Trump said that nobody knew health care was this complicated. Here’s the truth: it’s only complicated because we made it so to insure (no pun intended) that we do not go to universal single payer and ditch the markets.
Allow me to explain how simple it is.
In any population of American citizens where all are covered by a health care insurance plan that provides quality coverage, the cost of that plan is “X”. For every citizen NOT covered by a health care insurance plan that provides quality coverage, the cost of that plan is X+1. If there are two citizens, the cost is X+2, and so on. Why is this so?
- Every time a citizen lacks a health care insurance plan that provides quality coverage, that citizen is more likely to put off preventive care.
- Putting off preventative care leads to a higher chance of catastrophic injury or illness.
- Because of a law signed by President Reagan, The Emergency Medical Treatment and Labor Act (EMTALA), private hospitals are required to provide treatment to anyone coming to an emergency department until they are stabilized, regardless of their insurance status or ability to pay. This is an unfunded mandate.
- The unfunded mandate is funded, however, by hospitals charging those citizens with insurance higher fees to cover the losses from the EMTALA citizens.
- In short, the lack of preventive care and the use of the emergency department as a public health service is the most uneconomical medical model in the world, and this is part of the reason why the USA has the highest healthcare spending in the world.
If any new health care act signed into law by our government results in one more citizen without a health care insurance plan that provides quality coverage or 26 Million more, whatever that number is, it means that the overall cost to cover all the citizens in the USA will be HIGHER than it was before.
We do not need CBO scores. We simply need to acknowledge the truth as explained above in #1, #2, #3, #4, & #5.
Which leads us to this: If ALL citizens are covered by a health care insurance plan that provides quality coverage (like the one that our members of congress enjoy), our overall costs will be lower.
So what’s the problem? Well, in 20014, the CEOs of the Big Five for-profit health insurance companies all took home at least $10 million in 2014, according to each insurers’ annual filings with the Securities and Exchange Commission (SEC) (Aetna, Anthem, Cigna, Humana, UnitedHealth ).
Markets are the problem…and the Republican solution is “more markets!”
Who’s running this country anyway?
centralmassdad says
OK, but all that does is pretend there are no costs.
All the long-term cost savings of regular preventative care don’t kick in on Day 1, they phase in quite gradually over years–quite a few years.
Meanwhile, the costs start on Day 1. And, as happened with Obamacare, the effect of adding a lot of demand for health care services without an expansion of the supply of health care services is to increase the cost of health care services.
So how are those costs getting paid on Day 1, Day 2, and for the decade or so until savings start to catch up? The math sucks, which is why you want to ignore it.
johntmay says
Of course it does not all change on day one. Heck, it might take ten years of more to see the complete savings. That ought not matter anymore than it mattered to me when I spent several thousands on a new heating system that has a seven year payback. Yes, for the next seven years I will be paying more than I was paying. That does not make what I did foolish, nor will going to single payer via the federal government and the elimination of ineffective, expensive markets.
How are those costs getting paid? Well for one, the elimination of the multi-million dollar CEO salaries will just be the start of the savings. The elimination of expensive emergency departments for routine treatments will be another.
Making perfect the enemy of the good is not a strategy I support, and that’s what the insurance company CEO’s want us to do (AKA the “markets”)
jconway says
I still see you falling into the underpants gnome trap without a roadmap that takes us from A to B. You’ll need one to win over skeptics like CMD. We will also need a well thought out plan to avoid the Vermont outcome. This was the point of my honest thread-not to shit on single payer. I support advancing it, which is why I want to find the smartest way to get there.
Christopher says
But it doesn’t require reinventing the wheel. It’s just Medicare without the age restriction and plenty of other countries have it. I understand the Canadian system started in the provinces so maybe ours can too.
jconway says
I think a public option is an easier sell at either the state or federal level. And it will eventually lead to near universal coverage within the public system anyway. But it will cause a lot less disruption to the health care economy which those other countries didn’t have when they created their system and absorbed private insurers or hospital systems.
johntmay says
Getting people on that road map will be easier once they see that uninsured citizens increase overall health care costs.
centralmassdad says
But when you bought your heating system you got the benefits. But the “we” in single-payer is a bit more complicated. The gap before the benefit kicks in is going to require vast sums of money, even in the context of federal budget numbers.
And I don’t think that it is very controversial to suggest that the plan is for “we” to benefit but for “them” to pay for it. Who is them? The rich, but the problem with the 1% is that there are more of the rest of us. And because the cost of the proposal is so great in the short term, that means that even if you get a much more progressive slope in the tax structure, there would need to be major, major tax hikes reaching far down into the tax brackets in order to pay for it.
That’s why VT had to back off– their single payer programs were going to require tax hikes that weren’t politically sustainable. Median income taxpayers stood to benefit by no longer having to spend $800 per month on health insurance. Great! But, we have to raise your taxes by $2400 per month to do it. Once reality set in, they had to back off– even though “we” would be spending less overall after a period of time.
When you wave away “what would it cost” and CBO scores and the like, you do it for the same reason Mitch McConnell did– the numbers are tough. And if Dems campaign that way, simply saying– “we will spend less overall, its a no-brainer!” then, once in power, they will look as foolish as the Republicans, and for the same reason.
So, again I say– single payer sounds super! But, show me how much it will cost and how those costs are going to be paid.
johntmay says
What benefits did I get when I bought my system? My house is the same warm comfortable place it was before. I am now spending about $50 a month more on overall household budget because while my heating bill is about $50 a month lower than before, my loan for the system is costing me $100 a month. It will not be until after seven years that this investment pays off.
Vermont backed off because the for-profit people spent a fortune to lobby against single payer non-profit.
Single payer, and the additional preventive care it automatically provides will cost less.
johntmay says
How is it possible that the average citizen in Vermont would be paying almost $30K a year when the average cost per person in the USA for health care is $8,000? Something is not adding up here.