Medicare-for-All

[sparky]

http://sanders.senate.gov/newsroom/news/?id=47d632b8-4a43-4d2b-b500-cb2c105e93ef

WASHINGTON, May 10 -- Sen. Bernie Sanders (I-Vt.) announced today that he introduced legislation to provide health care for every American through a Medicare-for-all type single-payer system.

Rep. Jim McDermott (D-Wash.) filed a companion bill in the House to provide better care for more patients at less cost by eliminating the middle-man role played by private insurance companies that rake off billions of dollars in profits.

The twin measures, both called the American Health Security Act of 2011, would provide federal guidelines and strong minimum standards for states to administer single-payer health care programs.

 

[Greenbeard]

The twin measures, both called the American Health Security Act of 2011, would provide federal guidelines and strong minimum standards for states to administer single-payer health care programs.

I was skimming through the bill a bit last night. It's a very interesting contrast with the perennial single-payer bill, H.R. 676, which really is Medicare-for-all--that is, a single federal program that operates very much like Medicare. Sanders and McDermott, on the the other hand, are proposing this state-administered variant, so there would actually be (presumably) 51 single-payer programs, though I believe states do have the option of joining together to form multi-state systems if they wish.

So it really raises the question of, if you were going to have a single-payer system, would you want it administered at the federal level largely without state involvement, or would you want individual states to administer their own single-payer program? That is, it's the Medicare structure vs. Medicaid structure question.

Seems like it's usually taken for granted that it would just be a Medicare expansion and thus entirely federal. Very interesting that Sanders and McDermott have gone the other route and put states in charge in their proposal.

 

[auditor0007]

The twin measures, both called the American Health Security Act of 2011, would provide federal guidelines and strong minimum standards for states to administer single-payer health care programs.

I was skimming through the bill a bit last night. It's a very interesting contrast with the perennial single-payer bill, H.R. 676, which really is Medicare-for-all--that is, a single federal program that operates very much like Medicare. Sanders and McDermott, on the the other hand, are proposing this state-administered variant, so there would actually be (presumably) 51 single-payer programs, though I believe states do have the option of joining together to form multi-state systems if they wish.

So it really raises the question of, if you were going to have a single-payer system, would you want it administered at the federal level largely without state involvement, or would you want individual states to administer their own single-payer program? That is, it's the Medicare structure vs. Medicaid structure question.

Seems like it's usually taken for granted that it would just be a Medicare expansion and thus entirely federal. Very interesting that Sanders and McDermott have gone the other route and put states in charge in their proposal.

Isn't that how Canada's system is run, by each Province?

 

[Two Thumbs]

Isn't MA going broke under the single payer system?

Just kidding, they got $15 billion of our dollars to keep it going instead of paying for it themselves or admitting it was a bad idea and dropping it.

I did csr work for a comany that did med sup part D. In an office of about 250, we each averaged 1 call a week were the customer told us that they were not dead.

Medicare declared them dead and cancelled thier insurance. told the cust to call us to take care of it, which is a lie, MC has to take care of it. Basically, the cust goes w/o any insurance for at least 3 months while they try to prove they are not dead.

Please tell me why you want to foist such a terribly run system on everyone.

 

[GHook93]

Sanders is a self-proclaimed communist. He will get little support. If the public option couldn't get through with a strong Democratic majority in both house and senate, why would anyone thing UHC could get through with a Republican House majority and slight majority in Senate?

 

[Two Thumbs]

Sanders is a self-proclaimed communist. He will get little support. If the public option couldn't get through with a strong Democratic majority in both house and senate, why would anyone thing UHC could get through with a Republican House majority and slight majority in Senate?

He knows it won't fly.

this is just another; "see the gop is evul! They want to kill poor people." slanderous plan.

If he actually intended it, he would have used the momentum built for obama care months ago.

 

[Wiseacre]

Can somebody explain to me how we can implement a single payer system and keep the costs down? Provide care for many millions more people who can't pay for it, and have no incentive to not seek free treatment? We don't have enough doctors as it is, so aren't most people going to show up at emergency rooms for a common cold? Better than waiting 6 months to see a provider,right? How could we avoid the so-called death panels where a group of bureaucrats decide the criteria for who gets treatment and who doesn't? How many doctors and providers are gong to opt out of Medicare or retire altogether if this happens?

 

[JBeukema]

I'm still drawn to 'medicare plus'- revamping Medicare and opening it to all American adults who choose to enroll. Allowing younger, healthier individuals in would better spread risk and should bring down costs. Also, we need to ensure that various providers must compete for contracts and health care providers are able to purchase medications from the least expensive (verified) source

 

[Two Thumbs]

I'm still drawn to 'medicare plus'- revamping Medicare and opening it to all American adults who choose to enroll. Allowing younger, healthier individuals in would better spread risk and should bring down costs. Also, we need to ensure that various providers must compete for contracts and health care providers are able to purchase medications from the least expensive (verified) source

Government run medicare is not based on age. Granted, most are seniors. But the government can't keep track of who is not dead yet, so there is no way they will be able to track who is what age.

 

[JBeukema]

Can somebody explain to me how we can implement a single payer system and keep the costs down?

The more young and healthy folk you have in the system, the lower costs will be.

Provide care for many millions more people who can't pay for it, and have no incentive to not seek free treatment?

There;s a reason for copays. Copays serve to disincentivize abuse by making there be an up-front cost to seeing a physician

We don't have enough doctors as it is

That is a problem stemming from our lack of investment in our people

, so aren't most people going to show up at emergency rooms for a common cold?

No, that;s what they do now, since they have no insurance.

How could we avoid the so-called death panels

Simple. Stop making shit up and being a retard.

where a group of bureaucrats decide the criteria for who gets treatment and who doesn't?

You mean like every single health insurance system ever?

 

[RDD_1210]

Sanders is a self-proclaimed communist.

He is? I know you guys like to use terms interchangeably but I'm pretty sure he's a socialist, not a communist. The one time you can actually claim someone in American politics is actually a socialist and you go and choose the wrong label. What a shame.

 

[Wiseacre]

Can somebody explain to me how we can implement a single payer system and keep the costs down?

The more young and healthy folk you have in the system, the lower costs will be.

Really? What have they got to do with lowering costs? I can see them increasing revenue if you require everyone to pay in, but then aren't you going to exempt people under some income threshhold? Which is most of the young people just starting out?

Provide care for many millions more people who can't pay for it, and have no incentive to not seek free treatment?

There;s a reason for copays. Copays serve to disincentivize abuse by making there be an up-front cost to seeing a physician


Sure, but again, aren't you going to exempt co-pays for those who can't afford it? They won't have any incentive to not seek treatments.


That is a problem stemming from our lack of investment in our people

No, that;s what they do now, since they have no insurance.

How could we avoid the so-called death panels

Simple. Stop making shit up and being a retard.


Hey now, I wasn't tryng to be difficult, don't they already have somethinglike that in Britain? You don't think the gov't will try to hold down costs be detrermining who gets what treatment?


where a group of bureaucrats decide the criteria for who gets treatment and who doesn't?

You mean like every single health insurance system ever?

Sure, but how is single payer any better?

 

[JBeukema]

Spreading risk as a means of controlling costs is how insurance works.

If you don't get that, then there's no point pretending you belong in an intelligent discussion of the matter.

 

[Wiseacre]

Spreading risk as a means of controlling costs is how insurance works.

If you don't get that, then there's no point pretending you belong in an intelligent discussion of the matter.

Spreading risk in a single payer system? Seriously, I'm not getting it. Never claimed to be intelligent though, LOL. I cannot see at all how a bunch more of young people have anything to do with controlling costs, only more revenue.

Single payer, that's like only one insurance company, the US Gov't, right? So you add the young people into the system, even though most of 'em don't make enough money to pay in yet. But they have babies, and accidents and so on, so it's not like there's no cost involved with them. Not sure I'd assume their added revenue is enough to cover the costs of the rest of the uninsured who are now in the system.

 

[Two Thumbs]

Spreading risk as a means of controlling costs is how insurance works.

If you don't get that, then there's no point pretending you belong in an intelligent discussion of the matter.

Age only works with private ins.

 

[editec]

This would be, I think, the least worst solution to this vexing problem.

There is no panacea for the health care problem, folks.

There are only solutions which each bring with them their own problems.

 

[Greenbeard]

Isn't that how Canada's system is run, by each Province?

I can't say I know the ins and outs of the Canadian system, but yes, my understanding is that it's structured around provincial control.

Isn't MA going broke under the single payer system?

Since Massachusetts doesn't have a single-payer system, that would be a no.

Can somebody explain to me how we can implement a single payer system and keep the costs down?

That problem has to be attacked on multiple fronts. If you're footing the bill, the monetary cost to you is effectively the price of various health services multiplied by how many of them you're utilizing. So on the one hand you have to tackle the volume of services question. And that entails lots of things: focusing on prevention in lieu of expensive interventions where it's cost-effective to do so, and promoting healthier lifestyles; identifying low-value health services and encouraging use of high-value equivalents (e.g. build a strong knowledge base of the comparative effectiveness of competing treatment options, instead of just winging it); rewarding high-quality, coordinated care, and seeking to streamline care delivery; etc.

The focus with this part of the issue tends to center on improving care and reducing the need for excess volume. The other piece of it is prices, which tend to get pushed up as providers acquire market share.

The value of single-payer in addressing both pieces of the puzzle lies, of course, in payment. Payment and the structure of service delivery go hand in hand, which is why payment reform is generally considered to be a necessary precursor to substantive delivery system reform. Even now the public health insurance programs can be influential when they want to be: Medicare and state Medicaid programs are driving a transition from paper health records to electronic heath records as we speak. That stands to be revolutionary in terms of measuring quality and improving clinical decision supports. In that instance, the privately insured will still generally benefit because a doctor or hospital who accepts Medicare reimbursements and installs an EHR system in response to the Medicare incentive program also likely accepts private insurance and those privately insured patients still get to experience the benefits of EHRs.

So you don't even need a full-on single-payer system to spread potentially cost-saving innovations through the system. Single-payer just provides an even more potent tool for promoting quality and improving care. That doesn't mean that happens automatically, you still have to work at it. At the same time, it provides a counterweight to consolidated provider markets that currently may not exist in many places. The Sanders bill seems to rely on global budgeting for hospitals (if memory serves, so does H.R.676, the more famous single-payer bill) which turns the hospital pricing issue on its head.

 

[Toro]

The provinces are responsible for healthcare in Canada but the federal government sets standards and transfers funds to the provinces if they meet those standards, effectively having a great influence on policy.

 

[Wiseacre]

Isn't that how Canada's system is run, by each Province?

I can't say I know the ins and outs of the Canadian system, but yes, my understanding is that it's structured around provincial control.

Isn't MA going broke under the single payer system?

Since Massachusetts doesn't have a single-payer system, that would be a no.

Can somebody explain to me how we can implement a single payer system and keep the costs down?

That problem has to be attacked on multiple fronts. If you're footing the bill, the monetary cost to you is effectively the price of various health services multiplied by how many of them you're utilizing. So on the one hand you have to tackle the volume of services question. And that entails lots of things: focusing on prevention in lieu of expensive interventions where it's cost-effective to do so, and promoting healthier lifestyles; identifying low-value health services and encouraging use of high-value equivalents (e.g. build a strong knowledge base of the comparative effectiveness of competing treatment options, instead of just winging it); rewarding high-quality, coordinated care, and seeking to streamline care delivery; etc.

The focus with this part of the issue tends to center on improving care and reducing the need for excess volume. The other piece of it is prices, which tend to get pushed up as providers acquire market share.

The value of single-payer in addressing both pieces of the puzzle lies, of course, in payment. Payment and the structure of service delivery go hand in hand, which is why payment reform is generally considered to be a necessary precursor to substantive delivery system reform. Even now the public health insurance programs can be influential when they want to be: Medicare and state Medicaid programs are driving a transition from paper health records to electronic heath records as we speak. That stands to be revolutionary in terms of measuring quality and improving clinical decision supports. In that instance, the privately insured will still generally benefit because a doctor or hospital who accepts Medicare reimbursements and installs an EHR system in response to the Medicare incentive program also likely accepts private insurance and those privately insured patients still get to experience the benefits of EHRs.

So you don't even need a full-on single-payer system to spread potentially cost-saving innovations through the system. Single-payer just provides an even more potent tool for promoting quality and improving care. That doesn't mean that happens automatically, you still have to work at it. At the same time, it provides a counterweight to consolidated provider markets that currently may not exist in many places. The Sanders bill seems to rely on global budgeting for hospitals (if memory serves, so does H.R.676, the more famous single-payer bill) which turns the hospital pricing issue on its head.

Had to rep you for your response, even though I don't agree with much of what you said. You obviously put some time and thought into it, and for that I thank you.


Now - preventive care, healthier lifestyles, using low-value services, sounds great but I don't see why these ideas will change things in a any appreciable way from the way they are now. I'm not seeing any savings happening here.

 

[Wiseacre]

Isn't that how Canada's system is run, by each Province?

I can't say I know the ins and outs of the Canadian system, but yes, my understanding is that it's structured around provincial control.

Isn't MA going broke under the single payer system?

Since Massachusetts doesn't have a single-payer system, that would be a no.

Can somebody explain to me how we can implement a single payer system and keep the costs down?

That problem has to be attacked on multiple fronts. If you're footing the bill, the monetary cost to you is effectively the price of various health services multiplied by how many of them you're utilizing. So on the one hand you have to tackle the volume of services question. And that entails lots of things: focusing on prevention in lieu of expensive interventions where it's cost-effective to do so, and promoting healthier lifestyles; identifying low-value health services and encouraging use of high-value equivalents (e.g. build a strong knowledge base of the comparative effectiveness of competing treatment options, instead of just winging it); rewarding high-quality, coordinated care, and seeking to streamline care delivery; etc.

The focus with this part of the issue tends to center on improving care and reducing the need for excess volume. The other piece of it is prices, which tend to get pushed up as providers acquire market share.

The value of single-payer in addressing both pieces of the puzzle lies, of course, in payment. Payment and the structure of service delivery go hand in hand, which is why payment reform is generally considered to be a necessary precursor to substantive delivery system reform. Even now the public health insurance programs can be influential when they want to be: Medicare and state Medicaid programs are driving a transition from paper health records to electronic heath records as we speak. That stands to be revolutionary in terms of measuring quality and improving clinical decision supports. In that instance, the privately insured will still generally benefit because a doctor or hospital who accepts Medicare reimbursements and installs an EHR system in response to the Medicare incentive program also likely accepts private insurance and those privately insured patients still get to experience the benefits of EHRs.

So you don't even need a full-on single-payer system to spread potentially cost-saving innovations through the system. Single-payer just provides an even more potent tool for promoting quality and improving care. That doesn't mean that happens automatically, you still have to work at it. At the same time, it provides a counterweight to consolidated provider markets that currently may not exist in many places. The Sanders bill seems to rely on global budgeting for hospitals (if memory serves, so does H.R.676, the more famous single-payer bill) which turns the hospital pricing issue on its head.

Had to rep you for your response, even though I don't agree with much of what you said. You obviously put some time and thought into it, and for that I thank you.


Now - preventive care, healthier lifestyles, using low-value services, sounds great but I don't see why these ideas will change things in a any appreciable way from the way they are now. I'm not seeing any savings happening here.

The EHR thing also sounds great, but we're talking a lot of money here, not just to bring it online but also to maintain it. Systems that large will have periodic shutdowns and also a potential for hacking data and loss of privacy. If you don't have hard copy backups of treatment, sooner or later somebody is going to die as a result of a lack of information if the system goes down. It ain't the panacea that many think it is.