Medicare for All: Leaving No One Behind | Hacker News Reader

Medicare for All: Leaving No One Behind

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25 pointsfosco21 comments

To call our healthcare a market system is laughable. There so many protections and regulations and distortions. In addition, when your house is in fire, you don't shop fire departments.

In a life or death scenario, you certainly aren't shopping hospitals. And so they can gouge you hundreds of $$ for even simple things like ice packs and Tylenol. Our system is a scam. One hour in the ER should not cost $5000

But what about when it isn't an immediate emergency? There are plenty of healthcare needs where you totally do have time to shop around and find the best bang for your buck, if the system let you do that. (There could be a startup idea in there, even. A simple website to help find the most effective, cheapest endoscopy or wisdom tooth extraction or STI test or mole check or whatever.)

That is the underlying problem though. There is no "shopping around". Either your plan allows it, or does not. If you need a procedure, your choices are effectively limited to who is on your coverage list.

FWIW, I live in an area where there is ONE healthcare option (Racketeering/monopoly). I (as an independent consultant) pay $1640/mo for a $5,000 family deductible. So basically, I pay over $19,000/year for the PRIVILEGE of paying another $5,000 and that's assuming I only go to the doctors "they allow" me to go to. (it was $800/mo for a $1500 family deductible prior to ACA). Obama can EABOD.

The only people who like the ACA are the people who don't have to pay for it.

Edit: Also I was in an MVA in July, the Emergency Dept. didn't accept my insurance at all - so who gets the bill? I do. The MVA wasn't my fault, but that bill is still my responsibility.

The auto insurance company. That is why you have medical on your policy. Of course you may have to sue someone to get it.

That's another crazy part of our system. Medical coverage is baked into your health insurance, your auto insurance, your property insurance, workman's comp insurance. A medicare for all plan, should require comensurate decreases in all of those policy areas.

Yeah, it will take a lawsuit, and that, I am told will take ~18 months +/-. I'm on the hook until then. So far, with lost work, PT and imaging, I'm already out almost $20k

There is no shopping around because nobody will give you a price.

If I had a say, I'd like to see universal coverage for all Americans (and market rate buy in for workers on visas) but provide it at several levels.

Everyone working or non-working gets some kind of base coverage --to which they can buy a ala carte additional coverage/perqs. At the base level people who behave healthy (but not necessarily healthy) get breaks (premium perqs) for trying to be healthy in terms of diet and activity (activity monitors, etc.)

In addition to some base coverage, people can opt in to more premium coverage with shorter wait times, additional non-essential care, opt out of lifestyle monitoring, etc.[1]

That way the system can be streamlined to be efficient in handling 80-90% of cases and then have the second, premium system available for those who want or need less ordinary medicine.

If you can keep 80-90% of your pop healthy efficiently and then you get the rest to pay extra for their added needs, I think that could make the economy more effective, overall.

I own a medical clinic with my brother who is a physician. He has opted out of medicare and medicaid because of the increased overhead and cashflow issues that are incurred when dealing with the government. Instead we charge $50 per month for a base membership to the practice and bill patients slightly above cost for labs, and supplies. I think this will be the model for most Americans in the future. Most medical costs are not emergency related and people just need someone to give a quick medical opinion when they are concerned. For people with a chronic condition like COPD or diabetes they get a monthly visit have their vitals checked and can come back next month without paying crazy high fees. For emergencies, people usually also carry a high deductible plan so they are only using insurance for costs that can't be paid out of pocket.

The primary mechanism by which money is saved is price controls, under a single payer system. This should be extremely scary. And I'm saying this as someone who voted for Obama in 08, 12 and HRC in 16.

Healthcare products are complicated. Getting the price right is a very hard problem. Markets, generally speaking, have proven to be a fairly effective way of settling on price. This is basic economics.

From my experience the US health care market is not a functioning market. No price transparency, widely variable prices for the same thing, huge and inefficient bureaucracy.

It would be interesting to see if there was regulation for open pricing, billing standards and others. If that doesn't happen, Medicare for all is definitely a good option.

I totally agree with everything you said except that last sentence. Insurance seems to be something of a failure as is. That said, MFA seems like just another insurance system. Except customers can never opt out of it, never develop a competing system, and are now bound to its inefficiencies forever.

Medicare & Medicaid has always been an option for everyone - its just that if you made too much money, then you didn't qualify. It was a safety net for the poorest people. It was not meant for students just out of school (who presumably had skills to get a job with benefits) or people who are perfectly happy not progressing or producing in their lives (which is fine, just don't demand that "society" pays for everything).

It's a low information market with zero competition. Allow import of drugs. Allow insurance to operate across state lines. That's what Trump was suggesting during his campaign. I'd go further, though, and stimulate the flow of information. Picking a doctor right now is a freaking nightmare, all you have to go on is what the doctor says about herself, yet insurance companies sit on tons of data they are unable to use and unwilling to share. Costs, outcomes, malpractice rates - it's all there, you just need to give a shit, which insurance companies do not.

If there was one useful regulation it would be to mandate opening up all costs and quality data. A lot of people won't like that but until then the US health market doesn't deserve the name "market"

At one point I read that the british universal system is actually cheaper per-person than the US market determined system. Sorry I don't have a reference for that, but anecdotally, I can recall several stories of simple items like "saline solution" receiving excessive markup in the market system because it would all be covered by the insurance anyway. I wish some more knowledgeable healthcare people can comment here.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... backed up by lots of solid references. TL;DR for 2015, US per capita spending was $9,451; Canada was $4,608; U.K. was $4,003.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Using life expectancy as a basket proxy for average effectiveness of care, Canada is 12th, the U.K. 20th, and the United States 31st. It's broadly accepted that on average, medical outcomes are generally better for pretty much every indicator (infant mortality, length of hospital stay, etc.) in countries with effective universal health care, at much less the price.

Ah thank you.

Who is pantheonsite.io, and why isn't this linking straight to https://berniesanders.com/issues/medicare-for-all/?

The only moral way of providing healthcare is based upon need not ability to pay.

If you introduce any pay structure into healthcare you are saying that those with money can reserve scarce resources ahead of those without.

You are saying rich people are more important than the poor and the poor should die more quickly to get them out of the way.

If you live in a society that takes that view, how long before you become the poor?

I'm a Bernie supporter.. and like the single-payer idea... but if that can't get passed--how about we get rid of Insurers--and make HOSPITALS provide insurance.

You pay your local hospital $x per month based on income... something like 4-6% of your income if you earn > $30k.

The hospital might get some gov't subsidies based on # of insured patients it carries.

When you travel your hospital covers the bills at other hospitals. Since each hospital = insurer they will work/negotiate with other hospitals for faired deals than they would w/ insurance companies.

This also will do away with some of the billing requirements and could streamline that process a bit.

A good startup might be creating the billing systems that manage all of this, and centralizes everything between different hospitals.

No HMOs, Networks, etc... Hospitals could choose what extras they might cover like infertility/etc... as a bonus so patients might pick a different local hospital that has better coverage..

The boon for the hospital: Monthly recurring income from all it's patients - past, present, and future.

Happy to see this. Free market health care has failed, glad there is a critical mass of people willing to get something new.

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