What kind of health care system do you want? (Poll)

Here I voted Medicare for all, because that's what's best for the country and my fellow Americans.

However, I'm fine with dem candidates running on Medicare opt-in (this is essentially what Obama ran with: "The public option" and it was his first bid in the healthcare battle which was immediately squashed and then we passed obamacare by the skin of our teeth) because it is polling extremely high, in the 70s I believe.

For those unclear on the difference, Medicare for all is essentially a single payer system in which the entire taxpaying public is the risk pool, and all payments go into an out of a single provider. This option is what most of the developed world is doing, and they all get better health outcomes on far less money than we do. However, it polls very poorly if you tell people that they'll lose their current insurance, because that is scary.

"Opt-in" means that there is a large-government run system that people can opt into if they have no coverage, poor coverage, or simply want to change from their current provider. Although this is will work alongside private insurance, the industry will fight this with everything they have, just as they did in 2009, because they know a public option will eat their lunch. For those who don't know government-run healthcare operates at far lower overhead than private. Here, the conventional 'government does it inefficiently' mantra is flipped. In healthcare, it's not true.

Another note for those who don't know: there is almost no country on earth with single-payer that doesn't also have a higher tier, usually private, so that those with more money can buy more or better care.

 

From the physician perspective, I don't see that as being true at all. I rotated through 3 different VA's in training and not one would I say was more efficient than any of the non-VA sites. Not knocking the quality of care provided, because it honestly was perfectly adequate, but the wait times and access to care are dismal in the VA system.

Examples:
-Hospitalists at local VA have a cap of 12 patients on their service. Hospitalists across the street at the private academic medical center cover 20-25 on their list.
-Clinics at the VA commonly see up to 20 patients a day. It's not uncommon to see 30-40 a day in other non-VA outpatient practice settings.
-The local VA schedules 30 minutes for outpatient CT study (radiology) slots. Anyone who knows anything about radiology knows a CT scan commonly takes under a minute with a few minutes need before and after to get patients in and out of the CT suite. Non-VA practices sometimes double book OR triple book a 30minute slot.
-All VA's still use an electronic medical record designed in the 1990's (without many updates). When I rotated through a VA ICU a few years ago they still used a vitals documentation software written in the 1980's and ran with command line prompts.

Maybe we're quibbling over "efficiency" but the VA is no more efficient at healthcare delivery than the post office is at mail service IMHO. There may be lower overhead but that comes at cost. It costs money to staff a CT/MRI scanner with technologists to run them, particularly in the evening and overnight. It is certainly cheaper to not run those scanners after-hours but it is absolutely not an efficient use of a multi-million dollar CT/MRI machine to have it idle for 16 hours a day.

*Sidenote, I have heard stories of the military running its military hospital imaging centers 24/7 for outpatient work. Supposedly, its not uncommon for an active duty soldier to be scheduled for a 2am Saturday morning MRI for their injured leg.

And yet, medical tourism exists. Plenty of people come to the US for care they can't/don't get in their home country. There's something to be said about that.

 

Of course you are right.

It's a huge dilemma on how to address what doesn't work while not breaking what does.

I'm liberal. Heart of hearts if i built a healthcare system from scratch I'd want universal healthcare. However, working within the current system I see many potential drawbacks to making the switch from the current model to a Medicare-for-all scenario.

 

Good info from your post, on this medical tourism...

This is a glowing worldwide trend and it's mostly for lower cost (I believe India lead the mkt share today). Because care has improved so much worldwide (along with international accreditation), the # of American going oversea for care has grown from 350k in 2003 to over 1.4M in 2017. Cost is a driver, but quality and availability of specialize care is the enabler. Specialist treatments or access to specialized drugs is now all over the developed world, including UK, Germany, US, Taiwan, S.Korea, ...

It's mostly an outflow, not an inflow.

 

To clarify, I think most people here when talking about government-run health care are really referring to government run payment systems - insurance/etc. The VA is truly government-run hospitals, but I don't think anyone except maybe the most extreme left are advocating for that in general.

 

I don't know if you have really ever used insurance, but coverage is getting worse. Companies are giving people these high deductible plans which are terrible. You really don't even know what is covered until you use it. Even if you go to a hospital which is in network and the doctor there is in network if some non network person comes in during surgery then your insurance isn't going to pay for them, or if a hospital sends your labs to out of network lab then they aren't going to pay for it. Or if you have an emergency and you end up an out of network hospital you are screwed. In any case you find out after you get a bill.

Obamacare was a crappy solution to be an already terrible plan which has this country paying double what other countries are while not even covering everyone.

Trying to waste our time trying to fix a bad system is just kicking the can down the road.

 

Glad to have the perspective of someone in the business.
Generally, if I ever read a criticism of 'government run healthcare' in the states, VA will be the first mention. As others have mentioned, I don't think it's an apt model because
- Pretty much no one is advocating for the nation to run on such a system
- VA and similar programs consistently run into funding issues because Republicans keep defunding them and then pointing and saying "look! We told ya government doesn't work!"

My point about the cost of administrative overhead is simply that. Medicare overhead runs at 2-3 percent of total costs. Private insurance 12-18 (and in some cases more.) Private insurers must of course turn a profit, and the millions of dollars going to CEO salaries have to come from somewhere. This is not an entirely fair comparison, because some administrative costs increase quality of healthcare. However, considering the fact that we are constantly reminded that anything government run is automatically much worse than anything private run, the above numbers are very glaring.

For-profit insurance has systemic obstacles that simply cannot be overcome:
- It is always more profitable to take people's money and deny care, than to provide it
- Shareholders actively punish companies that spend more to provide better care
- Very poorly allocated risk pools
- And so much more!

The wealth-based, for-profit American system is good at "superhero care". We have the coolest most expensive ****, and we can treat the rarest, weirdest, most difficult health problems for those who have the money.
America's wealth can be better allocated to creating far better health outcomes for far more people.

Most medical tourism is done to get cheaper care, as others have noted. I know an American who went to Brazil for a stomach staple because it was much much cheaper. Some tourism in Europe is done simply because different countries have different medical policies. I have a friend who's due to have a baby any day now, she could have the baby in Germany or Austria and have world-class care, but she's going to Denmark because a specific hospital will do deliveries of babies who are positioned bottom first without opting for C section first and that's what she wants. (I'm not advocating for or against particular practices, just saying people cross borders over issues like these.)

 

What is best for me and my family?

Keep it the way it is. We have exceptional insurance and the quality of care we receive is the highest in the world. I have lived in places like Ireland and Canada and the medical care is not as good.

What is best for the country?

I am really not sure. I believe based on my travels and experience that the quality of care in the rest of the world is drastically over rated. It is good for basics though.

 

This is how the Canadian health care system functions, aboriginal don't pay a dime extra. Hospital staff must take mandatory courses on how to welcome them in their own native language and take care of them properly

 

If it's through your employer, your salary is probably depressed relative to if they didn't have to subsidize your premiums.

 

I don't know of anyone who wouldn't want coverage of some kind and I'm not certain where you got that impression from.

"forced off insurance" wasn't my phrasing but that is essentially what would occur under some of the medicare-for-all plans. Indeed, everyone would have coverage however being switched from an employer based plan to a government plan without a desire or consent could absolutely be construed as being forced.

It's a similar idea to "keep you hands off my guns," "stay out of my religion," don't intrude in private citizen's lives. Clearly there are issues with those stances since the government is already involved therein.

My feeling on this, and one that is shared by many in this country, is that personal choices trump government choice. Is there somewhere in the constitution that says the government should be tasked with the personal welfare of its citizens?

To be clear, I'm in favor of the government being more involved and have more oversight of the healthcare industry, but those of use who subscribe to the ideas of, and desire for, a limited self government see this as outside the purview of what governments are supposed to do.

Thanks for sharing your story. It's reasons like these that the healthcare issue must be focused on. While your concern about those who can't afford the buy-in option is valid, there are subsidies and other programs for those individuals. I don't pretend they're currently perfect as is.

Ultimately, I think the goals need to be:

• The same coverage for everyone
• Be cost effective
• Allow for choice (doctor and hospital)
• Allow for supplemental coverage

As some have stated, giving universal coverage and allowing private insurance could be a possible solution however I simply don't believe a complete switch to medicare-for-all and an end to insurance is tenable.


Something I haven't seen mentioned in this thread is, how many people would lose their jobs by getting rid of private insurance? According to wikipedia pages the 5 largest insurers in the US cover 140 million people and they employ over 500,000 (apparently united has 300,000). Certainly, if the government expands medicare and does away with private insurance then some of those jobs would migrate over, but the vast majority of those 500,000 would be out of work. This is a big issue that would have to be addressed.

 

Public backbone with private supplement.

 

I'e said this before, but since we now have a thread on it... I'd rather bet on ACA, but if we're going away from that, I'd prefer a Medicare for All over a Medicare opt-in. These kinds of hybrids with a market product competing with a regulated product create dysfunctions. You could end up with the sickest people taking the government option while the market delivers a lower price for healthy people. You could have a mispriced regulated option that's so cheap that the private insurance industry dies anyway. And I know what Republican administrations would want to do with a public option -- slash the budget as much as possible to minimize freeloading and the tax burden for all the people who are going to rely on their private insurance anyway. We see it in K-12 education, where they cut funding to reduce property taxes for the voters who either don't have school-age kids or send them to private schools. So, I prefer we either fix the market to make market forces work in our favor, or we destroy the market outright and put everyone on the public system. No half-measures. Given that choice, I'll take the market.

 

I voted for Medicare 4 ALL. Now Bernie Medicare for All includes glasses, dental work, hearing aids, $200/yr cap on pharmaceuticals and no copays and deductibles. So I could go for Medicare Buy In with the government buying it for everyone who wants it. Libertarians and the ideologically opposed could keep their beloved employer provided insurance with their complicated billing and deductibles, copays, drug costs, out of network issues, gaps or hassles when they switch between jobs etc.

 

^^^THIS^^^

I've always wondered what would happen to the overhead/salaries/profits/etc of corporations/companies/employers who no longer have the need to offer insurance to their employees. That's a ton of money employers can use to raise salaries, increase profits, invest & grow the business etc. Seems like it would be a boon to businesses. My family alone costs my company 7K a year for health insurance. We're not a giant company, but with 300 employees at..let's say 3.5K a year per employee (assuming many don't have kids, or are single, so let's be conservative and say half of my family's costs as an average) that's $1.2 million they would save each year.

 

It is well worth it.

I get a standard of care that is not available elsewhere in the world.

Now having said that, I am well aware that for a lot of American's that is not the case and hence why I have mixed feelings.

Ultimately something needs to be changed. Obama deserves credit for making any changes, but it needs to go further.

 

Whatever the God Emperor wants.