US Healthcare

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US Healthcare

Post by BirdWatcher on Thu Nov 08, 2018 5:49 pm

Ready for some off-topic discussion?  I post this here because, even though Teetime and ramblinman & myself rarely agree on pub/private football or even politics, I really do value their opinions on serious stuff.  Heck, most of you guys are thoughtful participants in non-football topics.    I wrote this up after a late night discussion with friends about US health care.     Please fire away at the ideas presented below.   Don't compare it to ObamaCare, or even our current system (?).  Just tell me why it wouldn't work.....  Very Happy   or how it could be improved


Medicare is a large bureaucracy and has infrastructure, already in place, that (Democrats) will tell you is cheap and efficient.  44 million recipients use MediCare.   UnitedHealthGroup, as the largest private insurer, has 144 million customers.   I believe Medicare is “good” health care, but not great.  If it was great, my employer wouldn’t provide me with a “medicare supplement” to purchase the “total” package on the market.

No one has been able to explain to me how we move from 3rd party, huge corporations paying for healthcare to single payer without a huge market disruption and economic chaos.

I believe single-payer can be useful and efficient.  Singapore combines single-payer with personal responsibility to achieve this.   I’m not convinced the Canadian/UK/German model works well for US citizens who are used to instant gratification.   All my Canadian friends come here and pay themselves when faced with 8-10 month waits for service.

If Medicare is a good service and value, with infrastructure in place, why don’t we sell the coverage to people who don’t have insurance?   Everyone who pays their Medicare taxes would still pay those taxes to cover the 65 and older population.  And even if you “purchased” Medicare as a 40-something end user, you’d still be responsible for Medicare taxes deducted from your check.  For the sake of this discussion, let’s call buying Medicare “MediPay.”

MediPay would be available to you, even if you had pre-existing conditions.   MediPay already has a risk pool of 44 million people (minimum) and so the premium costs could be distributed.   Would all pre-existingly sick people flock to MediPay?  Yes, but so would many more who want to join a huge pool of people for a low premium.   If you ran a small business and WANTED to provide healthcare but couldn’t afford it, you could stipend your workers for part or a majority of the MediPay premium.

I think the beauty of a MediPay system is the clout that legislation could put behind it.  Drugs are expensive, mostly because we let them be.  MediPay could determine a National Formulary, with defined costs nationwide.  There’s no reason an EpiPen in California should cost more than one in New York.  Amazon and UPS/FedEx have proved that costs are equalized across our nation.  I’m not saying the government would SET the price of the drugs… they would just set the price that MediPay would pay.  Other insurance companies would be free to pay more.  But they wouldn’t.  MediPay setting the base price would drive down the price other providers would see.  I could see legislation that required that MediPay drug prices be, for example, a percentage (110%?, 120%? 90%?) of what the same drug costs in a worldwide sample from the EU, Far East, Middle East, etc.

I think MediPay should set a National Scale for Procedures.   Not to IMPOSE those prices on providers, but to set the limits that MediPay would pay, and let other insurance providers follow suit, if they wished, or offer an upsell to their customers.    For instance, a GP Office Visit might be set at $100.   That’s about the price I paid at the local Doc-In-A-Box last year for a checkup, no labs.   Should the National Scale be indexed for higher cost of living areas like New York?  Or would keeping the MediPay reimbursement the same nationwide drive doctors to migrate away from New York and move to underserved areas like mine in Appalachia?  No fix in our healthcare system will ever come until we have clear transparency on prices for procedures.

I think what eventually would happen is that 100% of Americans would have MediPay, either through their companies, unions or self-bought.  And existing insurance companies would exist to sell MediPay Supplementals and upscale insurance products.     That’s how Canada and the UK are today:  people have general, good coverage, and people with money pay extra for private doctors or added insurance.


What are the holes in this idea?

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Re: US Healthcare

Post by OldTitan on Thu Nov 08, 2018 6:13 pm

BirdWatcher wrote: Drugs are expensive, mostly because we let them be.  MediPay could determine a National Formulary, with defined costs nationwide.  

The counter-argument is the best drug research in the world is done in the United States because of the amazing profits to be had - medical/drug companies are willing to shell out big bucks for medical research because it pays off.

It is a deeply flawed research system, but a reduction in costs of patented medicines would curtail research.

Otherwise, I like most of your proposal.
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Re: US Healthcare

Post by 19delta on Thu Nov 08, 2018 9:07 pm

While the initial intent of MediPay might not be to set costs, that is pretty much exactly what will happen, especially as MediPay becomes a defacto monopoly. When doctors are told by MediPay how much they will be paid, that will lead to a shortage of doctors.

How is the US Post Office doing? What about AMTRAK? The feds aren't really good at running businesses.
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Re: US Healthcare

Post by BirdWatcher on Thu Nov 08, 2018 11:33 pm

OldTitan wrote:The counter-argument is the best drug research in the world is done in the United States because of the amazing profits to be had

Ya, I'm married to former Pharma Rep.... I heard that tale for 25+ years.

But the US is the biggest market in the world. Don't bigger markets, if they're free, drive prices down?

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Re: US Healthcare

Post by ging on Fri Nov 09, 2018 11:10 am

something something football something something something playoffs something something something multiplier something something something something something
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Re: US Healthcare

Post by ramblinman on Fri Nov 09, 2018 12:42 pm

I'm in my 60s (gulp).  For most of my adult life, I have generally embraced conservative political views and have voted for candidates who espouse similar views most of the time.  

However, I don't march lockstep with conservatives on all issues and universal healthcare is one of those issues.

I was actually FOR Obama care, until Obama and the Dems pulled a fast one in the way they went about getting it passed into law.  The means do not justify the ends.  

I simply believe that having access to decent healthcare for everyone should be a heck of a lot easier than it is in this great country of ours.  I don't understand how anyone can argue against that belief.

What if we had taxpayer funded universal healthcare all along and people HAD to pay for their own kids' education, without the benefit of taxpayers with no kids subsidizing the education of children?  Don't like it?  Me neither, and I'm a private school guy!  Why is education for all deemed important enough to fund through taxes, but healthcare for all isn't?  

BW, there are two reasons why I take issue with your question of why don't we sell medicare coverage to people who don't have insurance.  The first is because, as you pointed out, medicare is not great coverage.  It's basically bare bones.  The second is because there are tens of millions of people out there who simply cannot afford to pay for what you propose selling them.
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Re: US Healthcare

Post by BirdWatcher on Fri Nov 09, 2018 7:14 pm

ramblinman wrote:
The first is because, as you pointed out, medicare is not great coverage.  It's basically bare bones.  

I, personally, have GREAT coverage, really cheap. But I don't use it. I would be interested in a bare bones coverage, with a catastrophic rider.

ramblinman wrote:
The second is because there are tens of millions of people out there who simply cannot afford to pay for what you propose selling them.

Don't those people go on MediCAID? What I proposed (MediPAY) should be cheaper than what you'd buy from United Healthcare, no? No profit motive for MediPay, small overhead.... isn't bare bones, affordable coverage better than no coverage?

So far I've seen two basic objections: one is government doesn't do this well; and one that this doesn't go far enough.....

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Re: US Healthcare

Post by ramblinman on Fri Nov 09, 2018 9:47 pm

BirdWatcher wrote:
ramblinman wrote:
The first is because, as you pointed out, medicare is not great coverage.  It's basically bare bones.  

I, personally, have GREAT coverage, really cheap. But I don't use it. I would be interested in a bare bones coverage, with a catastrophic rider.

ramblinman wrote:
The second is because there are tens of millions of people out there who simply cannot afford to pay for what you propose selling them.

Don't those people go on MediCAID? What I proposed (MediPAY) should be cheaper than what you'd buy from United Healthcare, no? No profit motive for MediPay, small overhead.... isn't bare bones, affordable coverage better than no coverage?

So far I've seen two basic objections: one is government doesn't do this well; and one that this doesn't go far enough.....

Thank God you dont need the great coverage...now. You'd be s.o.l. if you were in really poor health with the bare bones coverage you are interested in.

As for Medicaid, "those people" can go on Medicaid only if they fall below certain income thresholds. If you live in Illinois, and you are unmarried with no dependents, you basically are disqualified from Medicaid if you earn $16K or more a year. Good luck making ends meet if you also have to pay for health insurance or even your MediPAY concept in order to receive decent health care.
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Re: US Healthcare

Post by BirdWatcher on Fri Nov 09, 2018 10:55 pm

ramblinman wrote:Thank God you dont need the great coverage...now.   You'd be s.o.l. if you were in really poor health with the bare bones coverage you are interested in.

It's a choice. I choose the highest out-of-pocket and the highest co-pays in exchange for low monthly premiums ($135). if I fall off my horse or a mountainside, I'll have a big pile of bills. If that happens and I need to have a plan that covers office visits, rehab, etc., I'm sure my premium will be much higher. As it is, if I need a checkup, I pay the $80 cash price at the FastPace.

It's also a choice that I eat right, work out, don't smoke and drink moderately. Disease is not a choice, but health is.

So, your objection to MediPay is that you don't think it will be affordable? Or comprehensive enough? I think it's a good way to get to single-payer by slowly squeezing the private insurance companies out of the basic care game.

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Re: US Healthcare

Post by ramblinman Yesterday at 11:42 am

BirdWatcher wrote:So, your objection to MediPay is that you don't think it will be affordable?  Or comprehensive enough?   I think it's a good way to get to single-payer by slowly squeezing the private insurance companies out of the basic care game.

It would be a step in the right direction, but it would not be comprehensive enough for the people who need it the most.

Again, why is education for all worthy of being paid for through taxes but healthcare for all is not?
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Re: US Healthcare

Post by BirdWatcher Yesterday at 12:02 pm

ramblinman wrote:Again, why is education for all worthy of being paid for through taxes but healthcare for all is not?

My proposal doesn't say that education is more or less important.

How would you get from where we are (private 3rd party payer) to taxes paying for everything? Realistically.

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Re: US Healthcare

Post by ramblinman Yesterday at 12:34 pm

BirdWatcher wrote:
ramblinman wrote:Again, why is education for all worthy of being paid for through taxes but healthcare for all is not?

My proposal doesn't say that education is more or less important.

How would you get from where we are (private 3rd party payer) to taxes paying for everything?  Realistically.

Do you agree that public education should be available for all and it should be paid for through taxes? If so, then why shouldn't healthcare for all be paid for the same way?

As for paying for universal healthcare, it would likely require a complete overhaul of the current federal income tax system...which is in need of an overhaul anyway.

Remove employer subsidized health insurance from the equation, and employers would have more money to pay to workers in the form of higher salaries. Enact a VAT or flat income tax system, or some combination thereof. The key would be to remove the loopholes that allow wealthy folks to not pay their fair share.

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Re: US Healthcare

Post by BirdWatcher Yesterday at 1:16 pm

I've long advocated a true flat tax. 20%, with a generous exemption up front, no deductions, not even for mortgage or charity. I think I even posted it here for discussion. But that's not realistically gonna happen. Too many lobbyists.

I think MediPay would (slowly) get employers out of the healthcare business. And (slowly) get 3rd party health insurance to be "icing on the cake," not the primary provider. You might not like that "rich" people could afford "extra" insurance, but that's how it works in Canada and the UK now. And you might not like the current state of MediPay benefits, but as scale is brought to the MediPay system, benefits could be increased if needed. Or not. Maybe we can't afford it.

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Re: US Healthcare

Post by BirdWatcher Yesterday at 1:19 pm

Another point: education is basically a state's responsibility. Do you want the states to "own" healthcare for their residents? As a Libertarian, I prefer that. But I don't think you'd get much Democrat support for states'-rights-healthcare.

I'm looking for a real, practical solution. I bet Teetime has one... Smile

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Re: US Healthcare

Post by Head Idiot Yesterday at 1:42 pm

BirdWatcher wrote:I've long advocated a true flat tax.  20%, with a generous exemption up front, no deductions, not even for mortgage or charity.  I think I even posted it here for discussion.  But that's not realistically gonna happen.  Too many lobbyists
My dad told me one of the reasons he voted for Pritzker was so we could get a "fair" income tax. He said a flat tax is the dumbest idea ever. I asked how the idea of everyone paying the same % isn't "fair". He didn't have an answer. It's amazing the level of hatred the left has been able to generate toward "the wealthy".
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Re: US Healthcare

Post by dusty7 Yesterday at 2:41 pm

Head Idiot wrote:
BirdWatcher wrote:I've long advocated a true flat tax.  20%, with a generous exemption up front, no deductions, not even for mortgage or charity.  I think I even posted it here for discussion.  But that's not realistically gonna happen.  Too many lobbyists
My dad told me one of the reasons he voted for Pritzker was so we could get a "fair" income tax.  He said a flat tax is the dumbest idea ever.  I asked how the idea of everyone paying the same % isn't "fair".  He didn't have an answer.  It's amazing the level of hatred the left has been able to generate toward "the wealthy".

Most people look at taxes and only see the $$$ amount people are paying and often don't take into account the effect or the tax incidence the tax has on an individual. All flat taxes are technically regressive where lower income earners are more negatively effected by the tax.

For example, 5% flat income tax
$20,000 = 1,000 in taxes
$30,000 = $1,500 in taxes
$60,000 = $3,000 in taxes
$150,000 = $7,500 in taxes

People against flat tax often argue that the $1,000 is more important to the $20,000 income earner making ends meet than the $7,500 to the $150,000 since they have more money to go around but all are paying the same % but people often just look at the $$$ amount.

I don't have a dog in this fight just trying to help inform.

Here is a link I think a lot of Americans should watch. It's about how our tax system really works in the analogy of paying a bar tab. I show this to my students and they always get a kick out of it. https://www.youtube.com/watch?v=Xj7nRc3_EG0

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Re: US Healthcare

Post by OSUBucks Yesterday at 3:22 pm

dusty7 wrote:
Head Idiot wrote:
BirdWatcher wrote:I've long advocated a true flat tax.  20%, with a generous exemption up front, no deductions, not even for mortgage or charity.  I think I even posted it here for discussion.  But that's not realistically gonna happen.  Too many lobbyists
My dad told me one of the reasons he voted for Pritzker was so we could get a "fair" income tax.  He said a flat tax is the dumbest idea ever.  I asked how the idea of everyone paying the same % isn't "fair".  He didn't have an answer.  It's amazing the level of hatred the left has been able to generate toward "the wealthy".

Most people look at taxes and only see the $$$ amount people are paying and often don't take into account the effect or the tax incidence the tax has on an individual.  All flat taxes are technically regressive where lower income earners are more negatively effected by the tax.  

For example, 5% flat income tax
$20,000 = 1,000 in taxes
$30,000 = $1,500 in taxes
$60,000 = $3,000 in taxes
$150,000 = $7,500 in taxes

People against flat tax often argue that the $1,000 is more important to the $20,000 income earner making ends meet than the $7,500 to the $150,000 since they have more money to go around but all are paying the same % but people often just look at the $$$ amount.

I don't have a dog in this fight just trying to help inform.

Here is a link I think a lot of Americans should watch.  It's about how our tax system really works in the analogy of paying a bar tab.  I show this to my students and they always get a kick out of it.  https://www.youtube.com/watch?v=Xj7nRc3_EG0


Agree with your argument. This is why our Federal tax is a progressive tax. The idea that those who can afford to pay more should pay more. Our soon to be former Governor got trounced last Tuesday night by a guy who ran on a progressive tax system which is interesting. Our Governor speaks about all the gloom and doom which will happen if we go the progressive tax route. Our Midwestern neighbors like Iowa, Wisconsin and Minnesota have progressive tax systems and they are doing pretty well fiscally, certainly much better than Illinois.
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Re: US Healthcare

Post by Teetime Yesterday at 5:03 pm

I like Medipay. I like it mainly because I agree that it would lead us to the place we are eventually going to end up.....a single payer system that uses its weight to control price increases in the medical field.

On it's own, Medipay has lots of advantages over the current system but you asked not to compare it with the current system....only shoot holes in it. I don't want to shoot holes. There would be lots of difficulties in conversion from employer paid health, but I think it could be done over a period of years....first your lowest paid 20% go to Medipay, then 18 months later, your lowest paid 20% go to Medipay, just do that for five conversions and then do everyone that's left....boom, no more employer paid plans.

Medical care isn't just another commodity. It's far more precious. The conversion to a single payer system will come with lots of bumps and bruises. There will be those that claim they are leaving the medical field, or avoiding entry into the medical field because of single payer (and maybe because of Medipay), there will be others that get into medicine because of single payer.

http://pnhp.org/what-is-single-payer/

It stands to reason that there will always be a disparity between the healthcare that is affordable by the ultra wealthy, the wealthy, the middle class and the poor. I think its likely that disparity will exist after single payer but there will be a level of good healthcare that is not just "available" to the poor but that every single citizen is automatically enrolled in.

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Re: US Healthcare

Post by BirdWatcher Yesterday at 5:46 pm

dusty7 wrote:For example, 5% flat income tax
$20,000 = 1,000 in taxes
$30,000 = $1,500 in taxes
$60,000 = $3,000 in taxes
$150,000 = $7,500 in taxes

This is getting off-topic, but that's not how a flat tax works out. Assume a 5% flat tax, with a standard exemption of $20,000.

You earn $20,000, your tax is ZERO dollars, or 0.0% of your income
You earn $21,000, your tax is on the $1000 OVER the exemption amount, or $50. Your effective tax rate is POINT 2 PERCENT (0.2%)
You earn $30,000, your tax is on the $10,000 OVER the exemption amount, or $500. EFFECTIVE tax rate of 1.6%
You earn $100,000, your tax is on $80k, your tax due is $4000. The effective rate is 4%

Only millionaires and above effectively feel anything close to a 20% tax rate.

My Flat Tax plan had a $50,000 exemption (or whatever the US Median income was)

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Re: US Healthcare

Post by dusty7 Yesterday at 8:53 pm

Sorry about going off topic but I was just explaining the basic concept of flat tax. I understand it's not how it's actually structured but just stating the basic concept of tax incidence and how all flat taxes are regressive.

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