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Reason why government run health care in the U.S would be bad

Bucky

Bucky

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United States Department of Veterans Affairs. We already have government ran healthcare in the VA. Tell me if we replicate this system for the entire country it will be a good thing
 
Bucky said:
United States Department of Veterans Affairs. We already have government ran healthcare in the VA. Tell me if we replicate this system for the entire country it will be a good thing
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Medicare and Medicaid are also government run health care systems. They seem to work pretty well.

But, you still may be right. Our government is so screwed up right now that it couldn't do what every other modern nation has done: Provide universal health care for less than what we're paying now.

MAGA indeed.
 
Most of the talk I've seen is about government-reimbursed health care, not government-run health care.
 
Dittohead not! said:
Medicare and Medicaid are also government run health care systems. They seem to work pretty well.

But, you still may be right. Our government is so screwed up right now that it couldn't do what every other modern nation has done: Provide universal health care for less than what we're paying now.

MAGA indeed.
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Hospitals are closing because Medicare and Medicaid do not cover the full cost of health care. Private insurance makes up for the money lost to Medicaid and Mdedicare.

"The yawning gap between payments to hospitals by Medicare and by private health insurers for the same medical services may prove the biggest obstacle for advocates of “Medicare for all,” a government-run system.

If Medicare for all abolished private insurance and reduced rates to Medicare levels — at least 40 percent lower, by one estimate — there would most likely be significant changes throughout the health care industry, which makes up 18 percent of the nation’s economy and is one of the nation’s largest employers."

Hospitals Stand to Lose Billions Under ‘Medicare for All’ - The New York Times




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Gladiator said:
Hospitals are closing because Medicare and Medicaid do not cover the full cost of health care. Private insurance makes up for the money lost to Medicaid and Mdedicare.

"The yawning gap between payments to hospitals by Medicare and by private health insurers for the same medical services may prove the biggest obstacle for advocates of “Medicare for all,” a government-run system.

If Medicare for all abolished private insurance and reduced rates to Medicare levels — at least 40 percent lower, by one estimate — there would most likely be significant changes throughout the health care industry, which makes up 18 percent of the nation’s economy and is one of the nation’s largest employers."

Hospitals Stand to Lose Billions Under ‘Medicare for All’ - The New York Times




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If Medicare for all abolished private insurance and reduced rates to Medicare levels — at least 40 percent lower, by one estimate — there would most likely be significant changes throughout the health care industry, which makes up 18 percent of the nation’s economy and is one of the nation’s largest employers.
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So, "abolishing" private insurance would be a bad idea for sure. For one thing, Medicare does not pay the whole bill, only 80% of it. Private insurance would still be necessary, even with Medicare for all.

How is it, I wonder, that nations that spend far less than we do nevertheless seem to have hospitals still open?
 
Bucky said:
United States Department of Veterans Affairs. We already have government ran healthcare in the VA. Tell me if we replicate this system for the entire country it will be a good thing
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Alrighty then

The VA health system, as a matter of fact, does an excellent job overall. In 2018, they had over 7 million patients, about half age 65 and older. They handled nearly 120 million outpatient visits; over 15 million mental health outpatient visits; they manage over 150 hospitals and 800 clinics. That's more patients than the 7th largest private insurance company.

Numerous studies also show that the VHA is more cost-effective, faster and higher quality than private care. 90% of VHA enrollees stay with the VHA; of the 10% that turn to private care, most go right back to the VHA.

As a result, veterans who get care through the VHA are satisfied -- at higher rates than Medicare, by the way, one of the single most popular federal programs. Plus, the overwhelming majority of veterans dislike the idea of privatizing health services for veterans. (Most legislators don't like it either, as they know that paying for private care would cause VHA spending to soar.) The idea of privatizing the VHA is so toxic that almost no one ever directly advocates for privatization.

The problems facing the VA are real -- but are also vastly exaggerated, both by the media and by the extremists who despise the very idea of government providing services. It should also be screamingly obvious that private health care has huge problems in the US, especially before the ACA. I.e. screaming "The VHA sucks!!!" because of a few genuine and well-publicized issues is not a real argument, because you aren't putting it into any sort of context or comparing it at all to private health care and its myriad problems.

And of course, there are the dozens of advanced nations who offer government-managed health care, that do better than US health care on almost every count; not to mention Medicare and Medicaid, which work very well.

Aren't you glad you asked?
 
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Dittohead not! said:
So, "abolishing" private insurance would be a bad idea for sure. For one thing, Medicare does not pay the whole bill, only 80% of it. Private insurance would still be necessary, even with Medicare for all.

How is it, I wonder, that nations that spend far less than we do nevertheless seem to have hospitals still open?
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Well... that's a great question.

One.. most nations do not have the comprehensive coverage in their health insurance like we do. For example.. our medicare covers far more than most other single payer countries.

Two: They pay their providers way less money.. in many cases.. they simply have lower costs because pay in these countries is lower.

Three. They have reduced access to hospitals and care. They keep the hospitals open.. because they have fewer hospitals and fewer beds.

There is a cost in the US when we have local hospitals just minutes away in a rural area... when in another country.. that person would travel an hour to go to a regional hospital.

That's why hospitals in the US are closing. As reimbursement tightens up and decreases.. hospitals that don't have the volume..simply can't survive.
 
Visbek said:
Alrighty then

The VA health system, as a matter of fact, does an excellent job overall. In 2018, they had over 7 million patients, about half age 65 and older. They handled nearly 120 million outpatient visits; over 15 million mental health outpatient visits; they manage over 150 hospitals and 800 clinics. That's more patients than the 7th largest private insurance company.

Numerous studies also show that the VHA is more cost-effective, faster and higher quality than private care. 90% of VHA enrollees stay with the VHA; of the 10% that turn to private care, most go right back to the VHA.

As a result, veterans who get care through the VHA are satisfied -- at higher rates than Medicare, by the way, one of the single most popular federal programs. Plus, the overwhelming majority of veterans dislike the idea of privatizing health services for veterans. (Most legislators don't like it either, as they know that paying for private care would cause VHA spending to soar.) The idea of privatizing the VHA is so toxic that almost no one ever directly advocates for privatization.

The problems facing the VA are real -- but are also vastly exaggerated, both by the media and by the extremists who despise the very idea of government providing services. It should also be screamingly obvious that private health care has huge problems in the US, especially before the ACA. I.e. screaming "The VHA sucks!!!" because of a few genuine and well-publicized issues is not a real argument, because you aren't putting it into any sort of context or comparing it at all to private health care and its myriad problems.

And of course, there are the dozens of advanced nations who offer government-managed health care, that do better than US health care on almost every count; not to mention Medicare and Medicaid, which work very well.

Aren't you glad you asked?
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A few counterpoints.

One.. the difference is not so much in the quality of care.. because studies do show that the VA provides pretty good quality of care. But that's not the issue. You are talking about providers here. So yes.. I treated I the VA system. I was a contractor in VA hospitals. Some of the were good.. some poor.. but the same issue was seen in private hospitals as well.. some good some bad.

The issue when it comes to the VA.. is HOW that VA insurance is administered. Who gets qualified for care and when? How far do they have to travel?... how many visits do they get.. and so on.

Sure.. you see a study that a patient that needs a rotator cuff repair.. goes into a VA hospital and he gets the same or better care than a patient with that same rotator cuff repair that goes into a private hospital.

But..what you don't see.. is that the patient that needed the rotator cuff repair that was a VA patient.. the hoops that they may have had to go through and the delays to getting his care...

Meanwhile..the fellow with medicare.. got scheduled for surgery in two weeks without the pre authorization and other crap the VA often makes patient go through.

And in worse situations..we really don't know... because the VA has had a history of not putting those denials etc..on the books.. that's why there have been instances were Vets died while waiting for care.
 
Bucky said:
United States Department of Veterans Affairs. We already have government ran healthcare in the VA. Tell me if we replicate this system for the entire country it will be a good thing
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That's due to a lack of funding. We can point to the long wait times, the denying of claims, all the stupid **** private companies due to screw people as well. That's a dumb argument, but then again, you are are a right winger, throwing out dumb talking points without any actual argument to back it up is your MO

And also as usual, just make up a position people don't take. It's not government run healthcare, but single payer. But again, this is par from the course since you don't have any actual arguments to the real positions people take so make up ones that nobody ever made
 
Sampson Simpson said:
That's due to a lack of funding. We can point to the long wait times, the denying of claims, all the stupid **** private companies due to screw people as well. That's a dumb argument, but then again, you are are a right winger, throwing out dumb talking points without any actual argument to back it up is your MO

And also as usual, just make up a position people don't take. It's not government run healthcare, but single payer. But again, this is par from the course since you don't have any actual arguments to the real positions people take so make up ones that nobody ever made
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Hmmm... you think its a dumb talking point.

Interestingly... why do you want Trump to be in charge of your healthcare? Because that's exactly what happens with a government run single payer (medicare for all).
 
jaeger19 said:
Hmmm... you think its a dumb talking point.

Interestingly... why do you want Trump to be in charge of your healthcare? Because that's exactly what happens with a government run single payer (medicare for all).
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I'm on Medicare now. Does that mean Trump is in charge of my healthcare?
 
jaeger19 said:
The issue when it comes to the VA.. is HOW that VA insurance is administered. Who gets qualified for care and when? How far do they have to travel?... how many visits do they get.. and so on.
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With VHA, "qualification for care" is an issue because they have to verify your eligibility (service record etc). With universal coverage, those issues largely disappear.

When it comes to travel distance? For private care, that's getting worse and worse as rural communities continue to lose population, and as the profit motive encourages more and more doctors to specialize and work in urban areas.


Sure.. you see a study that a patient that needs a rotator cuff repair.. goes into a VA hospital and he gets the same or better care than a patient with that same rotator cuff repair that goes into a private hospital.

But..what you don't see.. is that the patient that needed the rotator cuff repair that was a VA patient.. the hoops that they may have had to go through and the delays to getting his care...
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Rotor cuff surgery in the US can cost you up to $25,000. I'm gonna take a risk and say that navigating the bureaucracy is easier for most vets than coughing up $10-25k, or even covering the deductible -- especially since the VA can also provide disability (and private health care insurance companies do not).

Again, studies show that wait times for VHA are as good (if not better) than in private care.

More importantly is that you can't pluck out one or two anecdotes of what's happened to you and your friends. You need to do a full comparison which covers a variety of procedures, parts of the country, population density, age of participants, quality of care, and so on.


Meanwhile..the fellow with medicare.. got scheduled for surgery in two weeks without the pre authorization and other crap the VA often makes patient go through.
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So you're criticizing a federal health coverage system by... comparing it to a federal health coverage system? Seems like an odd tactic.

(I might add that preauthorization and denial of care were routine features of private health insurance systems before the ACA.)


And in worse situations..we really don't know... because the VA has had a history of not putting those denials etc..on the books.. that's why there have been instances were Vets died while waiting for care.
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Yes, and there are also instances of people in private coverage who died waiting for care -- or worse yet, who died because they did not have any coverage at all.

Again, it sounds like you are focusing exclusively on the negatives of the VA, while completely ignoring the significant downsides of the private system, including but not limited to:
• Very high costs (high enough to cause a high percentage of bankruptcies, not to mention how the US spends double the OECD average on medical care)
• Obscure or incomprehensible billing and costs
• Impediments to job changes (since your health insurance is tied to your work)
• Profit motives resulting in massive inefficiencies that favor insurers, pharmaceuticals, hospitals etc
• Millions going without any coverage at all
• Emergency rooms slammed with people who don't have any other way to get care

What can I say, I'm not paralyzed with fear that a federal health system will be a total disaster, based on the VHA.
 
Gladiator said:
Hospitals are closing because Medicare and Medicaid do not cover the full cost of health care. Private insurance makes up for the money lost to Medicaid and Mdedicare.

"The yawning gap between payments to hospitals by Medicare and by private health insurers for the same medical services may prove the biggest obstacle for advocates of “Medicare for all,” a government-run system.

If Medicare for all abolished private insurance and reduced rates to Medicare levels — at least 40 percent lower, by one estimate — there would most likely be significant changes throughout the health care industry, which makes up 18 percent of the nation’s economy and is one of the nation’s largest employers."

Hospitals Stand to Lose Billions Under ‘Medicare for All’ - The New York Times




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Your link is just speculation. No Medicare For All law exists.

Hospitals close due to lack of patients, not because of Medicare or Medicaid. Hospitals in larger metropolitan areas tend to make good profits. It's the rural hospitals that are struggling because they typically handle fewer patients.
 
Visbek said:
With VHA, "qualification for care" is an issue because they have to verify your eligibility (service record etc). With universal coverage, those issues largely disappear.

.
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No.. they evaluate what they determine is the persons medical necessity. So you have a person that has been seen by a primary physician.. and is referred to therapy for what appears to be a torn meniscus tear. They get seen by the therapist and the therapist has to apply for visits to see them. that can take up 4 weeks (or longer if they get lost in the system). then after the therapists sees them and they aren't getting better (and sometimes.. that's because the stupid VA give the therapists visits like 2-3 visits.. and then you wait another 2 weeks or 4 weeks to be authorized for more.)…. then the patient gets referred to a surgeon. The surgeon sees them.. and then gets an MRI.. its positive.. an then the waiting game begins for authorization for surgery.

In the private sector... It usually would be seen by the primary.. right into therapy (or directly to the surgeon)… then referral to surgeon and then surgery. usually much less delay.

Now..the preauthorization does lend itself to decreasing costs... (not always in the case where a patient ends up in surgery when therapy would have fixed it but they authorized so few visits that it made therapy ineffective)..

Its one of the ways.. by the way that other countries save money. So there is a trade off..decreased access and delay in treatment... but some savings in decreasing "overutilization".

When it comes to travel distance? For private care, that's getting worse and worse as rural communities continue to lose population,
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Actually its not do to rural communities losing population. Its due to decreasing reimbursement which makes providing services in rural areas that might actually still be increasing in population but simply don't have enough population to be profitable with declining reimbursement.

So you're criticizing a federal health coverage system by... comparing it to a federal health coverage system? Seems like an odd tactic.
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Not really. Because our medicare is NOT like how other countries work. Our medicare usually covers more and has less hoops to jump through than other countries single payer. Our VA on the other hand.. and our Medicaid.. is more similar to how other countries operate. And even then.. to be honest. our VA and Medicaid is BETTER than most single payer countries.

So the point is..if you are going to try to get the savings that other countries get.. you are going to have to do what those other countries do.. which generally means less coverage and more hoops to jump through... (which by the way is how the VA insurance gets a good portion of their savings).

Rotor cuff surgery in the US can cost you up to $25,000. I'm gonna take a risk and say that navigating the bureaucracy is easier for most vets than coughing up $10-25k, or even covering the deductible -- especially since the VA can also provide disability (and private health care insurance companies do not).
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IF they get authorized for the surgery.. if they are authorized for the surgery sure...Which is why Vets like the VA.. especially if they don't have any other insurance.

However in general.. patients aren't coughing up 10-25K for surgery if they have insurance in America. Deductibles were limited in Obamacare.. and here are out of pocket limits etc. Face it.. if everyone without VA was having to cough up 25K... rotator cuff surgeries would be very rare... but they are not.

So the reality is.. yes.. if you have private insurance..you will have to pay more for your surgery than if you go the VA route... BUT.. there is a trade off in that you are more likely to GET you surgery if you go the private route in the first place.. and you are more likely to get the surgery and after care FASTER.. with less delays.. if you go the private route.

Yes, and there are also instances of people in private coverage who died waiting for care -- or worse yet, who died because they did not have any coverage at all.
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Not so much after Obamacare.
 
Again, it sounds like you are focusing exclusively on the negatives of the VA, while completely ignoring the significant downsides of the private system, including but not limited to:
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The irony of your statement is that you are the one that focused on only what you perceived as the positives of the VA.. while I brought to back to reality of the potential trade offs of the VA system,

Now.. on to:

• Very high costs (high enough to cause a high percentage of bankruptcies, not to mention how the US spends double the OECD average on medical care)
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Okay.. first lets start with the glaring lie here that medical costs are causing a high percentages of bankruptcies. This is a bold face lie and I have debunked it many times on this forum. Study after study has pointed out that when people cite medical reasons for bankruptcy.. the actual AMOUNT of medical debt.. compared to consumer debt is VERY LOW.. in other words.. the vast amount of debt they incurred was NOT medical debt.. it was consumer debt. The real reason for bankruptcy for medical reasons.. is not medical debt... its the LOSS OF INCOME.. that accompanies being sick or caring for a sick child etc.

Even in comparison with other countries.. like Canada.. that has universal coverage etc.. has shown that when Canada and the US had similar economies.. and similar bankruptcy laws.. Canada had just as many if not more bankruptcies.. in other words.. having single payer.. lower health costs DID NOT reduce bankruptcies compared to the US.
Obscure or incomprehensible billing and costs
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BWWAAHHHH... the VA is one of the WORST to deal with when it comes to billing and costs and reimbursement.

Impediments to job changes (since your health insurance is tied to your work)
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Very true.. except in most single payer countries health insurance is still tied to work.. for example Canada.. because the single payer doesn't cover lots of things outside the hospital.. so Canadians have to get private insurance.. usually through their employer.. for things like pharmaceuticals.

Profit motives resulting in massive inefficiencies that favor insurers, pharmaceuticals, hospitals etc
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True.. but without profit motives.. there is little reason for anyone to be in business..now is there. Which means a massive drop in employment in this country as healthcare is one of the leading.. if not the leading producers in jobs.

Millions going without any coverage at all
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This is not due to a private system. This is due to how our private system works.

What can I say, I'm not paralyzed with fear that a federal health system will be a total disaster, based on the VHA.
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Sure.. either because you don't have insurance now or you have really bad insurance..(which its hard to have an insurance worse than VA but it might be possible).. or because you don't know how the VA works.

Most americans with private insurance.. would see VA coverage as a downslide from what they have. For those that have private insurance AND the VA,.. well they like that.. because they have dual coverage.

And for those that have VA alone..they are happy because without it.. they would not have coverage.

If you want a true test of the VA.. have people with good insurance.. suddenly have to switch to va coverage only.. and see how they like it.
 
manofknowledge said:
Your link is just speculation. No Medicare For All law exists.

Hospitals close due to lack of patients, not because of Medicare or Medicaid. Hospitals in larger metropolitan areas tend to make good profits. It's the rural hospitals that are struggling because they typically handle fewer patients.
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Bingo.. and that's because of lower reimbursements from Medicare and Medicaid.

Remember..these hospitals did exist.. and now they are struggling..and that's because as the payer mix goes more toward medicare and Medicaid.. and medicare and Medicaid pay less and have been DECREASING reimbursement... rural hospitals simply don't have the volume.. to stay alive in an environment where medicare and Medicaid pay less.
 
jaeger19 said:
Bingo.. and that's because of lower reimbursements from Medicare and Medicaid.

Remember..these hospitals did exist.. and now they are struggling..and that's because as the payer mix goes more toward medicare and Medicaid.. and medicare and Medicaid pay less and have been DECREASING reimbursement... rural hospitals simply don't have the volume.. to stay alive in an environment where medicare and Medicaid pay less.
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The fact is that people are leaving rural areas in droves. These hospitals simply don't have the patients they once had.
 
Bucky said:
United States Department of Veterans Affairs. We already have government ran healthcare in the VA. Tell me if we replicate this system for the entire country it will be a good thing
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Is anyone suggesting VA for everyone?
 
manofknowledge said:
The fact is that people are leaving rural areas in droves. These hospitals simply don't have the patients they once had.
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Nope...

Sure there are some areas where rural areas are losing people... but who are they losing? Younger healthy people that are going elsewhere to find work . In general.. this is not the population that needs healthcare. Which. Leaving the aging population that is more Medicaid and medicare based.

the truth is.. often the actual DEMAND for healthcare in rural areas is expanding.. because of an aging population. while the ability to pay for it is declining because of reductions in reimbursement from Medicaid and medicare.. and also the loss of a few but higher paying private insurance clients.
 
jaeger19 said:
Nope...

Sure there are some areas where rural areas are losing people... but who are they losing? Younger healthy people that are going elsewhere to find work . In general.. this is not the population that needs healthcare. Which. Leaving the aging population that is more Medicaid and medicare based.

the truth is.. often the actual DEMAND for healthcare in rural areas is expanding.. because of an aging population. while the ability to pay for it is declining because of reductions in reimbursement from Medicaid and medicare.. and also the loss of a few but higher paying private insurance clients.
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Your point is valid, it's just oversimplified. Yes Medicare and Medicaid provides less revenue than private plans, but it provides more than an empty bed which is what these hospitals are dealing with.

Nearly a quarter of rural hospitals are on the brink of closure
 
manofknowledge said:
Your point is valid, it's just oversimplified. Yes Medicare and Medicaid provides less revenue than private plans, but it provides more than an empty bed which is what these hospitals are dealing with.

Nearly a quarter of rural hospitals are on the brink of closure
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Sure.. but you have to understand why the empty beds.. part of that is the changes that medicare and Medicaid have done that have reduced reimbursement. A decade ago.. a total knee operation for an medicare patient.. meant three days in the hospital, possibly a snf or swingbed stay in that same hospital and then discharge to home or continued snf.

With the changes in reimbursement.. that same total knee is being discharged to home in some cases.. THAT day.. and almost certainly the next day.

Of course there is less need for beds then. And hospitals are punished for admitting these patients and punished for holding onto them.
 
Bucky said:
Isn't that what essentially Bernie Sanders/Warren/New York Mayor promoting?
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Not really in Bernies case.. because the VA system isn't just insurance.. it also owns a good portion of its medical staff, etc.in other words the providers in the VA system work for the government. .. the VA would be more like the UK system.

Bernie Sanders idea builds upon the medicare system. (oh the problems here are huge)… but I did not see evidence that medical providers will be federal employees
 
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