Medicare for All (for Less!)
August 20, 2018 8:57 PM   Subscribe

Why Americans Spend So Much on Health Care—In 12 Charts - "Prices are hidden behind insurance deals, hospital consolidation pushes up costs and the health sector is a growing power in the economy."
"One striking fact: of the 500 largest publicly traded companies by value, 16% of value is classified in healthcare (up from 4% in 1984); that excludes almost every hospital and physician's office."

"Health care expenditures are rising for everyone in the US. But they account for 19% of the disposable income of poorest 20% of American households. Staggering figure!"

"Surprise! Monopoly pricing is a factor in America's high health care costs."

"Catching up with @mwetschler, an ER physician who got into a surfing accident in San Francisco and woke up unable to move from the neck down. 'A temporary quadrapalegic'. His story is the best and worst of the U.S. medical system."

"Smith writes in 'The Wealth of Nations' that there should be public provision of health care services." (Hayek too ;)

"Thank you, Koch brothers, for accidentally making the case for Medicare for All!"
How a libertarian analyst inadvertently made a good case for Bernie Sanders' Medicare for All - "Right-winger Chuck Blahous set out to bury Medicare for All; instead, he showed how it will improve coverage and save money."

Conservative Think-Tanker Accidentally Argues That Single Payer Could Save Americans $2 Trillion - "Talk about an own goal."

Analysis: Bernie Sanders' $32 trillion Medicare-for-all plan is actually kind of a bargain - "The federal government would spend a lot more money on health care, but overall US health spending would be about the same as otherwise projected."

Fact-Checking the Fact-Checkers on Medicare-for-All - "The fact-checkers on the Mercatus M4A report are being ridiculous."

The Washington Post Keeps Publishing False Claims About Medicare for All - "The newspaper continues to spread a lie about Bernie Sanders's Medicare-for-All plan — despite its own fact checker admitting it's wrong."

Medicare for All Fact-checking Debacle and Autism - "Matt and Liz tell the story of the Mercatus M4A study and all of the ridiculous fact-checking that has followed it."

Jake Tapper' Dishonest Fact Check On Bernie Sanders and Alexandria Ocasio-Cortez on Medicare for All - "Will @jaketapper correct his inaccurate fact check on Bernie Sanders and @Ocasio2018 on Medicare for all, or will he let his mistaken reporting stand?"

also btw... more...
-Why a patient paid a $285 copay for a $40 drug
-Reagan, Deregulation and America's Exceptional Rise in Health Care Costs
-Opposition to Medicaid expansion was one of the cruelest deeds of reactionaries in the 2000s
-Enrolling Americans in Medicaid Is Now Cheaper Than Subsidizing Their Obamacare Coverage
-Want a Better Health Care System? Check Out Japan (not their medical schools tho)

oh and...
America might be ready for democratic socialism. It's not ready for the bill. - "Single-payer health care, a jobs guarantee, and free college would require massive tax hikes. There’s no way around it."
"'We only have empty pockets when it comes to the morally right things to do, but when it comes to tax cuts for billionaires and when it comes to unlimited war we seem to be able to invent that money very easily', Democrat Alexandria Ocasio-Cortez says."

"The tragedy is that the short-term economic gains from military funding often come at the expense of more meaningful jobs gains that could come through investing in health care, education, clean energy and more."

"Economists think of technology as being the fundamental driver of productivity. But though we all have supercomputers in our pockets, we're paying MUCH more for construction, health care, education and asset management without actually getting much more out of these services."

"The least thoughtful bitcoiners and policy analysts think that 'laws of math' make their case for them."

"America's healthcare system is grossly, horribly inefficient. If you put all those inefficiencies in the public budget, obviously you'll blow up the debt. If only some other country had tried single payer, then we could look there to learn how to reduce costs..."

"One-sided fiscal responsibility - where the Republicans run up all the deficits and still get to claim they're the deficits hawks - is a game Democrats seem increasingly disinclined to play."
Some of the Left's Ideas Start Going Mainstream - "Health care isn't the only issue where the Overton Window — or the range of ideas deemed worthy of consideration — has shifted to the left."

Democratic socialism, explained by a democratic socialist - "Many proponents of Medicare-for-all aren't driven by any kind of ideology — they're simply sick of high deductibles and constant claims denial and ballooning medical debt, which is one of the top causes of personal bankruptcy in the US. But in fighting for Medicare-for-all, people will inevitably start asking basic questions like why corporations are allowed to get rich off of something that should be a basic human right. Medicare-for-all might not be socialism, but at its core, it's a demand to take something out of the market." (via)
posted by kliuless (46 comments total) 84 users marked this as a favorite
 
The direct link to the article might be better.
https://www.wsj.com/articles/why-americans-spend-so-much-on-health-carein-12-charts-1533047243
posted by Quackles at 9:21 PM on August 20, 2018 [6 favorites]


I got the bill for hysterectomy today. The total cost was just over $20K. One of the benefits of being chronically ill is that I max out my deductible by March (my company offers three plans and I pay the highest premium for the lowest deductible, which is $2K per person). My responsibility was $90.80. I very nearly cried because I felt so, so grateful. I have the ability to pay a high premium for employer provided health insurance, but I want anyone who needs a hysterectomy to be able to get one for under a hundred bucks out of pocket, so hell fucking yes Medicare for all. Tax the hell out of me for it. My family is upper middle class. We, personally, need to pay more taxes, not less.
posted by Ruki at 9:30 PM on August 20, 2018 [44 favorites]


I had an operation on my wrist a couple of years back. I don't know what it cost, because I'm in New Zealand where we have public health care.

We spend a third of what America spends and no-one goes bankrupt through medical costs. More than that - I can still work and I don't suffer pain every day because I got good and free health care.

Private healthcare is literally killing you. Why the hell do you Yanks put up with this shit?
posted by happyinmotion at 9:42 PM on August 20, 2018 [29 favorites]


There are so so many things I could rage against or discuss about how thoroughly fucked up healthcare is in this country, how I support Medicare for all, etc. But I think this is one of the more salient points to bring up. On Gofundme, approximately half of the campaigns are healthcare related. In six years, nearly $1 billion went to these causes. Think about that. Let that sink in (I'm most likely preaching to the choir here). Morally there is no argument or debate about this. It is just wrong. Illness and the desire to continue to live are not profit centers. Healthcare is a right and the entire system should be not-for-profit.

I've had plenty for frustrations with healthcare costs and my insurance, but I consider myself extremely lucky comparatively. I've never had to face the specter of bankruptcy because of an injury or sickness or face the soul crushing decisions that people less fortunate face daily.

It is past time Americans demand swift and immediate change. Our lives literally depend on it.
posted by theartandsound at 9:49 PM on August 20, 2018 [15 favorites]


I had already been aware of monopoly pricing being the major factor in costs apart from prescriptions. I feel like this info was making the rounds years ago.

TL;DR, doctors and hospitals charge you more *because they can*.
posted by runcibleshaw at 9:50 PM on August 20, 2018 [9 favorites]


I had a mole like thing removed and being referred to a surgeon for reasons, it took less than 10 minutes but in a hospital. No biggie. The system has an online patient access that while annoying seems to update quickly and I clicked through and was appalled as charges rose well above $10k. Mentioning this to my primary who I'd been with for so long he's the head of the clinic, I assume he's tuned in on issues. The response was "that's just 'funny' money". Now I didn't dig but the charges somehow evaporated and out of pocket was just the co-pay. One interpretation is that some billing is along the lines of insurance tactics of 'bill something extraordinary' and get a smaller percentage but more than if more realistic amounts were claimed. Raw street dickering. Which probably works fine for funded insurance plans but totally screws over folks that do not have leverage.
posted by sammyo at 10:11 PM on August 20, 2018 [6 favorites]


Private healthcare is literally killing you. Why the hell do you Yanks put up with this shit?

We actually hate it a lot. We don't "put up with it", we're just trying to get by in a system that is crushing us. These insurance companies are way too big to sit back and let the government put them out of business. And also, racism. Our system is extremely racist and politicians are afraid of upsetting racists, who don't want The Others to get anything, even if it means having nothing themselves. Racism is also a huge part of why our attempt at fixing it via Obamacare is being dismantled piece by piece right now.
posted by bleep at 10:12 PM on August 20, 2018 [47 favorites]


My job used to include shadowing doctors at a bunch of large hospitals. Some observations from that time:

When doctors are asked how much a procedure costs, they very often have no idea. It's just not information they're privy to.

Doctors often count the seconds in their head during the visit. They do this throughout the day, constantly looking for ways to shave seconds off their visits. The time the visit is taking is foremost in the doctors mind always.

When a lot of doctors leave the room, they're reaching for their phone to look up your symptoms on Google. Not some special medical information database. They're doing a 3 second search on Google.

Most patient charts contain treatments doctors don't understand. As in, they're familiar with the condition, but have no clue why anyone would treat it they way it's being treated. It's standard practice to say nothing.

When you read about a hero doctor diagnosing someone with strange symptoms, that's a doctor working on their own time searching a medical database like Medline. If you had a bunch of strange symptoms, wouldn't you want access to that database?

I wish I still had the figures, but if you look at the projections for healthcare costs in the United States they're obviously unsustainable. The current system will crash whether government healthcare programs come or not. It's true if you're a Democrat or Republican.
posted by xammerboy at 10:27 PM on August 20, 2018 [23 favorites]


From the article:

Contributions to employer-sponsored health coverage aren’t taxed, which makes it less expensive for companies to pay workers with health benefits than wages.

No. Polls prior to the ACA of large company executives, particularly unionized companies, consistently showed that large corporations want out of having to provide health insurance for their employees. It’s a Byzantine system negotiating health plans, and it’s the fastest rising item, often the single costliest item, on a company’s ledger. Since the ACA, which granted companies large tax incentives to provide health care in order to get it passed, most large corporations have stayed silent on the single payer issue, largely because it is so controversial with enough people that they’re afraid to commit to the wrong side. I suspect secretly most would still rather eliminate this department of their company. And there are some notable business people coming out in favor.

Humira, an immunosuppressive, is the best-selling drug in the U.S.


What? Also no. Come on, WSJ, this is an important issue that we need accurate, credible reporting on. Blockbuster drugs are obviously a thing, but their cost isn’t a thing that affects that many people. Most people can and do take generics. The problem is the negotiations with drug companies on pricing and the cost sharing for these drugs that most of us take.
posted by Slarty Bartfast at 10:29 PM on August 20, 2018 [6 favorites]


Another reason for Medicare for all - the mister had his annual physical last week and his doctor prescribed a stronger eczema cream, after first checking to see if our insurance covered it. How not all medications are covered by all insurances is baffling to me. When he got the pharmacy, his insurance info wasn't in the system for some reason, so he found out the non-insurance price is $192. With insurance, it was a $5 co-pay.
posted by Ruki at 10:31 PM on August 20, 2018 [2 favorites]


Oh no, I forgot my WSJ rule. Don’t read the comments. Never read the comments.
posted by q*ben at 10:33 PM on August 20, 2018 [1 favorite]


To clarify my drug cost comment, the place I work gets 540b pricing on meds which means the price our pharmacy pays is the price negotiated by the government for government entities (military, public health, IHS) and we sell it to uninsured people for cash at cost + enough mark up to pay for overhead. Usually I prescribe something that doesn’t cost more than $5, most brand name meds come in at $50-60, and then there’s the odd company that wouldn’t negotiate and those meds are $200+ and I just don’t prescribe them because there’s always a reasonable alternative.

When Harvoni and the other Hep c treatments came out, they were priced by the Pharma companies at $80,000-150,000 for a course of treatment (slightly less money than letting someone die of cirrhosis or get a transplant). Insurance companies simply refused to cover it, except for the very sickest individuals (who are also the ones most likely to fail treatment and who, on death’s door already, are likely to receive the least benefit). Then, a concerned group of citizens here in Washington state filed a lawsuit to get WA Medicaid plans to cover it, stating that it’s discrimnatory and didn’t have a logical medical rationale. They won their case and the Washington state health care authority promptly removed Hep C treatment from the purview of the five big medical insurance companies that administer Medicaid here, then the state negotiated hard with Gilead and Purdue. A settlement was reached where both parties refused to disclose the final price but now when I prescribe Hep C meds I deal directly with the state who has always approved treatment after I jump through the entirely reasonable single set of hoops. The actual price of Harvoni the state pays is a closely guarded secret but knowing enough people on the purchasing committee with hints they’ve dropped, it’s likely it’s somewhere around $10,000-20,000 for a course of treatment. All the private insurance companies are not paying full retail, but clearly much more than the state.

It’s not the retail price the drug company advertises, it’s the shady and often consumer-unfriendly negotiations that take place that means you end up paying $600 for a medication you never expected to need when you were buying insurance.
posted by Slarty Bartfast at 10:56 PM on August 20, 2018 [19 favorites]


I wrote in the mega thread previously about my last endometriosis surgery.

OR/Hospital:
$36,658 - Amount Billed
$17,515 - Discounted Rate
$15,764 - Amount Paid by Insurance
$1,751 - Amount You Owe

That doesn't include the $3600 out of pocket I had to pay to my surgeon because insurers often won't approve RESECTION - otherwise known as the only effective surgical treatment for endometriosis. That didn't include other labs/anesthesiologist, etc. Overall we hit our deductible and paid about $7k to $8k out of pocket. Luckily my husband has an understanding job and could take time to care for me after, otherwise we would have had to find in-home care or fly my parents out.

And yet.. my cosmetic mole removals got covered ($1k) because I guess they billed it as preventative or something?

All of it is a mess. I don't think there is a simple solution. But the fact that people are constantly forced to die, suffer, become homeless, or live in pain because they cannot afford healthcare. It's not how we should treat people. But the people out there against this stuff pretty much think I should die or suffer. That I somehow failed and need to suffer the consequences. And there is a whole lot in it for them to line their pockets with.
posted by Crystalinne at 11:37 PM on August 20, 2018 [4 favorites]


PS this doesn't even begin to cover the fucking disaster that is SSI or SSDI. Though healthcare goes some way to helping those most at risk for health related financial problems.
posted by Crystalinne at 11:40 PM on August 20, 2018 [3 favorites]


I've had multiple chronic illnesses, punctuated by acute illnesses and injuries, for most of my life.

I will never be without medical debt. The idea of having all one's medical bills paid off is something that I truly can't wrap my head around. I don't even pay a lot of attention anymore, because there's just not that much I can do about it other than deciding whether a problem really needs to be treated by a doctor or not.

I will never have good enough credit to buy a house or a new car. I will never have a nest egg.

I've been fortunate in that most of the pharmacies I've used have had a policy of telling the customer if their co-pay is higher then out-of-pocket cost (a lot of antibiotics seem to work out this way). I've also been extremely lucky to have the family I do

I long ago got over being bitter about all this comma because it's just the way things are and have been. But Jiminy H. Tap-Dancing Cricket, it pisses me off that we, the people, haven't been able to get this shit fixed for the next generation.
posted by The Underpants Monster at 12:00 AM on August 21, 2018 [16 favorites]


> All of it is a mess. I don't think there is a simple solution

Centralized government health care seems like a pretty simple solution to me. It's a lot simpler than the current system.
posted by scose at 1:59 AM on August 21, 2018 [11 favorites]


When a lot of doctors leave the room, they're reaching for their phone to look up your symptoms on Google. Not some special medical information database. They're doing a 3 second search on Google.

I have an appointment at OneMedical today that I've paid $200 for in the hopes of finding a doctor who doesn't google a well-known, but unpopular, form of testosterone in front of me* while also telling me how lucky I am to go to a clinic that is so familiar with trans people. Really I'm just griping about my experience with that clinic (the googling was the first straw, not the last). But there's something obviously profoundly broken about the fact that I can attempt to buy myself both competent care (cross your fingers) and a clinic that runs in a (hopefully) quasi-efficient manner. And so I've become complicit in the problem.

*Not "Let me find the prescribing information, I've never had a patient using it" but "I've never heard of that".
posted by hoyland at 3:21 AM on August 21, 2018 [1 favorite]


One thing I've noticed is the cultural bias doctors have toward prescribing visits to other doctors. I finally just had to start telling my doctor that I wasn't going to go get a half dozen tests done "to rule X out" because I can't afford even the 20% I owe on the bill.

Example: I have a weird knee pain that didn't come from an obvious injury and A: seems to be gradually getting better B: definitely feels better in the short term when I can ride my bike 3-5 days a week. Rather than acknowledging that what I'm doing is working, the doctor wanted me to get x rays and MRIs and see an orthopedist - all stuff I'd do if each of those wouldn't have a bill of $400 after insurance pays its 80%. As it is, my reasearch revealed that doctors can't do much for knee problems even if they know what's wrong, which they often don't - surgery has a low success rate and even physical therapy, which is just exercise and stretches, isn't proven to help. The doctor has to know this. But something compels her to prescribe a battery of tests and visits anyway.

They also have this habit of performing tests on me during my yearly physical without informing me that the person performing the test is a "specialist" so that what I expected to be covered 100% by insurance is not, so now I've decided to ask up front what anything they want to do will cost before agreeing to it.

This is not a market in any real sense. At any other kind of market, the price is made known to me prior to purchase, and I am usually able to make myself aware of both the price and quality of products offered by competitors. Neither is possible in healthcare.
posted by eustacescrubb at 4:15 AM on August 21, 2018 [6 favorites]


Health care, fighting climate change, maintaining infrastructure, you name it..."We weren't ready for the bill" will be written on our society's tombstone.
posted by The Card Cheat at 4:20 AM on August 21, 2018 [5 favorites]


Private healthcare is literally killing you. Why the hell do you Yanks put up with this shit?

We're not "putting up with it". More like "it has been forced upon us thanks to an oligarchy that has convinced half of us that the alternative is an evil mind virus of Satan".
posted by EmpressCallipygos at 4:35 AM on August 21, 2018 [9 favorites]




I recently finally found a doctor, after a half-year of searching for a doc who was A) In-network, B) Accepting new patients, and C) Had an appointment available earlier than November (seriously!) On the down side, my new doc is over a half-hour drive away. Oh well. At least they could see me in July.

After talking with me, the first thing they did was bump my antidepressant from 300mg to 450mg. My antidepressant has been available as a generic for decades now, and is available in a 450mg pill. Yay!

Nope.

It turns out that the 450mg version of my generic antidepressant is manufactured by a single pharma company which markets that strength under a brand name! And, of course, this "brand-name-generic" is not in my insurance company's formulary, and a month's supply would cost me over $600. For a decades-old generic!

So, we punted and my doc called-in a script for both 300mg and 150mg pills to bring me up to the 450mg they want me at. That was just recently, and we aren't sure yet whether my insurer will treat that combo as a single prescription, or treat it like two prescriptions and ding me with two copays.

Unfortunately, the only chance M4A ever becomes a thing in the US is after Congress guts the existing Medicare system (which the Republicans have plans to do, along with Medicaid), making it a cheap-but-worthless choice for everyone other than the poorest of the poor, who simply cannot afford private insurance. There's a better chance of the US dissolving into warring city-states than there is of single-payer ever becoming a thing. At least in my remaining lifetime. Hell, I'm not at all sure Medicare will exist when I reach that age, in 5 or 6 years.
posted by Thorzdad at 5:24 AM on August 21, 2018 [2 favorites]


Why the hell do you Yanks put up with this shit?

As with most things: a combination of stupid, evil, and powerless, depending on which Yanks you ask.

And I am going to sit on my hands now so I don't say anything about the 2016 primary.
posted by Foosnark at 5:36 AM on August 21, 2018 [2 favorites]


When doctors are asked how much a procedure costs, they very often have no idea. It's just not information they're privy to.

I'm sure many Australian doctors search the Medicare Benefits Schedule Online A-Z. It has everything that attracts a benefit/rebate for medical (not allied) services. It's quite fascinating to browse, if you like that sort of thing. Check out the bottom left of each service where it has the fee, and the rebate amount. That fee is the 'scheduled fee'; the benchmark from which the rebate is determined. Services which have an 85% rebate are out-of-hospital services, 75% services are in-hospital. Many GPs 'bulk-bill' which means they charge the rebate only, and they deal directly with Medicare on the patient's behalf so there's no actual bill. Those that don't bulk-bill require a copay, which can't be insured against except for in-hospital services, but then only up to the scheduled fee. Australian doctors know their scheduled fees very well in most cases, because it dictates their earnings (to a point, they are free to charge more in their private practice) and is often the topic of grumpy public discussion.
posted by Thella at 5:37 AM on August 21, 2018 [1 favorite]


Of all the issues in American health care, for that one author to focus on the fact that doctors are “paid too much” (at just $200,000) seems so bizarre. I believe US doctors do a four year undergrad, four year med school, and then 3-7 years of residency. Of course it makes sense they would need higher compensation to account for the shortened years of earning potential and the high cost of all the education. Perhaps shortening the length of education would be an option - the four years of undergrad seems superfluous and is not necessary in many nations, like Quebec, and residency probably does not need to be seven years. Perhaps leaning heavier on allied health.

In Ontario Midwives are being positioned to take over low-risk pregnancies from Family Practioners due to lower-cost and better outcomes (midwives are direct entry, four years of mostly clinical education and one year residency paid at full wages). Shorter, more focused education, cheaper services, better outcomes. What’s not to like?

I do not begrudge Doctors their salary at all. A bigger unnecessary financial drain on the American health care system is insurance executive salaries, most with much less education than doctors with a bigger paycheque. Talk about smoke and mirrors!
posted by saucysault at 5:44 AM on August 21, 2018 [8 favorites]


Why not just make health insurance illegal and price everything a la carte?
posted by Veritron at 6:01 AM on August 21, 2018 [1 favorite]


Because some health care will still be too expensive to afford even if you "fix the market" by removing insurers. It isn't only price inflation that makes health care so expensive. It makes it a lot worse... but also, health care is just expensive to administer.

And, of course, how expensive these procedures have to before you can't afford them will depend on your circumstances. We would still have a system where people go bankrupt or die because they can't afford health care.
posted by Kutsuwamushi at 6:33 AM on August 21, 2018 [4 favorites]


People in the U.S. are not "putting up" with this. Most are desperate for a better system, and those who aren't are ignorant of their personal peril. 99% of us are one bad day away from medical bankruptcy.

Our leaders need to start providing for the desperate, and they better do it fast. Desperate people tend to fall for empty promises from bad people who say they'll make everything better.
posted by FakeFreyja at 6:42 AM on August 21, 2018 [2 favorites]


Why not just make health insurance illegal and price everything a la carte?

As horrible as insurance companies are, they really do exert some pressure to keep prices down to various degrees. If left to their own devices, doctors, hospitals, etc. would be free to charge something closer to those pre-insurance-adjustment prices. And, they would.
posted by Thorzdad at 6:44 AM on August 21, 2018 [1 favorite]


Why not just make health insurance illegal and price everything a la carte?

Because the bodies piling up on the street would smell really bad.
posted by Kadin2048 at 6:56 AM on August 21, 2018 [20 favorites]


Most are desperate for a better system, and those who aren't are ignorant of their personal peril. 99% of us are one bad day away from medical bankruptcy

I'm not sure the number is quite that high, and those that aren't one bad day away have a lot more sway than those that are. Also the disinformation campaign (tons of Canadians come to the US for medical care / the UK KILLED BABY ALFIE EVANS!!! is always in full swing) and people legitimately believe that turning US medical care into a free market just like many Republicans say would fix everything. But they never do anything to turn it into an actual market which we then can take steps to make it 'free'.
posted by The_Vegetables at 7:00 AM on August 21, 2018 [1 favorite]


Why not just make health insurance illegal and price everything a la carte?

Because insurance, per se, as a form of risk-pooling, is a really great idea - have a large group of people shoulder the cost for what turns out to be a much smaller group of people's medical needs at any given time. Over the course of a lifetime, everyone gets their turn to be taken care of.

The problem is that insurance which covers human-rights-level services is ruined by the profit motive. Markets, as it turns out, are a terrible mechanism for managing cooperative efforts. Democracy, provided the democratic process itself is not too corrupt, is a much better mechanism.

The problem we have in the US is that the democratic processes have become corrupted by people who favor markets over democracy. That's why while we used to have great schools and infrastructure and postal services and utilities and our standard of living, even for those of us outside the wealthy elites, was the envy of the world, now, we're mediocre at best, and terrible at many things.
posted by eustacescrubb at 7:42 AM on August 21, 2018 [11 favorites]


The one truly shocking graph was showing rates of respiratory disease, which have been steadily declining for the OECD but for the US have remained completely flat.
posted by grumpybear69 at 7:54 AM on August 21, 2018 [1 favorite]


justshowerthoughts: If you have $1,000 in cash and spend 1 penny, that’s the equivalent of Jeff Bezos spending $1.5 million
posted by cricketcello at 9:16 AM on August 21, 2018 [8 favorites]


Centralized government health care seems like a pretty simple solution to me. It's a lot simpler than the current system.

Yes it’s fairly simple but at the same time I don’t trust OUR government, at least the way it’s currently structured, to suddenly start giving a shit about sick and disabled people. Going through the disability process right now has me very much feeling as I suspected about this.

Would my endometriosis surgery have been covered by government healthcare? Or would they look at the model set out by insurers towards women’s healthcare and only cover the type of surgery that literally causes more damage?

Healthcare IS complicated. Healthcare is influenced by what we have now and switching it over to a central thing will not magically make it better.

I’m ALL FOR healthcare for all. It’s a human right. But I think sometimes it assumes all these other specific coverage/denied services problems would solved too.
posted by Crystalinne at 9:16 AM on August 21, 2018 [3 favorites]


Paul Singer, Doomsday Investor - "The head of Elliott Management has developed a uniquely adversarial, and immensely profitable, way of doing business."
[Jonathan] Bush, the co-founder and C.E.O. of the health-care technology company Athenahealth, had just finished a three-day race with his company’s sailing team, going from the Bahamas to Bermuda. Bush is the nephew of one former President, George H. W., and the cousin of another, George W., and his professional and personal lives were intertwined...

Bush had co-founded Athenahealth, a platform that digitizes patient medical records and billing claims for hospitals and health-care providers, in 1999, and he had built it into an enterprise with more than a billion dollars in revenue. One of the firm’s marketing taglines was that it freed doctors and nurses to spend more time doing what they loved—practicing medicine—and less time on paperwork. Athena served more than a hundred thousand health-care providers.

Cohn told Bush that Athenahealth was a great business, and that he should be proud of it. Still, Cohn went on, there were problems. Athena’s stock price had recently declined, which he said was hurting morale and affecting the company’s ability to recruit employees... Gradually, Bush diverted his attention from running Athena to focus on repelling, or appeasing, the hedge fund.
Google parent company invests $375 million in Oscar Health - "Alphabet is pouring $375 million into Oscar Health, a small insurer that thinks it can use big data to revolutionize its industry."
The health insurer was co-founded in 2012 by Joshua Kushner, whose brother, Jared Kushner, is President Trump's son-in-law.

Oscar is one of several startup insurers that hoped to capitalize on the Affordable Care Act and the millions of Americans flooding the individual health insurance market. However, the company struggled in its early years as Obamacare got off to a rough start.

Its outlook has since brightened. Oscar expanded into new geographic areas last year and this year, and it plans to enter the Medicare Advantage business in 2020.
Anthem, Walmart Partner On Senior Access To OTC Medicines - "Anthem, which operates Blue Cross and Blue Shield plans in 14 states, said the program will allow seniors in Anthem's Medicare Advantage plans to use 'OTC plan allowances to purchase OTC medications and health-related items, such as first aid supplies, support braces, and pain relievers'. The purchases can be made at Walmart's 4,700 stores and via the retailer's web site when the program begins in January 2019."
For Walmart, the deal expands the retailer's relationship with health insurers in an effort to bring more customers inside its stores. It also comes as rival online retail giant Amazon is slowly entering the prescription business, recently buying online pharmacy PillPack. Amazon also earlier this year launched its own over-the-counter brand of medicines called Basic Care...

For Walmart, the deal expands the retailer's relationship with health insurers in an effort to bring more customers inside its stores. It also comes as rival online retail giant Amazon is slowly entering the prescription business, recently buying online pharmacy PillPack. Amazon also earlier this year launched its own over-the-counter brand of medicines called Basic Care.
Okay, Here's the Plan: We Turn All Our Health Information Over to Google, Amazon and Microsoft and Then... - "We are jointly committed to removing barriers for the adoption of technologies for healthcare interoperability, particularly those that are enabled through the cloud and AI. We share the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs."
To address the problem, these tech companies are proposing to build tools for the health community around a set of common standards for exchanging health information electronically, called "FHIR."

Resistant to change

The government and the private sector have tried to fix this problem for decades, spending billions in the process. Unfortunately, the bulk of that funding was spent on moving doctor's offices from paper-based systems to electronic ones, and not on data sharing.

There are strong economic incentives to keep things the same. The creators of market-leading medical records software, like Epic and Cerner, have no reason to open the door to deeper-pocketed tech giants. For providers, keeping information trapped within a hospital or health system makes it harder for unsatisfied patients to shop around and potentially leave. But in health care, unlike in most other sectors, that kills vulnerable patients.

"These fee-for-service hospitals are fighting tooth and nail to retain patients — and the vendors are responding to these needs," Dr. Bob Kocher, one of the key architects of the Affordable Care Act and a health tech investor with Venrock previously told KQED in 2015. "They [some hospitals] have not wanted features that make it easier to share information."

Ultimately, health insiders say, today's announcement is a recognition that that something needs to change.
What Does Knee Surgery Cost? Few Know, and That's a Problem - "The price we pay for health care often has little connection to what it actually costs. One hospital decided to investigate."
posted by kliuless at 3:16 AM on August 22, 2018 [2 favorites]


Centralized government health care seems like a pretty simple solution to me.

Well, it's a simple solution, but the process of getting there isn't, absent magic wands or death squads.

The efficiency of a single-payer system is also why it's likely to attract a huge amount of opposition. All that "inefficiency" is also known as "jobs" and "profits" depending on what side of the equation you're sitting on. And the US is really not good at getting rid of industries, even when they're hideously inefficient or actively harmful, as long as they employ people. (See also: coal mining, unsustainable offshore fishing, etc.)

There are whole sectors of the US economy, giant corporations with thousands and thousands of employees, that just wouldn't exist under a more rational system, and don't exist in other countries. There are companies that do nothing but negotiate kickbacks (the euphemism is "contract and price management") between hospitals and medical wholesalers. There are companies that do the same thing for pharma. There are probably companies that intermediate between manufacturers and wholesalers. There are people—probably in the upper hundreds of thousands if not more—who do administrative or clerical work that wouldn't exist except for the stupid insurance system. (See Athenahealth, above.)

These jobs, constituting a nontrivial fraction of the national economy, are basically the real-world version of Douglas Adams' telephone sanitizers — they're all destined for the "B Ark" if we ever get our collective shit together. And even if we all privately agree that "Medicare for all" is a sensible idea (and lots of people do, privately and after a few beers, even in the depths of the medical-industrial complex), people have a tendency to not vote themselves out of a job. There's more than enough of them, when combined with all the money that's going to come from the corporations whose business models are threatened, to derail any sudden change—unless it's carefully planned and executed.

At the same time, there's a terrible shortage of actual medical personnel. IMO there's been a lot of focus, particularly during the Obama administration, of the financial side of healthcare, but not a lot of attention to whether we actually have the ability to deliver services to that many people, or increasing the supply of doctors, or provide functional alternatives to doctors. At least in my area, there's such a shortage of MDs in many specialities that they don't even take insurance. (Just try finding a psychiatrist who takes insurance. Good luck.) That's right now. I can easily imagine that if you suddenly went "Medicare for all", a lot of doctors would just say "uh, sure—cash in advance". Or you'd see even more "concierge healthcare", where you pay a fat annual fee just for the privilege of working with a doctor (and not interacting with any poor people). Sure, you could force hospitals receiving Federal funds to accept insurance, but it's going to be difficult to force individual physicians to do it, continuing the ER-as-GP problem we have today, creating or even worsening the cost-control problem and undermining the system out of the gate.

AFAIK, there's no clear path to unwinding an industry as big as healthcare in the US. Taking the private insurance companies apart is the most straightforward bit—you could treat them like failing banks and slowly roll customers towards the Federal insurer-of-last-resort until nothing else is left. But I don't think going after just the insurance-coverage angle is going to be successful; there needs to be a path out for the people involved in the system, preferably something that also fills the demand for actual medical services. The political system of the US is designed—intentionally—to make it very difficult to run roughshod over a dedicated opposition group. There needs to be a win-win if we ever want this to happen for real.
posted by Kadin2048 at 9:23 AM on August 22, 2018 [3 favorites]




etc.
-Fact checkers have a Medicare-for-all problem
-Jake Tapper's Faulty Medicare for All Fact-Check
"Mercatus is buying facebook ads to promote a false claim that Blahous will, when pressed on it, admit is false and say that he 'obviously' doesn't mean provider payment rates would drop 40 percent overall."

"This is the whole game. Don't worry about Russians spreading fake news on facebook. Worry about Mercatus spreading it through gullible and biased mainstream media sources through a surgical comms operation."
There are people—probably in the upper hundreds of thousands if not more—who do administrative or clerical work that wouldn't exist except for the stupid insurance system.

American Gangster: "You know, I don't think they want this to stop. I think it employs too many people. Judges, lawyers, cops, politicians, prison guards, probation officers. They stop bringing dope into this country, about 100,000 people are going to be out of a job."
posted by kliuless at 6:34 AM on August 23, 2018 [3 favorites]


Reuters: would you support a Medicare For All platform?
posted by The Whelk at 9:36 AM on August 23, 2018


They stop bringing dope into this country, about 100,000 people are going to be out of a job.

Indeed. I recall people involved in the illicit drug trade were blamed, at least in part, for helping to scuttle California's first marijuana legalization initiative. (Cynically, I think some of the recent success of legalization is in part because it became clear how much money is at stake, and people got the lobbying money flowing proportionately. Funny how that works.)

The problem is that healthcare reform—real healthcare reform—would have as its whole point the curtailment of a huge expenditure of money. There would be winners, lots of them, because a ton of people would suddenly have money to spend on other stuff, but the upside is diffuse, and the downside is concentrated, so it's a tough fight. I think it's inevitable, but it's going to be a slog, nationally.
posted by Kadin2048 at 3:04 PM on August 23, 2018 [1 favorite]


"The greatest wealth transfer in American history has been from the working/middle class to a wasteful hc system. Sadly, once-mission-based hospitals lost their way failing to address healthcare caused 20 yr long economic depression for working/middle class. Time for reset."

"The most dangerous thing in America is an empty hospital bed." - Jeff Brenner, UHC & Camden Coalition of Healthcare Providers

"They oppose single-payer because they love how bad private insurers are at negotiating lower prices... The amount we overpay for health care in this country could effectively fully fund a welfare state on par with most of Europe."
-Nearly 20% of US hospitals weak or at risk of closing, analysis finds
-Your Office Doctor Is Getting a Big Push From Private Investors
-Priced Out of Health Insurance, Americans Rig Their Own Safety Nets
posted by kliuless at 7:26 AM on August 25, 2018 [1 favorite]




I'm currently being charged $2,000 for a three day urine culture test that can be had at the local CVS for $100. We're on a high deductible plan, so our primary physician is Doctor Google, and his assistant, "Highly rated medical care items at Amazon."
posted by mecran01 at 6:06 AM on August 27, 2018 [1 favorite]


Medicare for All Makes Other Spending Priorities Easier
The naive way to think about how much fiscal room the government has is to just look at the tax level. The US tax level is currently 26 percent of GDP while Denmark’s is 46 percent of GDP. So, under the naive take, the difference between those two numbers, 20 points of GDP, is basically the total conceivable budget for new government taxes. If you spend 10 of those 20 points on Medicare for All taxes, then you only have 10 more points left. But if you spend only 2 points on a complicated scheme of refundable tax credits, then you have 18 points left. Or so the reasoning goes.

But this an entirely incorrect way to think about it. The amount of money available for non-healthcare spending is determined, not by the tax level, but by the amount of money going into the healthcare sector. If you are spending 25 points of GDP into the healthcare sector, then those 25 points are unavailable to you regardless of how healthcare spending is financed (i.e. whether through Medicare for All taxes or private insurance premiums). Put differently: if your universal healthcare system relies upon individuals pumping in, say, $3 trillion of cash into the healthcare sector out of their own pockets, then that $3 trillion of cash is not available for you to tax for other purposes. It’s already been claimed by the healthcare sector.
posted by kliuless at 6:09 AM on August 28, 2018


fwiw, re: Epic, TIL: "[Judy Faulkner] Working in her Wisconsin basement, the computer programmer founded the country's leading medical records company, Epic Systems, in 1979. The $2.7-billion enterprise handles the medical records of more than 230 million patients, and is used by top medical centres such as Johns Hopkins and Mayo Clinic. Worth $3.5 billion, Judy Faulkner signed the Giving Pledge, promising to donate 99 per cent of her money to philanthropic causes within her lifespan."
posted by kliuless at 6:14 AM on August 28, 2018


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