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‘Medicare for All’ can mean at least two different things

Sen. Kamala Harris, D-California, says that she absolutely favors a “Medicare for All” program.
REUTERS/Elijah Nouvelage
Sen. Kamala Harris, D-California, says that she absolutely favors a “Medicare for All” program.

The slogan “Medicare for All” can mean two things. Well, at least two. One of them would be a much bigger, and, to some people, much scarier change than the other. But the two meanings are both out there, which isn’t really helpful but makes it necessary to clarify the two ideas.

Sen. Kamala Harris, D-California, who is considered a top contender for the Democratic nomination for president in 2020, gave a CNN televised town hall forum Tuesday night. She came across as strong, smart and brave. But my feelings about the “brave” part was undermined when I subsequently read about a small maneuver she employed to fuzz up her position on the future of health care.

In response to a question, Harris said that she absolutely favors a “Medicare for All” program. Her words suggested that she meant the version of “Medicare for All” that completely replaces and eliminates private health insurance and replaces it with what is sometimes called “single payer.”

But maybe not. Let me try to clarify/explore a few terms, because we’ll hear a lot about this matter as next campaign develops.

Under “socialized medicine,” pretty much all health care facilities are owned and operated by the government and health care providers are government employees. All citizens are covered. This is what they have in England. At present, full-bore “socialized medicine” is not part of the mainstream American policy discussion.

Under “single payer,” doctors and nurses are not all government employees and the federal government doesn’t own all the hospitals, but government pays all or most medical bills, which greatly reduces or eliminates the need for private health insurance.

Medicare is a single-payer system, but, of course, it doesn’t cover us until we hit age 65. The United States is among a small minority of wealthy nations in not having either of these systems (except for seniors, via Medicare, and the poor, via Medicaid).

America has long been nervous about anything that can be called “socialism,” and Republicans are adept at turning any discussion of increasing government’s role as a step toward socialism. “Socialized medicine” is a nonstarter in U.S. politics, used only as a club to pummel anything that increases the government’s role.

Versions of “single payer” also used to be considered politically suicidal, but that’s changing. Bernie Sanders is for single-payer, has been for years, which is among the reasons many handicappers assumed his chances for the 2016 presidential nomination were low. But they were wrong. Sanders came close. One reason, perhaps, is that he adapted his language to refer to the single-payer approach as “Medicare for All.”

In American politics, “socialism” is a bad word, “Medicare” is a good word. And I’d say our political culture is in a period of transition of how scary the term “single payer” is, and how powerful a tool it will be for the right to label all liberal ideas “socialism.” But that power isn’t gone, so Republicans pounced on what Harris said on CNN about Medicare for All to gin up the red menace.

“Medicare for All,” on the other hand, currently has two meanings. It may mean that private insurance goes away, the federal government pays all the bills, but the federal government would also, of course, have to decide what was covered. If you like your current private or employer-subsidized health insurance, you might be worried that “Medicare for All” might not pay for all the benefits you are currently getting.

But it turns out that there is a less radical, perhaps less-scary version of “Medicare for All,” because it is optional. Under this version of “Medicare for All,” all Americans, including those under 65, would have the option of buying into Medicare, if they choose, but would also have the option of keeping their private health insurance. It’s a Medicare option for all, but those who preferred their current private insurance could stay put. And Harris is apparently for that, too, although you wouldn’t have known that if you had only heard what she said on CNN.

This CNN story about Harris’ town hall forum includes a video clip of that exchange at the top. A woman from the audience asks Harris specifically whether she favored a health care solution that would “cut private insurance companies, as we know them, out of the equation.”

Harris replied: “I believe the solution … is that we need to have Medicare for All. That’s just the bottom line.”

The audience applauds. But there was nothing in the exchange to even hint that Harris might be referring to either of two ways of reaching the goal, one of which would phase out the private health insurance industry, and one of which would not.

I don’t mean to overdo the notion that Harris was deceiving, but she does seem to want to have it both ways without making that clear. The Medicare “option” for all plan might be great.

David Leonhardt of the New York Times used his daily email yesterday to clarify this. He did a good job. Harris’ staff explained the two versions of what might be called “Medicare for All,” and said that she favors both, but that the more radical approach that would make Medicare universal is “what she’s running on.”

I don’t want to overdo how dishonest her answer might have been. She didn’t exactly lie, but her answer seemed too cute, and meant to deceive. She should have said something like: “I favor making Medicare available to every American who wants it. There’s a bill in Congress that would do that by making a Medicare buy-in available to every American, while leaving the private health insurance industry to compete with that option. And there’s a bill that would do it by making Medicare universal for all Americans, which would mean the end of the private health insurance as we have known it. As president I would sign either of those bills. The goal is to have every American insured.”

Comments (153)

  1. Submitted by Sean Olsen on 01/31/2019 - 08:54 am.

    I think the extent to which people are trying to find fault with Harris’s answer is absurd. Her position is clear: she favors the mandatory-for-everybody version of the bill, and that’s what she’s running on. But she’s also not opposed to interim bills (like the opt-in version) that could improve things while on the way to that ultimate endpoint.

  2. Submitted by Paul Yochim on 01/31/2019 - 08:55 am.

    When she says, “Medicare for all” does that include past, present and future members of the United States Senate, House of Representatives and other members of the ruling class?

  3. Submitted by Sean Olsen on 01/31/2019 - 08:56 am.

    It should also be noted that just about every Senate Democrat who may be in the Presidential race has signed on to multiple health reform bills. Even Bernie Sanders has signed onto bills that improve the ACA without being mandatory Medicare for All.

  4. Submitted by Bob Barnes on 01/31/2019 - 09:14 am.

    No one ever likes to discuss how to pay for it or how govt will ration what is covered. Medicare goes bankrupt by 2024 at the latest. Meaning they run out of special Treasuries to redeem. That will instantly add 800+ billion a year to the federal deficit annually going forward. And since the costs of healthcare still aren’t being addressed, good doctors will simply leave the practice because they won’t be paid for the actual costs. It WILL require moving to socialized medicine if enacted. (that is how Democrats work, incremental increases in govt control).

    Luckily we won’t get that far. The next big crash will hopefully put the kibosh on all this single payer/socialized medicine nonsense. Enforce the anti trust laws and healthcare costs would plummet by 80% or more immediately. That would make America the lowest cost healthcare among all 1st world nations by a large margin and put us below even places like Mexico in terms of cost.

    • Submitted by Pat Terry on 01/31/2019 - 11:20 am.

      No, that is totally false. Medicare won’t go bankrupt by 2024 (or 2026, the actual year you are probably referring to). It just won’t be able to meet 100 percent of its obligations based on current projected funding and spending as of then.

      • Submitted by Bob Barnes on 01/31/2019 - 12:27 pm.

        Actually it will go bankrupt by bankrupting the govt. Where do you think the US is going to be able to sell 2 to 2.5 trillion (or more) in new debt annually? It won’t. That’s 50+% of the entire current budget. The economy will collapse and federal spending will have to be slashed in half or more. Or they print and we go Venezuela / Zimbabwe.

        2024 is now the projected year they run out of special treasuries. IF we have any economic downturns before then that date will move closer to now.

        • Submitted by Pat Terry on 01/31/2019 - 12:53 pm.

          That’s not how this works.

          That’s not how any of this works.

        • Submitted by Sean Olsen on 01/31/2019 - 01:00 pm.

          Well, let’s be clear. Yes, it’s true that the Medicare Hospital Insurance trust fund (Part A) will be depleted in 2026. However, two important things. Part A represents only about 40% of current Medicare spending, and existing tax revenues will still pay 91% of Part A expenses. At current Medicare spending levels, that represents a $21B gap.

    • Submitted by David Markle on 01/31/2019 - 11:33 am.

      No question about it; single-payer would cost big money, just as Medicare does now, only much more. But it appears that single-payer, paid from higher taxes, would likely be cheaper than the present total bill for private health insurance and the public costs of care for the uninsured. And from a typical business perspective, the costs of private insurance are hurting us.

      • Submitted by Bob Barnes on 01/31/2019 - 12:32 pm.

        Factually incorrect. Insurance isn’t what is hurting us, it’s the monopolies in the entire healthcare system that are driving up costs. Insurance has to cover those costs as best it can. Mandating what type of policies people can have also contributes to higher insurance costs to a degree.

        Medicare is just insurance. Once again NO ONE is talking about fixing the COST issue. If you and I went to the same gas station, would you pump the gas without knowing the price per gallon? And would you be ok filling your tank at 5 or 10 or 50 times the price per gallon that I pay? I doubt you would do either. But that is what healthcare is allowed to do. That is what we must end. We used the Sherman Anti Trust Act to bust up Standard Oil in the early 1900s…time to do that very same thing in the entire healthcare system (including insurance, pharma, hospitals etc)

    • Submitted by Todd Hintz on 01/31/2019 - 12:32 pm.

      Enforcing anti-trust laws will do exactly two things.

      1. Jack
      2. And I think you know how the rest of this goes.

      And Jack just left town.

      Here’s why.

      Vast swaths of the country have zero competition because the population density is too low to support two or more hospital and clinic systems. You can enforce all the anti-trust laws you want, but you can’t force someone to open a new hospital where they know they’re going to lose money from day one.

      Heck, there isn’t enough business in a lot of these areas to support even one hospital, let alone two or three. Are you then going to use the government to force them to open a hospital in those areas and then have the high density areas subsidize them? At that point you might as well go with socialized medicine and call it done because you’re already there anyway.

      • Submitted by Bob Barnes on 02/01/2019 - 09:01 am.

        In low density areas you have clinics and individual doctors offices. Even towns as small as 500 population had a small doctor’s office years ago. All of that is beside the point. Enforcing anti trust laws will break up the big monopolies and drive costs down as the fraud is removed from the system. So even if an area has just one hospital, prices for service will still be very low because they can’t price gouge anymore.

    • Submitted by James Miller on 01/31/2019 - 12:54 pm.

      Please explain how enforcing the current antitrust laws (which ones?) could potentially resolve all or part of the current healthcare costs. I’ve not heard mention of this anywhere else. Where did your data come from?

      • Submitted by James Miller on 01/31/2019 - 12:56 pm.

        I just read your previous response. Is there any traction on implementing the Sherman Antitrust Act to mitigate healthcare costs?

        • Submitted by Bob Barnes on 01/31/2019 - 03:14 pm.

          Medicare has a set rate for reimbursement. Doctors and hospitals charge privately insured patients many times that amount and get away with it. That is why generic drugs are going up not down. Btw generic drug companies are facing at least 2 class action lawsuits and maybe RICO charges as well.

          There is a sports reporter here in MN that had a rattlesnake bite and it cost him just over $50,000 for treatment if I recall correctly. The anti venom is extremely cheap from what I can find. A woman in AZ was charged upwards of 80 grand for 2 vials of Scorpion antivenom to get treated for a sting. I’ve read reports the hospitals get it from Mexico for $100 a vial.

          Similar things in pharma too. Pharmacists aren’t allowed to mention that you can buy many drugs out of pocket for less than your copay.

          Karl Denniger has written extensively on this subject as have others.

          • Submitted by Paul Brandon on 01/31/2019 - 06:38 pm.

            Pharmacists are allowed to tell you if you ask them.

          • Submitted by Mark Kulda on 01/31/2019 - 09:13 pm.

            Mediare’s reimbursement rate is set at about 45% of the provider’s billed charge. Usually this is not enough to actually cover the cost of care so the provider’s ‘squeeze the balloon’ and raised their charged rate, even though Medicare still pays the same. The effect is the shortpay is reflected onto the rest of the payers. Private insurers like Blue Cross negotiate a discount and pay about 60-65% of the charge. They are not billed ‘several times’ what Medicare pays. Work Comp pays about 90% of the billed rate. And, no-fault auto insurers and the uninsured pay the full sticker price, which is artificially higher because Medicare doesn’t reimburse enough to the providers to actually pay for the care. This is just one reason why Medicare for All or a buy-in won’t work for the providers, many of whom will cut care and cut the quality of the care. Americans like the idea of having our great healthcare system and having somebody else pay for it. But if Medicare for All is ever enacted the degradation of the system is not going to be very well liked.

    • Submitted by Karen Sandness on 02/01/2019 - 11:08 am.

      It’s funny how right-wingers wring their hands over the possible costs of universal health care but actively support beefing up what is already the world’s largest military establishment by several orders of magnitude.

      They think that the literal trillions spent in the various quagmires in the Middle East are “keeping us safe from terrorism,” when in fact, the “honor” culture of that region ensures that the relatives of every innocent person counted as “collateral damage”–all those schoolchildren and wedding guests and victims of mistaken identity–will feel duty-bound to exact revenge.

      Some right-wingers even think that the U.S. isn’t intervening in enough countries yet.

      But seriously, those who are so enamored of the private insurance system need to talk to a doctor in private practice to find out how the procedures of these companies actually drive up costs for the uninsured and require doctors to spend large sums on clerical help or to outsource to a billing service to keep track of the requirements of the various companies. And once the paperwork is submitted, our supposedly non-profit companies will look for any excuse to deny coverage.

  5. Submitted by Dennis Wagner on 01/31/2019 - 09:34 am.

    Well Eric, it looks like gotcha politics from this perspective, Settle on a pin head solution now, which suggests closed minded thinking, vs, this looks like a reasonable direction to go in, perhaps others can contribute and we can make some progress towards better healthcare by getting enough votes to push something better across the finish line, despite the efforts to “gin up the red menace”. We should have improvements in our health care, but we should also have folks take more responsibility for their personal health performance. Should the taxpayer be responsible for folks right to choose bad health habits, smoking, unhealthy diet choices, lack of exercise etc?

    • Submitted by Paul Yochim on 01/31/2019 - 11:06 am.

      Dennis, you are responsible for the life style choices of others. You have been doing it for quite some time.That is how the insurance business works. The risk is spread over all. As a healthy 64 year old who exercises daily, doesn’t smoke or consume alcohol or use illegal drugs and takes no medicines, why should I pay the same as an obese diabetic with heart disease and other comorbidities? I do. And an individual policy paid for with post tax dollars is not cheap.

      • Submitted by Dennis Wagner on 01/31/2019 - 11:43 am.

        Well PY I get it, there is a difference between a private market and a public program, no reason that I can think off why responsibility can’t be embedded into the program. Sounds like you support the issue of a certain level of personal responsibility, Which was my original point, we the voters should not push candidates to expose a “pin head” solution, leave the playing field open for discussion of reasonable ideas that we can push forward. The opposite of red-blue gotcha politics. Last perspective, Set up the program so the policies have to be reviewed at least yearly, not that laws are made and everyone walks away for 10 years while the experiment blows up. Sounds like a Deming thing, “CIP, Continuous Improvement Process, we have an education, perhaps we should use it? .

      • Submitted by Bob Barnes on 01/31/2019 - 12:34 pm.

        In a free market you wouldn’t. You would pay for a policy based on your needs and health. Yes there is a pool but each individual pays only what their individual policy covers. The pool is only dipped into when someone has to make a claim.

        • Submitted by Pat Terry on 01/31/2019 - 01:02 pm.

          Except that people with chronic illnesses could never afford coverage. The free market would price them out.

          That’s why there has never been a successful free market healthcare system.

          • Submitted by Bob Barnes on 01/31/2019 - 03:06 pm.

            They would pay a slightly higher premium but they would still be able to afford it. That’s how a free market works. We are talking about an 80% or greater reduction in the cost of actual care and a corresponding drop in insurance premiums. We would be back to about 3 or 4% of GDP on healthcare spending which is where we were traditionally before Medicare messed things up.

            • Submitted by Frank Phelan on 01/31/2019 - 03:33 pm.

              That is what I would call a faith based approach to the free market.

              Charming, really.

              • Submitted by Bob Barnes on 02/01/2019 - 09:06 am.

                It works in all other aspects of the economy even though our markets aren’t very free anymore. You can keep your religious references out of this as it has nothing to do with the subject. This is strictly an economics and math based solution that has been proven to work time and again under our Capitalist system for 2+ centuries.

            • Submitted by Karen Sandness on 02/01/2019 - 11:21 am.

              Slightly higher before Medicare?

              Private insurance companies did not want to sell policies to seniors, at least not at any price the average senior could afford, even in 1965.

              You know what the Republicans’ alternative proposal was? That seniors who couldn’t handle their medical bills could petition the federal government individually for reimbursement.

              Personally, Medicare is one of the best things that has happened to me in recent years. In the year before I qualified, I was spending $500 a month plus a $5,000 deductible for private insurance, the best deal I could get at the time. Yes, one of the worst provisions of the ACA is that it specifically allows insurance companies to charge people over the age of 50 three times as much as they would for a comparable person under 50.

              I was and still am healthier than the average person my age, a regular exerciser, a non-smoker, a very occasional drinker, and a non-eater of junk food, and I take no prescription drugs, but it didn’t matter. I turned 50, and the premiums automatically jumped.

              In practical terms, I would have had to spend $6000 in premiums plus the $5000 deductible to gain ANY benefit from insurance.

              Now my Medicare plus Advantage with drug plan comes out to less than $200 per month, and although I have modest co-pays, there is no deductible except for the drug plan, which I don’t use anyway.

              So Medicare was a godsend for me, and even more so for those of my age (mostly, but not all women) who would be either dead or homeless if they had to trust the Mindless Cult of the Free Market.

      • Submitted by Robert Gauthier on 02/04/2019 - 10:51 pm.

        Because DM II is largely a genetic disease, 70-80%, not solely obesity, as you indicate.

  6. Submitted by Ray Schoch on 01/31/2019 - 09:35 am.

    Sean Olsen take seems accurate to me, and Paul Yochim’s question is a relevant one, as Congress members in either/both houses have far better health coverage than most of us. But then, they also have a more generous retirement plan than most of us.

    Personally, I’m fine with either option. I’d be OK with doing away with the health insurance industry altogether, making medical school and nursing school free, doctors and nurses government employees, all, or nearly all, hospitals nonprofit, and health care available to everyone, paid for by tax dollars that now go to the private sector. I’m also OK with a lot of other permutations of universal coverage that aren’t that radical, and would pop fewer veins in the temples of people who like to call themselves “conservative.”

    Eric’s hypothetical answer in his last paragraph would work for me. Industrial nations all over the world have universal coverage. Some do it entirely through the government, a few through a tightly-regulated private sector, and some with a combination of government and private providers and coverages. The goal in all of them, as Eric’s last sentence makes plain, is to cover everyone. Were I running for office, and thankfully, that’s not the case, universal coverage would be my goal, as well, pretty much regardless of how we got there.

    No one should face bankruptcy because of medical bills. Everyone in the country is going to die eventually. Many will die quickly, many will suffer a serious illness or injury and linger for a while before they depart. Why should the inevitability of illness and/or death drive a family into poverty?

  7. Submitted by Gerald Abrahamson on 01/31/2019 - 09:54 am.

    Mandatory universal health care, public/private, rated #1, AND costs about half (per capita) of the cost than the US.

    • Submitted by Bob Barnes on 01/31/2019 - 10:35 am.

      I can give you an easy solution that would be half of that even or less. It doesn’t even require any legislation really as the laws have been on the books for over 100 years. We would just need to enforce them. It’s called the free market. Just enforce the anti trust laws (Sherman and Clayton along with Robinson Pattman et al) and we would see an immediate drop in costs of 80% or more.

      • Submitted by Pat Terry on 01/31/2019 - 11:17 am.

        Absolute nonsense. There are plenty of examples of single payer providing cheap, effective health care, and zero examples of free market solutions working. Because the free market doesn’t work for health care. Because it will make it prohibitively expensive for those who are sick. Its just nonsense

        • Submitted by Bob Barnes on 01/31/2019 - 12:38 pm.

 you were saying? That is a free market solution that is currently working in the US and prices are roughly 80% lower than other hospitals/clinics.

          Single payer isn’t cheap and only rations care because it can’t reduce costs any other way. IF those single payer nations were paying their fair share on drugs, their costs would be nearly equal to ours.

          We can lower our costs by 80% or more overnight which would put us at half or less the cost of any single payer system. That is a mathematical fact.

          • Submitted by Pat Terry on 01/31/2019 - 01:00 pm.

            Yes, as I was saying, absolute nonsense. That a clinic network uses a different pricing mechanism brings costs down for certain kinds of treatment doesn’t address any of the issues with the healthcare system

            • Submitted by Bob Barnes on 01/31/2019 - 03:02 pm.

              You clearly don’t know how markets work or what free markets are then. They are providing top quality care at 20% of the cost right here in the US under this messed up system. They are the model of how we should be running things.

              • Submitted by Dennis Wagner on 01/31/2019 - 03:49 pm.

                Seems that a lot of the Google search results strongly disagree with your conclusions. So we get to chose, BB or ~ 813,000,000 google results. Who wins the credibility contest?

                • Submitted by Bob Barnes on 02/01/2019 - 09:10 am.

                  Google? Seriously ? You do know they skew results based on bias right? Even former Google engineers have admitted that. You’ll notice that the top results are all Kaiser…a completely biased organization with an agenda.

                  I gave you an example that is working despite the messed up system we have and they are far less expensive than ANY single payer or socialized system on the planet, by a lot.

                  I’ll take the 80+% reduction in costs any day over a govt controlled mess that is nearly as expensive with worse outcomes.

                  • Submitted by Dennis Wagner on 02/06/2019 - 05:59 pm.

                    BB, you really got to be kidding me: From your perspective: Everything is a left wing conspiracy, with that mentality, you will never lose, despite having .zero factual evidence to support it. Might just as well argue with a wall, same results.

              • Submitted by Paul Brandon on 01/31/2019 - 06:41 pm.

                A totally free market means that you can cherry-pick your customers (can you say no pre-existing conditions). That cuts costs way down, but it means that people who need medical care the most can’t afford it.

      • Submitted by Todd Hintz on 01/31/2019 - 12:41 pm.

        Free market is pretty much a non-starter. It hasn’t worked anywhere else in the world and it won’t (and isn’t) working here. All you’ll get is the same collusion that we see in other markets. Regional players will all consolidate until there are a couple of national companies, who will then squeeze out competition no matter where it springs up.

        And, if by some miracle you prevent this from happening, there’s still the issue of profit motive in the system. The CEO will still want his private jet, his dry cleaning paid for by the company, and his mistress and wine cellar covered.

        (All true stories, by the way. Courtesy of a friend who does forensic accounting.)

        Being for-profit companies, they’ll try to maximize income while minimizing expenses because they’re beholden to the stockholders. Unfortunately, that is not conducive to keeping the population healthy. They’ll go back to denying pre-existing conditions, putting caps on care, denying vital procedures, and so on.

        Just like they did before.

        • Submitted by Bob Barnes on 01/31/2019 - 03:00 pm.

          That is not how a free market works. That is a govt regulated market where the big players buy off Congress to run competitors out (see Dodd Frank for example). The current system in the US isn’t free market either. We have a monopolistic system filled with fraud and racketeering. We have politicians that refuse to enforce 100+ year old laws to end all that.

          In a free market, competition always exists. Look at almost any product in the stores to see a somewhat free market in action. Apple can’t squeeze everyone out of the cell phone market. Others pop up and offer phones at lower prices. That’s how a free market works. Without profit, there is no motive for innovation. Take a look at nations like Russia, Cuba etc for examples of that.

          The reason they were capping pay outs or dropping policies was due to govt regs and mandates. Competition is all but gone. In a free market you choose what your policy covers. It’s not mandated by the govt. Costs of medical care would plummet as would cost of premiums. Insurance would be much cheaper because there wouldn’t be nearly as many claims due to people just paying out of pocket. Fewer claims and lower care costs = lower premiums , so low everyone could afford it. A family of 4 would likely spend about $200 a month on health insurance under the free market.

          • Submitted by Kurt Anderson on 02/01/2019 - 02:41 pm.

            “Left to themselves, economic forces do not work out for the best except perhaps for the powerful.”

            Galbraith, Economics and the Public Purpose (New York: New American Library, 1975), p. viii, xi.

    • Submitted by Mark Kulda on 01/31/2019 - 11:58 am.

      France has an interesting model but I’m not sure its one Americans would want.
      The system was paid for through a roughly 6% tax on income by the employee and about 12% by the employer. Plus there are co-pays on every treatment provided so the system is not free to consumers. There were recent reforms that tried to bring those rates down by charging higher taxes on higher income citizens. This also wouldn’t be popular in the US.
      The treatment in France follows a somewhat unpopular system in the US. Consumers have to designate a ‘referring doctor’ to get primary care and then must get a referral from that doctor to see a specialist. That’s the HMO style system that people in the US hated. If the ‘referring doctor’ refuses to let you see a specialist then you have to pay for the specialty care all on your own.
      Emergency treatment is novel in France and I wish it were implemented here. In the US, when you call an ambulance, a paramedic or EMT arrives at the call and then they transport you to the hospital. In France, the ambulances are staffed with emergency doctors so the very first treatment is by an MD not an EMT. Great idea, but they are not part of the public system and you have to pay for them separately.
      Herein lies the biggest problem. The payment to providers in France is woefully inadequate for US standards. The average MD in France earns about $90,000 a year while in the US its more than double that. Over $180,000 a year. (Medical school in France is very, very cheap though so no $200,000 student debt bills!) Still, how many bright young people will go into medicine if that’s roughly going to be their salary? This highlights the endemic problem with Medicare for All. The reimbursement rates to keep the system from bankruptcy will be so low that it will imperil the quality of care. Wait times for care in France are more than four weeks for specialists. Not sure if that will fly in the US.
      A buy-in or optional program is not much better. The government run program will have much cheaper rates because the government, being the biggest buyer of healthcare, can drive the reimbursement rates lower than what the private sector can bargain for. Soon the private payers will be driven out and the only option will be the government option. Then with low reimbursement rates, providers will be extremely squeezed to cut corners. If the government doesn’t own or operate the providers, there will be severe cutbacks to service and quality.
      Curiously in France, 85% of the citizens take part in private supplementary insurance which is what would probably happen here in the US under Medicare for All. But then that begs the question how much wasteful duplicity will there be?
      While Medicare for All is a great moniker, Americans likely don’t have any idea of what it really means once you look carefully at the details. And once the details are known, they almost certainly won’t like the reduced quality of the system that would undoubtedly ensue.

      • Submitted by Paul Yochim on 01/31/2019 - 01:02 pm.

        Mark, you are misinformed if you think the average medical school debt is $200,000. Mine was almost that when I finished training 35 years ago.

        • Submitted by Mark Kulda on 01/31/2019 - 09:22 pm.

          You are right, Paul. I just pulled the $200,000 figure as an example and I’m sure it is much higher now. But my point was even without an enormous debt load, I don’t think a $90,000 average annual salary is going to be very enticing to many people. I have a friend whose sister is an NHS nurse in England and they have the same problem. They are woefully understaffed because they don’t pay enough and the people they do have are less than the best. He admits his sister doesn’t really want to be a nurse and he says she’s not even good at it. She just took it because its a job. Do we really want that here?

      • Submitted by John Edwards on 01/31/2019 - 03:07 pm.

        Mark’s solution is worth considering, but he makes a common mistake when he said: the system was paid for through a roughly 6% tax on income by the employee and about 12% by the employer. No. As any employer knows: it the employee who pays the 18 percent tax. This is similar to another myth: my employer pays half of my social security. False. That concept is simply a bookkeeping ruse fostered by politicians. The employer withholds 6.2 percent from the worker’s paycheck, as well another 6.2 percent he sends directly to the federal government. The cost to the employer is the same whether all 12.4 percent is deducted from the employee’s paycheck or not.

        That is similar to the employee who thinks he got a tax “refund” when what actually happened was his over payment was returned without interest. As Eric’s column points out, wording matters.

  8. Submitted by Pat Terry on 01/31/2019 - 11:22 am.

    The only “Medicare for All” that will get enacted is the optional one. That should have been part of the original ACA. The mandatory one will never survive judicial review, much less the fight the insurance industry will put up.

    It should be “Medicare for anyone who wants it.” If you’d rather keep your private insurance, knock yourself out.

  9. Submitted by Bob Petersen on 01/31/2019 - 11:29 am.

    This is entirely a misnomer because many Democrats are now admitting that they want single payer so they can continue to move to a government takeover of healthcare. They think they can have everyone covered because ‘we are behind the rest of the world’ and then there is the absolute fallacy that healthcare is a right (a right does not infringe nor cost anything to another individual).

    Government has time and again it is horrible at running anything. Just look at the VA as that is what would happen. They have to ration care and those in charge falsify reporting. If anyone deserves care, it is our veterans and our government fails them. But instead, scores of hurting vets suffered.

    Then go to the rest of the world has. It is two tier. For those that have private insurance get to the front of the line. For those that need anything have to wait for long periods of time. Add to that, the cost is astronomical. My friends in Canada hate their care. It’s only good for routine things but terrible on anything relatively serious or specialty care.

    Add to it that all of the metrics used to validate the ACA was falsified to where states sued because of it. We were sold by Obama that families would save $2500 per year and that families could keep their plan and their doctors. Only to find out that was the biggest lie ever! Costs went through the roof, coverage disappeared, and it left families absolutely lost. And let’s not get into all the problems people have just signing up.

    So to cover this as, meh, it’s only small potatoes because of word nuance is misleading to say the least. I would have expected this article to be more forthright in what people like Kamala Harris is trying to do, just another leap into the desire for government to take the whole thing over.

    • Submitted by Pat Terry on 01/31/2019 - 11:49 am.

      Rather than do a point by point refutation of the numerous, obvious falsehoods in this comment, I am just going to address the idea that the idea of health care as a right being a fallacy.

      Its not a fallacy because its not something that is objectively true or false. Its an opinion. Some people believe that everyone should be entitled to affordable healthcare. And some people believe that you aren’t – that if you are sick and can’t afford medical care, that you are out of luck.

      • Submitted by Bob Barnes on 01/31/2019 - 12:47 pm.

        A “right” cannot involve anyone it can’t require someone else do something, pay something, provide something etc. That is why healthcare is not a right regardless of what anyone wants to claim.

        Yes everyone should be able to purchase healthcare at an affordable cost but no govt system will ever make it affordable. Only free markets can make things affordable by competition and innovation. About the only reason places like the UK and Canada don’t spend as much as we do is because we’re covering the drug costs. If they had to pay what we pay, they would be right there with us on costs.

        • Submitted by Pat Terry on 01/31/2019 - 01:10 pm.

          Rights can’t involve anyone else? That’s completely absurd. The reason someone’s rights are an issue at all is in the application of how they apply to other people.

          Again, there are many systems where governments have provided affordable universal healthcare. And zero systems where the free market has done it.

          • Submitted by Bob Barnes on 01/31/2019 - 02:49 pm.

            Rights do not require another person to do anything. Your right to say what your want does not require someone else to provide you with something. Healthcare requires someone treats you. Therefore it is not and can not be a right.

            I gave you an example of the free market. You cannot keep saying none exists. There are many more here in the US like the Surgery Center of Oklahoma. You know exactly what a procedure will cost before you ever walk in the door. Their prices are posted online. Compare those prices with others (if you can find them). You will find they are 20% of the cost of most other places for the same exact procedures.

            • Submitted by Matt Haas on 02/01/2019 - 10:29 am.

              I thought the healthcare system is supposed to collapse at the 40-45% reimbursement rates of Medicare. It will apparently flourish at 20%? That’s some “interesting” logic, to be sure.

    • Submitted by Dennis Wagner on 01/31/2019 - 11:53 am.

      BP, don’t want to get on your bad side, but “Government has time and again it is horrible at running anything” This is a pretty broad statement! Does it include WWII, FBI, CIA, Interstate System, Hoover Dam, Desert Storm, the founding of the country, the Louisiana Purchase, building of the Panama canal, Landing on the moon, Civil Rights, Social Security, EPA etc. etc. Got a bunch of veteran buddies that are fine with the VA, medicare.

  10. Submitted by Tim Smith on 01/31/2019 - 12:04 pm.

    It is easy to be for things, the big question is how do you pay for it? The Bern’s plan would add $32 trillion to the debt in next ten years. How do you tax that? Or how do you convert that from money currently spent by States, individuals and businesses? Sanders doesn’t even try to.

    I said this last week, only chance any method works is if you get providers to accept the Medicare fee schedule aka make a whole lot less per patient and procedure. Good luck.

    • Submitted by Pat Terry on 01/31/2019 - 12:56 pm.

      Bernie Sanders used imaginary numbers and funny math, but there are serious people trying to solve this.

    • Submitted by Syuart Orlowski on 01/31/2019 - 12:59 pm.

      That same study says the US would save $2 trillion overall by adopting Medicare For All. And we would cover 30-40 million more people. How can we afford to keep the system we have now? We pay twice as much per person on healthcare as Canada and three times as much as England. And the quality, according to studies, is worse.

      • Submitted by Bob Barnes on 01/31/2019 - 02:34 pm.

        Pretty much every word of that is false. The UK spends a little more than half a what we spend as does Canada. They have worse quality as well. 18 out of the top 20 hospitals are in the US. We have the best quality of care despite what Kaiser claims. Socialized medicine is simply rationed (either you wait long periods of time to get treatment or you are denied certain treatments). Also, those nations have a 2 tier system where the rich have private insurance and get any care they want immediately while everyone else has to wait.

        • Submitted by Paul Brandon on 01/31/2019 - 06:44 pm.

          That’s why we rank about 17th in the world in mortality, and it’s getting worse every year. Doesn’t sound like the world’s greatest to me.
          We do have the world’s best treatment for rare diseases, but that doesn’t help most of us.

        • Submitted by Mark Kulda on 01/31/2019 - 09:36 pm.

          And, (I like the point made earlier but it needs repeating now), the cost disparity is so high between the US and other countries because we are massively subsidizing their drug costs. Drugs cost was less in other countries in part because we pay for the R & D with our high prices.
          Plus one other major factor that doesn’t make it into any of these studies has to do with outcomes. Americans simply have a far worse lifestyle than other countries. People keep saying Netherlands is a great example of a health care system that works because it has great outcomes. But Dutch people have the highest average level of physical activity of anybody in Europe. In the US we have a very high obesity rate, very low rate of physical activity and the highest fast food ratio in the world. So you can see why our outcomes are not going to be very good. It’s not because of the medical system and because of this we don’t need to destroy it by forcing it though a single payment system that will stifle innovation and quality.

          • Submitted by Frank Phelan on 02/01/2019 - 01:16 pm.

            We taxpayers pay for a good deal of the research into new drugs, then in an act of socialism we hand that over to the drug manufacturers free of charge.

            In any case, they spend more on marketing than on research.

          • Submitted by Paul Brandon on 02/01/2019 - 01:43 pm.

            Drug companies spend more on advertising than they do on research, and money spend on both advertising is spent mostly on me-too drugs to compete with existing and profitable drugs; not for new drugs to treat currently poorly treated conditions.

        • Submitted by RB Holbrook on 02/01/2019 - 09:27 am.

          “We have the best quality of care despite what Kaiser claims.”

          Because what do experts know, right? Free market! It must be better!

          The fact that Canada has better health care outcomes than the US, even though it spends less money, should mean something. The fact that Canadians and Britons are largely satisfied with their systems also should mean something (yes, I’m sure you can dredge up several anecdotes to the contrary. Duly noted; don’t bother).

          • Submitted by Mark Kulda on 02/01/2019 - 01:05 pm.

            It’s tough to compare satisfaction levels. People in the US are very satisfied with the quality of their care because it is a top notch system. They are not happy about how much it costs. If you took the UK system and the Canadian system, with their long wait times and other problems, and you subjected American consumers to those conditions, I’d bet the satisfaction of Americans with the UK and Canadian system would be very low. In the UK, they are short about 50,000 doctors and almost 100,000 nurses due to low pay. Americans want the best health care but they seem to want somebody else to pay for it.

            • Submitted by RB Holbrook on 02/01/2019 - 02:25 pm.

              People in the US are not satisfied with how health care is distributed.

              Overall, Canadians are very satisfied with their health care system. As far as the UK goes, look what happened when PM Thatcher proposed getting rid of National Health.

              • Submitted by Mark Kulda on 02/01/2019 - 04:36 pm.

                Just because citizens are enamored with their own country’s health care system doesn’t mean we should necessarily adopt it elsewhere. If you took Britons and Canadians and brought them here to the US and asked them to compare, I’m sure they’d rave over our system. If you took Americans to the Canadian and British system and asked them to rate it, they’d almost certainly hate it. So such comparisons about satisfaction mean absolutely nothing.

                • Submitted by Paul Udstrand on 02/02/2019 - 11:20 am.

                  It’s kind of funny when “free market” champions try to argue that customer satisfaction is irrelevant. Customer satisfaction is supposed a core principle of market paradigms.

                • Submitted by Karen Sandness on 02/03/2019 - 05:32 pm.

                  During the lead-up to the ACA, I had a lull in my workload and happened to get into reading British newspapers on the subject of health care. One of the papers asked if any readers had experienced both the British and American systems, and if so, which they preferred.

                  They received 800 replies, and since I was at loose ends, I read them all.

                  Only ONE person preferred the U.S. system, and he was a physician who thought that he could make more money in the U.S.

                  Not that all the respondents were sold on the British system, though. Some of them had traveled or lived in a number of countries, and about 10% said, “Our system is fine, but the French/Swedish/German/Canadian/whatever system is better.” Never the American system.

                  Japan has one of the less generous universal health care systems, but even my fellow American-born translators who live over there prefer it to the U.S. system. The premiums are based on your household income, and the copays are large, but if your copays exceed a certain amount, you receive a rebate, and there is no charge for treatment of certain catastrophic or chronic conditions.

                  One could also ask Americans who have lived in European countries or suffered illnesses or injuries while traveling there. The reviews are generally favorable.

                • Submitted by RB Holbrook on 02/04/2019 - 08:49 am.

                  Never mind the experts.

                  Never mind the opinions of the people who actually use it.

                  I see a trend.

  11. Submitted by Syuart Orlowski on 01/31/2019 - 12:55 pm.

    Sorry, but no. Medicare For All is referring to a bill, which would create a single payer system in the US. The ‘buy-in’ is called the buy-in. They are not interchangeable. People say that ‘Medicare for All’ and ‘single payer’ healthcare can mean a lot of things, but that’s not really true. I think Kamala Harris just misspoke in that interview

    Secondly, who is really in love with their insurance plan? I am not. Hardly anyone I know does. People love Medicare, Medicaid and MinnesotaCare (evidenced by surveys). Our system is a mess, we need real reform. A ‘scary system’ is one where we pay the most per person for care, while it ranks towards the bottom of the industrialized world in quality overall. Like we have now.

    • Submitted by Pat Terry on 01/31/2019 - 01:27 pm.

      A lot of people do not want to replace their private insurance with single payer. Look at how angry people were with the ACA, which only required them to buy insurance.

      The buy-in is the only viable option. Its also the only thing that stands a prayer of getting by the Supreme Court.

      • Submitted by Karen Sandness on 02/01/2019 - 11:33 am.

        One of the reasons that people who hated the ACA hated it was that the threshold for subsidies was too low for many parts of the country. I recall it was something like $47,000 at first.

        In high-cost states, that is barely middle class, and to be required to buy high-premium, high-deductible insurance on top of that was intolerable.

        • Submitted by Frank Phelan on 02/01/2019 - 01:18 pm.

          It also didn’t help that Dems stood by silently while it was savaged by the right in waves of well funded attacks.

          • Submitted by Karen Sandness on 02/03/2019 - 05:20 pm.

            Right, and since the process was so secretive (Obama holding closed-door meetings with the insurance companies? I hated it when Cheney held closed-door meetings with the energy companies, and I hated this. No president should hold closed-door meetings with any industry. It reeks of corruption.) that a lot of people I talked to here in Minneapolis thought the Dems were working on single-payer.

            Why shouldn’t they have believed it? There was no one telling them anything different.

            Accordingly, the right wing propaganda machine began spreading horror stories gleaned from Canadian and British tabloids. They played upon the fact that most Americans had no idea what kind of plan Congress was working on, did not realize that it bore no resemblance to the Canadian or British systems, and were unaware that the Canadian and British systems are completely different from each other.

            I went looking for detailed information about the details of the plan, and I had to dig through the website of the Kaiser Family Foundation to find it. I do not recall an executive summary being released anywhere else, and the one I finally found online appalled me.

            It was mostly corporate welfare for the insurance companies: granting them a captive clientele, allowing them a loss ratio much more generous than the one they had done just fine on in the 1990s, allowing age discrimination, and subsidizing their exorbitant premiums for part of the population. Yes, there were some good provisions, such as not allowing rejections for preexisting conditions, but most of the worst traits of the insurance industry were left untouched.

            The ACA is one reason why I was never an unquestioning fan of Obama. He came up with this adaptation of the Heritage Foundation plan either in a naive attempt to win Republican votes or because he meekly asked the insurance companies what they would accept. In effect, he compromised with himself in an attempt to win Republican votes and instead of making the small Blue Dog Caucus give in to the far more numerous Progressive Caucus, he went the other way around.

            Given the sorry story of the ACA, I would LOVE it if the Democrats would begin with a full-blown, Canadian-style single payer bill or a British-style full-service government-run medical system. Maybe both. I would like to see them keep insisting on it in Congress and to make up explanations of the system that would amount to no more than five bullet points on an index card. They would promote these bullet points to their constituents at every opportunity. They would be as stubborn as Republicans trying to repeal the ACA.

            After a few months of this, they would say, “OK, Republicans, maybe this is a bit much. What do you propose?”

            And then, maybe, just maybe, we would end up with a public option.

      • Submitted by Syuart Orlowski on 02/03/2019 - 01:44 am.

        I would contend that the political climate has changed a lot since 2009. Just look at the popularity of Bernie Sanders and Alexandria Ocasio-Cortez. I don’t think they would get media time back then.

        I would also argue that a single payer system is the economically and morally right thing to fight for. It has no chance of passing for the next few years, but after that who knows. I will continue to fight for the dream even though it seems impossible.

  12. Submitted by Todd Hintz on 01/31/2019 - 01:05 pm.

    Option #3

    I didn’t see Eric address an option #3 in his column, so I thought I would bring it up.

    #1: Private insurance goes away entirely.
    #2: People have the option to buy into the public program or keep their current plan if they prefer.

    Splitting the difference though, there’s another way. Have everyone on the public plan. They all benefit and all contribute. But this doesn’t lock out the private insurers. The government will provide basic coverage and the private insurers can provide supplemental coverage, should people want it.

    I’m personally not in favor of this option as it creates a two tiered system, so it’s not as egalitarian as I would prefer. But it would help reduce the panic of people who are afraid we’re getting rid of all private insurance.

    • Submitted by Mark Kulda on 01/31/2019 - 09:53 pm.

      Well you’ve stumbled onto a dirty little secret that supporters of Medicare for All and the Buy-In option don’t want you to know.
      The system you described is exactly what they have in France and Germany. Low income citizens get ‘free’ health care paid by a tax on the rich (but they still have to pay high co-pays and even premiums). But they get treated at the public owned and public paid medical clinics and hospitals. Middle and upper income citizens all have private insurance and get private treatment. Guess which system has better outcomes? The public system has long waits and lower quality care and you guessed it, lower outcomes.
      But when gathering statistics to derive an ‘outcome’ for comparison purposes, the entire nation’s health care outcome, both public and private, is blended into one statistic and THAT statistic is compared to the US system.
      So when you hear that Germany and France have a better system that’s publicly paid and it has a better outcome, just know that the ‘outcome’ is only better because of the quality of the private system that people buy separately.
      It is not a fair apples-to-apples comparison. The US system is far superior to any in the world. It has a terrible payment problem that can be fixed without destroying it though single payer or a buy in option.

      • Submitted by Paul Brandon on 02/01/2019 - 12:08 pm.

        Please reconcile ‘best system’ with ‘shorter life span’ without biting your own tail.

        • Submitted by Mark Kulda on 02/01/2019 - 01:07 pm.

          Lifestyle is one major reason if not the dominant reason. Compare obesity and diabetes rates in the US with both. The US has far worse rates. Factor out both and redo the comparison and I’d bet there would be a major difference in mortality and outcomes.

      • Submitted by Paul Udstrand on 02/04/2019 - 08:25 am.

        Mark, I don’t know what data or who’s metrics your looking at but the US has consistently the worst outcomes among the nations you’re citing here. Your information is simply mistaken.

      • Submitted by Paul Landskroener on 02/07/2019 - 09:50 am.

        The disparate health outcomes in US, Germany, France reflect more on the incomes of those who use the public system than any flaws in the health care system. At most, only 20% of health outcomes depends on access to or use of health or medical care. The other 80% depends on things like living environment (housing, crime, air and water quality), lifestyle choices (diet, smoking, drinking), and genetics. The quality of medical care matters, but not as much as most people think.

        • Submitted by Paul Udstrand on 02/07/2019 - 10:59 am.

          Sorry Landskroener but your shifting apples to oranges when you make statements like:

          “At most, only 20% of health outcomes depends on access to or use of health or medical care. The other 80% depends on things like living environment (housing, crime, air and water quality), lifestyle choices (diet, smoking, drinking), and genetics. The quality of medical care matters, but not as much as most people think.”

          We’re talking about paying for health care, that means medical practice and health care outcomes… not over-all population health.

          You can’t conflate the two. Even in healthy populations and scenarios where people are have better standards of living people still have heart attacks, and cancer, and broken bones. THOSE are the metrics we’re looking at, and US providers fail in that comparison.

          Yes, the health care industry in the US tries to deflect it’s poor performance by claiming we have an unhealthy population to begin with, but statistically that’s irrelevant. It’s just a way trying to claim that people wouldn’t need health care in the first place if they lead healthier lives… so we shouldn’t complain about the quality of health care we’re getting, we should just eat more fruit.

    • Submitted by Connie Sullivan on 02/01/2019 - 12:00 pm.

      “Splitting the difference though, there’s another way. Have everyone on the public plan. They all benefit and all contribute. But this doesn’t lock out the private insurers. The government will provide basic coverage and the private insurers can provide supplemental coverage, should people want it.”

      Todd: This is Medicare, precisely.

      That’s why everybody likes it. I like it, because Medicare fights to lower the obscene costs providers charge (we must finally give Medicare the right to negotiate drug prices folks!), and my private insurance supplements that by taking up the co-pays and deductibles.

      If our goal is to provide affordable health care for everyone–the largest “pool” we could have–then a public option is a Must.

    • Submitted by Charles Holtman on 02/01/2019 - 01:57 pm.

      No one but you has offered this, but it seems like the obvious and appropriate approach. Society decides that everyone should have access to a basic level of health care (a thoughtful society works out what that should be). Applying it to all addresses risk pool issues. Folks can always exercise their choice to augment that thru the private market.

      For some parts of the economy, it makes sense for supply to be fully, or almost-fully, collectivized (i.e., socialized). Health insurance is not one of these (nor would it be feasible). Much as a guaranteed income (or guaranteed retirement/disability income, i.e., Social Security) doesn’t preclude folks going out and earning more, a guaranteed level of health care shouldn’t preclude folks who can and choose to from acquiring more.

      Contrary to the dishonest silliness from the Right, those on the left favor a thoughtful mixed economy and don’t think Pol Pot had it right.

  13. Submitted by joe smith on 01/31/2019 - 01:17 pm.

    The DNC needs to get its messaging straightened out. Tom Perez said they want health care for all not just the wealthy, 90% of Americans are on some form of a health plan. Since when is having 9 out of 10 folks covered considered elitist?
    There are many things the free market could do to lower prices but we have elected officials (on both sides) beholding to insurance companies and drug manufacturers.
    Sadly, it has come to a failed ACA and now “free” healthcare for all. News flash, having 9 out of 10 folks covered is as good as you can do. Healthy folks 25-40 have never bought health insurance and won’t in the future.

    • Submitted by Dennis Wagner on 01/31/2019 - 03:56 pm.

      JS, not to get picky, but aren’t “insurance companies and drug manufacturers” suppliers/vendors competing in the free market? Should they not be able to set their pricing on “whatever the market will bear”? Isn’t patent law in place to allow the inventors many years of exclusive rights to their inventions, read: set prices to “what ever the market will bear”.

      • Submitted by joe smith on 01/31/2019 - 06:07 pm.

        Dennis, not even close to a free market. Insurance companies can’t sell over state lines, by law. To get a product to the market place you have to jump through hoops set up by Federal Govt. Most small companies can’t afford the price of getting a drug cleared by the FDA.
        Nothing in the Medical world has free market principles, from insurance, to drugs available, to actual care…..

        • Submitted by RB Holbrook on 02/01/2019 - 10:09 am.

          “Insurance companies can’t sell over state lines, by law.”

          They can and do. The five largest health insurers in the US (United Health, Anthem, Aetna, Humana, and Cigna) all operate in multiple states. The only law preventing insurers from crossing state lines is the law that an insurer will not do it if it doesn’t seem profitable to do so.

          “To get a product to the market place you have to jump through hoops set up by Federal Govt.”

          For the most part, insurance is regulated by state governments (States’ rights! Booyah!). There are requirements for health insurers set by federal law, but those are the same for insurers operating in one state or multiple states.

          The idea that insurers can’t cross state lines is more right-wing talking point nonsense. Honestly, I marvel that it has had such currency.

  14. Submitted by Paul Brandon on 01/31/2019 - 02:11 pm.

    Another option is the German system.
    Payment is still by private insurance corporations, but under tight government regulation. There is a government price list for all common procedures, so all insurance companies charge the same rates. So they compete, not on price, but on service. The more customers they can attract, the more their executives make. Plenty of incentive.
    There’s a good description at
    You can see that German health care costs are about 9% of GDP, while ouirs are about 17% — nearly double.

  15. Submitted by Lee Wenzel on 01/31/2019 - 02:14 pm.

    Medicare is an entitlement program and not insurance. The distinction is that by definition insurance has premiums underwritten to risk. My Medicare premiums are not related to my personal risk. We insure for things over which we have to no control. Do I have control over my health? We insure only for loss. Health is a goal of well-being.

    Secondly, Medicare is not a single-payer. Many Medicare programs are subcontracted to private payers such as U-Care.

    Why do we need a payer? Why can’t I sign up with Mayo, Allina, Fairview, HealthPartners or other delivery systems and disintermediate the payers saving maybe 30%? Why can’t we replace paying claims retrospectively with prospective payment the way we do with education? We moan about costs, but every cost is someone else’s revenue. Therein lies the answer to my questions.

    • Submitted by Gerald Abrahamson on 02/01/2019 - 09:45 am.

      Medicare exists because there is *no* private market that can provide health care insurance at an affordable price. The “target market” is, by definition, highly prone to medical expenses that are relatively more expensive AND more difficult to treat due to age and frailty. The definition of insurance, or how insurance functions, is the one never mentioned: The ones who do NOT file (significant) claims are the ones who subsidize those who DO file large claims. This is for ALL types of insurance, not just health insurance. The people who do not file auto claims subsidize those who do file auto claims. The people who do not file homeowners’ claims subsidize those who do file homeowners’ claims, and so on. The key point is the subsidy portion of insurance. With people who are over retirement age, there is no available insurance *because* there are no similar groups that can subsidize their claims. Thus, the option is to have some type of subsidy (Medicare in the US, funded by a tax on workers) OR to have no health care coverage for that age group (given the lack of a universal health care system in the US).

    • Submitted by Paul Udstrand on 02/04/2019 - 08:29 am.

      Medicare IS a taxpayer financed health insurance program. It’s no more an entitlement than any other service you pay for. If pay for a private golf club membership, that entitles you to golf on that golf course. If you pay premiums to Park Nicollet THAT entitles you to use their services.

  16. Submitted by James Hamilton on 01/31/2019 - 03:35 pm.

    To the best of my knowledge, no one has proposed a detailed plan for what they are calling “Medicare for All.” Many seem to expect that the individual’s cost would be the same as it is for those currently Medicare eligible. They wouldn’t be.

    Last year, my total out of pocket was $4394, including Medicare Part B, my Advantage plan premiums, my co-pays, and my pharmacy costs. My costs were heavily subsidized by the Medicare Trust Fund and by the restrictions on charges imposed on providers by Medicare. The current trust fund is woefully insufficient if we tried to apply it to the population at large. Many providers claim Medicare reimbursement doesn’t cover their costs as it is. If that is true, then they would likely refuse to treat Medicare patients unless those rates increase.

    My wife’s insurance premium exceeded $600 a month, even though subsidized by the State of Minnesota last year due to a law intended to soften the blow of premium increases. That $7200 is more than three times my combined cost for Part B and an Advantage plan. Even if you subtract twenty percent for insurer overhead and profit ($1440) her premiums were $5760, more than twice my combined premiums.

    Where do people think the difference will come from? It will have to come from them (payroll taxes or premiums) or from their employers (ditto). There is no third option.

    I have long thought the German system referred to by Paul Brandon was something America should look at, if only because it includes both public and private insurance.

    • Submitted by Connie Sullivan on 01/31/2019 - 04:56 pm.

      We could start to handle this by reversing that big tax cut the Trump-McConnell team organized inn 2017–there’s about $1.5 trillion dollars right there to fund social benefits for Americans who are not wealthy. Going to waste (no jobs created, no capital improvements made because of those tax cuts–have you been paying attention to that news, that contradicts a whole part of the premise for the tax cuts to corporations and the wealthy?)

      Just a thought, for all you naysayers who are worried that there’s not enough money to help with health care for all Americans. There is enough money,

  17. Submitted by Tom Anderson on 01/31/2019 - 04:45 pm.

    Private insurance will continue to exist (thankfully) for people who want better care, just as it does in the UK. Private doctors will still exist as many won’t take the pay cut demanded by a government paid plan. Taxes will have to go up to pay for the enlarged government plan, and that 32 trillion figure is probably the necessary amount to be raised.

  18. Submitted by Joel Stegner on 01/31/2019 - 04:46 pm.

    What we need is the public option. People can get their insurance through private or public plans – their choice. The private plans are subsidized by employers, in lieu of paying taxes. Anyone can sign up for a public plan with no preexisting conditions limits and income based subsidies – paying what is reasonable. If over time, employers drop their insurance, they start paying taxes to support the public option. I think that over time, many will make that choice, as why do employers really want to be involved in their employees healthcare. Without surging insurance costs in the picture, pay increases can reflect the success of the company – and the benefits of success not all going to executives and shareholder. If you have had any significant health expense, and almost everyone does eventually, you will realize that very few of us could afford the services we use without government assistance, any more than we can afford the full cost of public education.

    • Submitted by Paul Udstrand on 02/01/2019 - 09:13 am.

      The only problem with the public option approach is financing. No insurance scheme works if you don’t have a big enough pool to pay the bills, so yo have to come out the gate with a large pool.

      It’s important to remember that employers wouldn’t pay additional taxes or replace their current premiums with taxes in an MFA regime. MFA “premiums” would simply be deducted from paychecks like they are now in lieu of premiums. A scenario wherein employers pay nothing for their MFA employees but pay premiums for their privately insured employees yields a predicable outcome. The reason companies make such large co-contributions to current policies is private policies are so expensive, and the pool is too small.

      The best way to make a public option approach work, is to make it an opt-out. Everyone is automatically enrolled unless they opt-out. Simply adding a public option to the market will eventually kill private insurance, but it will be a vastly more expensive, time consuming, and complicated process.

      What you’ll see if anyone tries to simply add a public option to the market, is politicians tweaking Medicare so it doesn’t have an “unfair” advantage over private plans… in other words it won’t really be the universal option that it should be.

    • Submitted by Bob Barnes on 02/01/2019 - 09:29 am.

      None of that will reduce the cost of care and therefore the cost of insurance. None of these solutions address the actual cost of care. All anyone ever talks about is insurance. Why should a rattlesnake bite cost 50+k to treat?

      • Submitted by Bob Barnes on 02/01/2019 - 09:33 am.

        Oops hit post too soon. One case in San Diego was for 154,000 to treat a snake bite. The anti venom runs 2300 a vial and takes 4 to 6 vials usually. That’s about 9k for the drug, why is the hospital charging so much? The 154k bill had a pharmacy charge of 83,000+. How can you charge 10 times what something cost you and get away with it? (And I’m being generous as they get it wholesale so it’s cheaper).

        We need to fix the cost issue and insurance will fix itself. We need to enforce anti trust laws.

        • Submitted by Karen Sandness on 02/01/2019 - 11:38 am.

          The private insurance system is part of the reason that the list prices for medical treatment are so high.

          Insurance companies contract with providers saying that they’ll pay between 30-50% of the list price of any procedure. Therefore, in order to break even, the providers have to inflate their prices. This is a horrible outcome for the uninsured.

          • Submitted by Mark Kulda on 02/01/2019 - 01:12 pm.

            Actually, the government not paying enough to cover the cost of the actual treatment is the major factor why list prices are so high. Government (Medicare and Medicaid) are the largest buyers of healthcare in the country. Yet they reimburse at about 40% of the billed rate and its not enough to cover the provider’s costs. They then ‘squeeze the balloon’ to raise prices so that private insurance and cash payers make up the difference. You are right in that there’s an entity that causes list prices to go up, but you have the wrong entity. The blame is entirely on the government’s reimbursement rates. It’s also a major reason why MFA would seriously harm the quality of the care provided in the US.

            • Submitted by Paul Udstrand on 02/01/2019 - 03:35 pm.

              Medicare reimburses at rates around 60%, not 40%. But you really have to understand is the fact that providers are charging 300%-500% over cost, so even at Medicare rates they’re making plenty of money. For instance for a typical colonoscopy in MN providers will bill out $8,000 to $10,000. That’s nowhere near what it actually costs to perform a colonoscopy, including rent. The actual cost is around $1,500 – $2,000 including labs and anesthesia. So even if they “only” collect 60% of what they bill out, they’re still getting $4k – $6k.

              So no, the idea that providers are billing higher to compensate for low reimbursements is an old canard. When I worked in the hospital management was always telling us that the hospital only collected 42 cents on every dollar they billed out. Then we’d find out that they were charging $120 for an egg crate mattress you buy at Target for $20. And so it goes.

              Our health care costs are high because everyone overcharges and passes the cost on to someone else. No one can walk away from heart attacks or high blood pressure so one way or another people pay, or they die and suffer without.

              • Submitted by Mark Kulda on 02/01/2019 - 04:45 pm.

                This is from McKesson and just for hospitals:
                Here are the average reimbursement rates for large hospitals, organized by geographic region, according to the Revenue Cycle Index.

                Midwest — 29.88 percent
                Pacific — 27.51 percent
                South Central — 27.14 percent
                Mountain — 25.36 percent
                Northeast — 25.31 percent
                Southeast — 24.48 percent
                Northern Plains — 21.43 percent
                Southern Plains — 20.97 percent

                Factor in clinics and I’m sure the rate gets higher. But I not sure its around 60-percent of the billed rate.

                But you are correct, the chargemaster ‘billed’ rate is ridiculously higher than what the cost is. In the Workers’ Compensation system, I know of one hospital that implanted a medical device that ‘cost’ the device maker about $1500 to product but the hospital’s billed rate for the device was over $40,000! With so many stories like that, people really should understand insurance is not perfect but it tries to bring some reason to those costs by pushing back.

                • Submitted by Paul Udstrand on 02/02/2019 - 08:30 am.

                  Mark, you are correct regarding these rates, I stand corrected, thank you.

                  However, it doesn’t really tell anything other than that private insurers are paying far too much, and providers are charging far too much. If we should find that the reimbursements are too low once we switch to MFA, we can raise them. This isn’t a campaign to wipe out providers.

                  The current rates are all produced by a completely dysfunctional market with costs and billing that are completely out of control, everyone participant in the system is reacting to the chaos.

                  • Submitted by Mark Kulda on 02/05/2019 - 11:01 am.

                    I do hope that the reimbursement rates are set higher than what they currently are. (Full disclosure…vested self interest….my daughter is about to graduate with a nursing degree and I want her to earn decent wages while she can!) The experience in some other countries is the payment to doctors and nurses and techs is woefully below what it is in other countries.

                    • Submitted by Paul Udstrand on 02/07/2019 - 09:10 am.

                      Congratulations to you and your daughter. However you’re mistaken regarding comparative wages and salaries in developed countries, but it’s too complex to delve into here. Suffice to say that right now employers and executives determine wages, not reimbursement rates. And your daughter would do well to find work in as a MNA member.

        • Submitted by Paul Brandon on 02/01/2019 - 01:45 pm.

          The plural of ‘anecdote’ is not ‘data’.

        • Submitted by Dennis Wagner on 02/01/2019 - 04:53 pm.

          BB, could we please agree that 1 data point does not make a trend, OK an example of something that went out side the norm, fine, but not a trend line. Kind of like saying it was 26 below in Minneapolis, that doesn’t make Minneapolis the coldest place in America, much less the planet, it was for 2 days out of 365~ .548% of the year, since it happened last ~ 20 years ago, the number becomes insignificant. kind of like the probability of getting bitten by a snake in America is ~ 1/ 37,500 or ~ .0027%. Some of us would call that rationale vs irrational analysis.

      • Submitted by Paul Udstrand on 02/01/2019 - 12:51 pm.

        Bob, it’s not intended to reduce the cost of private insurance, it replaces private insurance with a less expensive universal public funded insurance. This will reduce the cost of health care over-all because a nationwide insurance program with 300 million patients will obviously have more leverage over provider charges. Insurance companies already negotiate discounts, Medicare does the same.

        The primary driver of health care cost in the US is over-pricing, it’s that simple. Our providers charge 2 – 20 times (or more) more than comparable services elsewhere, and our providers deliver worse outcomes and service over all.

  19. Submitted by Paul Udstrand on 02/01/2019 - 08:28 am.

    Arriving at a party late in the game has it’s drawbacks, and Eric is demonstrating one of them here. This “difference” between the two single payer systems is a non-issue, it’s a difference without a distinction.

    Look, Medicare RIGHT NOW is primarily administered by private insurance companies like Blue Cross Blue Shield and no is proposing that we change that in any dramatic fashion. Allowing private companies to offer insurance has never really been an issue because they simply won’t be able to compete with the public option in terms of coverage and premiums and anyone who want’s to pay more for health care or can afford to pay more will do so anyways.

    A majority of American’s want single payer, so let’s get over the “Pink Scare” narrative because it’s been an manufactured excuse to maintain the status quo neoliberal market model for decades. Single wasn’t kept of the table by fear of socialism, it was kept off the table by a powerful industry that makes trillions of dollars a year in the existing health regime. The two Parties haven’t kept MFA off the table because it’s a toxic idea, they kept off the table because they were servicing the benefactors.

    There’s a really nice article about past Party Servitude in the Washington Post:

    ” Democratic attacks on AOC expose the party’s fear of taking on moneyed interests” AOC is Occasio Cortez.

    Anyways, the point in discarding the illegitimate “Pink Scare” narrative is that single payer is and always would have been incredibly easy and popular to implement. THAT’S what Sanders’s had actually revealed, that’s why the Democratic elite fought so hard to keep people like Sanders off their ballots for decades. It’s just breaking down because the current system is undeniably unsustainable, and the failed compromises of the past are no longer acceptable.

    • Submitted by Tim Smith on 02/01/2019 - 11:05 am.

      the majority of Americans want single payer until they hear the more about cost, rationing,etc. then the majority becomes a minority. It is easy to yes to a concept, the devil is in the details.

      “Makes Trillions a year” what industry is that specifically?

      How does a public option save money?

      • Submitted by Paul Udstrand on 02/01/2019 - 12:04 pm.

        Tim, American support only increases substantially when people hear about the benefits and savings. 20% -30% off the top in saved administrative costs. Billions in saved pharmaceutical costs. Universal and irrevocable coverage regardless of age or employment status. The elimination of “networks” that control where you can even get health care. Absolute freedom to go to any clinic, hospital, or specialist you choose no matter where you happen to be when you need health care. Not to mention drastically improved efficiencies pushed out by nation wide electronic medical records that can be accessed by any provider of your choice no matter where you are. And you never see another bill again for the rest of your life.

        And what does this all cost? In the end about a trillion dollars less than we’re spending right now. I know… sounds like hell.

        • Submitted by Tim Smith on 02/01/2019 - 01:10 pm.

          you make it all so incredibly simple in a few paragraphs, it really isn’t though. Good luck getting medical providers to sign up, all patients on the Medicare fee schedule is horrifying to them and the reason we don’t have national health care. Make insurance companies the boogey man like good dems do, but the providers are a bigger obstacle and have both parties bought and paid for.

          Please share your polls and any other substantial facts and data to back up your “argument”. Thanks.

          • Submitted by Paul Udstrand on 02/01/2019 - 03:39 pm.

            Tim, almost every provider is already Medicare approved, they have to be for a variety of reason, in other words- they’re already signed up. Medicare reimbursement rates are more than sufficient to sustain providers providers are currently massively overcharging.

          • Submitted by Paul Udstrand on 02/01/2019 - 04:19 pm.

            Tim, the information I’m providing is ubiquitous, that’s why I’m not bothering to provide any links, anyone who make a honest effort to look it up will easily find it. Granted, neoliberal economists stumbled at first when they tried to evaluate the proposal, but savings and costs are pretty clear at this point.

  20. Submitted by Paul Udstrand on 02/01/2019 - 12:44 pm.

    About rationing, I’m sorry if I’m duplicating an existing but comment but it’s important to point out that Americans are already one of the heavily rationed populations in the world regarding health care. We are rationed by three basic mechanisms:

    1) Tens of millions of people simply don’t have access to reasonable health in the place because they have no insurance.

    2) Tens of millions more have insurance they can’t afford to use because of the high deductible and co-pays. This keeps them away treatment.

    3) Everyone else, with the exception of super wealthy who simply pay cash for their health care, is stuck with insurance companies that limit access to procedures, medications, specialists, or treatment outside of the a given geographical area or network of providers. Private insurance companies charge you tens and tens of millions of dollars a year to figure out how to deny you coverage so they make their investors happier. The administrative costs behind all those “reviews” is staggering and completely unnecessary, and in the end, it denies you coverage…THAT’S rationing for profit.

    All of this goes away with Medicare for All. With the exception of a few boutique providers almost every provider in the country is already Medicare certified and ready to accept Medicare patients… done. You go your doc or clinic or hospital, get your health care, and they bill Medicare, done. We could do this tomorrow, the system already exists, we just need to build it out to cope the larger scale.

    And a couple words about the poor Canadians, first, they have better access to better health care than we do. You may point some example of rationing here or there, but single Canadian example (or alleged example since most anecdotes turn out to myth) we can point to hundred of American’s who aren’t getting timely medical attention or any medical attention at all. Second, MFA isn’t a Canadian model. The Canadian model gets 94% of its funding from the Provinces, and they have way fewer Provinces than we have States. The MFA would be truly Federal program, so while there would be regional spending adjustments do to cost of living etc. you wouldn’t have funding issues driven by population based revenue models.

    Meanwhile you do all know that the US ranks last in most evaluations regarding our access, outcomes, and quality of patient experience right? We pay twice as much for worse access and health care.

    • Submitted by Mark Kulda on 02/01/2019 - 01:19 pm.

      One slight clarification….when you say “Private insurance companies charge you tens and tens of millions of dollars a year to figure out how to deny you coverage so they make their investors happier”….you actually should say “make their policyholders happier by letting them pay less than they would if they had to pay cash for all their medical treatment,” All managed care plans in Minnesota are non-profit and don’t have ‘investors.’ That being said, all have very hefty surpluses (which would be profit if they were for-profit organizations which they are not).

      • Submitted by Paul Udstrand on 02/01/2019 - 03:54 pm.

        Actually you’re mistaken Mark. You’re private insurance does NOT pass the savings on to policy holders, that’s why premiums have to been going up for decades. That’s why the US health care industry and the insurance industry are among the wealthiest and most profitable in the world.

        Getting back to a previous comment about negotiated discounts, one huge difference between Medicare and private insurance is that the discounts, or lower reimbursement rates Medicare calculates, actually saves Medicare users money. Private insurance does not pass along those “savings” to it’s customers, it treats those savings as profit, that profit goes to executives and shareholders.

        Now we have a little different situation here MN because our insurance sector is more heavily regulated. We discourage for profit players, but nevertheless our not-for-profit insurance and HMO’s do rather well, and they skim the discounts. You may recall a few years ago Mike Hatch had to file a lawsuit against Blue Cross Blue Shield precisely because they were pocketing “savings” instead of passing them back to their policy holders. Seems to me he sued another group, I want to say Alina but I could be wrong about that.

        At any rate, no none of this gets you lower premiums in the private sector, and MN is one of the few states that enforces not-for-profit requirements.

        • Submitted by Paul Landskroener on 02/07/2019 - 10:05 am.

          I’m afraid you’re the mistaken one Paul Udstrand. Regarding health insurance proper (i.e., not employer self-insurance for which the employer pays the medical bills and pays a fee to a health insurance companies to administer the program), premium rates are approved by the MN Department of Commerce and have to bear a relation to the expected and actual costs. It is not uncommon for MDoC to deny proposed rate increases when it determines that the rate is not justified. (Similarly, MDoC is concerned that plans do not UNDER-price their policies such that they won’t be able to pay claims.)

          Yes, health plans factor in small margins (2-4%) for capital to invest in new technology and other improvements, but there are not “shareholders” to whom “profit” is distributed. Yes, their executives are well-paid, but not disproportionately to their counterparts in other industries, and even if they volunteered their services and received nothing, there would be little “savings” to spread out.

          Furthermore, the ACA limits health plans to 15% of a premium dollar spent on administrative costs; 85% has to go to medical costs.

          Finally, we have a competitive health plan market in MN under which market forces require plans to develop and propose rates that (a) are sufficient to pay claims, (b) are sufficient to provide a small margin, and (c) are not so high that customers will go elsewhere.

          • Submitted by Paul Udstrand on 02/07/2019 - 11:16 am.


            You might want to read an entire comment, I said:

            “Now we have a little different situation here MN because our insurance sector is more heavily regulated. We discourage for profit players, but nevertheless our not-for-profit insurance and HMO’s do rather well, and they skim the discounts. You may recall a few years ago Mike Hatch had to file a lawsuit against Blue Cross Blue Shield precisely because they were pocketing “savings” instead of passing them back to their policy holders. Seems to me he sued another group, I want to say Alina but I could be wrong about that.”

            Now if you want to claim that we’re limiting profit margins to 4%, you’ll need to show us the books. And Obamacare did not eliminate Insurance profits, the 85% requirement applies to administrative costs, not over-all spending. Profit is NOT an administrative cost. Furthermore, if you’re referring to “health plans”, like HMO’s who combine insurance with care, the 85% rule just simply requires that they pay themselves more on the backside.

    • Submitted by Tom Anderson on 02/01/2019 - 05:56 pm.

      “1) Tens of millions of people simply don’t have access to reasonable health in the place because they have no insurance.”

      And yet they can receive care at any emergency room in the country.

      “almost every provider in the country is already Medicare certified and ready to accept Medicare patients”

      And yet many, many providers and doctors have stopped accepting any more Medicare patients.

      “Meanwhile you do all know that the US ranks last in most evaluations regarding our access, outcomes, and quality of patient experience right?”

      Which is why people from all over the world come to the U.S. (even at our own local Mayo Hospital) to receive this poor care.

      • Submitted by Paul Udstrand on 02/01/2019 - 09:27 pm.

        Emergency rooms treat emergencies, they don’t do cancer screening or routine physicals or provide mental health services, nor do they do basic maternal health or post natal follow up etc. So no, emergency rooms aren’t plan B for people without insurance. You can’t get diabetes or high blood pressure, or afib management in an emergency room. And emergency room treatment is twice as expensive, so you wouldn’t want to send people to emergency room for health even if you could.

        Providers could not refuse Medicare patients if EVERY patient is a Medicare patient. And no, they’re not going to go out of business or flee to some other country that pays no more or even less than Medicare.

        People travel all over the world in search of health care, there are clinics like Mayo everywhere. The fact remains that the US has ranked in the bottom of amost every health care metric when compared with almost any other developed country. Health care isn’t a tourist industry, we have 300+ million Americans who need health care.

  21. Submitted by Dennis Wagner on 02/01/2019 - 01:28 pm.

    A reference point for cost would be helpful, 2017 reference.
    Cost per capita USA, $9,403, Population: 325.7 Mil=$3,062,557,100,000 per year on medical/healthcare, that’s over $3T for those that don’t like the zeros.

  22. Submitted by Kurt Anderson on 02/01/2019 - 02:20 pm.

    Is anyone under age 65 aware that Medicare is not a single-payer plan? It does not compete with the private market; they supplement each other. My wife and I are both on Medicare and our family premiums (not counting the Medicare tax that we still pay) total more than $700 for Part B (x2), supplement (x2) and prescriptions (x2). So the proponents of “Medicare for All” still have a lot of ‘splainin’ to do.

    • Submitted by Paul Udstrand on 02/01/2019 - 04:02 pm.

      Kurt, it’s important to understand that Medicare for All would not be the same Medicare your currently using, it would much more expansive and inclusive. Some of the problems with your current Medicare regime flow our several current requirements that Medicare NOT compete with private insurance, or that it’s restrained from policies that private insurance covers. This is why you have a mish-mash of private, supplemental, and Medicare and Medicaid. In other words, it’s the presence of the private insurance market that actually creates most of your problems. Those problems evaporate when Medicare take over all payments. You’d be going from having multiple policies to having a single policy, and that would be much more efficient, affordable, and easy to use. That’s how we splain it.

      • Submitted by Kurt Anderson on 02/04/2019 - 08:50 pm.

        I support efforts to fix all this, but I am skeptical that massive, as opposed to incremental, changes are the best approach. In our recent lives we were self-employed persons paying full market rate for insurance. High deductible policies are this simplest form of insurance you can have == you pay thru the nose, the carrier pays nothing (but the fee reductions the carrier negotiates for you are very valuable). The ACA (aka Obamacare) gave us a couple of years of premium reductions but then they shot up as never before and carriers began to exit the market. I attribute this to the determination of ACA opponents to destroy the initiative rather than apply important tweaks and fixes.

        In short, expensive as it is, we reached Medicare age in the nick of time and feel relieved even at $700/month. However, some of our friends, retirees from employer-sponsored insurance plans, suffered some major sticker shock.

    • Submitted by Dennis Wagner on 02/01/2019 - 04:42 pm.

      Well KA, not sure what to say, for the wife and myself looks like ~ $135/Month x 2, medicare stand alone, + ~ $25 each for part D, that’s a long climb from ~ $750/month when the wife had std. over the counter health insurance plan with a +$3K deductible.

      • Submitted by Kurt Anderson on 02/04/2019 - 08:41 pm.

        I assume you have a Medicare Advantage plan for your “supplement.” The terms here get confusing. We looked at that but realized that as “young” Medicare participants we have a similar dilemma as young people in the insurance market. Medicare Advantage saves a lot of money while you are young and relatively healthy but you are not allowed to upgrade later to a traditional “supplemental” plan with better coverage when you need it. So we opted out of Medicare Advantage (cost $0-85) and as one adviser suggested, “sucked it up” and got into a traditional supplemental plan which has a going rate of about $219 per person. Our Part D is $14 more than yours; we accepted that in order to have our own version of a single payor (a single carrier).

      • Submitted by Kurt Anderson on 02/04/2019 - 09:24 pm.

        BTW if you are not purchasing a supplemental policy, you are rolling the same kind of huge dice that younger persons roll when they choose not to be insured.

        • Submitted by Dennis Wagner on 02/05/2019 - 03:13 pm.

          KA, nope we are running naked medicare, the bottom line on supplements was this, if you expect to be in the hospital for what is it longer than 60-90 days, it will pay off maybe! The number of folks that are continuously in the hospital for longer that 60-90 days is ~ zero. and if they are, its probably from an accident, not an illness. And that is where the insurance guy more or less hung up on me, along with never responding to my questions, on what is the cost difference for X, Y Z. Maybe I’ll be eating my words, but 30 some odd years ago I took the life insurance companies bet, (I bet I was going to live) so far still living, I thought betting I was going to die was not good for my disposition. Same issue, I bet I am not going to get 90-100 day + continuous illness. Need to ask yourself a question, who has the $ and what is their bet? They are betting you aren’t going to get sick, you are betting you are!

    • Submitted by Paul Udstrand on 02/02/2019 - 09:11 am.

      One thing that might effect current Medicare and Medicaid premiums is work history and income. It can also make a difference what State you’re in. When my mom was living here in MN a trip to the ER for AFIB got her a $600 bill. When she moved out to MA that same ER visit cost her nothing. Also if you have private supplemental plans (not everyone does or can afford them) etc. etc. and if you did or didn’t enroll at a certain time.

      Again, all of this goes away with MFA because everyone is automatically and irrevocably enrolled at birth, actually BEFORE birth given the fact that pre-natal coverage is automatically provided. And since Medicare and Medicaid under an MFA regime are responsible for all of your bills, you don’t need supplemental coverage of any kind.

      Not only all of this, but most MFA proposals include providing hearing-aid and eye glass coverage witch is huge for people over 40.

  23. Submitted by Paul Udstrand on 02/01/2019 - 04:25 pm.

    Just one more point. The truth is that MFA would actually make providers money because it would save them millions in administrative costs. Right now there are dozens of payers, all with their own process, discounts, and rates. And when these payers challenge or deny payment the providers have to scramble to figure who’s gonna pay and that ranges from legal fees to collection agencies. All that goes away with MFA, you have a single payer with one set of rates and procedures. I’m guessing the savings in administrative costs alone would more than make for the lower medicare reimbursements rates.

  24. Submitted by Alan Straka on 02/02/2019 - 11:35 am.

    They want to put everyone on Medicare and get rid of the insurance companies. Anyone on Medicare can tell you the only way Medicare works is by buying a medigap or Medicare advantage plan-from an insurance company. There is a whole lot Medicare does not cover plus it only pays 80 percent with no cap on out of pocket expenses and if you want drugs included you need to purchase a drug plan-from an insurance company. A single payer system like they have in other countries might work, Medicare for all without an insurance backstop, not so much.

    • Submitted by Paul Udstrand on 02/02/2019 - 05:06 pm.

      Alan, again, MFA wouldn’t be the same medicare you currently have, it would be much more comprehensive. You wouldn’t need private insurance backstops anymore. Those backstops arise from the fact that Medicare is currently limited in coverage and availability, in order to prevent it competing with private insurance.

      • Submitted by Alan Straka on 02/03/2019 - 05:56 pm.

        As I mentioned, a single payer system as in other countries might work but if candidates insist on calling it Medicare without any further clarification then pointing out Medicare’s shortcomings is fair game. I know they are being disingenuous in using the name Medicare, it is dishonest and they should be called on it.

        • Submitted by Paul Udstrand on 02/04/2019 - 08:32 am.

          Alan, since we would IN FACT be expanding Medicare into a universal single payer regime… it WOULD be called Medicare, there’s nothing disingenuous about calling some thing what it is? Your car is not the same car Henry Ford was rolling off the assembly lines back in the 1920s… but it’s still a car.

    • Submitted by Dennis Wagner on 02/03/2019 - 09:02 am.

      AS, it appears some supplemental insurance sales guy wrapped your head around you need medicare supplemental rhetoric hype, or you will go bankrupt! Had that discussion its a bunch of bunk. You must have a part D (Drug Prescription) from the private sector today, its part of the medicare program. There is Part A and Part B medicare, they have different deductibles. My medicare experience W/O a medigap or supplemental etc. has been very positive. A lot more so than when I had over the counter insurance, no referrals required, nothing is out of network, Every facility I have used takes medicare, and the coverage has been exceptional, but I live in the metro area. What is interesting is, folks complain that a medicare for all would more or less bankrupt the system, however then they complain about co-pays or deductibles, i.e. away to keep the system solvent and reduce abuse. We can also expect that the free market insurance folks will find away to stay in business one way or the other. .

      • Submitted by Alan Straka on 02/03/2019 - 05:28 pm.

        Plain vanilla medicare is great if you are relatively healthy but if you get seriously ill, a lack of an out of pocket cap can bankrupt you. i would be doing just fine without a supplemental policy but like any other insurance, I buy it just in case something really bad happens.

  25. Submitted by Paul Udstrand on 02/03/2019 - 09:50 am.

    Forgive me for not point this out earlier but this is complex subject with a lot of moving part. Some here currently on Medicare have been pointing out some of it’s flaws, and those are legitimate observations. But many complaints center around the fact that some Medicare recipients have to buy “supplemental” coverage, Mr. Srakka referred to it as private “backstopping”

    Here’s the thing, the fact is that Medicare was created to be a backstop for holes in private insurance coverage, and that’s exactly what it is. Most of the people on Medicare (over 65, disabled, etc.) would be considered high risk for a variety of reasons. If you’re on Medicare more than likely you couldn’t afford to NOT be on Medicare because private premiums for high risk patients are prohibitively high. One of the problems with Obamacare is that while it make private insurers accept applicants regardless of pre-existing conditions… it doesn’t regulate how much private insurance can charge those applicants.

    So the truth is that you’re not really buying private insurance to fill gaps in Medicare coverage, you’re getting Medicare to fill private insurance gaps.

    Originally the plan WAS to expand Medicare but the health industry oligarchs blocked that agenda with the help of BOTH parties. This had nothing to do with fear of socialism by the way, it was always about the money. In any event, this why Medicare today is so much more complex and problematic, it’s not the health care backstop it’s supposed to be as much as the catch basin for patients the private sector doesn’t want to risk providing coverage for. AND as THAT kind of entity, Medicare is prohibited from “competing” with the private sector. Much the same way the Post Office was for decades prohibited from delivering packages like those UPS and Fedex were delivering. Those prohibitions had nothing to do with the Post Offices ability to deliver packages… they just weren’t allowed to compete in the market.

    It’s important to remember that back in the olden days (1964) when Medicare/Medicaid were created, one of the primary drivers at the time was providers like hospitals who were complaining about having to treat so many patients who couldn’t pay.

    With MFA all those “gaps” and market “competition” restrictions are eliminated because Medicare becomes the “single payer” for everyone.

    • Submitted by Kurt Anderson on 02/04/2019 - 09:07 pm.

      So for truth in labeling, let’s call it SFMA (Super-Medicare for All).

      • Submitted by Paul Udstrand on 02/05/2019 - 09:55 am.

        Right now Medicare is restricted to certain applicants… making it available to everyone is perfectly well and honestly described by the phrase: Medicare for All… The “all” part is the difference.

  26. Submitted by Robert Gauthier on 02/04/2019 - 12:46 pm.

    Medicare is not cheap, it has little preauthorization, which is why seniors like it- no hoops to jump through.
    This quality makes it ripe for fraud, which is why Medicare”mills”
    Have been used by crime to defraud the government, which leads to an over aggressive DOJ chasing down fraud, whether it exists or not (looking at high volume providers and assuming they commit fraud until the providers can demonstrate otherwise).
    Expansion of Medicare, by itself, will not increase access as many providers either directly or indirectly refuse care to these patients due to poor reimbursement or excessive work to get reimbursed.
    Getting a fixed price insurer will create market change, but it may not be good.

    I have often wondered why we don’t make a national catastrophic care insurance program to cover the expensive illnesses, say a lifetime cap of $50000 for any one condition, partially paid by a tax on everyone, heavy taxes on booze, cigarettes, large fines on DUI and other “lifestyle” crimes and then let people buy insurance for maintenance and low cost medical needs, (preventative care, cancer screening and basic dental. This would (should) lower premiums by extending costs to whole population for serious illnesses, increase general health by maintenance and screening, and finally buy generic meds for common diseases, such as HTN, hyperlipidemia, Diabetes and give them away free – cost is minimal and benefits are cost effective.

    • Submitted by Paul Udstrand on 02/05/2019 - 09:53 am.

      Health is expensive, which is why health insurance is so expensive. Again, Medicare would reduce our health spending by about a trillions dollars. Medicare premiums in a MFA regime would be considerably lower than they are now, and they would be much lower than private premiums.

      Medicare is not more prone to insurance than private insurance, fraud is fraud and you find it everywhere.

      The problem with public catastrophe plans it that it’s just another of socializing risk while privatizing wealth. It just creates yet another mechanism that allows private insurers to dump their liabilities onto the public.

      MFA is better because not only would it cover catastrophic scenarios along with everything else… it would actually bring costs down so catastrophes would cost as much.

  27. Submitted by Paul Udstrand on 02/05/2019 - 10:03 am.

    I would just make last comment regarding this entire conversation. One of Eric’s observations is that for some reason intermediate market solutions like a public option might be less frightening to some people than a full-on Medicare for All.

    I think people need to ask themselves why they find a dramatically better and universal health system so “frightening” to begin with? What’s so scary about health care as a human right? Why does universal and irrevocable health care spooky? Unless you are an insurance executive this represents a dramatic improvement in your life and the lives of people around you. Are you just making your comfort level of some kind a priority over everyone else’s well being? After decades of failed compromises why are you looking for another failed compromise?

  28. Submitted by Paul Landskroener on 02/07/2019 - 10:15 am.

    I think that most of those here advocating for Medicare for All really mean that they want Medicaid for All. Medicaid covers practically everything for no premium or co-pay. It is the comprehensive coverage everyone dreams of, until they realize that (a) it pays providers even less than Medicare and so many providers won’t accept Medicaid, creating access problems and (b) the cost of providing Medicaid for all would be even higher than Medicare for All.

    • Submitted by Paul Udstrand on 02/07/2019 - 11:22 am.

      “It is the comprehensive coverage everyone dreams of, until they realize that (a) it pays providers even less than Medicare and so many providers won’t accept Medicaid, creating access problems and (b) the cost of providing Medicaid for all would be even higher than Medicare for All.”

      Again, providers won’t walk away from the only insurance plan in the nation, and if rates are too low we can raise them, this isn’t plan to eliminate providers. You can’t talk about the “cost” of MFA without also talking about the reduction in over-all health care costs, and the elimination of much higher private insurance premiums. Obviously the MFA would cost more than the current regime, but over-all it would cost about trillion dollars less. People seem to keep forgetting that RIGHT NOW we’re paying two to three times more for worse outcomes and less quality. MFA doesn’t ADD to that expense, it replaces current expense.

  29. Submitted by Paul Udstrand on 02/08/2019 - 10:17 am.

    There’s a newish study that explores and explains how MFA could/would be paid for, and it’s impact on health care cost and the economy from the University of Massachusetts. You can find the PDF’s at this link:

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