Libertarian666 wrote: ↑Sun Feb 16, 2020 3:06 pm
WiseOne wrote: ↑Sun Feb 16, 2020 11:40 am
MangoMan wrote: ↑Sun Feb 16, 2020 8:31 am
D1984 wrote: ↑Sun Feb 16, 2020 3:40 am
AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health
INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well)
physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).
Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
This defeats the whole purpose and incentive for opting out as a provider (capitlism!). If you can't charge more for delivering a better (or, in this case, more timely) service, you may as well stay in the system for the increased volume. The only reason the concierge model works here is because of supply and demand coupled with un restrictive pricing.
We already basically have socialized medicine here in the US in most cities, it just looks different. If you practice here in Chicago in a non-concierge practice, you are limited to charging the fees set by insurance contracts or medicare since almost all of your patients have one or the other, and if you don't participate in the PPOs, you won't have any patients at all as they will just go to the guy 2 doors down who is in-network. And the premiums of the wealthier people help pay for those receiving subsidies. Voila: defacto sociailzed medicine.
Actually, Medicare isn't the source of delayed treatment in the American system. It's the private insurers that play the preauthorization game that results in delays and denials. Yet another reason to avoid Medicare Advantage plans like the plague.
I agree that an insurance model that covers routine, low-level expenses is idiotic and makes about as much sense as, say, getting haircut insurance, but I'm resigned to that being fixed in stone. If you accept that, then a Medicare for all system may in fact be our best solution. I wish medical insurance could work more like it does in veterinary medicine, where the added costs of a full coverage insurance policy for a pet are necessarily greater than what you'd spend for the routine care that it covers - so those policies basically amount to a stupidity tax. Also, because insurance isn't nearly so intrusive in the pet world (minimal documentation requirements, no preauths), office visit costs are a lot lower. Gives you an idea of what they would be in the human world without that added layer of insanity.
So let me see if I understand this.
The current "Medicare for some" (mostly over 65 with a few others) is completely and utterly bankrupt, having unfunded liabilities in the tens of trillions of dollars (see
https://www.marketwatch.com/story/the-f ... 2018-06-15).
Therefore expanding it to five times its current size is a good idea.
Is that right?
Medicare's unfunded liability over a 75 year period (the next 75 years) is $37 trillion as per the article. Well....that sounds scary. Actually, that is only around 2.27% of GDP per year. That doesn't sound quite as scary, does it? Think tanks that publish articles like this use the 75 year or 100 year or even (if the Trustees are still making it as of 2020; I thought they quit making that one for SS and Medicare back in the mid-2000s) the "infinite horizon" period in order to scare people. In actually it is likely even less than 2.27% of GDP per year since I derived that figure using today's GDP (and assuming per capita GDP will never grow in real terms since then....i.e. it will grow with inflation but total GDP will never grow beyond inflation and population growth i.e. I assumed ZERO productivity growth which I think we can agree is just a wee bit unrealistic), dividing $37 trillion by 75, and dividing that number by today's GDP (which again, I assumed no real increase whatsoever in except for via population growth and inflation) and projecting today's GDP out 75 years. Finally, most of the unfunded liabilities are going to occur in later years (the Trust Funds don't even start running a deficit until the mid to late 2020s) so given the time value of money it would be even less in terms of a % of GDP if we had to raise taxes enough
immediately to fund it since we would be building up extra money in the trust funds staring from right now--and it would be earning interest--for at
least the next several years before we spent even one extra cent out of the revenue the new taxes would generate.
Also, if you calculated private insurance companies' liabilities the same way they calculated Medicare's liabilities (IIRC the Trustees--likely quite correctly--assume costs will increase in line with the aging of the population and assume medical cost inflation will continue to outpace regular inflation) and calculated said insurance companies' income to service those liabilities by assuming premiums were
never allowed to increase other than through inflation, population growth, and GDP per worker output growth (when calculating unfunded liabilities the Trustees AFAIK are assuming current tax rates and no increase in FICA or income taxes at all; the total amount of taxes can grow with more people or inflation or real output/GDP growth but tax rates themselves are assumed to stay at whatever current rates are) and that if insurance payouts for medical care increased faster than said premiums well then...too bad, too sad...you still won't be allowed premium increases enough to offset this....I'd bet that you'd come up with a pretty hefty "unfunded liability" estimate for private insurance as well. Needless to say private insurance companies do not have this problem because they can increase premiums as needed in order to stay solvent; Medicare has to rely on Congress and the White House OKing tax increases; it can't just increase its own funding stream (taxes) with the ease which insurance companies can increase
their funding stream (by hiking premiums).
The problem that creates such a huge "unfunded liability" in either case is that medical costs keep increasing faster than inflation and usually they even increase faster than inflation plus real GDP per capita growth. FWIW Medicare seems to be better at controlling costs per beneficiary than private insurance; see
https://www.modernhealthcare.com/articl ... study-says ; presumably this is because it has more bargaining power than private insurers.
EDIT - given that the Trustees projected the present value of Medicare's "unfunded liabilities" was $37 trillion then perhaps they should've contextualized that by comparing it to the present value of all GDP over that same 75-year period. Back in late 2010 the projected present value of 75 years worth of GDP (what you would have to pay now to receive the discounted value of 75 years worth of GDP paid to you) was $791 trillion (
https://seekingalpha.com/article/207272 ... iabilities ). Given that real inflation-adjusted GDP has increased around 23 percent or so since then we can presume the 75 year discounted present value of all the GDP for that timeframe (for the next 75 years starting today rather than starting in late 2010) has increased as well. That would put said value at around $972 trillion (give or take a trillion $ either way); $37 trillion is a bit over 3.78% of that. Not exactly insurmountable.