Jayapal and Sanders Medicare for All Bills: One Is a Lot Better Than the Other
thedeductible.com
thedeductible.com
I'm a single payer noob. Can someone explain to me why such a clause is necessary? If people are already paying for health care coverage from a federal system through taxes, why would they pay more to purchase a plan that duplicates that coverage from a private insurer? And if nobody is paying for that duplicate coverage, why is it necessary to outlaw it (rather than just letting insurance companies decide it doesn't make sense to sell it anymore)?
It makes me suspicious that they need to outlaw something that would appear to be unnecessary under the rest of the system they're creating. It makes me think the outlawed coverage might actually be useful for some reason, in which case it would be a bummer for it to be outlawed.
Because legally, such a plan offers you literally nothing and there is no rational reason why you should purchase it. To purchase it would be irrational and likely a result of someone trying to swindle you out of your money.
> why would they pay more to purchase a plan that duplicates that coverage from a private insurer?
A few reasons I can think of:
- They're continuing a plan they've had for years and would rather keep paying for it than accept change.
- Marketing tricks them into it despite it being a stupid idea (see timeshares for evidence this happens in reality).
- Because it comes as an add-on to a larger package with something that _does_ have value.
- Providers don't realize the anticipated reductions in administrative overhead, since they may still need to retain the same complexity in billing but just with a radically different distribution of claims.
- Consumers may still end up having issues with providers accepting plans. Especially if you leave a loophole that allows providers to decline the single-payer option but accept the private versions that cover the same service.
- Consumer confusion can come into play related to covered services. One potential draw of the private version would be lax qualification standards for a specific coverage item. But if they decline coverage and the consumer tries to fallback on the single payer system, they may not have gotten the proper approvals or step therapy to have the procedure covered. The private company will have a marketing department to ensure negative consumer sentiment ends up falling on the lap of the single payer system.
- Economies of scale. The single payer system has market power specifically explicitly because of the fact that they own the whole consumer pool. If you allow it to remain fragmented, it lowers the single payer's negotiating power.
- Risk pool. The private company is more likely to skim off the healthiest consumers from the risk pool, and leaving the unhealthiest. This causes all kinds of issues from a political standpoint. The private companies can offer more attractive "perks" (like covering the same procedure, but streamlining the qualification process) because their risk pool is less likely to actually need that procedure. This would incentivize the top end of the market to purchase the plans (or offer as employee benefits, such as now), who would then feel negatively about the single-payer option because they're being forced to pay into that while not actively using it since it appears "worse" (even though it covers the same things).
At the end of the day, the clause isn't strictly necessary for a single payer system. But without that clause, you introduce quite a few failure modes and unnecessary friction points that can be completely avoided by simply disallowing duplicative private policies from being sold.
I think your first point kind of gets at the crux of it though: you want providers to only have to support a single payer in order to reap the administrative efficiencies, so you either need to make a law that says that providers must only accept payments from the single national plan, or that insurers can't offer plans that pay separately. Those two options seem equivalent to me, but the first one (forcing providers to only accept payments from the national plan) seems more intuitive than the second to me.
But even if you can make it work out from an economics standpoint, it can ultimately fail from a political standpoint if people feel like it's a failure. And there are a lot of entrenched interests that would benefit from a failed single payer experiment. My other points were geared towards that component. Letting the multi-payer environment die out organically leaves a grey area with potential consumer confusion and frustration during the transition period, and also leaves the infrastructure in place to easily roll back the single payer plan if you adequately exploit that frustration. Forcefully cutting over to a single payer system allows a clean break so both the consumer and provider side of the market has the opportunity to validate if the claims in the single vs. multi payer debate can be realized, without creating a giant attack surface for political and market shenanigans that could kill it before it really got going. It also raises the level of effort required to roll back the single payer system, since the infrastructure and and staffing to support it is reduced more rapidly than if taking a "let them die on their own" stance.
Healthcare is a utility, not a profit center, of course we’re going to compress unnecessarily high wages (or cut unnecessary non-provider jobs ruthlessly).
I think even "they" would appreciate the efficiency of consistent single-payer system. Just imagine the incredible overhead of bureaucracy that would be achieved, no more need of departments set to deal with insurance problems and all. Surely they appreciate how this will all be streamlined and made efficient.
Those doctors you mention picked the wrong career for fat cash and prestige. We can’t allow a broken system to continue because of previously made bad decisions.
At the base of the issue is that being a doctor is a difficult, stressful job that requires high intelligence and sometimes even high physical dexterity. While it's nice to think that people would choose to do it because it's moral to take care of people, I don't think it's fair to expect that these people wouldn't want to be appropriately financially rewarded for their gifted skillset.
Sarcasm of course. In my opinion, these are two great ideas for getting Trump re-elected.
Whether hospitals and doctors are really charging fair prices aside can't cost reductions also be accomplished by cutting out middlemen? I think there's going to be far more pushback from those rent seekers than the service providers.
Dr's get x% based on patients they saw + hours booked in the OR. Hospital administrators would have pay caps of 1 million per year. Hospitals that struggle could get grants and loans while the system corrects and adjusts to pay them more so they meet their budget constraints.
Medicare administrators and lawmakers already do set iron-clad rates for service. The rates are relatively low, which is why there's a shortage of doctors willing to treat Medicare patients.
And being nitpicky on claims isn't so much a matter of pricing. Instead the insurers are trying to prevent waste, fraud, and abuse.
Government could also give grants/subsidies to help w/ the system as needed or tax relief. I think fair % might be 2% per 30k annual salary upto 10% of income.
> I write this essay as both a long-time organizer, writer and speaker for a single-payer (the older name for “Medicare for all” system) and a strong supporter of Senator Sanders.