Democrats’ ‘Medicare for All’ Idea is Horribly Misleading

The proper comparison isn't to Medicare but another government health program that isn't faring so well.

It is very likely that the Democratic presidential candidate in 2020 will end up campaigning on something he or she calls “Medicare for all.” And no wonder: a recent poll finds that 70 percent of Americans support “Medicare for all.”

Here’s a very brief description of that term from progressive rock star and Democratic Congresswoman-elect Alexandria Ocasio-Cortez:

Anyone who has any experience with Medicare knows that is not what Medicare is. Traditional Medicare covers relatively little: those who use it aren’t reimbursed for vision and dental services, for example. Also, without purchasing a MediGap supplemental plan, Medicare comes with deductibles and copays. Traditional Medicare is not “free at the point of delivery” and monthly premiums are automatically deducted from recipients’ Social Security checks. Millions of seniors have opted out of traditional Medicare and instead receive Medicare Advantage, which more resembles traditional private health insurance.

Even some progressives acknowledge that “Medicare for all” isn’t what many on the left think it is. “The more you look at it, the more ‘Medicare for all’ is, well, misleading,” New York‘s Ed Kilgore wrote last year. In fact, Kilgore said, Medicare isn’t at all what Democrats actually want, which is single-payer health insurance.

There is a simple reason why Democrats prefer to use the term “Medicare for all” over “single-payer”: it polls better.

But if “Medicare for all” is not the right way to describe a single-payer plan, what is? Would the troubled VA system work as the proper analogy? The answer is no. The VA is more like the UK’s National Health Service, a single provider of health care services paid for by the government. (Though ironically, a recent reform of the VA expanded its reliance on the private sector to deliver health care to vets.)

The proper comparison is to another existing government health care program: Medicaid. Medicaid, which is funded jointly by the federal and state governments, insures millions of low-income patients, children, and the disabled, or an estimated 20 percent of all adults. There are no monthly premiums and no deductibles (though there can be small copays for pharmaceutical drugs).

The Medicaid program is the closest America has to “single-payer,” in that one payer, Medicaid, pays for health care services. But you will not find many single-payer proponents touting the Medicaid system, which was expanded in most states with the passage of the Affordable Care Act. That is because Medicaid has created unsustainable costs for many states and is in need of reform.

My mother is disabled, with congestive heart failure, COPD, and insulin-dependent diabetes, and must take a battery of medications in order to live. She is on Medicaid. I have been helping her navigate her benefits and it’s certainly been an eye-opening experience.

My mother has had problems getting some of her medications filled because Medicaid requires prior authorization for many of them, whereas under private health insurance that wouldn’t be a problem because she would simply call her doctor and make an appointment. Yet on Medicaid she’s had problems even finding a doctor, since most doctors will not take Medicaid. Ultimately, my mother had to pay a substantial sum out of pocket to a doctor that does not take Medicaid just to get refills on her life-saving medicine.

Other problems persisted. My mother had difficulty getting her insulin filled because Medicaid does not cover the type of insulin she uses. She was forced to rely on insulin samples from her doctor, some of which were expired and made her ill, until she was able to get a refill when her Medicare Part D coverage kicked in.

My mom’s terrible experiences with Medicaid are hardly unique. While there isn’t a study that’s tracked doctors’ participation in Medicaid over time, a 2013 survey from the CDC showed that only 68.9 percent of doctors were receiving new Medicaid patients, compared to 84.7 percent of private insurance patients and 83.7 percent of Medicare patients. Another 2013 survey from Oregon showed that outcomes between those on Medicaid and those who were uninsured were not statistically different.

Fiscally, Medicaid is in desperate need of reform. It is a driver of our unsustainable national debt and is wreaking havoc on state budgets. Expanded Medicaid spending is forcing state governments to choose between raising taxes and cutting other services.

We already know the future if single-payer health care is implemented in the United States: worse quality of care, decisions made by unaccountable bureaucrats instead of doctors, and unsustainable spending and debt.

Yet opposing that future doesn’t mean conservatives can just say no. The problem of affordable health care is a serious one. For example, in 2019, my health insurance premiums will be $40 more than my car note.

Conservatives need to promote alternatives such as direct primary care where patients pay monthly fees to their family doctors in exchange for service. Health insurance should be reserved for truly emergency and catastrophic cases.

As long as conservatives continue to defend the status quo—or the pre-Obamacare era—single payer is all but inevitable. And judging from America’s ongoing experiment with Medicaid, that would be a disaster for both the nation’s finances and wellbeing.

Kevin Boyd is a freelance writer. He has been published at The Federalist, IJ Review, the New York Observer, the Atlanta Journal-Constitution, and the National Interest. You can follow him on Twitter @TheKevinBoyd.

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  1. Andrew Smethurst says:

    “We already know the future if single-payer health care is implemented in the United States: worse quality of care, decisions made by unaccountable bureaucrats instead of doctors, and unsustainable spending and debt.”

    If this is the truth, why are we the sole industrialised, first world country that doesn’t have single payer or gov’t run healthcare? We pay the most, have shorter life expectancy, many remain uncovered and medical bills are the largest cause of family bankruptcy. I am not quite sure what his agenda is but Mr. Boyd would have more success arguing black is white.

  2. JonF says:

    Medicaid is as good or as bad as the state government administering it wants it to be. Here in Maryland it’s OK (I was on Medicaid for five months this summer while I was unemployed; I also have a couple of friends who are on Medicaid more long term due to disabilities). However there are states which have made Medicaid a “poor program for poor people”. If middle class people who vote were using the program however you can bet the worse abuses of that sort would be cleaned up ASAP. As for the experience your mother had with an uncovered med, a good many people have experienced similar problems with stingier and stingier workplace plans (and Big Pharma deserves much of the blame too). Several years ago I had to stop using my asthma med because the new health plan at work no longer would pay for it, and it was too pricey for my budget. So for a good many people even those problems would be nothing new that they aren’t already dealing with.

  3. Some Wag says:

    If the US adopts single payer, the reluctance of doctors to accept Medicaid won’t likely be a fault carried over from the current ghettoization of Medicaid patients to the new regime. If they like to receive money for service, I mean.

  4. Parrhesia says:

    “Medicare for All:
    – Single-payer system
    – Covers physical, mental, & dental care
    – 0 due *at point of service*”

    This is Britain’s National Health Service (NHS)! There you have a mouse-model of what you are proposing to implement. Go over there and check it out! See how you like it!

    Also, like the Brits, you end up having an International Health Service as foreigners pour in to take advantage thereof.

  5. SteveM says:

    Moving the “who pays” food (Medicare for All) around the plate of U.S. health care is completely bogus. As long as the U.S. has a fee for service model, health care CANNOT be reformed. It can only be blown up.

    “Big Health Care” in the U.S. is a collection of crony cartels. So there is a “doctor shortage” in the U.S. Why? Why aren’t medical schools being hammered into increasing class sizes? Why isn’t the government encouraging for-profit medical schools and fast-tracking accreditation? And OBTW, why aren’t health care prices publicly posted and consistent no matter who pays or how? As long as the cartels are in place, nothing substantive will change.

    “Conservatives” always point to the deficiencies of the Britain’s NHS as an argument against socialized medicine. Consciously neglecting to mention well run alternatives like in Germany. German per capita health care costs are 44% less that U.S. per capita costs. The quality of service and access to care is excellent. The German model is not perfect, but the Perfect in the enemy of the Good Enough.

    And re: Conservatives need to promote alternatives such as direct primary care where patients pay monthly fees to their family doctors in exchange for service.”

    Direct Primany Care, i.e., “Concierge medicine” is being played up by the Social Darwinist Conservatives who can afford it. It’s a sham for everybody else. A doctor who employs the model cuts his/her patient list from 3,000 to 1,000. Then charges a 75 bucks a month fee just for the right to make an appointment. That’s $900,000 annually in the doctor’s pocket for merely maintaining a data base. And OBTW again, when the docs reduce their visit counts by 2/3rds, where do all of those other sick patients go?

    This piece by Kevin Boyd which ignores my points above reads like it was written by a stooge for the Big Health Care status quo.

  6. balconesfault says:

    Traditional Medicare covers relatively little: those who use it aren’t reimbursed for vision and dental services, for example.

    How is this different from almost all health care insurance policies people are buying today?

    Also, without purchasing a MediGap supplemental plan, Medicare comes with deductibles and copays.

    Again – pretty much anything people are buying in the marketplace comes with deductables and copays. If you choose Medicare Part A, these are minimized.

    Traditional Medicare is not “free at the point of delivery” and monthly premiums are automatically deducted from recipients’ Social Security checks.

    That is, if you (or your spouse) haven’t paid Medicare taxes for at least 40 quarters (10 years). If you’ve paid Medicare taxes for 40 quarters or more then there aren’t monthly premiums.

    If one is going to engage in a debate over healthcare, you should at least be honest.

    The reason Medicare for All polls better is because a significant percentage of those advocating for Medicare for All envision it being a program that someone can buy into, instead of purchasing from a for-profit insurance company in the marketplace.

    The Democratic Party actually has a division between those who want a purely tax funded single payer system, and those who want a system with Medicare buy in.

    And yes, a large number of doctors opt out of providing Medicaid services. As an intellectual exercise – do you think that would continue to be the case if the country moved to single payer?

    We already know the future if single-payer health care is implemented in the United States: worse quality of care, decisions made by unaccountable bureaucrats instead of doctors, and unsustainable spending and debt.

    Your first assertion hinges, I assume, on the Oregon study you referenced. And it relied on the following to evaluate quality of care: “They found no statistically significant difference in elevated blood pressure (1.33 percent less incidence in Medicaid vs. control, p=0.65); high cholesterol (2.43 percent less than control, p=0.37); high HbA1c (0.93 percent less, p=0.61); or Framingham risk score (0.21 percent less than control, p=0.76).”

    How about evaluating whether those on Medicaid had a lower mortality rate? Whether they missed less workdays or schooldays due to infectious disease? How about comparing bankruptcy filings?

    Concluding that Single Payer would result in lower care is a defeatist attitude … particularly when America already spends more in public dollars on healthcare than almost every nation which has a single-payer system … and then spends that much again in private dollars.

    On your second point – yes, insurance bureaucrats are perhaps slightly more accountable than government bureaucrats – if you’re willing and able to get lawyers involved. The number of horror stories out there of people caught up in the insurance bureaucracy while trying to resolve a staggeringly high medical bill are legion.

    Third – unsustainable spending and debt. See above, where the US already is spending more in public dollars per capita than most single payer countries. A well run single payer system would hopefully achieve efficiencies from taking all the money spent on VA and Military Hospitals and Medicare and Medicaid and tax paid healthcare benefits provided to Federal, State, County, City, School District etc employees … not to mention the tax revenue loss from corporations deducting employee policy costs … and using them to treat people rather than running parallel bureaucracies and feeding taxpayer money to fund insurance company overhead and profits.

  7. FL Transplant says:

    How about “Tricare for All”? Tricare seems to work well for the military who are covered by it, after all. The biggest problem with Tricare seems to be when military families are stationed somewhere remote from any meaningful military population–recruiting duty, graduate student at a university–where there are so few covered by the program that local medical practices don’t accept Tricare because there are so few covered in the area that it isn’t worth their while (something that I think will be a big problem if the “Insurance across state lines” ever happens. How many medical practices in south central PA are going to accept insurance coverage from the Central Alabama Rural Medical Co-op?) But the coverage offered seems to work well.

  8. Kent says:

    “Conservatives need to promote alternatives such as direct primary care where patients pay monthly fees to their family doctors in exchange for service.”

    Family doctors are the only affordable part of the health care system in this country. Your average family doctor is over-worked. My PCP would happily take $250 from me for a 1/2 hour of checking me over and writing a prescription or two.

    But I can’t do that. Instead, my employer has to pay $20,000 (which could otherwise go in my pocket) to some insurance company who will then pay my PCP $150 for the same 1/2 hour visit.

    Why? Because in the event I go to a hospital, there is no mechanism to set a cap on expenses. In a competitive capitalist market, this is done by competition for customers. However, since people go to hospitals generally in an emergency situation and cannot compare prices, there is no competition and therefore no capitalism.

    We are stuck with a “free market”. Where hospitals and insurance companies are free to collaborate on setting the highest price possible.

    And since most conservatives are slaves to free market ideology instead of competitive capitalism, it is impossible to look to conservatives to find a solution.

    Feel free to note the dripping sarcasm as a sign of my utter contempt for the kind of logic afforded in this article.

  9. Swifty says:

    “We already know the future if single-payer health care is implemented in the United States: worse quality of care, decisions made by unaccountable bureaucrats instead of doctors, and unsustainable spending and debt.” You can’t be serious. Healthcare procedures cost far more in the US than every country in the Western world (all with national healthcare programs) because of the profit imperative built into the American system. The US also has the highest infant mortality rate in the West because of the appallingly bad healthcare options for the poor and working class.

    Not that numbers (or compassion for the poor) ever seem to sway anti-national-healthcare advocates, but this graph shows that the US has the highest per-capita medical costs in the West. https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_systems_in_Canada_and_the_United_States

  10. CLW says:

    If only the GOP was capable of demonstrating the balance of fiscal pragmatism and social responsibility expressed in this thought piece! Instead, they’ve obsessively pursued the destruction of the ACA, based upon their hatred for Obama and their absolute refusal to accept any meaningful role for government in ensuring everyone in America has quality health care. While the GOP has fiddled, lives, time, and money have been wasted.

  11. Nelson says:

    Good point. VA medical for all is probably more sustainable. And make Representatives and Senators use it too so it gets the support it needs.

  12. Tim D. says:

    Yet another unproductive article. Government can do nothing but fail, so the alternative is… what?

    The root of the problem with the US health care system is the pricing. Massive increases in health care spending are neither normal nor inevitable. Until the late 70s, medical inflation ran at about 1-2 percent above overall inflation. Then, for nearly two decades, we suddenly went nuts and allowed every player in the health care industry—doctors, hospitals, drug companies, device manufacturers—to go on a wild spree of increasing their prices as much as they felt like. Being a physician changed from being a comfortable, upper-middle-class occupation to being a member of the top 2 percent. Hospital CEOs got rich. Pharmaceutical companies introduced rafts of new medications and discovered they could charge whatever they wanted and no one would stop them.

    Finally, in the late 90s, the party ended. We all woke up to discover that an entire sector of the economy had grabbed an extra trillion dollars for itself for no particular reason except that they could get away with it. So we finally got serious about reining in health care costs, and we did. Medical inflation went back to 1-2 percent above overall inflation in the early aughts, and lately it’s been even lower than that.

    Unfortunately, the crazy years pushed prices permanently higher. So year in and year out, the health care industry still gets their extra trillion dollars. We’ll probably never claw that back.

  13. Chuckles in WA says:

    “since most doctors will not take Medicaid.”

    “the CDC showed that only 68.9 percent of doctors were receiving new Medicaid patients”

    Direct contradiction. Hack.

  14. Mr. Morningstar says:

    “We’re the greatest country in the world. We’re the best in everything. …except we can’t do health care, unlike the rest of the world.” American exceptionalism for the win.

    “We already know the future if single-payer health care is implemented in the United States: worse quality of care, decisions made by unaccountable bureaucrats instead of doctors, and unsustainable spending and debt.”
    In our current system, doctors don’t make those decisions either. CEOS and CFOs accountable to small groups of shareholders whose only concern is rate of return and stock price make those decisions. I’ll take my chances with the folks on Capitol Hill who are beholden to me for their cushy positions over the folks on Wall Street, who owe nothing to me and gave us Enron, Lehman Brothers and “too big to fail”.

  15. Anthony M says:

    Sorry, but people are just about done with private health insurance companies. The whole system needs to be remade, as anyone with experience accessing healthcare in the USA can tell you.

    The problem for free marketeers is they won’t acknowledge that healthcare isn’t like other goods. It’s necessary, it’s unpredictable for consumers and providers, you can’t create a system that drives down cost through competition, how can a free market function when businesses are required to provide a service without payment, etc. Our system is then understandably a complete mess.

    The real long-term debate will be how much is nationalized… just the insurance, or also the provision? You’re better off fighting over that, because something will change, and soon.

  16. JLF says:

    A true single payer plan would leave no room for any other reimbursement, not insurance, not self-payer. The only source of income for health providers would be the government. That would allow the government to control costs – provide services at what the government pays or don’t provide services at all – and to meet demand – if everyone (EVERY single person) received the same care, there would certainly be incentive for politicians to meet the care demanded.
    And it would cost a lot, probably more than the “Medicare-for-All” advocates suggest, but also less than the “keep-government-out-of-my-health-care” types say.

  17. Gary Buchert says:

    “As long as conservatives continue to defend the status quo—or the pre-Obamacare era—single payer is all but inevitable. And judging from America’s ongoing experiment with Medicaid, that would be a disaster for both the nation’s finances and wellbeing.”

    It’s not simply a matter of offering better ideas – it’s also about marketing them. If “single-payer” doesn’t poll well, neither does “free-market,” because people have the (wrong) assumption that the latter is responsible, in part, for the high cost of healthcare.

    Cynical as this sounds, a part of me kind of hopes for single-payer implementation, because I think buyer’s remorse is necessary to get people to give up the fantasy of universal healthcare in the U.S. There’s a reason why it “works” in some countries but not in others. You’ll never hear its proponents ever mention its failures.

  18. Rick says:

    I agree with Kevin on most of is points. But paying a primary care doctor monthly, with insurance reserved for emergencies and catastrophic things, ignores an important element: specialists. How would you pay those folks? The standard of care is higher (e.g., for diabetes treated by board-certified endocrinologists) than for “family doctors” such as internal medicine or family medicine specialists. I would not want my diabetes treated by a family practice doctor if an endocrinologist were available to me.

  19. BobS says:

    Mr. Boyd, your mother’s experience with Medicaid sounds like a nightmare- she should quit.

  20. Hyman Rosen says:

    “Expanded Medicaid spending is forcing state governments to choose between raising taxes and cutting other services.”

    You don’t even hear yourselves any more, do you?

  21. Whine Merchant says:

    Democrat attempts to fix a bad system = BAD.
    GOP support for cartel-friendly ‘do nothing’ = GOOD.

    Is this a shill for the health insurance cabal, or??

  22. Joe says:

    Your comparison of Medicare and Medicaid is misleading. You completely ignore the fact Medicaid is not one system, but varies from state to state. I have Medicaid and Medicare. As for prior authorization, Medicare is always slower and covers less than Medicaid, at least for me. It is true that fewer doctors accept Medicaid. Why is that? Medicaid pays lower rates than Medicare and private insurance. Maybe Republicans constant efforts to cut Medicaid funding, both at the state and federal level, has something to do with that. Reimbursement rates could be raised, but Medicaid recipients don’t vote Republican, so why bother? As for the health of Medicaid patients, Medicaid was designed for poor, elderly and disabled people. Did you know that poor, elderly and disabled people have worse health than other people? Sorry, but the welfare state didn’t cause Muscular Dystrophy.

  23. DrivingBy says:

    “If this is the truth, why are we the sole industrialised, first world country that doesn’t have single payer or gov’t run healthcare?”

    First, the above statement is not true. Let’s just take one example, Switzerland. The Swiss have mandatory health care – you must purchase insurance, with your own money. The government does offer assistance to those who can’t. This has worked so for because most Swiss are, well, Swiss. The norm is to develop marketable skills and use them. Not too many of them blow $250K on college to become full time baristas and then complain that stuff isn’t free.

    By the way, Venezuela is an industrialized country which in the 1950s was the richest in South America and on par with Western Europe. It has more oil than Saudi Arabia, plus ample fresh water and arable land which KSA does not have.
    They also have the ideal, full government health care system.

    Our system pre-ACA was an overly bureaucratic mess, not a well functioning free market, for most not a government run entitlement, but a big headache. Yet it was a productive one; we’re less than 5% of the world’s population but do over 80% of the world’s medical research.

    If you have a rare or hard-to-treat condition, chances are that if a treatment exists anywhere it can be found in the USA. Try having cancer outside the expected age bracket while relying on NHS. Cases like that of Keely Devine can happen anywhere, but they happen more in Britain. K.D had the signs of cervical cancer and asked for the appropriate test, NHS refused. She was “too young to need it”.

    When there is a single payer for your supper, they will eventually become the single master deciding what you eat.

  24. Brian Villanueva says:

    The further you get from “the patient pays the bill” the more your healthcare costs will balloon. High deductible, policies work pretty well, since the patient has the incentive to evaluate prices for everything except a major catastrophe. In the other extreme, a 0-deductible, 0-copay policy, the patient does not know or care how much things cost.

    That may sound great — “people’s healthcare shouldn’t be conditional on their ability to pay.” However there is no free lunch. If you’re a car dealer, imagine your customers stopped asking about the price of your cars — what would you do? Would you develop new more-efficient sales processes? Would you build a new multi-level garage and sell off some real estate? Would you cut your commission rates to save a few dollars? Or would you just raise prices indiscriminately? The $200 Tylenol3 on a hospital bill is not a myth — I’ve seen it many times on my own bills.

    You will not lower healthcare costs until you re-incentivize the patient to care about price. 0-copay, 0-deductible plans (exactly what Medicaid provides and Obamacare encourages) should be illegal.

    As long as patients experience medical care as “free”, costs rise.

  25. JonF says:

    Re: But paying a primary care doctor monthly, with insurance reserved for emergencies and catastrophic things, ignores an important element: specialists. How would you pay those folks?

    It also ignores the fact that for a large number of people even a 400$ bill is a catastrophe. The people who propose these sorts of ideas tend to think everybody has a six figure income, and if some people don’t, then they’re trash anyway and don’t matter.
    Another issue” People with chronic illnesses (and the author should be attuned to that one given his mother’s situation): are they to be stuck with some gargantuan deductible year in and year out?
    No, the solution is quite simple: do like every other remotely civilized nation on the planet has done and enact true universal healthcare (whether single payer or not) covering everything necessary for everyone. We know that works! Why reinvent the wheel?

  26. MM says:

    Gary: “Because I think buyer’s remorse is necessary to get people to give up the fantasy of universal healthcare in the U.S.”

    If the issue was put to the 100+ million private sector workers with private health care to vote on in a national referendum, you wouldn’t even get a majority buying in, whether it’s called single-payer or Medicare for All.

    Even before Obamacare was the amorphous and dubious law of the land, the vast majority of people, upwards of 90%, were satisfied with the quality of their health care:

    https://www.politifact.com/truth-o-meter/statements/2010/mar/10/george-will/will-says-95-percent-people-health-insurance-are-s/

    There’s a simple marketing trick that progressives often use to defend profligate spendings. Just tell everyone in the labor force that the government would take over their private health plans, with no guaranteee that the costs will go down, the quality won’t go down, and their taxes won’t go up. Because that would be the truth.

    And it’s also a simple marketing tactic to point out that, according to the government itself, between Medicare for the old and Medicaid for the poor, almost $250 million is wasted per day in “improper payments”, approximately 10% of total health care expenditures by the government:

    https://www.gao.gov/key_issues/reducing_government-wide_improper_payments/issue_summary

    I suspect that most people in favor of total government-run health care, which is the de facto situation when the government alone has total control of the money, are already on Medicare or Medicaid or don’t have health care at all.

    The conservative solution to problems with the cost of U.S. health care isn’t a free market and nothing else. It’s probably the Australian or Japanese model, freer markets, but also a certain amount of government coercion in the marketplace.

  27. Kafka says:

    If Medicaid is so bad why doesn’t your mother hop on a private insurance plan? It’s not like you’re being held against your will.

  28. Ken T says:

    Parrhesia:
    This is Britain’s National Health Service (NHS)! There you have a mouse-model of what you are proposing to implement.

    No it is not. Period. You literally do not know the first thing about the subject. Start by educating yourself about the difference between “Single Payer” and “Single Provider”. Then and only then will you be able to even start trying to understand some of the issues being discussed here.

  29. TheSnark says:

    The article’s main point is that conservatives need to come up with a coherent plan for health care. Obamacare did not pass because it was such a great program, it passed because the Republican had no alternative to offer. Something will always beat nothing.

    Same thing happened in 2017. The R’s chanted “Repeal and Replace”, but it was obvious to all that they had no plans for “Replace” part.

  30. Fran Macadam says:

    Another aspect is that lifestyle choices are contributing to health costs, and that the medical treatments, while expensive, do not have much effect on outcomes, and are often positively harmful. There is a great deal of deception in the system, wishful thinking as well as the outright greed.

  31. john says:

    There are literally dozens of models out in the rest of the world delivering better health care ( if you believe statistics) for lower cost. Some are fully public, some are mixed.
    The first step is admitting you have a problem.

  32. JeffK says:

    On TAC, looks like 75% of the comments are for some type of single payer, and against the author. What does that imply?

  33. BobS says:

    Mr. Boyd, your mother’s experience with Medicaid sounds nightmarish. I don’t know how you can allow her to remain in the program for another minute.

  34. Patricia McCoy says:

    You DO realize that one of the basic reasons that the United States does not have Universal Healthcare that could have been implemented after WWII is pure racism.

    Whites, especially in the Syouth didn’t want BLACKS nor any other non Whites to have health care of any kind. Even if they had the cash, you were not allowed into White hospitals. An exception back then were some Catholic hospitals- that worked for my Great Grandmother.

    My elderly friend told me that upon hearing and being brokenhearted by hearing of an injured Black child in the Jim Crow south being refused to be taken to a hospital, even though he was willing to pay for the child’s expenses( the child died without any medical aid) that Danny Thomas started St. Jude. Democrats aren’t the ones salivating over trying to destroy the ACA.

    Right now, we are in the midst of the public and elected officials trying to reestablish Jim Crow- the GOP and hard White “Nationalists” as they euphemistically call themselves and they get silent support from the Greek, Russian and Serbian Orthodox communities!

  35. Oleg Gark says:

    You know what else is horribly misleading? The belief that Republicans have any viable alternatives to the Democrat’s Medicare for All plans. All the Republican “alternatives” are partial solutions with minimal public funding. Generally speaking, Republicans are just fine with the current system where good healthcare is predicated on having a good job with benefits. The fact that millions fall through the cracks doesn’t faze them at all. The Democrats, on the other hand, when they take an occasional break from identity politics, realize healthcare is the one issue that can unite their side.
    Someday, the Republicans will regret fighting Obamacare tooth and nail, since it will be much preferable to them than the system that replaces it.

  36. madge says:

    “First, the above statement is not true. Let’s just take one example, Switzerland. The Swiss have mandatory health care – you must purchase insurance, with your own money. The government does offer assistance to those who can’t.”

    The government also sets the prices insurance companies charge, bans any discrimination on basis of age or medical conditions, and sets prices for providers. In other words, if pre ACA United States (more or less free for all) is 1 and the NHS (all medical professionals are employees of the state is 10), the Swiss are somewhere around 6-7.

  37. Laualie says:

    I’m not going to read this article because of the picture you chose.

  38. drew says:

    “My mother has had problems getting some of her medications filled because Medicaid requires prior authorization for many of them, whereas under private health insurance that wouldn’t be a problem because she would simply call her doctor and make an appointment”

    Every part of this scenario is a delusional fantasy. Good luck getting an appointment, good luck getting that medication approval, and most of all good luck absorbing the full cost of the drug when the private insurance says the medication is medically unnecessary (all very real things that happen often – my granny refers to the constant paperwork her insurance requires as her part time job).

    The author has been very lucky to avoid any meaningful interaction with the health care system before now. I hope he stays healthy.

  39. John says:

    “Conservatives need to promote alternatives such as direct primary care where patients pay monthly fees to their family doctors in exchange for service.”

    I see comments criticizing this suggestion, but I have some experience with this arrangement. It can work well, and would likely change the family medical practice for the better in this country. So many private practices have become corporate practices and this manageable model would bring many doctors back to private practice.

    When I was growing up my father had only catastrophic insurance provided by his employer. This was fairly common where we lived, and our family doctor had a solution, you could pay them a fee, either monthly or once a year, and receive whatever care the office could provide for free. Dad would write the one check when he got his bonus and know that his primary medical needs were covered. He then bought a prescription plan at a local pharmacy and our medicines were covered.

    Later his employer began offering a full fledged medical plan, but it, according to him, substantially more expensive than his arrangements, and covered substantially less. so, he stayed with his arrangement, until the state essentially outlawed it through regulation.

    The doctor didn’t worry about costs for his patients, and didn’t need to bill them and had so many people coming in that he had to hire a second doctor. The doctors son told me years later that when his father was forced to end the arrangement, he had to spend so much time on administration that his father decided to retire instead.

    I really think this is a something that America should seriously explore, it could reduce costs and expand primary care for the poor.

  40. EarlyBird says:

    Why does Ocasio-Cortez always looked deranged in every photo? Does she go to sleep with that same expression?

  41. SteveM says:

    Re: Oleg Gark, “Someday, the Republicans will regret fighting Obamacare tooth and nail, since it will be much preferable to them than the system that replaces it.”

    Oleg, the Republican plan is Obamacare without the mandate. I.e. subsidized craptastic lower cost (less stratospheric really) premiums with absolutely stratospheric deductibles and paper thin provider lists. Only the government won’t put a gun to someone’s head forcing him/her to buy it.

    Like Obamacare (which is a junk program), those policies will be cruel illusions that provide access to health insurance but not health care.

    What makes Obamacare much more preferable to Obamacare without the mandate is not clear to me.

    BTW, the policy asides by Republicans like allowing the purchase of insurance across state lines are easily demonstrated to be bogus. The Republicans and the Democrats want nothing to do with actually taking on the Big Health Care cartels.

    Obamacare is a sop to Big Health Care, the Republican plan is a sop to Big Health Care. American consumers are the chumps caught in the middle.

  42. Christopher says:

    The assertion that, unlike Medicaid, private healthcare plans don’t require prior authorization for medication makes it clear the author doesn’t know what he’s talking about. I help fill out prior authorization requests for a medical practice and can assure you that private insurance companies are just as interested in controlling costs by denying coverage of expensive medications as the government is, if not more so.

  43. Sid Finster says:

    Ever since I was a kitten and had to go to the vet, it was apparent that healthcare is not subject to market economics, at least not as far as humans are concerned.

    “Free markets” assume, among other things, an infinite number of suppliers, an infinite number of buyers, and perfect information.

    When you are lying flat on your back with a funky medical condition in the ER in Stutsman County, North Dakota, none of these things are present.

    Unless you have been to medical school and are keeping up on the latest literature, and have a treatment menu with a price list, you have no idea whether the recommended course of treatment is:
    * medically necessary but overpriced (and the nearest competing hospital is only an hour away – good luck!)
    * not the standard treatment for your condition but supported by a respectable minority of medical opinion
    * the result of a misdiagnosis
    * harmless but won’t help
    * a palliative at most
    * medically necessary and you’re getting a hell of a deal here, human!
    * 100% pure quackery
    * any of a hundred other variations.

    Well, you might be able to have that discussion with the attending physician, *if* you were an MD *and* if you didn’t happen to be comatose and with a variety of tubes sticking out of sensitive areas of your body.

    It’s even worse when you’re a housecat.

  44. Anthony M says:

    @EarlyBird

  45. cka2nd says:

    Kent says: “Instead, my employer has to pay $20,000 (which could otherwise go in my pocket)”

    Excellent comment, Kent, except for this parenthetical, unless you were shooting for satire there, too. Said $20,000 is more likely to got to buying back your employer’s stock or padding the compensation packages of its board members and senior management than it is to end up in your pocket.

  46. Lori Lee says:

    Here’s a link to an informative 30 minute podcast to complement this article. It reviews the fundamentals of healthcare’s impact on government debt and proposes a basic solution that marries coverage for all with the beneficial forces of the market.

    https://www.ced.org/podcasts/debt-101-how-healthcare-contributes

  47. cka2nd says:

    JeffK says: “On TAC, looks like 75% of the comments are for some type of single payer, and against the author. What does that imply?”

    That more conservatives read TAC than libertarians, and that even conservatives recognize that the current system of relying on private health insurers has serious problems. See also the relatively recent conservative recognition that income inequality is not a good thing, and the various conservatives – like the gentleman who exposed this Commie Pinko Red to TAC – who gradually moved from being hard-line free traders to being “free trade” skeptics.

  48. Noah172 says:

    JonF wrote:

    No, the solution is quite simple: do like every other remotely civilized nation on the planet has done and enact true universal healthcare (whether single payer or not) covering everything necessary for everyone. We know that works! Why reinvent the wheel?

    Thing is, those other countries adopted their systems a long time ago, when health care was a sliver of GDP, and before medical workers (that’s more than doctors) got accustomed to inflated incomes (politically difficult to reduce). They also adopted their systems when they were largely demographically homogeneous and had little immigration.

    America could have had some sort of universal system in 1945 or maybe 1965. Instead, we let inertia bias after World War II preserve the wartime tax deduction for employer-provided health benefits, which quickly became politically untouchable (Ike toyed with axing it, unions freaked out). Under Nixon, there was a bunch of debate over health care, with proposals for Medicare buy-in, state-level public option coverage, or mandates on employer coverage coupled with employee cost sharing and/or increased payroll tax. Support for these plans was a mix and match of liberals and conservatives in each party, but in the end, tax increases were unpopular, unions and oldsters didn’t like cost-sharing, both parties feared the insurance lobby, and the inflation monster of the time made people doubt costs could be controlled.

    As another commenter astutely noted, medical inflation got out of hand in the 70s through 90s, and was eventually reined in, but without clawing back all the salary growth for medical workers (again, more than doctors; American nurses are paid better than in most other countries).

    We could blame Presidents Roosevelt through Johnson or maybe Nixon, or, heck, every voting citizen of the 1940s through 70s for the failure to adopt a universal system, but they are not emotionally satisfying villains like the Kochs and Pharma and Joe Lieberman and Drumpf.

    TL;DR Reform of 2% of GDP is easier than reform of 18%.

  49. Noah172 says:

    Another aspect is that lifestyle choices are contributing to health costs, and that the medical treatments, while expensive, do not have much effect on outcomes, and are often positively harmful

    Ding, ding, ding.

    Americans drive more than other advanced peoples and have more car accidents.

    We have more violent crime.

    We have more obesity and diabetes (partly cultural problems around diet, partly unhealthy farming and food processing practices, partly likely genetic factors with blacks and Hispanics [Amerindians]).

    We have too much substance abuse (legal and illegal).

    No health insurance reform can fix these issues. And healthier living and different genetics explain some (not all) of the cost savings in some other countries (say, Japan).

  50. DifferentNameBecauseYouDidn'tLikeTheLastOne says:

    drivingby:

    “Try having cancer outside the expected age bracket while relying on NHS.”

    I did. I had acute leukaemia when I was 35, which was the age group with the lowest probability for getting the condition.

    I saw my General Practitioner about the pains in my joints I was suffering. He refered me for blood tests and X-rays at a nearby hospital walk-in clinic, so I did that the next week. I got a phone call within days telling me to come in urgently for more tests, so I did, and then I got brought in to the ward and was starting chemotherapy a week after that. Three cycles and a bone marrow transplant later I was starting to look forward to maybe getting back to work, which I did a year after that.

    That was ten years ago. Now I get annual check-ups with a specialist who looks at the latest blood test results. I’m happy with the service I’ve received.

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