Category: Healthcare

A Contract For Americans (2/10)

Medicare For All – Saving money on our biggest bill

Right now, the United States spends nearly $12,000 per person on health care. That’s 65% more than Switzerland and 71% more than Germany. However, we spend $5,790 per person (including partial benefit enrolees) on Medicaid.  Think about that for a minute..  We pay about HALF the amount for health care for our citizens who are, by and large, requiring the most health care.  (Side note – Medicare is mostly age-based and for the elderly, Medicaid is run by the states and based on income more like an anti-poverty and disability program).

And what do we get for our money? The average life expectancy in the US is now 76.6 years in 2021, down from 78.8 in 2019. Think that sounds good? In Japan, it’s 85 years overall, with 88 years for women. What do you think Japan pays for healthcare. It’s $4,961. We’re paying 2.4 TIMES what Japan pays and 10% less ‘life’ for all that expense.

So how about Medicare-for-all?  Think we can’t pay for it?  Well we’re already PAYING more than double so we’d be SAVING money!  ….and we could END the abomination that ONLY exists in THIS country known as “Medical Bankruptcy”.

As of 2019 (before some Medicare financial juggling was done), we spent $796 billion on Medicare. It’s really hard to nail down what Medicare-for-all would cost per-person. We know that covering the elderly costs ABOUT the national average ($12,000) but that’s also the demographic that needs the most services. The whole idea of insurance is to spread the risk. So maybe using Japan as an example isn’t 100% fair – after all, they have a different lifestyle and MUCH healthier food habits (which could be a topic for another post). What about the UK? The UK spends just over $4,400 per capita for their NHS and they have a life expectancy of over 81 years. Or how about Canada? At $4,402 per person and a life expectancy of 82 years, what are they doing right that we’re doing wrong? Single-payer health care.

An example? Over the past couple of years, my wife and I have needed MRIs. First we had to get them approved by the insurance company. My wife needed to go through TEN MONTHS of useless, ineffective therapy because the doctors couldn’t diagnose her problems – TWICE – that the MRIs, when finally approved found INSTANTLY. In my case, I “only” had to go through 4 months of therapy before my therapist angrily went to bat for me to get an MRI because her therapies weren’t having an effect (I had a stress fracture in my leg that an X-Ray didn’t see and my wife had ligament damage in her shoulders and ankle). Keep in mind that I have GOOD health insurance that costs $20,000/year in premiums (between ‘my’ share and my employer’s share). …and that’s before all the deductibles, co-pays and out-of-pocket exceptions.

When I saw the bill? It was over $5,500 for the MRI. Reduced in price over $1,000 for the insurance company but still left me with a $600 deductible/co-pay (remember, we waited MONTHS for this IN PAIN). However the RETAIL price for an MRI (which isn’t covered by Quebec’s health care plan but CAN be covered by an MRA) outside of Montreal is $501.29 USD. Why my insurance company doesn’t put me on a bus to Quebec and save a couple thousand dollars, I don’t know. That’s the WALK-IN price. …and they don’t hide it. Try to get that from an American clinic.

We need to examine whether or not the profit motive should be paramount in health care.

Also, keep this in mind – we pay more for the same prescription drugs compared to other countries.  WAY more..  You can look at per-capita spending. You can look at drug prices themselves. Many of those drugs are manufactured here in the US and shipped overseas.  Even if it’s just next door in Canada.  You could look at India.  You can look at Europe.

That we allow this profligate spending for the benefit of health insurance and drug company shareholders is stunning.

Medicare-for-all would save a BOATload of money. The people making billions off of other people’s misery would have to just sit on those billions. Doctors and nurses wouldn’t have to fight with every different insurance company – the savings in standardization alone (only having to have one set of records) would be immense.

Oh – and those clerks and other line workers who would be out of work at those insurance companies? They can be hired at HHS to help administrate Medicare and Medicaid with the influx of millions of new subscribers. I’m sympathetic to them. They aren’t the ones making my wife go through years of pain. They aren’t the ones screwing us over.

Every other industrialized country does this better than we do. It’s just another example of how those who sloganeer about the US being the best country in the world have their head in the sand.

Medicare-for-all. Do you think I’d trade $20,000 in premiums for a 4% income tax? The math says it’s a no-brainer. It gives workers a raise, saves employers money and covers the less-fortunate. It ought to be a law that, on your pay stub, you not only see how much YOU pay for health insurance but your employer’s part as well (typically from more than twice to four times as much as the most common splits are 80/20 or 70/30).

Medicare-for-all. Do you think we’d have more trust in doctors if we didn’t have to avoid them because of the cost? Do you think we’d be healthier if we got health care sooner rather than waiting until the pain is too much? What do you think the ramifications are if we went to medical professionals instead of Google?

Who stands to profit if we don’t? Insurance companies.

Who stands to profit (and live longer) if we do? We The People.

Health Care – Complaining is easy, solutions are hard. Or are they?

When it comes to health care, it’s easy to complain.  All you have to do is find something you don’t like and complain about it.  Bitch about it.  Moan.  Tell the world “There ought to be a better way”.  Now, what that better way should be requires more thought and analysis.

The health care system we have today is a hodge-podge of band-aids grafted on to a model centered around the concept of health insurance.  But it wasn’t always this way.  In fact, over 70 years ago President Harry Truman had a proposal for Universal Health Care.  In the aftermath of World War II, Truman saw under-served populations counting in the millions and wanted to do something about it.  At roughly the same time, the United Kingdom started it’s National Health Service with it’s single-payer system.  So let’s take a look at where we are, 70 years later..

First, a comparison for a sense of proportion:

  • U.K. population: 65 million.
  • U.S. population: 321 million (just under 5x as many)

So let’s use a factor of 5 when we have to compare numbers between our two countries.

What is the UK spending on their National Health Service?  For Fiscal Year (FY) 2015/16 the budget was £116.4 Billion.  At today’s exchange rate (£1 = $1.27), that’s $147B.  Now, multiply that by 5 and you get a little under $740B for a theoretical cost for an “NHS-like” plan scaled up to the size of the United States.  Let’s keep that number in mind.

What are WE spending on health care?  Let’s look at our government expenditures first.

That’s a total of $1,436,200,000,000 or $1.4 TRILLION.  …and that’s just to cover the elderly, the extremely poor and our veterans.  Somehow, the UK manages to cover EVERYONE for just over HALF the cost, adjusted for population.

But that’s not the end of our spending…  In 2016, total US health expenditures were going to top $10,000 for every man woman and child in the country.  …to a total of $3.35 TRILLION.  This would be after you add in what insurers are paying out in benefits and what people are paying out in co-pays, deductibles, fee-for-service, etc.

But what about all the horror stories that we hear from Republicans about Obamacare?  That’s their wallet talking.  Specifically, the wallets filled with insurance company cash.  Insurance companies are trying to have it both ways.  In public, they’re claiming that the ACA causing them losses, but when they have to report to the SEC, by law, they have to admit that they are figuratively swimming in cash.  When you press them they even admit to making money on Obamacare.

But let’s go back to that extrapolated UK number..  $740B.  That covers EVERYONE.  What does our $1,436.2B cover?  The elderly, poorest of the poor and veterans.  What about everyone else?  We’re paying 94% MORE to cover a FRACTION of our people!  Maybe there’s some quality of care issues – like our health care is better than theirs and that is why it’s so expensive!  Let’s look at some numbers:

So..  We pay more, get less, wait longer, die sooner, go broke more often and have to find our passports to get better-priced care..  Why do we put up with this?  (My personal theory is that we’ve been a very parochial country since at least the end of World War Two – anything not invented here isn’t ‘Murican enough for people)

But take a look at those numbers above.  For just over HALF of what our taxes are now paying – we could have an NHS-like system in this country.  FOR OVER $700 BILLION LESS THAN WE PAY NOW TO COVER A MINORITY OF OUR PEOPLE – THAT’S MORE THAN THE ENTIRE FEDERAL BUDGET DEFICIT.  Though, I have to confess, the Medicaid spending numbers DO include spending at the STATE level.

Oh – and after that – we’d have a couple TRILLION dollars in private spending left over – to help make up for the predictable crash in the stock values of the private insurers.  But that’s not so bad.  We could adopt a plan like France or Germany and allow for private, supplemental insurance for people who can’t wait until later in the day or tomorrow to see their GP.  Believe me, the insurance companies will find a market and try to sell to it.

I’m not even including the savings we could get by being able to negotiate drug prices.  How about the savings if we banned drug advertising over the air like we used to?  No more “purple pill” ads telling you to “call your doctor”.  Guess what – your doctor already knows about the drug – and you calling their office only makes them stop what they’re doing for patients they’re seeing.

We can learn from other countries and improve upon their experiences.