'Everybody In, Nobody Out': What's Known About the Medicare for All Act of 2019 | Hacker News Reader

'Everybody In, Nobody Out': What's Known About the Medicare for All Act of 2019

commondreams.org

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I think that being able to leave a job and still have the same health care would be transformative for entrepreneurialism in the United States.

I’ve known lots of folks over the years who’ve felt tied down to a job because they were the only member of their family to have health insurance, and they couldn’t afford to risk their spouse or children getting sick.

I think that's a big reason so many non-insurance companies are fighting against the idea of universal healthcare for all citizens, they like having this tremendous power/leverage over their employees.

That's interesting. I've wondered for a long time why non-healthcare industries don't lobby hard for universal healthcare. It's a huge cost and administrative nightmare.

Agreed. There's actually a term for it: Job lock. https://en.wikipedia.org/wiki/Job_lock

This. When I lost my job in 2013, I considered making an attempt at a freelance/contract career. That stopped when I got a rejection letter (not an increase in price, a full-stop rejection) from my preferred open market insurance provider. (And it was for being too skinny.)

My insurance isn't great, but I hit my copay (and Out-of-pocket-max) for the year in January, so I'm locked in for the year.<br><br>Come to think about it, maybe this is part of the plan for High Deductible plans.

Ugh this is so true. The high-deductible plans are designed to both reduce costs to employers and also keep employees locked in due to high out of pocket max.

At this point we are just paying to avoid the Obamacare tax penalty.

There is no tax penalty https://www.healthcare.gov/fees/fee-for-not-being-covered/

Yes I know not any more after tax year 2018.

You don't think you still would be paying for it, just because you loose the choice of whom your paying?

I have no idea what you're trying to say.

Want to bet the actual legislation is just minor tweaks to ObamaCare re-branded as "Medicare for all"? Why do I suspect the article is overly optimistic and that the author is just reading into vague and noncommittal comments made in meetings that they think will make it into the bill?

The ACA is loosely based on the ultra-conservative Heritage Foundation’s 1990s-era alternative to ‘Hillarycare.’

Medicare for All, definitionally, offers single-payer access. The Heritage Foundation was trying to prevent exactly that.

Also, I can tell you’ve never spoken to Congresswoman Jayapal, because she doesn’t make vague or noncommittal statements (source: I’m a constituent and have been to several of her constituent coffee events.)

"Medicare for All, definitionally, offers single-payer access..." Yes that is what the definition of Medicare for all should be but we are already seeing presidential candidates trying to redefine "Medicare for All" to the point that it doesn't mean much at all. I hope you right on Jayapal but till we see the bill's text we won't know.

we are already seeing presidential candidates trying to redefine "Medicare for All" to the point that it doesn't mean much at all.

What are you referring to?

https://www.cnn.com/2019/01/29/politics/kamala-harris-medica...

That is disappointing. Thanks for the link.

Sidebar: in the two hours since I posted my comment above, Jayapal has announced her first town hall event of 2019. Seattleites should come and ask her questions about Medicare for All. https://twitter.com/RepJayapal/status/1093942183495905280

Maybe the government should treat healthcare like it does student loans. A healthy, educated person is more likely to make more money, and pay more in taxes. So, its more of an investment then a handout. Money flow wise, it makes more sense for government to pay the healthcare for a working adult then a retired one. And they already pay for > 65 year olds and offer student loans to any student.

That would make more sense if we had a more preventative healthcare system. We have a mostly reactive one unfortunately.

The problem with over promising with healthcare is that you can't walk it back and healthcare becomes the most expensive or second most expensive thing on the government budget.

The other problem with government healthcare is that you're basically giving the government some control over your body. It will be the government's business whether you're out of shape or overweight or indulge in too much sugar etc, because the government is paying the medical bills.

That’s my point. If it’s an investment it’s not a cost center, but a profit center.

> healthcare becomes the most expensive or second most expensive thing on the government budget.

Has that happened in other advanced economies? Genuinely curious - I don't know what share of the UK national budget the NHS consumes, for instance.

> It will be the government's business whether you're out of shape or overweight or indulge in too much sugar etc, because the government is paying the medical bills.

First off, this happens to a small extent already with private insurance companies. Companies do "wellness fairs" for employees, insurance companies give people discounts for going to the gym etc. It could increase in future right?

Second, I think most people want to be healthy, regardless of who's paying the bills, because your quality of life is so much better. I could see many people not changing their oil on time and driving terribly if they were guaranteed free car repairs forever. But healthcare isn't like that.

>Has that happened in other advanced economies? Genuinely curious - I don't know what share of the UK national budget the NHS consumes, for instance.

Yes, this is the case in the UK.[1] Public sector spending for 2019 is around £842 billion for the UK. £256 billion is spent on "social protection" and €166 billion on public healthcare. That's 18-19% of the total budget being spent on healthcare. Keep in mind though that healthcare in the US would be much more expensive. US healthcare workers earn more compared to GDP per capita than UK healthcare workers.[2] I think it would be rather likely that healthcare such as this would rival social security in terms of cost if it applied to everyone.

[1] https://www.gov.uk/government/publications/budget-2018-docum... - under section 1.7

[2] https://economix.blogs.nytimes.com/2009/07/15/how-much-do-do...

>First off, this happens to a small extent already with private insurance companies. Companies do "wellness fairs" for employees, insurance companies give people discounts for going to the gym etc. It could increase in future right?

I think it's likely that it will increase, but now the government has more of angle to argue why they should have the right to control your behavior.

>Second, I think most people want to be healthy, regardless of who's paying the bills, because your quality of life is so much better. I could see many people not changing their oil on time and driving terribly if they were guaranteed free car repairs forever. But healthcare isn't like that.

Most people don't want to be told that they're not allowed to eat X, because a bureaucrat living a thousand miles away says it's bad for you, especially when the evidence isn't stellar. It also allows for corporations to lobby harder on laws around people's habits.

If the government finds that using "a screen" for more than 8 hours per day is bad for you, you probably wouldn't like it if the government would now argue that they should be able to monitor your usage of screentime and potentially penalize you in some way, right?

We are now facing the consequences of many decades of inaction to deal with the looming healthcare catastrophe. Now that a majority see a serious need for action, we will get an avalanche of progress.

If the Clintons had been a little less ambitious back in the early 1990's and proposed lowering the age for Medicare coverage by 1 year each year, we could have learned gradually how good an idea this is. If that had worked well, everyone over 40 would now be in (way more than 50% of the health care money), and we could have some confidence that Medicare covering everyone would be a good idea.

The course of urgent progress is seldom smooth.

And then once you put it into place you realize that your system is not sustainable, just like every other country's healthcare system due to demographics. Now you have a big problem on your hands and the only real solution is to cut back on spending.

Only in America can we have a military bigger than the next 10 countries combined, but universal healthcare is untenable financially.

If your demographics suck, use technology to increase healthcare productivity. If your practitioners are too expensive, train more so their wages are in line with other developed countries.

These are not unsolvable problems, and I do not trust anyone who says they cannot be solved.

I agree, but I do not think that we can write an acceptable, realistic, and unambiguous definition of 'solved' before we start, because fighting with a bear always involves some learn-by-doing. It will take a long time for people to accept that a new healthcare system is anywhere close to good enough, and we cannot confidently anticipate now what will be politically acceptable as 'good enough' after people get accustomed to living and dying under the new system. This could certainly be a project that could organically generate some shared values as a by-product, if it is done with political wisdom and skill, but that is just another aspect of a very rich strengths/weakness/opportunities/threats environment that must be navigated.

> It will be the government's business whether you're out of shape or overweight or indulge in too much sugar etc, because the government is paying the medical bills.

This seems more like a pro than a con, considering currently through lobbyists the government is more likely to encourage to you indulge in too much sugar, etc.

But are you sure we're going to get things right this time as opposed to all the other times? I have my doubts about that, which means that we could have the law try to promote "healthy food" that actually isn't healthy. The same goes for all kinds of other activities. Would you be alright with the government restricting how many hours a day you can use a computer?

Medicare is NOT health insurance. It is a credit card that starts to fill-up after age 55. States, by law, are required to collect on the debt you and your family acrue for your medical care. The government, in collecting this debt, will place a lien on your estate. Beyond that, your children can be liable for what you owe.

If everyone in the US were to be shifted into this program it would likely be the largest private property grab by a government anywhere in the world in modern history.

Don’t take my word for it, start here and do your own research:

https://www.medicaid.gov/medicaid/eligibility/estate-recover...

Not saying a better aporoach to healhcare isn’t necessary in the US. It is. Just saying this is not a good idea.

Can someone explain why it's worth paying attention? With a Republican majority in the Senate and Trump in office, the chance anything like this will pass before the 2020 election is nil. And whatever might pass then will be different.

I'm reminded of how when Obama was in office, the House attempted to repeal Obamacare 61 times [1] and it seems it was entirely symbolic.

[1] https://en.m.wikipedia.org/wiki/Efforts_to_repeal_the_Patien...

Because every Democratic candidate for President is going to have to have a position on health reform, and Medicare for All is emerging as one of the most popular options among those that have declared so far. So the question of what exactly Medicare for All would mean in practice is of primary importance to the agenda the eventual Democratic nominee will bring to the table.

I still think some kind of Medicare-for-all legislation or "Trumpcare" is Donald Trump's ultimate goal for his presidency. "I am going to take care of everybody... Everybody’s going to be taken care of much better than they’re taken care of now."

Trump only does what benefits Trump. Trump will sign what bills benefit Trump to sign.

If congress can put a healthcare bill in front of Trump that can be branded as "medicare for all" for one audience and "we repealed Obamacare" for another audience (the possibility of the latter branding being a necessity in order to get any Republicans in congress to vote in favor of the bill) then Trump will almost certainly sign it. It doesn't actually have to provide "medicare for all" or "repeal Obamacare". It just has to look enough like it does to pass it off that way to the American public. He just wants to be able to say "look everyone, I repealed Obamacare" whether or not it's technically true.

The "which news is fake news" circus and people's increased skepticism of what they read and see on the news should make the latter part much easier because it gives Republicans more wiggle room to vote for something that looks a lot like Obamacare 2.0 or "medicare for all" and then turn around and act like they repealed Obamacare in front of their base in 2020.

I for one am hopeful. This seems like a potential win for everyone (well, scummy insurance companies notwithstanding).

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