Health Costs And Benefits

Americans have been arguing over health care (actually, health insurance) for my entire life–and as I frequently mention, I’m old. Every time the federal government has extended access to health insurance, conservative politicians have insisted that America cannot afford it.

“Medicare for All” proposals invariably meet with outrage–and disinformation. In addition to insistence that universal health care would bankrupt the country,  opponents used to warn that extending access would ruin what they say is the “best medical care in the world.”

That claim that “we’re number one” has diminished considerably, as more people have recognized that we’re actually number thirty-seven or thirty-eight, and that the only people who receive the “best” medical care are people who have lots of money. But Republicans have continued to insist that America just can’t afford universal coverage.

Which brings me to a very interesting report in The Hill, titled “22 Studies Agree: Medicare for All Saves Money.”

The evidence abounds: A “Medicare for All” single-payer system would guarantee comprehensive coverage to everyone in America and save money.

Christopher Cai and colleagues at three University of California campuses examined 22 studies on the projected cost impact for single-payer health insurance in the United States and reported their findings in a recent paper in PLOS Medicine. Every single study predicted that it would yield net savings over several years. In fact, it’s the only way to rein in health care spending significantly in the U.S.

All of the studies, regardless of ideological orientation, showed that long-term cost savings were likely. Even the Mercatus Center, a right-wing think tank, recently found about $2 trillion in net savings over 10 years from a single-payer Medicare for All system. Most importantly, everyone in America would have high-quality health care coverage.

The studies found that Medicare for All would eliminate three-quarters of the estimated $812 billion the U.S. now spends on health care administration. Administrative costs in the United States are so high because insurance companies–and there are hundreds, if not thousands of them– individually negotiate benefit rules and rates with thousands of hospitals and doctors. They also require different billing procedures , use different forms and have different rules for submitting claims.

The studies estimate that savings from Medicare for All would be about $600 billion per year. And that’s not including savings on prescription drugs, estimated to be another $200 or $300 billion a year if we paid about the same price as other wealthy countries pay for their drugs.

Even more savings are possible in a Medicare for All system because, like every other wealthy country, we would have a uniform electronic health records system. Such a system generates additional savings because system problems would be easier to detect and correct. A uniform claims data system helps reduce health care spending for fraudulent services. In 2018, total U.S. health care costs were $3.6 trillion, representing 17.7 percent of GDP.

The “cherry on top” of these calculations? Savings were calculated assuming the elimination of deductibles and out-of-pocket expenses.

The article also pointed to something that is not widely understood: government already pays approximately two-thirds of all American health care costs. A few years ago, when I participated in a multi-disciplinary study, the calculation was that some seventy percent of all health costs were being paid for by some unit of government– not just via Medicare and Medicaid, but also through the VA, CDC awards of research dollars,  federal, state and local health care programs, coverage for government employees (including thousands of employees of public schools and universities), and ACA tax subsidies for private insurance.

A more expansive and accurate cost/benefit analysis would also include things like the decline in bankruptcies–some 50% of personal bankruptcies are due to medical costs not covered by insurance.–and evidence that crime and other forms of social discord decline sharply when social safety nets improve.

Here’s my question: if Medicare for All improves health care and costs less, what is the real reason so many Republicans oppose it?


  1. I think that your writing is quite convincing! I would support Single Payer easily! More troubling to me, though, is the lack of looking methodically at the options, and rationally trying to determine what the best system is. I would suggest that the options include:
    1. Deregulated “Open Market”- “true capitalism”
    2. The current somewhat hybrid system
    3. Tweaking of the current system
    4. Medicare – for those who want it – private health insurance for those who don’t want it – with or without a mandate that all or all of certain groups – have health insurance
    5.Single Payer – handled differently in different countries – various options within it
    6. Significantly regulated – private insurance – mandated coverage – similar to the Swiss System – see: – or numerous other references.
    Why not – explore all these options – and any others – that one can come up – and then debate which is best? I think that Single Payer – would “win” the debate, but it should win – not out of “simple facts” – but rigorous analysis – not simply comparing the current system with it. Even – if we move to it – there are various – ways it could be done: administered publicly/privately, handled nationally/by individual states/by sub-areas – Metropolitan Statistic Areas and similar and no doubt other options- e.g. – how are drug prices negotiated ? How much “power” do the various interests (drug companies, hospitals, doctors, alternative medicine providers, groups representing various consumer interests) – in working out the particulars. etc.

  2. “Every time the federal government has extended access to health insurance, conservative politicians have insisted that America cannot afford it.”

    “The studies found that Medicare for All would eliminate three-quarters of the estimated $812 billion the U.S. now spends on health care administration. Administrative costs in the United States are so high because insurance companies–and there are hundreds, if not thousands of them– individually negotiate benefit rules and rates with thousands of hospitals and doctors. They also require different billing procedures , use different forms and have different rules for submitting claims.”

    The Medicare for all/single payer explanations I have seen propose a plausible and affordable health care/insurance system; what I have never seen is the solution of what would be done with the current estimated $812 billion Administration system or the billions in health care providers and Big Pharma. That trifecta is the current corporate health care system which is not going to just disappear. What form of “elimination” would be used by the government after 47 years of health care being a rapidly accelerating for-profit business…thanks to President Richard Nixon and Senator Ted Kennedy. Is that the cost Americans can’t afford? And Republicans (conservatives) are the primary corporate heads in the Administration system whose CEOs are paid annual salaries in millions of dollars.

  3. There are two reasons Republicans shudder at the thought of Medicare for All.. First, Privatizing is their religion. Second, think of all of the campaign contributions from the Insurance Industry that would “go away” if the government handled the whole thing.

  4. Until you realize the game is a giant con in Washington, you’ll continue asking, “Here’s my question: if Medicare for All improves health care and costs less, what is the real reason so many Republicans oppose it?”

    The actors playing politicians are both paid to oppose it. Still, since the GOP is supposed to be conservative and has targeted propaganda like Fox News (which is having serious leadership issues right now within the Murdoch family), they are more vocal about their opposition.

    This gives the DNC controlled politicians an out.

    Obama has control of both houses and produced Obamacare from the same conservative think-tank that produced RomneyCare.

    Biden doesn’t want it either, even though 72% of Americans want it. I think he used the “S” word during his debates with Trump. My favorite line was Joe telling Donald, “I beat those guys!”

    Sheila’s question requires peeking behind the curtain to see who funds all the actors supposedly representing the people; the actors include politicians, think tanks, higher learning institutions and their employees (specifically researchers and economists), and the media. Did I leave anybody out?

    Basically, all those profiting off our current sham called healthcare don’t want M4A.

    Also, if you run through the scenario of M4A, I can tell you that once our government becomes responsible for our healthcare, think of all the industries that negatively impact our health who will be impacted. There are many in our deregulated capitalist system today.

    As you project into the future, M4A will begin a domino effect on our entire economic system from top to bottom. Who would buy ads in newspapers and TV? Who would fund our political class?

  5. I agree with Pascal:
    campaign contributions from the Insurance Industry that would “go away”

  6. And don’t forget the TV advertising money. Some 70% of ads are health related. (Actually, it seems higher.) The media don’t want to talk about this, it’s their bread and butter.

  7. I used to assist in teaching economics in a high school socials studies class. Shortly after ACA had passed in 2010 we took on a project to understand how health care is paid for in the USA and Indiana. We mapped out all the different ways a family in Indiana has to access health care and represented it on posters on the wall. By the time we were done every one of the high school seniors in the class asked: “WHY does this have to be so COMPLICATED?!?!”.  One young girl was in tears because she knew she would not have health insurance coverage after she graduated. This was in a deeply conservative rural school district.  (Here’s the graphic we constructed out of that exercise if anyone wants to see it – I updated it again over the next few years:  )

    That experience  led this blue dog Democrat down the path to a socialized health care payment system, aka Medicare For All.  But payments isn’t the only problem. In fact, it’s the smaller of two big problems, the other being the inefficiency of the delivery side of the health care system, which has largely been built on a model called “fee-for-service” where a medical provider is paid a set fee for each specific medical service it provides to a patient. Those fees are determined several ways but the big three are: 1) An appointed board decides what Medicare and Medicaid will pay per service, 2) Fees are negotiated between providers and private insurance companies, and 3) providers set their own fees to charge customers directly. I think everyone knows that the M/M fees are the lowest and that providers make up for those by charging insurance companies more, and by charging patients astronomically more, knowing that much of it will be uncollectible but a lot of it is forcing individuals and families into financial ruin. They have also finely tuned their treatment programs to build LOTS of repetitive services into them to ensure a more sustainable source of increasing revenues.

    ACA, aka Obamacare, dabbled with an experiment to move away from the fee-for-service model and towards a total-care payments system where, for example, a family practice would be paid a set fee for a patient’s care regardless of how many office visits they require. Or a hospital would be paid a set fee for a knee-replacement surgery. Also, a system of rewards and penalties would be implemented to ensure a focus on total quality management and continuous improvement. But this has largely been an insignificant program and the insurance industry has fought it all the way. 

    M4A, or something very close to it – M4M – Medicare for More, would finally enable society to break the back of the fee-for-service model and move towards a payment system that actually results in healthier outcomes for patients and not corporate income statements. Another element of this is the extent to which regional health care providers such IU Health (Clarion) and Parkview Health in NE Indiana have exploited their monopoly power to extract more revenue from patients and insurance companies than they would if there was more competition. Addressing this issue will likely result is some significant disruption in certain local markets and may have the impact of closing less profitable hospitals that serve lower income people and in rural areas.  Congress will have to subsidize them directly and not through an archaic and hyper-complicated payments system.

    But don’t expect the insurance industry to go down without a fight – I’ve read where they already have the same public relations firms readying an all out disinformation campaign to meet the Biden Administration at high noon in town square.  Bernie is dead to rights on this one. The fact is that with M4A there is still plenty of opportunity for the insurance industry to market supplemental policies just like they do today for Medicare.

  8. Yes to all who write here today. The BIG LIE had been there in Republicanville for almost a century. Coolidge nurtured it. Hoover matured it. But the Reagan/Regan disaster added the horror of Milton Friedman’s “Supply-side” lie.

    As Pascal so ably mentioned this morning, the donors from big insurance are simply compelled to bribe government, otherwise they disappear. Remember, it was Reagan/Regan who allowed private insurance to sell health care coverage and the great rip-off was on.

    So, as long as we keep voting for Republicans, we will be a second or third class nation with regard to our health care. The pathetic “free market” model is a reactive model so that more insurance profits can be made.

    BTW, is it any wonder that so many stadiums have insurance companies as their naming rights?

  9. One thing I never hear addressed: how *mental* health practitioners will be affected by Medicare for All. Medicare does not cover any services out of network, which means that for a large fraction of patients working with a large fraction of practitioners, costs to the patient will massively go *up*, or income to practitioners will massively go *down,* probably both. Long explanation below…

    Mental health services are reimbursed in-network by all insurances, including Medicare, at very low and constantly-shrinking rates, disturbingly small fractions of the typical rates charged by those who do not participate in insurance panels. Practitioners are not allowed to balance-bill (to ask the patient to pay the difference between what the insurer covers and the actual fair-market cost of the services.

    Plus, because very few mental health situations are life-and-death, the notion of “medical necessity” is routinely abused by insurers to retroactively deny payment for treatment rendered in good faith and to deny access to treatment for patients who most certainly need it but aren’t gonna need hospitalization (which is mostly just babysitting to prevent suicide and increase medications) without it. And further, issues in how research is conducted and funded play into the hands of those who claim (falsely) that the only “evidence-based treatments” are those which claim to be able to solve any emotional problem in a half-dozen sessions of highly scripted work.

    It is widely held, and quite reasonably so, that it is impossible to justify the cost of higher education and the extended period of required unpaid or low-income training required to become a licensed mental health professional, if one is planning to participate in insurance panels. Yes, there are some nice federal student loan forgiveness programs for public service, but (a) they still have not fixed the “forgiven loans are income so you still have to pay taxes on them” bug, (b) it’s widely reported that these programs are administered is such Kafka-esque fashion that it’s quite dangerous to presume that you’ll actually be able to collect on that benefit at the end of the process, and (c) being confined to (not exaggerating, I ran the numbers!) functionally McDonald’s-level wages during the five years of public service is a massive opportunity cost that far outweighs the actual benefits of the program. Unless someone’s heart and soul is in community mental health, financially, they’re probably better off not taking advantage of those programs.

    Thus, many mental health practitioners do not participate in insurance panels (including Medicare). The going rates for self-pay are at least a living wage (when you look at the dollar amount per hour, you have to also recognize that a full-time mental health professional typically can only spend about 20-25 hours per week providing billable services to patients), but even so are quite low compared to the self-pay rates charged by medical providers at similar levels of training and experience, as well as by other professions which historically we don’t use insurance to cover, like attorneys, accountants, electricians, etc. And the going rates for self-pay mental health services have increased only very slightly if at all over the course of recent decades.

    What makes it doable for private practitioners and the patients who wish to work with them is that many private insurance plans include some (often substantial) reimbursement to the patient for out-of-network providers. The provider is paid a fair wage, the patient handles the insurance paperwork and ends up being reimbursed by the insurer for a large fraction of what they paid to the provider, making the services still more expensive than in-network, but usually not so much more expensive as to make them inaccessible.

    Sure, those plans cost more, and in many situations involving routine ongoing mental health work, it is probably financially a wash for the patient. I’m totally willing to believe that in actual mathematical reality, the savings to the patient because the insurance plan is less expensive should make it easy for them to afford paying the self-pay rates. But that is *not* how patients think. They think of mental health as something that *should* be covered under their insurance already so why should they have to pay for it “again”? They’ve already spent the money they didn’t spend on a health insurance plan that would have covered out-of-network benefits on something else.

    At present, Medicare has *no* provision for out-of-network benefits for mental health. What is the proposed fix for this problem?

  10. Yes, we’re burdened by at least three major dysfunctions. Competition among insurance companies hugely increases the costs of health coverage (extremely high insurance admin costs and provider billing/collection/contract-negotiating costs). For instance, many hospitals have more billing clerks than beds. Second, we have the highest health care prices in the world by far (and Indiana has among the highest hospital prices in the nation). Many reasons for this (some are playing out in our legislature right now) including lack of transparency and anti-competitive language in contracts between providers and payers. Finally, we still have nearly 10% of the population without health insurance which is particularly dangerous at times like these. With respect to overhead and prices, these may represent over $1 trillion per year. This represents income to someone and those on the losing side of any effective reform will fight like crazy to stop it.

  11. It really isn’t overly complicated

    After all, isn’t universal healthcare communist? Or maybe socialist? The GOP fought Social Security, they fought Medicare, and they fought the ACA.

    When Obama was fighting for the universal healthcare under the ACA, you would see these huge rallies held by local GOP members touting the dangers of sliding into totalitarianism. And, of course it would all start with Barack Obama and the ACA. Just like they claimed earlier for Social Security and Medicare.

    So, how do you convince people that something they really really like, is really really bad? In Kentucky, that state had the largest enrollment in the ACA of really any state. But, here’s the oxymoron, you would see in these huge rallies, at least 25% of the people roiling against healthcare even though they were protesting in their Hoveround mobile chairs, with pennant flags attached claiming an imminent slide into totalitarianism!

    So, I remember the question being asked, these folks got their own transportation devices through Medicare probably at no cost, but then they were against universal healthcare!

    The crux of the issue, was that these white folks felt they were the only ones entitled to get this socialized healthcare, because it was part of their privilege. They were angry that someone who was an immigrant or someone not like themselves, (insert your trope here) would get the the same benefits they receive!

    This is been going on for a long long time, and, they will even roll out the preachers to support their argument, LOL! And let’s not even get into the slavery issue or civil rights! The propaganda is all the same.

    Because we know the evils of communism, socialism and sliding into totalitarianism if everyone who is not white can get healthcare!


    Because these evangelical Christians are as stupid as they are, it didn’t take long for them to start believing in Jewish laser beams from space starting fires, or blue lizard people being members of Congress or worse, or that babies were being juiced so to speak for chemicals that would give certain individuals eternal youth, or that crimes your white neighbors have committed can’t really be true because white folks really wouldn’t do that so, it’s a false flag issue! And let’s not forget cannibalism! Brainwashing doesn’t just happen overnight, and happens over an extended period of time with continued bombardment of an alternate reality.

    It’s just that social media put it on steroids! So, here we are! Christians talking about taking care of their fellow man, but denying them healthcare, shelter, education, work, coverage under a social safety net that they enjoy themselves, and just plain human dignity and equality. The phrase compassionate conservative is an oxymoron. How can both things be true? How can one be a concerned Christian but withhold compassion and empathy towards their fellow man? How do these churches collect billions of charity dollars, but, claim that a universal safety net is evil?

    Just think about denying contraception, then think about the amount of children who live in poverty because their parents or whomever is taking care of them, can’t really take care of them, because there is no healthcare, there is no educational equality, and on and on and on, it truly is a rabbit hole that is mortifying! Because that rabbit hole contains the next generation of starving and neglected children! Remember, children are a poor man’s hobby so to speak, especially when there is nothing else.

    If, these religious organizations just act like their dogma instructs, there wouldn’t be any wars, everyone would have enough food, there would be education and healthcare, and, they would actually follow their dogma concerning empathy and compassion for all. But, that would limit their power craving! So, the driving force is power and control. Whether it comes from government, religion, or the corporate realm, the continuous onslaught for control and power will always bring misery instead of relief!

  12. M4A is self-evidently the right answer. But, someone does need to plan for what happens to the folks in the insurance industry if/when it’s implemented. I’m not talking about CEO billionaires. They’ll be fine.

    But, there are LOTS of low level insurance sales people and that kind of thing (WAY more than in the coal industry or even oil I’d bet). When you drop 100,000 extra people off their jobs, you better have something to do with them as part of the plan.

  13. George Marx – a thoughtful answer. Consider things that Obamacare wrought that hadn’t been considered.

    Also for consideration, the hundreds of thousands of people employed by the health insurance industry and providers who support “administration”. What happens to them?

    As usual with complex problems, silver bullets create unanticipated wounds.

  14. I note that you mention both the VA and CDC for their medical research dollars, but they are small potatoes compared to NIH and DoD, who spend billions every year on medical research.

    C. Everett Koop, M.D. recommended years ago that we streamline records and invoicing for all health care. He maintained that we would save millions if we only standardized the claim form. We didn’t even do that one small thing. Are we that afraid of change? It seems we are.

  15. “At present, Medicare has *no* provision for out-of-network benefits for mental health. What is the proposed fix for this problem?”

    Aimee; excellent question. Social Security seems to act on Disability applicants with mental or emotional problems faster then those with physical disabilities yet everyone must be on SS Disability for two years before they qualify for Medicare. Because I had $3,100 in my savings account when qualified for Social Security Disability, that amount disqualified me for Medicaid assistance plus all forms of public assistance.

  16. The question is why are Republicans opposed to this?

    First we don’t have a Health Care System, the US has a Health Care Industry. The distinction is important, because in a industry, you have people that make a lot of money. They pay for a lot of a lobbyists , and now direct campaign contributions as well. This keeps a lot of pro-business, anti-regulation Republicans very happy.

    Secondly, if we had universal health care, it would be much harder for Republican politician to whip up the hate and fear of “those people” getting a free ride when those people also include many of their people.

  17. Oh… Do I have to mention that in this day and age of electronics, if you want a written document from your health care provider, you have three choices; go to the office in person, ask for it to be mailed, or get a FAX machine.

    It might be the most regulated industry in the country but the communication technology for the average customer is stuck firmly in the 1980’s!!

  18. Dan; there is also an ongoing problem contacting health care and businesses by E-mail; that was almost universally accepted as an alternative to phone calls. E-mails could be responded to at any time convenient to the recipient and the sender could send in the middle of the night. Being totally deaf, E-mails are – or were – my primary source of communication. Now; if I can find an E-mail contact, I tell them I am deaf, cannot use a phone and ask a question or for help and they respond by E-mail giving me their phone number.

    I discovered another issue in this day and age of electronics; I pay my bills by check, no longer do banks return your checks and now they do not maintain a copy of front and back if you need proof you have paid a bill. The only option is a copy of your full bank statement with the check number, name of recipient and date cashed. I also do not use my cell phone to conduct business; my son provides it to text family members and there is an emergency contact in case I need assistance from public safety.

    Another health related issue; the “Help I’ve fallen and can’t get up.” pendant isn’t as life-saving as advertised. My friend’s went off in the middle of the night; she woke hearing loud male voices in her downstairs and all lights were on. They finally came upstairs and found she had not summoned them; they knew of no reason the beeper went off. About 2 weeks later she fell coming down back stairs, slammed head and face into the cement block wall and was unconscious for an unknown time. She repeatedly pressed the alarm but no one responded; after screaming for help, a neighbor came to her aid and called 911. It seems the fire department had forgotten to reset her pendant. Progress does NOT always mean improvement!

  19. We “cannot afford health care” but we can pour billions nay trillions of dollars down the military industrial complex rat hole. What a load. As long as reactionaries like McConnell have power we will never be a civilized country that looks out for those who need the most help. Being a patriot does not mean knee jerk support for all things related to war. Being a patriot means supporting your fellow citizens AKA neighbor.

  20. It was Bernie Sanders who made Expanded & Improved Medicare For All Act a part of his platform in 2016 and 2020. The Corporate Press spent more time and effort trying to scuttle Expanded & Improved Medicare For All Act than actually giving it an honest appraisal. When you think about it the current system of Capitalist Health Care is what America is all about, i.e., if you can afford Health Care You can have it. If not Too Bad, So Sad.

    Progressive Democrats have introduced Expanded & Improved Medicare For All Act for several years now. The latest attempt was H.R.1384 – Medicare for All Act of 2019. One very notable person absent as a Co-Sponsor is Nancy Pelosi.

    Our former DINO from Indiana Joe Donnelly said, “But when you talk ‘Medicare-for-all’ …you start losing the people in my state,” Donnelly added. “When we start talking about, ‘Hey, we’re going to work together with the insurance companies to lower premiums,’ that’s what connects.”

    The DINOs are united in their opposition to Expanded & Improved Medicare For All just like the GOP is. What their option is seems to be keeping the insurance companies and the health care industry healthy in lieu of keeping the American people healthy.

  21. The best that is possible from where we are is to start the journey with appropriate resources towards a goal. We have to create a cabinet-level position and a new Department to work out the more detailed goals and a process of transition. That work would span more than a single Presidential Term.

    We didn’t get to the moon overnight and we won’t figure out how to satisfy our right to health care either without a consistent mission over many years to figure it out.

    Unfortunately, we have in the present political environment no means to set national purpose anymore. No sense of who we want to be and become and no way to establish that. China has completely outflanked us in that way, not that we should admire her means but if we don’t get to a similar place we will stagnate our future away.

  22. It is my belief that so many Republican oppose such a system because, until the NRA took over their party, the insurance industry rather “owned” it. Like, apparently, everything else having to do with the GOP, itself raison d’etre, is to accrue power and money, period. Here is s relevant quote form a Daily Kos article put out today: “Conservatism: We’ve been ignoring ethical and moral choices for more than 40 years!”

  23. Hey Dan My primary care doc gave me my health care records immediately after I saw her as did the doctor who did my colonoscopy.

    The administrative costs of our health care industry are definitely a big part of what makes health care in America so expensive. This includes all the doctors and nurses who work so diligently at insurance companies to deny “unnecessary” medical interventions for the patients.

    I watched for years as insurance companies decreased their coverages for needed inpatient days for detox, and day partial programs for people with substance use disorders. There is system stigma against people with mental health and substance use disorders in the health insurance industry.

    The “free market” system in the health care industry has driven costs up. It has also led to the closure of many rural hospitals. The loss of these hospitals is another reason people in rural communities have felt left behind by state and federal government representatives.

    But even if we go to a single payer system, failure to invest in public health and programs that motivate people to eat healthier food and to exercise will not help us reduce health care costs as well as we might. The food industry contributes to our health disorders and the FDA does nothing to compel them to make healthier food. It’s the price we pay for convenience. And now we have the issue of food scarcity in certain communites especially communities of color and/or poverty.

    The current pandemic has demonstrated what happens when our public health infrastructure is terribly underfunded. We have not been able to mobilize against this pandemic nearly as well as we mobilized to defend ourselves at the onset of WW II. (Of course, part of our inability to mobilize is due to the prior administration’s failure to move effectively to contain the virus.)

    I can only hope that the next 2 generations will be able to move toward a single payor system or some sort of universal health care. After all, health care is a right, not a privilege.

  24. Aimee – The “fix” will be fixed by comprehensive legislation. Sheila – Last time I checked (via Senator Warren), medical bankruptcies comprised 41% of all bankruptcies (whose impacts are worse than suggested in that millions of innocent non-medical creditors have billions of dollars in claims discharged in Chapter 7). Vern – The privatization of healthcare, as I understand it, began in 1973 with Nixon’s old buddie Kaiser in California. Lester – I once had an argument in re single payer with a fellow IU graduate, a urologist, in Grand Rapids. He said his only objection to single payer was the effect it would have on the employment of billing clerks and other such personnel. I pointed out that the transportation industry survived the horse and buggy to the motor car and truck industry and that new employment opportunities were provided by the building and care of such new vehicles and that any innovation could result in temporary unemployment as new skills were needed etc. I also told him that I thought universal access to cheaper and better healthcare was more important than the temporary unemployment of billing clerks or any other segment of the economy.

    I have been a single payer aficionado since the phrase was invented and impervious to insurance company propaganda paid for by premiums which could otherwise be spent for actual healthcare. Single payer is clearly better, more comprehensive, and cheaper than the present hodge-podge design of the healthcare industry, which by contrast resembles the horse and buggy era of yesteryear. Time for a motorcar.

  25. All – perhaps single-payer is the ultimate solution. I can assure you from 25 years of management consulting experience working on large “change” projects, the key to success is the transition plan. I have yet to see someone propose something pragmatic and comprehensive. Maybe a reader here could point to something? A healthcare system for 300M is not a switch to turn on or off…

  26. That is an excellent column and exposes the feckless nature of the Republican objection to providing health insurance or care to everyone. The real reason Republicans object is the nature of political fund raising. Health insurance companies, medical providers, Pharmaceutical companies, the malpractice industry etc. provide a treasure trove of campaign contributions which will be diminished or maybe even eliminated. A less obvious reason (and maybe not yet considered by politicians) is the shift that will occur in who people complain to about the inability to obtain a health care service. Any “Medicare for All” program will need to set forth which services are covered and which are not. Disappointed patients will complain to Congress instead of to their health insurance companies. The specifics of health care services and “wait times” etc will become hotter political issues. Another serious issue is what to do about “malpractice”. Will health care providers get immunity or partial immunity? Will judgments be capped? My wife and I spent last winter in London and learned that Parliament is bombarded with complaints about health care services and quality. The English system seems to permit victims of malpractice some relief. If the US can afford the best Armed Forces in the world it should be able to afford health care services that afford the best to all.

  27. A few people have raised racism as a reason for the public being against health care. That’s undoubtedly true. (I listened to an interview with a writer who’d interviewed a white man from a southern state who had cancer. When asked about universal health care, his main concern was that “others” would get it, so he wasn’t in favour. By the time the book came out a year later, the man had died.)

    This may be a factor with some in the public, but I don’t think the GOP specifically cares about the racism factor, although many of them are definitely racist. To my mind, the biggest issue is probably control over employees. Right now, many people are tied to jobs they hate due to the health care “benefit” provided by the company. A universal health care system would eliminate that control mechanism and improve workers’ lives. Can’t let that happen!

    P.S. Insurance companies should not be involved in a health care system, or at least they would need to be tightly controlled and regulated. The system will be fundamentally corrupted in any situation where the insurance company has the possibility of making more money by providing less care or covering less cost.

  28. Those lower level employees of health insurance providers have skills that can be of key use in a M4A system. Ask them about how to solve some of the logistical problems they might face in a universal provider network. I’ll bet there would be some practical solutions offered. Too often, the last people to be involved in any new or upgraded program are those who are expected to use them. Been there and done that way too many times.

  29. JD – you are a great idealist! How many times have you seen that on a national scale? LOL

  30. For me, if we need government healthcare, then it should be 100% government ran. The benefit folks on the phones, the nurses, the doctors, etc. should all be employees of Uncle Sam and whatever the current federal benefit package applies should apply to these folks as well. Basically, every single hospital system should be a federal building. This also means that wages would be capped, as there is no reason a doctor should be making more than the president of the United States.

    Usually this is where some, maybe many, medical folks (especially nurses and doctors) start to not agree with a full-on government ran system. The fact is the whole push for government healthcare is because there will be a windfall of cash for raises, bonuses, etc. etc.. There is always talk about cutting out insurance companies and overhead, but remember, for ever $800K/year hospital administrator that loses his or her job, that is an $800K job that no longer pays state taxes, federal taxes, property taxes on second or third homes, luxury taxes on boats, RVs, etc. depending upon the state. I once read a appeal on a divorce case. The husband was an ER doctor in the Indianapolis area making $300K/year (the appeal was about financial support). That was many years ago, so I’m guessing the pay has went up. How can a government healthcare system pay an ER doctor at possibly one hospital, almost as much as the president of the US?

    Ultimately I think the future of healthcare will be government funded. I’m pretty sure we won’t see any savings and billions, if not trillions, will just be added onto the national debt. I just don’t see a working solution to this issue given how connected the current system is with healthcare companies, various hospital and healthcare provider networks (Community, IU Health, and Riverview are just a few in the greater Indy area). Ones best bet is to stay as health as can be. Who knows how well the system will run once the government gets involved. If it becomes nothing more than adding huge sums of healthcare debt onto the national debt, then likely not a huge issue, until the debt finally becomes an issue.

  31. “It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than a new system. For the initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders in those who gain by the new ones. ”
    ― Niccolò Machiavelli

    Good quote the GOP and the Corporate Democrats (DINOs) profit by the current system. One reason the Expanded & Improved Medicare For All has “lukewarm” support among the citizens of the USA is the total blackout by the MCMega-Media of it.

    I cannot think of anytime CNN, MSDNC or FOX presented Expanded & Improved Medicare For All in a fair manner. It will not happen.

  32. Lester – I agree with your statement – you are absolutely correct that the transition is key to success – we can’t flip a switch and dump everyone into the Medicare system – it would crash.

    Now for the other part – in science, you learn that how you define your system (open, closed, boundaries, etc.) matters – in IT, you learn that how you define the “scope” of the project matters – so it is, but usually ignored, in cost-benefit analysis.

    The billions spent on basic research isn’t to harvest patents for the government, it is to till the soil and plant the seeds that the applied researchers (often drug companies) can reap the benefits of – The speed of the vaccine development owes much to years of basic research, most of it on the taxpayer’s dime – so is that billions of wasted money? billions of aid to drug companies? how would you count that?

    So how do you count cost-benefit; an example given above – say 100,000 insurance workers lose their jobs – the anti-reform people will say “see, massive job loss” (of course they don’t care about that if private business does it) – but Medicare will need more workers, so maybe it is only 50,000 jobs lost – or maybe, with transition planning, we might realize that increasing the Medicare workforce even further will save time for doctors, reduce waiting time for patients, and make life easier for everyone.

    Funny, a lawyer (sorry, just and example) can charge hundreds of dollars per hour, but who cares how much time the “little people” spend waiting for service, or dealing with an automated phone answering tree.

    There are many reasons for the opposition to to universal health care – Privilege – “rich people are rich because of merit, and thus deserve more” or “god chose who should be rich and we shouldn’t mess with that”

    Of course, we know one of the chief reasons there was opposition to Medicare – their worst fears came true – black people can actually go to any hospital (assuming they have insurance) and there goes segregation – hell, now you have Jew-doctors with admitting privileges in hospitals that aren’t named Sinai (and Black doctors in medical schools other than Meharry or Howard) — and let’s not talk about all of those Chinese and South Asian physicians – gads, the medical system might look like America – there goes segregation again

  33. Gerald, my question is what the proposed fix *would be* in the comprehensive legislation. If part of the fix involves highly trained mental health professionals being forced to take a 70% pay cut (again, I’m not making those numbers up), then what is the other part of said fix that fixes that fix?

    I’m in favor of single payer in theory, but mental health care isn’t something that fits well into that model. Most industrialized countries have a single payer system that handles basic care for all, and then people can also purchase supplemental private insurance. Which is bad on a theoretical basis because it still creates a two-tiered SES system, but at least makes it possible.

  34. Tri Care is government insurance that’s used by current military that can be used in private sector. It covers 100% not the 80/20 like medicare. We have medicare now which is good, but the rig-a- ma-roll of supplemental is a pain. Increasing premiums & deductables and condescending terms like “donut holes” used to assure their(HCI) desired level of profit are also a pain.
    Government (our tax dollars) underwrite the most severe health care cases in US with Medicaid(catastrophic), Medicare(elderly) and VA(war tauma). Private health Insurance manipulates the playing field of health care too much, interfering in the patient/healthcare provider contract in detrimental ways. I remember Obama sharing when his Mother was battling cancer, and had to spend energy/ time on phone with the insurance company. How she must have felt, being seriously ill and having to worry about how to cover/pay for her treatment. His first hand knowledge helped him formulate the basis of ACA. Competitive market tactics are not conducive to healing, that’s not how humans heal. Parasympathetic (calming)mode is, and health outcomes would improve if that was established, by taking the cost worry out health care.
    I agree with John H, that Healthcare insurance tied with employment is burdensome. Take employers out of the equation and allow employees to negotiate their pay in more dollars and have more freedom to change jobs.
    The abuse of the policy holders pool is core to the problems. Taking multimillions out for profit kills the essence of insurance. Instead of investing and expanding the pool to increase coverage and reducing premiums, it’s used to pay shareholders,executives, lobbyists and politicians. It’s an unhealthy negative feedback circle.
    Insurance used correctly is a tool to protect assets, but when it comes to healthcare the for profit insurance model interfers in desired outcomes.

  35. An Indiana hospital features prominently in a NY Times Article and not in a good way, but it is not the only hospital doing this.
    When Monica Smith was badly hurt in a car accident, she assumed Medicaid would cover the medical bills. Ms. Smith, 45, made sure to show her insurance card after an ambulance took her to Parkview Regional Medical Center in Fort Wayne, Ind. She spent three days in the hospital and weeks in a neck brace.
    But the hospital never sent her bills to Medicaid, which would have paid for the care in full, and the hospital refused requests to do so. Instead, it pursued an amount five times higher from Ms. Smith directly by placing a lien on her accident settlement.
    Parkview is among scores of wealthy hospitals that have quietly used century-old hospital lien laws to increase revenue, often at the expense of low-income people like Ms. Smith. By using liens — a claim on an asset, such as a home or a settlement payment, to make sure someone repays a debt — hospitals can collect on money that otherwise would have gone to the patient to compensate for pain and suffering.
    They can also ignore the steep discounts they are contractually required to offer to health insurers, and instead pursue their full charges.
    The difference between the two prices can be staggering. In Ms. Smith’s case, the bills that Medicaid would have paid, $2,500, ballooned to $12,856 when the hospital pursued a lien.
    How Rich Hospitals Profit From Patients in Car Crashes

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