Medicare For All vs Income Levels

Just wondering how different income levels stacked up vs single payer

I would rather have Medicaid for all - I already have Medicare and make well under $50K/year.

ttwtt78640 said:

I would rather have Medicaid for all - I already have Medicare and make well under $50K/year.

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i often advocate for a Medicare for all model of single payer, but generally think of a Medicaid for all system when i'm arguing for it. as for salary level, i'd prefer that everyone have the same coverage and for it not to be linked to salary.

Do You Want Medicare For All?

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I'm indifferent about whether all have (or have access to) Medicare or whether all don't have (or have access to) Medicare.

FWIW, not much in my estimation, my income exceeds $50K/year.

I make over $50k and while I would prefer a type of single-payer system, I don't favor medicare for all.

Interesting how there are zero responses from anyone under the $50,000 income level.

I just voted Medicare for all. Since Medicare has deductibles and copays everyone would pay something out of pocket. And everyone would then need to buy a tie-in plan out of pocket. The drug plan requires some out of pocket too. So it would be cheaper to provide to the general public than Medicaid for all, which pays everything in full, and is costly as H***.

Moderate Right said:

Interesting how there are zero responses from anyone under the $50,000 income level.

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I believe post 2 was in that reply group. I would like universal Medicare as a safety net, like SS. It would seem that like SS, you could have a 401K separate account and fund it as you choose to improve your care-not put well, but I hope you know what I mean by improve your care.
Regards,
CP

I'm a big supporter of Medicare for All. It's more efficient and covers the entire population. The only reason to not like it is paranoia over government.

Moderate Right said:

Just wondering how different income levels stacked up vs single payer

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Medicare pays doctors less than most private insurers do. In some cases significantly less. This is one reason I am not yet convinced that Medicare-for-all is the answer.

What I'd like to see before we try single-payer at the national level is for one state, just one, to get it up and running and fix the inevitable glitches that any new system has. Then let's go from there.

Phys251 said:

Medicare pays doctors less than most private insurers do. In some cases significantly less. This is one reason I am not yet convinced that Medicare-for-all is the answer.

What I'd like to see before we try single-payer at the national level is for one state, just one, to get it up and running and fix the inevitable glitches that any new system has. Then let's go from there.

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That might be a good idea. I think the first step ought to be eliminate the operational expense and profit to Insurers and turn that savings into funding for a Medicare plan. I am afraid of big government too, but to me, health care seems to be much like police or fire protection. One big thing bothers me, and that is how to keep a new government plan from becoming bloated, overstaffed, and cumbersome. I don't know how you would do that, but there must be a way.
Regards,
CP

concernedpuma said:

That might be a good idea. I think the first step ought to be eliminate the operational expense and profit to Insurers and turn that savings into funding for a Medicare plan. I am afraid of big government too, but to me, health care seems to be much like police or fire protection. One big thing bothers me, and that is how to keep a new government plan from becoming bloated, overstaffed, and cumbersome. I don't know how you would do that, but there must be a way.
Regards,
CP

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One of the lesser known features of Obamacare was that it required health insurance companies to spend at least 85% of its revenue on patient payments. Requirements such as that seem like a good place to start.

concernedpuma said:

That might be a good idea. I think the first step ought to be eliminate the operational expense and profit to Insurers and turn that savings into funding for a Medicare plan. I am afraid of big government too, but to me, health care seems to be much like police or fire protection. One big thing bothers me, and that is how to keep a new government plan from becoming bloated, overstaffed, and cumbersome. I don't know how you would do that, but there must be a way.
Regards,
CP

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In what way is health (medical?) care like police or fire protection? Medicare does nothing but pay medical care bills - it has no doctors, nurses, hospitals, ambulances or clinics thus it is not a medical care provider. The VA system is more like a police or fire department since it actually provides medical care directly.

33. Medicare is a Private?Public Partnership*||*Center for Medicare Advocacy

https://www.medicare.gov/supplement.../how-medicare-works-with-other-insurance.html

ttwtt78640 said:

In what way is health (medical?) care like police or fire protection? Medicare does nothing but pay medical care bills - it has no doctors, nurses, hospitals, ambulances or clinics thus it is not a medical care provider. The VA system is more like a police or fire department since it actually provides medical care directly.

33. Medicare is a Private?Public Partnership*||*Center for Medicare Advocacy

https://www.medicare.gov/supplement.../how-medicare-works-with-other-insurance.html

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If you find your definition to be more apt, okay. I understand police aren't doctors. My point was that Police, Fire, and other municipal services are supported, paid for, and used by everyone. In that vein, they are an acceptable tax supported expense. What is the difference between regulating and supplying clean drinking water(excluding Flint) and providing medical treatment to ill humans?
Regards,
CP

concernedpuma said:

If you find your definition to be more apt, okay. I understand police aren't doctors. My point was that Police, Fire, and other municipal services are supported, paid for, and used by everyone. In that vein, they are an acceptable tax supported expense. What is the difference between regulating and supplying clean drinking water(excluding Flint) and providing medical treatment to ill humans?
Regards,
CP

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The difference (actually a similarity) is that drinking water is a public utility and (just like medical care) folks are billed for their actual water (or medical care) use.

What most (including you?) seem to want from UHC is for the payment (via a tax bill?) to be based on one's income and to have one's use (or non-use) of medical care facilities/services have no absolutely no impact on that (fixed annual?) cost.

ttwtt78640 said:

The difference (actually a similarity) is that drinking water is a public utility and (just like medical care) folks are billed for their actual water (or medical care) use.

What most (including you?) seem to want from UHC is for the payment (via a tax bill?) to be based on one's income and to have one's use (or non-use) of medical care facilities/services have no absolutely no impact on that (fixed annual?) cost.

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Not to split hairs, but most municipal water suppliers (in my experience) levy canister charge's whether you use it or are gone for months. I wouldn't ever want to be in a position where, as adults, the less you offer, the more you get. In fact, I noted earlier that a 401K instrument could be incorporated for those wanting more than a Medicare essentials would provide. There are already savings plans offered through many employers for just that reason. I'm not sure of your thoughts on SS, but can you see the similarities? In practical terms, we are already subsidizing the poorest of us, by paying cost's that include losses from the non-payment of others. Not to mention, if you have to visit an emergency room, you will be waiting along with those who must use it for essential care.
Further, doesn't it just seem wrong that we can afford weapons to destroy the world several times over, (maybe even defeat Martian's), but can't provide basic health care to children?
Regards,
CP

I prefer having timely, efficient and high quality care that I have a greater say in rather than a monopoly run by government that will increase wait times, lower quality and take more out of my paycheck in taxes.

ttwtt78640 said:

I would rather have Medicaid for all....

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So would the people on base Medicaid.

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Fiddytree said:

So would the people on base Medicaid.

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Medicaid is truly a single-payer system since it has no premiums, deductibles or co-pays. It does seem to have one quirk: the 'expanded version' of Medicaid can act as a loan against your estate.

https://www.seattletimes.com/seattl...se-lsquopaybackrsquo-from-estate-after-death/

Phys251 said:

Medicare pays doctors less than most private insurers do. In some cases significantly less. This is one reason I am not yet convinced that Medicare-for-all is the answer.

What I'd like to see before we try single-payer at the national level is for one state, just one, to get it up and running and fix the inevitable glitches that any new system has. Then let's go from there.

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Well, we kind of tried that with Massachusetts and Obamacare. I agree that Medicare for all is not the answer. The answer is never to stiff it to doctors and providers, which is what most single payer systems do, unless they just downright cut them out of the picture altogether and have less facilities with longer wait times or cut down on the number of doctors and have nurses provide the care to patients instead.

Moderate Right said:

Well, we kind of tried that with Massachusetts and Obamacare. I agree that Medicare for all is not the answer. The answer is never to stiff it to doctors and providers, which is what most single payer systems do, unless they just downright cut them out of the picture altogether and have less facilities with longer wait times or cut down on the number of doctors and have nurses provide the care to patients instead.

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You're comparing apples and oranges. No state has single payer yet, so we don't have a test case in the US. Medicare doesn't count as it covers a specific subset of Americans.

People advocating for a state based solution as a precursor/requisite to any national rollout seem to consistently ignore the issue of displacement: if you try to leverage your state based SP in order to get better prices, some level of capacity is going to be displaced to other states that pay more; this is particularly problematic in the case of smaller states like say, Vermont. In general, it's a problem of economy of scale, and thus probably can only work in the larger, more economically powerful jurisdictions. As such, state-based SP could work well in the case of large markets like California where providers/suppliers make enough on the volume to compensate for the loss of margin under such SP so this displacement effect wouldn't be particularly significant, but bought corporate Dems spiked it (Anthony Rendon in particular) so we may never know: https://newrepublic.com/article/143650/killed-single-payer-california

Just goes to show you the reach and influence of private money in public office; even in the most progressive states, it can and does still win through in a big way.


Ultimately though, there is more than enough proof worldwide that SP or some other format of UHC works better than the existing system pound for pound/dollar for dollar, and thus I see a state-based proof of concept as being unnecessary/superfluous.


Probably the greatest risk to SP's functionality in the States is in fact money in politics and the corruption/de facto looting/pork that inevitably accompanies it: lobbyists are going to meddle and palms are definitely going to get greased via electoral finance, directly and indirectly for the awarding of contracts, terms, spending and so on that isn't in the best fiscal interest of the taxpayer/country; we can only hope that this inevitable corruption proves tolerable.

Moderate Right said:

Just wondering how different income levels stacked up vs single payer

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My income level isn't a factor in my response. Estimates from both left and right leaning studies say M4A would cost $32 trillion dollars over ten years. That equates to about what we currently take in in taxes each year. And those estimates are likely to be on the low side and unbounded. So, I see little intelligence on doubling the national debt to buy a system that offers so little benefit and has the potential to degrade medical care.

Bullseye said:

My income level isn't a factor in my response. Estimates from both left and right leaning studies say M4A would cost $32 trillion dollars over ten years. That equates to about what we currently take in in taxes each year. And those estimates are likely to be on the low side and unbounded. So, I see little intelligence on doubling the national debt to buy a system that offers so little benefit and has the potential to degrade medical care.

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I've seen straight up partisan studies per the Koch funded blatantly partisan Mercatus Institute say M4A would cost $32 trillion over ten years (while also saving trillions in overall health spending), but a far more reasonable one by Kenneth Thorpe put the price tag at $25 trillion over ten, and a more optimistic one by economist Gerald Friedman put it at about $14 trillion over ten; in general it relies on how large you expect the savings to be, not whether they're existent (while also affording universal coverage in the process):

https://www.politifact.com/truth-o-...1/how-expensive-would-single-payer-system-be/

MrPeanut said:

I'm a big supporter of Medicare for All. It's more efficient and covers the entire population. The only reason to not like it is paranoia over government.

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Only paranoia I feel about M4A is cost - estimates are $32 trillion additional. And since there's no cap that number is minimum. Medicare works for two reasons - the recipients are far fewer than the contributors and, most providers up their charges to private insurers to make up for the low rates medicare pays.