The Contradiction at the Heart of Bernie Sanders' Medicare for All Plan

[BARRYOSAMA]

1 hour ago, Wabash82 said:

Don't know for certain if there are such hospitals, but I suspect that many inner-city urban and some rural hospitals are pretty close to that, simply due to the nature of the  populations they serve. 

But I am also having a little difficulty  understanding why you are so concerned about the prospect that some hospitals that can't compete at lower margins will close, with the tradeoff being consumers' overall cost for health care will be lower? Isn't that the exact outcome you've told us would result if health care was a free market system? 

When confronted by logic what will Muda do??

A. Make a personal attack.  You're the the smartest guy in the room.....blah blah blah

B. Move the goal posts to some unrelated topic

C. Both A and B

[Muda69]

11 hours ago, Wabash82 said:

 

But I am also having a little difficulty  understanding why you are so concerned about the prospect that some hospitals that can't compete at lower margins will close, with the tradeoff being consumers' overall cost for health care will be lower? Isn't that the exact outcome you've told us would result if health care was a free market system? 

I'm concerned because the lower margins won't be caused by free market competition, but due to an effective government takeover of the system.  The ends don't justify the means.

 

[Wabash82]

That’s fine. I also sometimes have an objection on principle to proposed policies or actions of our government even though those policies or actions might well be in my personal best interest, financially or otherwise. I guess I wasn’t clear as to your position because the article that you quoted at the beginning of this thread focused on questioning the practicality (economic viability) of Sanders’ proposal, rather than presenting an argument against it based on principle. 

[Muda69]

Lots of guarantees, none of them leading to anything but earlier death and the depravities of socialism.: https://spectator.org/medicare-for-all/

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.....

Reality imposes limits. Ever since we were kids, we all hated limits. Parents imposed limits. We could not have more than twelve milkshakes daily or more than eight twelve-ounce glasses of whipped cream with dinner. Never could understand why. The chocolate milk had to have some milk in it, too. Cholesterol? What’s that? Sugar? Diabetes? But, Mom — it tastes good!

Teachers imposed limits. When class was boring, we could not “go to the bathroom” every ten minutes. We had to raise our hands first.

Limits, limits. A world of limits dictated by a world of reality where there are no big rock candy mountains.

There is no question that our medical system needs improvement. If a person employed at Job 1 enjoys health coverage but contracts a severe chronic illness during the years working there, it is wrong and economically inefficient for a great capitalist enterprise like the United States that she thereupon must resist changing employment to a accept a better job elsewhere because the great health coverage at Job 2 will not cover her pre-existing condition. That is wrong and just-plain inefficient, causing skilled workers to contribute less productivity and to earn less than they can contribute and earn, and then they truly are motivated to contribute and earn.

Within our medical-coverage system, we can create economically sensible efficiencies for covering the health care needs of the comparative few who always responsibly have maintained health insurance but who subsequently, through no fault of their own, find themselves stricken with a severe disease: ALS, cancer, organ failure. The economic structure can be adjusted to externalize costs incurred by those relative few, spreading the coverage and risk among the greater population. Such a safety-net concept always has been at the heart of American kindness and decency, whether offered as crisis aid to states impacted by unexpected hurricane flooding, earthquake disaster, wildfire devastation. We cover such unexpected “Acts of God” when they strike people overseas. And we can and should find a formula for providing safety-net coverage for those stricken unexpectedly with perilous illnesses at home.

But the notion of providing free guaranteed wall-to-wall health coverage for everyone, though it sounds enticing, is a prescription for disaster.

First, under existing law, hospitals in the United States may not turn away seriously ill patients in peril. When a penurious patient is stabilized, private hospitals then may transfer the destitute uninsured patient to a public hospital. The American system as it now exists under capitalism does not allow people to drop dead in the streets. No private hospital will dare knowingly discharge an indigent patient who cannot be stabilized and safely transferred to a public facility; the liability and punitive damages it would incur for doing so deter them all.

On the other hand, if the Government institutes a system of free health care for all, there will be a huge increase in demand for health care because it then is free. That is human nature. Especially among elderly retired people with time on their hands, among hypochondriacs, and among others with empty days, such free care will populate doctors’ offices regularly with people who will burden medical workloads. The doctors will bill the Government, and the Government will reimburse. Middle-class taxpayers will foot the ever-spiraling costs with ever-spiraling taxes. “The Rich” always will enjoy access to skilled and clever tax attorneys and financial advisers who will assure that they escape the crux of the burden. As doctors’ calendars fill with appointments, it will become harder for truly ill patients to get an appointment to see that same doctor promptly when more urgently needed. Longer scheduling times will result in more illnesses among the public as minor ailments become more serious. In time, people will be compelled to give up long-standing personal health relationships they have enjoyed with their doctors and to seek appointments with less qualified doctors who, because of their generally weaker skills or more hostile “bedside manners,” are less in demand, less desired, and therefore can offer more calendar openings. In time, even their calendars will fill without their having to improve their skills or manner.

Because of the increase in medical appointments, and because the Government will be paying doctors at a rate lower than that of private insurance, doctors will have to see more patients each day to aggregate the same income, resulting in their providing less face time with each patient. The more timid patient who needs some extra time to explain a malady, a family history, or medications now being taken will not have the time to do so if perceiving that the doctor is in a rush. The doctor will be less curious to pause and inquire because she or he will have to move on. The quality of personal care will be compromised severely.

It will take longer to schedule a surgery date when needed. It will be harder to line up the surgeon desired. The quality of follow-up care will be compromised. More medical procedures and diagnoses will be delegated to less skilled physicians’ assistants and nurses’ aides. Because the Government will be paying, more necessary procedures will be denied arbitrarily by bureaucrats as medically “not needed,” more necessary pharmaceuticals will be denied as unnecessary or as not compatible with an idiosyncratic government list of approved uses. This is how the world actually works, even in current Medicare for the elderly. As the Government’s costs continue to skyrocket, new cost-cutting measures will be needed. More procedures will be denied, more medicine prescriptions denied, and older people will be deemed financially untenable to maintain alive with as much effort. Practical cost-cutting requirements will result in allowing octogenarians to die sooner, with less effort, denying many of them ten or more additional years of quality life.

One day, you will be as old as they.

If the goal of Medicare for All is to provide the “Non-Rich” with the same coverage provided to “The Rich,” that goal will fail as it always does. “The Rich” will not be disadvantaged for long. A private medical economy will develop, whether as an illegal underground “black market” or in transparent broad daylight. Concierge doctors will provide the best of private care for “The Rich” who will pay out of pocket for government-denied medicines, just as the cosmetic-surgery industry now works for those who can afford optional tummy tucks, cosmetic laser, and liposuctions. 

...

Despite best intentions, Government never works as well as private enterprise. That is why people turns to UPS, FedEx, and local mailbox stores at a mark-up even though the Government runs post offices. That is why people register their automobile documents at the Auto Club whenever possible even though the DMV exists for that purpose.

I personally lived under state-run medical socialism for two years in the mid-1980s. We were the laboratory for today’s vision of “Medicare for All.” We could choose from among a small number of political-party-affiliated health plans. But, really, it all was the same. Two images stand out these three decades later:

Whenever any of our family had to go to the doctor for any reason, we always saw this same elderly couple among patients in the waiting room. I once asked the doctor about them. He explained: “Oh, they are perfectly healthy. They just like to come by every day. Since it costs them nothing, and the Government pays for their doctor’s visit, why not?”

The Government was paying, and my income-tax rate was 70 percent for an income of $30,000 a year.

 

My other memory — far more serious. There was an outbreak in our community of Hepatitis A. The indicated vaccine to protect against Hepatitis A was gamma globulin. Everyone sought the vaccine. The doctors explained, however, that the Government saved money under socialized universal health care by restricting who may receive a gamma globulin vaccine. Under the guidelines of socialized medicine, the gamma globulin vaccine could not be administered until the percentage of local residents who contracted Hepatitis A reached a certain percentage of the population. Only then would the Government guidelines regard the situation as “epidemic,” thus eligible for community vaccination. As soon as the required number of outbreaks was reached, only then could he administer the vaccines under the rules of universal health care. However, he assured us — small comfort — that we soon would hit the outbreak threshold, raising us to “Epidemic” status, and then everyone could be vaccinated.

We endured the grim daily ghoulish ritual, waiting each morning to learn who next had been infected. Only 18 more to go. Only 13 more. Only 9. Only 7.

My friend and neighbor, Dan, flew his entire family to the United States of America to visit with his wealthy parents — and to get everyone a gamma globulin injection that his parents would pay for. Others who could afford to do so hired private doctors, paying in black-market American dollars for the vaccine. And those who, like most of us, could not afford private care in an economy where the cost of government health care led to such high taxes that we had no spare cash, just waited. Only 4 more to go.

Someone very dear to me was one of the last three to get infected before the magic “epidemic” number was hit. That person got hit with it hard. It was not life-imperiling, but it was debilitating for several months. That person had been earning a very good salary, was a star employee at work. For the next several months that person no longer could work. Under the impact of Hepatitis A, that person could not make the long daily commute to work, nor work the long hours. After consuming vacation days and sick days, that star performer was terminated. That person’s income ended. The entire family was financially devastated and needed to go on the public till. One Government program feeding into to the next, all taxpayer funded.

That, too, is the reality of Medicare for All. Compassion leading to epidemic and depriving dignity. Socialism always results the same.

 

[DanteEstonia]

23 hours ago, Wabash82 said:

Don't know for certain if there are such hospitals, but I suspect that many inner-city urban and some rural hospitals are pretty close to that, simply due to the nature of the  populations they serve. 

 

Tonopah NV has that issue. They have to have state funded medical care, because the nearest medical facility is 165 miles away in Pahrump.

[Muda69]

Obamacare Isn’t Paving the Way to Single-Payer: https://www.nationalreview.com/2019/05/obamacare-failure-shows-folly-government-health-care/

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This week the first congressional hearing on Medicare for All took place in the House Rules Committee. The following day, the Congressional Budget Office indicated that the transition to a single-payer system “could be complicated, challenging, and potentially disruptive.”

As a physician I wholeheartedly agree. And I don’t believe we are ever going to get there.

Ten years ago, when Obamacare was first being put together, many people — including yours truly — warned that the new law was a big step in the direction of single-payer. This was because it relied so heavily on government overreach, control, and subsidy, and locked patients into a unified form of insurance that covered many services you might not need (so-called essential benefits). In order to maintain profitability, insurers had to increase premiums, copays, and deductibles and shrink provider networks to the point where the insurance became completely dysfunctional. It seemed only a matter of time before the government would have to take the whole system over and provide coverage for all directly, as in Canada.

But then something happened that the Obamacare architects weren’t expecting. More than 6 million people a year, most of them under 35 and relatively healthy, decided to take the tax penalty rather than pay for an overstuffed policy they didn’t need. More and more insurers dropped out.

Then President Trump signed a tax bill that eliminated the penalty for failing to buy Obamacare-compliant insurance. Though Obamacare still exists, patients are now no longer coerced into it, and the Trump administration has used this sudden opening as an opportunity to add more choice with short-term skinny plans, association plans, and expanded direct-care models. These free-market solutions fit a health-care system with exciting new emerging treatments in the worlds of surgery, cancer immunotherapy, and genetics. I believe that coverage more suited to an individual’s needs may actually lead to more people choosing or being able to purchase private insurance than before.

So the dysfunction and unaffordability of the Affordable Care Act has brought us farther away from single-payer, not closer. The health-care solutions of the future are more and more high-tech, expensive, and personalized, requiring creative payment plans including installments, expanded health savings accounts, or payments that vary according to how well a patient responds to treatment. One-size-fits-all insurance is becoming less useful all the time.

The failures of Obamacare have helped inform both doctors and patients about what we wouldn’t like or want about single-payer coverage: restricted access to doctors and treatments, long waits, underpaid providers, higher taxes.

Nine years after Obamacare was signed into law, the employer-based health-care system, which provides coverage for over 170 million people, is still the bedrock of health insurance in the U.S. In fact it has never looked as good as it does now, compared with Obamacare’s woeful attempts to plug the holes in the individual market. As a physician who sees patients daily, I am more convinced than ever that a single-payer system would destroy the heart of the system by banning private insurance. Luckily, this is never going to happen here in the U.S., no matter how much Senator Sanders and others may want it to.

 

Edited May 3, 2019 by Muda69

[Muda69]

Bernie Sanders Thinks Medicare for All Would Solve America's Health Care Problems. It Would Make Them Worse.: https://reason.com/2019/05/08/bernie-sanders-thinks-medicare-for-all-would-solve-americas-health-care-problems-it-would-make-them-worse/

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Bernie Sanders (I–Vt.) thinks there's a crisis in American health care, and only Medicare for All can solve it. He's half right.

There is a crisis in the nation's health care system. But that crisis is Medicare itself—the program as it exists today.

In an op-ed for USA Today, Sanders says the current status quo is an "economic and medical emergency for millions of Americans." The solution, he argues, is to expand Medicare, the health coverage program for seniors, into a national, government-run health care program, because Medicare "guarantees coverage."

But that guarantee only goes so far—and we may discover its limits sooner rather than later.

In 2026, Medicare's hospital insurance trust fund is expected to become depleted, according to a report last month from the program's actuaries. Initially, it will bring in enough money to pay for about 89 percent of its expenditures. Over the next 20 years, that figure will dip down as low as 78 percent.

Insolvency doesn't mean the program shuts down entirely. But what it does mean is that in less than a decade, the program won't be able to pay all of its bills. When that happens, the program's supposed guarantee won't mean much at all. Health care for millions will be in jeopardy because of the federal government's consistently poor fiscal management.

People who rely on the program may not be able to access the care they need or may face much longer wait times. Benefits might end up being scaled back, or practically unavailable even if they are theoretically guaranteed. Alternatively, Congress could raise taxes to finance the program's full costs. Higher taxes, reduced benefits, longer lines, or some combination of the above: When a shortfall hits, those are the primary options.

Sanders' call for Medicare for All, in other words, ignores the longstanding problems with Medicare itself. His advocacy for single payer is almost entirely unresponsive to the longstanding fiscal challenges of the federal government's largest health care program, which, despite their predictability and inevitability, have proven stubbornly difficult to solve. If anything, Medicare for All would increase the scale of those problems, and put care for millions more people on the line in the process.

Under Sanders' vision of Medicare for All, private health insurance as we know it today would be outlawed. That doesn't just mean no competition. It means no alternative and no escape. So if the program struggles to meet its obligations, and care suffers as a result, there's essentially nowhere else to turn. Sanders would trap every American in a system that would almost certainly struggle with financing from the outset.

That's because Sanders, it's clear, has no idea how to pay for the program he has in mind. His proposal is vastly more generous than comparable universal coverage programs run by other countries. Multiple estimates have found that it would add about $32 trillion to the federal tab over a decade, even under generous assumptions. Yet Sanders has never proposed a specific financing mechanism to offset the massive increase in government spending his single-payer plan would entail.

Nor has he answered numerous other practical, necessary questions that designing and implementing single payer would entail: How exactly would health care providers be paid? What would happen when the expansion of coverage increased demand for health care services—especially if provider payments are simultaneously cut?

American health care has real problems; it's expensive, bureaucratic, and inequitable. But decades of government intervention has, if anything, only made these problems worse—if not created them in the first place. The tax break for employer-sponsored insurance in the aftermath of World War II locked people into job-based coverage and encouraged the purchase of ever-more expensive plans, insulating individuals from the cost of their decisions. The creation of Medicare (and to a lesser extent Medicaid) rapidly funneled huge amounts of federal funding into the hospital system and coincided with decades of increased national spending on health care. Federal health care programs now represent what is arguably the nation's largest long-term fiscal challenge.

But now the long term is almost here. And instead of addressing the deep and difficult problems that persist the current system, Sanders and his followers appear to have only one answer, which is to keep doing the same thing, but more of it. Sanders-style Medicare for All isn't the solution to our health care crisis—it's just a much bigger, much harder to solve version of the same crisis we already face.