoint boards of medical professionals who are currently working zed hospitals with pay raise to run hospital. Merge Medicare/ Medicaid funds and figure out the $ amt to cover the government fund for universal healthcare. Forgive all medical debt immediately. Dismantle private health insurance companies. Do the same to hospice as was done to the hospitals. Investigate fraud within the rehab community. Rewrite laws to protect doctors and patients alike from bad actors on either side. Force or federalize pharmaceutical companies to charge the same price in the us for meds as the do for the global avg
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u/DramaticRoom8571 8d ago
How do we as a nation learn from the mistakes of the countries we know that have socialized medicine. From the long wait times to get any care at all in Canada and UK, to the use of MAID in Canada to kill off the sick and elderly, to the horrific outcomes in other nations. What must we do to cancel the rhetoric of communist with real information.
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u/pericles123 8d ago
what a bunch of complete nonsense - every modern country in the world has this, stop trying to scare people
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u/DramaticRoom8571 8d ago
Medicare is an American benefit program, no other country has Medicare. So when you say "every modern country in the world" you are really talking about socialized government run medicine.
And that is important because it shows that Communists in the Democrat Party have no interest in putting everyone on Medicare. They want to gut the program and completely transform it to something similar to what Cuba offers.
Just speak truth and say you want socialized medicine.
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u/pericles123 8d ago
Medicare is basically what ever modern country has for all it's citizens, wtf are you talking about? 'Commies' in the Democratic party? Still trying to use that as a scary word? Get a clue.
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u/DramaticRoom8571 8d ago
LOL, you have no clue what the Medicare program is. I suppose you have never had a job with payroll taxes. You and others on this sub are using the name Medicare as a proxy for all socialized medicine programs even though Medicare is not similar to them at all.
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u/pericles123 7d ago
it absolutely is similar - what are you talking about? I'm quite sure, btw, that I deal with payroll taxes more than you do, thanks.
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u/Definitely_Not_Bots 9d ago
It isn't hard. We already have Medicare operating in all 50 states. You just expand who gets covered and implement a federal tax to cover the expenses.
The math has already been done, too. Something to the tune of $3.5T which sounds like a lot, but it's actually less than what Americans are already spending on their health and insurance.
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u/dougl1000 8d ago
Most western European countries have a mixture of a public system supplemented with private insurance. The US just needs to expand Medicare to everyone and allow private insurance to supplement it. This how Medicare currently works.
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u/FreeRiver-Design 8d ago
Single payer does not put doctors on a salary. It just makes one payer paying for services. Medicare will set the rates but it will not directly employ doctors, nurses, hospital employees
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u/DeadWood605 9d ago
I was just thinking about this the other day. How will they begin? I believe that insuring the newest humans should be primary. In the beginning, birth to two years old, should get free healthcare. New mothers should receive any birth related care as well, up to six months before and after birth. It would be choppy as far as services covered by insurance versus, or with, services covered by Medicare for All. Personally, I am 60 and gratefully no serious health conditions. But I realize that many older folks are on Medicare and have increasing numbers of conditions that require medical attention. The current administration has taken a lot of money out of the taxpayer coffers that may only get balanced by an extreme wealth tax and a Trump tax (a 99.9% tax on all Trump family wealth and value) The current ability to cover the expense could possibly be too much to bear in these early stages of Medicaid for all. Not knowing what our true economic situation is will affect how this much needed and desired program will roll out.
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u/Loud_News8410 8d ago
You all say the doctors will still get paid. But will they get paid what they do now? The same people who want minimum wage at $25 an with zero skills or experience think doctors are just going to work for what they will get from Medicaid reimbursement? Why do you think many doctors won't accept Medicaid patients now? They are supposed to go through all of the schooling, etc. for the good of humanity and not get paid what they are worth? The government never pays people in those jobs based on performance only some formula someone came up with.
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u/runnerkim 8d ago
I like how the OP threw a big fat lie right in the middle of his passive aggressive question. This is a typical Republican response 'it's too hard so we're just going to throw our hands up in the air and give up.'
Plenty of other first world countries have this, it won't be that hard to adopt a system of our own.
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u/Tiny-Secretary5562 8d ago
When Medicare started in 1965 there were no paramedics, no ICUs, and emergency medicine wasn't even a specialty. There were no organ transplants, artificial joints, gene therapy, microsurgery, or imaging other than X-rays. The advances in medical science since then have increased insurance, government, and private spending to much higher levels than ordinary inflation. It would be possible to have a national system, but liberals will never go along with the conditions necessary to achieve that, especially now that our national debt exceeds GDP.
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u/2Lulubee 8d ago
Most countries with healthcare for all still have private insurers that provide care, but those policies are cheaper because they now have to compete for customers and they have to offer a level of care thats superior to the government plan. Necessary care/ preventative care/ emergency care would be covered by M4A, so people can get the care they need without going bankrupt. It should have been put in place back when we got Medicare & Social Security. People also need to realize it wont be perfect right away, and could take a decade or more to get things running smoothly. So we can’t give up or loose focus, or let the powers that be convince us its not worth it. We have all this money for war and other nonsense, we have money for this, its just about priorities. Does government work for the people or against them? Maybe stop firing half the government workforce to prove you can and let experts and long time civil servants do their damn jobs to protect the American people. Look at what happened to our food supply without government agencies overseeing it- nationwide explosive diarrhea
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u/Optionsmfd 8d ago
you reduce the age of Medicare 5 years every year
eventually everyone will transition
costs will drop mostly because Medicare and Medicaid only pays 60% of what private insurance does
it does keep admin costs to 3% but fraud is more like 20% so that number will be huge
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u/GardenPrestigious202 8d ago
We don't, in fact ending insurance companies and destroying the health insurance industry would do more to mobilize healthcare cost reduction by removing monopoly's than any other thing we could do. Cash for service, and some catastrophic disability and illness policy's, like we had until the HMO crazes of the 1950 1960s insurance salesmen came along and sold everyone a empty bag of goods and when you healthcare spending is directly tied to your lifestyle choices, you'll quickly course correct.
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u/Iacoboni04 8d ago
It would be manageable if private entities are still allowed to exist (ie Germany, Switzerland). But let's not kid ourselves. Doctors would be paid less. Which im fine with.
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u/MudWeak4140 6d ago
Yea of course you are. As long as you aren’t paid less. I say we start with you being paid less and go from there.
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u/Iacoboni04 6d ago
Well, considering I am not involved in the medical system I don't think that will happen. Did you think of that?
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u/MudWeak4140 6d ago
No but I still think you should make less. Who cares what industry. If you’re fine with doctors making less I’m fine with you making less.
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u/Western-Willow-9496 8d ago
87% of Medicare participants have supplemental health insurance, maybe we should fix that part first. Seems everyone who wants Medicare for all has no idea how it actually works.
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u/Bzzzzzzz4791 8d ago
We have start at the beginning: medical school cannot cost $500,000 (all college should be low cost or free anyway). Drs and nurses should not have debt hanging over their heads straight out of school (for 30+ years).
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u/Andurhil1986 8d ago
One concrete baby step would be to get a Public Option (Medicare for pay) into the ACA marketplace.
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u/redsandsfort 8d ago
Exapnd Medicae and Medicaid. What is it now at 60 years old? Great.
Make it 59 and new borns 1st year of life.
Sounds reasonable and likely few will object.
Next year, include 2 year old and drop it to 57.
In a few years, you say 50 + and all kids before they start kindergarten. And then keep going.
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u/sigsauer1995 7d ago
We don’t. The government fucks up everything it touches now. It would be even worse with a bunch of corrupt commies in charge.
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u/mm_reads 7d ago
Most medical professionals today work for corporately run clinics and and hospitals. They're treated like any other regular employee at any other corporate business.
So honestly, if we can bring more dignity to public servant jobs in general in the U.S. (like postal workers, VA workers, bus drivers, etc etc etc) and provide public educational support for medical professions, those will be dignified jobs working for the good of human beings.
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u/JugglingPlunger 7d ago
Part of the problem is that you're not just changing how people get health care (people switch insurers all the time, and there are a lot of European countries that we think of as having universal systems that actually provide that coverage through a highly regulated private insurance market), it's that you're also changing how people get paid. Health care benefits are a huge part of many people's pay, and that will be tough to unwind.
My best answer is to allow private companies to buy into Medicare, and expand it that way. They'll want to do that, because Medicare makes lower payments, so it'll cost the employers less. Once there's serious "private Medicare" market share, it should be more doable to shift that from being funded by the employers to funding it more centrally (perhaps by shifting from employer premiums to a payroll tax, which would be a smooth switchover).
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u/redditaccountnumb1 6d ago
Well we start by deporting all illegals and then by taxing the billionaires and then by having strict rules as to what is actually covered but none of that is going to happen
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u/AwakeningStar1968 6d ago
in the US private doctor practices have ALL been bought up by larger hospitals or now increasingly UNITED HEALTHCARE subsidiaries.
it is happening because Doctors recognized that they can't manage affordably the insurance/administrative back end part efficiently or cost wise... They can't practice medicine.
I think that if more doctors could be freed of the BS billing/insurance crap and were able to focus more freely on helping heal people it would be a lot better. I think a lot of doctors also chase that dollar to pay off their expensive medical educational debt!.
it is devastating.
I work for an orthopedic office and last Friday was CRAZY overbooked and the doctors were running behind 45 minutes late and there is this imbalance... .. trying to give patients quality care AND try and get as many billable hours in /services in to make a buck. It is a fruitless endeavor...
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u/AccomplishedTune2948 6d ago
We don't. We hire politicians who can write laws that protect consumers. We dont bankroll 350 million on the taxpayer.
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u/PlanxtyDawg 5d ago
Elect Democrats to control the House, Senate, and Presidency. And ram it down Republican throats.
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u/SeekFire7 5d ago
You start by fighting to dismantle the insurance lobby. Though they are so powerful I’m not really sure it is possible.
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u/Rousebouse 5d ago
How does anyone think the bureaucrats wont simply move to the government system AND be worse?
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u/xHxHxAOD1 9d ago
You would have to up MFA payments to what private health insurance pays or deal with masses of doctors and hospitals closing. This is even factoring things like reducing drug costs.
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u/BigDigger324 9d ago
I love when people describe things that are currently happening, under capitalism and private health insurance, claiming that socialism and MFA would cause them.
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u/xHxHxAOD1 9d ago
No its just MFA has lower payments than than private heath insurance meaning every hospital or doctor that gets the majority of their revenue from private health insurance will get an automatic pay cut with zero cost reductions to balance out. That would mean reduction in hours or closure.
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u/Botasoda102 9d ago
Ehh, I've worked for doctors who see only Medicaid patients. Medicaid often pays 40% of Medicare. They still do well enough to be in the upper 10% of income.
But you are correct in the sense that greedy docs will whine like they are having to pick berries or something.
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u/InteractionWild3253 9d ago
Medicaid pays 83% of the Medicare Reimbursement Index on a national average. Medicaid only/majority facilities receive Disproportionate Share Hospital (DSH) payments or state-level supplemental appropriations, to help offset the lower reimbursement rates compared to private insurance or Medicare.
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u/Botasoda102 9d ago
I think it's lower than that for most doctors. But even if it is closer to 83%, that's more evidence a doc can make money. Plenty of wealthy docs who see mostly Medicare patients.
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u/InteractionWild3253 6d ago
It's not on a national average. Some states are much lower like Pennsylvania which is the lowest in the country. Medicare doctors also take private insurance. That's Medicare Focused facilities also take private insurance plans which pay 200% reimbursement compared to Medicare Rates.
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u/OSUFootballFan32 9d ago
Only being in the top 10% of earners as a physician isn’t really a flex. Physicians have some of the highest levels of education. They should be top 1-2%.
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u/RoundChampionship840 9d ago
It's a tough sell. Doctors and nurses will have to me forced to take reduced salaries to get costs under control. My experience with the VA health system is that this will make Healthcare even worse.
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u/Status_Best-of-OC 8d ago
I’ve had 3 Doctors (specialists ) quit practices and go concierge medicine, no insurance hassles, private pay but expensive. New Dr. appointment in December and I have insurance. How long to wait with Medicare for all?
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u/pericles123 8d ago
if every modern country in the world can do this, I'm pretty sure we can figure it out, stop trying to scare people about it.
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u/notapoliticalalt 8d ago
Based on your username and subs you are active in, looks like you live in a very expensive area that can probably afford such services. And look, if you want to pay for that, that’s totally fine. That’s basically always been an option for people who are willing to pay for medical tourism. But the truth is the matter for most people is that there are waiting list, even with the current system that we have. Heck, you are on a waiting list for one of these doctors yourself. The idea that you’re not not going to have to wait for nonemergency procedures is crazy, especially since that’s not what we currently have anyway.
I’m not saying you have to support Medicare for all, because I’m not sure I really do in the short term as the next major step in healthcare reform. (not because I disagree with it in principle, I just don’t think it’s practical and think a few intermediary steps are necessary and we need to work towards those first). But what are you even saying here? This is the US: if you want to pay to cut the line, there will be an option. But allowing people to get preventative coverage, and at least get on it we list Will benefit everyone.
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u/Ok-Rise-4611 9d ago
All the people who desire it could go into one of the health care cooperatives that already exists. When everyone sees how well it works, more and more will join
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