Medicare for All Could Eliminate the $600B Private Insurance Industry | Hacker News Reader

Medicare for All Could Eliminate the $600B Private Insurance Industry

fortune.com

31 pointsqsymmachus34 comments

The article talks about the current private insurance companies moving to a role of supplemental insurance. As an important note on this, that's how it works in both Canada and the UK, but in very different ways:

In Canada, private insurance is not allowed to cover anything that is covered by the public insurance. So, no jumping the queue by paying out of pocket or through private insurance. Hopping over to the USA and paying out of pocket is an option for the well off though.

In the UK, there is no such limit, and there is no cap on doctor earnings from private practice, but there are minimums on how much work must be performed for NHS, the public health system. Again, the well off have a way to jump the queue and receive faster/higher quality care.

How these types of factors would play into a US private insurance and private doctor practice of course is unclear, and would be key sticking points in any Medicare for All plan. One thing for sure is that the insurance companies are unlikely to go willingly. Kicking and screaming is more like it, at least if they aren't just nationalized with massive golden parachutes for all of the top brass.

As context for this, it's worth mentioning the broader difference between the health care systems in Canada and the UK:

- In the UK, the government works like a provider network that provides free* services. Doctors and other medical professionals are effectively government employees.

- In Canada, the government works like a health insurer that provides free* insurance. Doctors and other medical professionals work for private organizations that are paid by the government for the services they provide.

Discussion of socialized healthcare in the US, including Medicare for All, has exclusively or almost exclusively been based on the Canadian model.

*"Free" meaning "approximately free at the margin for the individual, but ultimately funded by taxes."

> but there are minimums on how much work must be performed for NHS

So basically doctors are not free in the UK?

I think the NHS actually pays for their training.

As someone who has lived in the UK with an amazing free healthcare system and now Australia who has a more complex model - but basically still universal free healthcare for the most part - I can safely say I took the NHS for granted in the UK. Australia is pretty good - most stuff will get fixed free, and they are at least transparent about where your tax goes (We have a Medicare Levy that is paid as a specific % of income, and a Medicare Levy Surcharge if you earn above a certain amount and don't take out private medical care).

Private Healthcare is offered as a perk to employees, not as an expected part of the package.

However - the article header sums this up - "Could Eliminate the 600B Private Insurance Industry" - Money talks and if you think for a second the super rich people running these companies give a shit over your welfare vs their money you are sorely mistaken.

This would always fall at the first hurdle - and if by some magic measure something passed (Obamacare for example) - the next person would just repeal it.

  an amazing free healthcare system

Well, sure -- you can't beat free.

And how many billion will that cost... Let's consider we have over 300 million people in the USA, and even $1K/person on average (it will be more) is $300 Billion (with a B)... added to the Federal Budget... it will be at least 2-3X that not even accounting for abuse.

With the efficiency savings from a nationalised entity 2-3x is a stretch, yes people will probably pay more tax, that tax will be significantly lower than what they probably pay for private medical care. It removes the onus on Employers to provide medical care as a "requirement", it provides people who cant afford medical care a choice of treatment rather than just 'dying'.

For older people with more medical issues, the tax will be lower than paying for private medical care. For younger people it will be a tougher sell. Also, don't underestimate the political power of those who are accustomed to the "freedom" of not having insurance and just going to the emergency room when they get hurt.

Nationalized health care will also have to grapple with freedom of religion. Does Medicare pay extra money for specialized operations so that Jehovah's Witnesses don't have to get blood transfusions? Does Medicare not cover certain medical treatments or procedures to ensure certain religious constituencies don't have their hard earned tax dollars paying for "sinful" activities?

It occurs to me just how much the US has poisoned its citizens against a national medicare type system.

You know - no one in the UK even thinks - "Well I am paying more in taxes to treat old people", we all realise that at some point we will all be there and not having to worry about it or maintaining it or being excluded from something certainly makes everything a whole lot less stressful!

Likewise I don't even think about how much I am paying for Midwifery, Anti Natal, Pediatric services etc - I understand that different people have different needs and that everyone should get a fair shot at getting what they need.

> For younger people it will be a tougher sell.

How about: You know how you're considering if checking out X is worth the money you'd pay? Now you can just do that and potentially save money on handling a severe problem later on.

Younger people, with the possible exception of the highest-earning younger people, would likely benefit from Medicare for All. Currently, coverage for older and unhealthy people is cross-subsidized by younger and healthier people, due to the ACA's 3:1 age band and "adjusted community rating" respectively.

It's unlikely that Medicare for All or any other broad public insurance program would be paid for by taxes on younger people specifically. More likely, instead of older and unhealthy people's insurance being cross-subsidized by younger people, it will be subsidized by high-earning and/or wealthy people.

I agree that freedom of religion makes things tricky. In fact, I'd broaden it to freedom of choice in general. Should we tax obese people because we don't want to subsidize their poor health decisions? What about smokers? How many times should we pay for expensive rehab facilities for drug addicts who repeatedly relapse? How long should we pay for comatose, vegetative patients to occupy hospital beds?

But for what it's worth, all of these decisions are already being made (to the extent that regulation allows) by private insurers, and while they'll be tricky regardless, I'd rather have them made by the government than by the private sector.

Short of DRAMATIC curbs to IP (specifically prescription patents) and negotiation processes, again for prescriptions, we'll wind up paying SO MUCH MORE, Like England.

Many Doctors will go private pay only like Canada.

I'm not saying it's great, what we have now... but I know how the political process works in this country, something more efficient is just plain very unlikely to happen and will likely make things worse.

Obamacare saw me paying about 3X for insurance premiums, or 5-6X for the max out of pocket. (actually chose a combination of both after the first couple years). Do you really think any more changes will make it better?

What do you mean, "Like England"? Healthcare in the UK is substantially cheaper than healthcare in the US. In fact, the US government spends more per capita on healthcare than the UK government does, despite the fact that most healthcare spending in the US comes from the private sector. https://www.bbc.com/news/uk-42950587

In any case, pricing needs to be negotiated very differently than it currently is regarding medicare prescription costs, which are iirc disadvantaged compared to insurance corporations.

> "Since 2010 the prescription charge has risen by 26 per cent compared to a rise in average earnings of 16 per cent over the same period. Working age people with long term conditions simply can’t sustain this."

https://www.mirror.co.uk/money/nhs-prescription-costs-set-ri...

A 26% increase over 8 years is 2.9%/year annualized. Inflation in the UK over that same period was 2.9%/year [0]. It’s unfortunate that real wages have declined during that time, but that seems like a separate issue.

I completely agree that Medicare needs to be able to negotiate prices for prescription drugs. That’s one of the few places where there’s clear room for incremental change in US healthcare.

[0] https://www.bankofengland.co.uk/monetary-policy/inflation/in...

what do you mean by we will pay more than UK? Comparing medicare for all to Obamacare makes no sense.

I'm not talking an Obamacare plan... I'm talking a generalized plan. Also, there is no way the US Government (Congress) could pass a universal healthcare without the kind of crap that was in Obamacare.

Since when does nationalizing anything make it more efficient?

Even assuming the best case scenario where something is more efficient at the time it was created, you still end up with something that not only doesn't become more efficient with time, it often becomes less efficient with time when it's government-run.

Efficiency maybe not - but at least it is not run for the benefit of shareholders - that only ever means increasing prices. Look at the UK rail system - it's a farce!

It’s clear we can only go up from the dumpster fire that is privatized US healthcare, and other nations have proven nationalization to be effective.

If you have a problem with the effectiveness of government, run for office or find a government job instead of complaining.

Being a Trekie, I'm a fan of healthcare as a human right, free of costs to the patient. My main concern is that the current (recent) congresses have shown that they cannot create effective legislation. When was the last time the government made something better or more efficient?

It's brilliant really, the Republican strategy: sabotage government from within until people stop believing it could have ever been effective. Win elections playing on people's fears, which are increased as society backslides into dysfunction. Meanwhile run a beautiful pristine operation serving the needs of corporations, protecting your donor base.

It's a total perversion of democracy and even human decency, but I sure respect it as a strategic play.

This is pretty much the essence of crony capitalism. Unfortunately I have to say Democrats are catching up to republicans on that department led by Pelosi and friends.

USDS/18F (I <3 you login.gov) is just one example I can provide. Just because you’re not aware of everyday progress due to government does not mean you should be so quick to write off such proposals.

Perhaps a better path forward is, “How can we use government to help arrive at the end state of universal healthcare”. Remember, “we” are collectively government.

Small legislation is different from major overhauls. We are seeing how well the first 3000+ page for healthcare is going

The ACA was a compromise championed by corporate Democrats with no spine, nothing as efficient or as comprehensive as Medicare For All.

Incremental change is no longer tolerable in this domain.

Depends on who you ask about small changes. I prefer the incremental to the monumental. So it is tolerable to some portion of the population

I advocate for the have nots, not the haves, hence my stance.

How does preference for the average size of legislation have anything to do with that?

Larger legislation sees more lobbying, and is thus more likely voicing the haves' voice

Forget about the doc size of the legislation. The longer we wait to cover everyone with healthcare, the more citizens who suffer and die. Incremental change saves less people over a longer time period. This is why I advocate for radical change on a shorter time scale. More people get the healthcare they need sooner. Incremental change does not deliver this.

If we can do Medicare For All in 100 pages of legislation, I’m all for it.

I'd imagine a small bill to deal with the opioid crisis would save a bunch of lives. Purchasing insurance across state borders would increase competition and statistical averaging of premium to payout ratio.

Two simple things to save lives and reduce costs.

ACA, big, radical, not what it was hyped to be

Rarely does being radical end up well

Sorry but you are doing too many generalizations here. Comparing ACA to M4All is almost criminal. To see who the ACA served you can simply look at the stock prices of major health insurance companies. The problem with your incremental change is that you are again leaving 30 million Americans uninsured.

> Purchasing insurance across state borders would increase competition and statistical averaging of premium to payout ratio.

No, it won't. They'll all move to the most corporate-friendly state. This already happened with credit cards - half the issued credit cards come out of Delaware.

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