ADDED: I don't know — and don't believe anyone could know — if the numbers will work out that neatly. Even if you pick an option and let the 10 years pass, you couldn't know, because you don't run the real-world experiment on the other option. Of course, everyone knows this. You still have to pick.
But let's assume for the sake of analysis that the 2 options cost roughly the same. Another way of putting this, is let's imagine the thought processes of an American voter who completely accepts the premise that the 2 options consume the same amount of money. Why would this person pick Option 1?
I think it would go something like this: I and my loved ones are on track to get a pretty decent share of the $52 trillion in health care services that will be provided in the next 10 years. I know everyone deserves access to health care, but I think there might some big groups of needy people — including people who are migrating to our country — who will be taking a lot more if we switch to Option 2, and my hopes and expectations, which I've built up over a lifetime, will not be met.
That is, even if the same amount of money is spent either way, there's an instinctive fear that if the money is amassed centrally and redistributed, you'll be worse off.
I'm not an economist or an expert on health care, and I haven't read the entire Elizabeth Warren document, and I probably never will. I loathe the subject of finance, and I respect it enough to refrain from offering half-assed opinions on the subject. All I am attempting to discuss is the instinctive emotional reaction to "socialized" medicine. And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money.
ADDED: My thought experiment, above, includes wondering about health care for all the migrants who are continually arriving in the country and who would, presumably, arrive in greater numbers in a Warren administration. Warren's plan does say something about immigration.
I support immigration reform that’s consistent with our values, including a pathway to citizenship for undocumented immigrants and expanded legal immigration consistent with my principles. That’s not only the right thing to do – it also increases federal revenue we can dedicate to Medicare for All as new people come into the system and pay taxes. Based on CBO’s analysis of the 2013 comprehensive immigration reform bill, experts project that immigration reform would generate an additional $400 billion in direct federal revenue.That is, the immigrants won't cost more. They'll provide more revenue.
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242 comments:
«Oldest ‹Older 201 – 242 of 242“Access to health care” is the euphemism for abortion.
Everyone has access to health care, Professor.
Some might have to drive farther since the US Is so big.
Nowhere in the US are bodies stacked like cordwood at hospitals.
IF they were, that would have been a selling feature for Obamacare.
"Ann says it cannot be a free market."
I think I remember her also telling us that a businessman would not make a good president, becuase government cannot be run like a business. Maybe it can't be entirely, but a law school can't be run like a law firm either, but I bet students would benefit greatly from listening to a working lawyer explaining the real world to them.
The government does almost nothing valuable itself. It runs everything through businesses, so naturally a businessman would in fact make a superior president, and has.
In a global sense, Medicare for all would control TOTAL Costs - because the amount the Government put into the system would be paid by Taxes and Borrowing. This doesn't mean the quality of the healthcare wouldn't decline, or that there wouldn't be massive fraud, waste and abuse.
Look at the College Education system. How much goes to Professors and how much goes to Administrators doing God knows what. Has the massive increase in tuition over the last 25 years results in better Professors are better educated students? Not that I can see.
Medicare for all, will also result - even more than it is today - in a politicized Health care system. Pols will start out-bidding each other and boasting about how much more they spent on Healthcare. Women voters will be told that if elected this Pol will Double the amount spent on XYZ and that the percentage of women doctors will be increased from Z to X. blacks and Gays were also pandered to. Our healthcare system and what it does will become a political football.
Remember when Trump said Mexico would pay for the wall and left wingers went apeshit?
Elizabeth Warren may as well have said Mexico is going to pay for 'Medicare for all'
This is the same thing 5,000 times bigger. How many do you suppose will have a problem with it? I don't mean Mayor Pete advocates who will use this as a campaign issue. How many will oppose this if she is President and tries to push it through?
Dozens I'm sure.
"AARP likes it when wait lists for hip replacements are 14 months long.”
AARP is a Democrat front group, so they will get right to work explaining to “seniors” that it is better that way.
The ultimate result will be a two tiered system, as in England. The Well-to-do 5% (including most congressman and senators) will use expensive private Health care. This system won't have price controls, and will attract all the best doctors and best health professionals. The other 95% of us, will be stuck with the American NHS.
We could have illegal immigrant doctors, those guys work long hours for next to nothing!
Ms. Althouse! Your question, "Would Medicare for All save money?" The answer is, "It could." But you must ask the follow up, "HOW would Medicare for All save money?"
We can look to other countries to find the answer which is, at risk of oversimplification, through some combination of access, price, and budget controls.
Let's just say that it's 202x and the Federal Single Payer Agency is projected to spend $5.20T that year. The President comes in and tells the agency, "I have a campaign promise to keep. I need that down by 5% next year."
OMB, or sombody, does the math . . . . Let's see, we'll spend $[a lot] on hip replacements this year. For next year we'll reduce the surgeon and hospital payments by 2.5% for each surgery and well cut the number of procedures performed by another 2.5%.
You ask how an agency cuts the number of procedures, of a certain type, performed?
Imagine that patient demographic analysis shows that, say, 97.5% of hip replacements are performed on patients under 76 1/2 so, easy, starting next year, any patient over 76 1/2 gets what Obama was going to offer, a sympathetic look and a bottle of aspirin.
Money Saved . . . easy! Need another 5% the following year? Still no problem . . . we just move that age threshold as needed. You remember Sarah Palin predicting decisions being made by Death Panels? Well, here they are.
I'll do one with a scheduling component . . . kind of like the VA. Imagine that you fell off your bike and hit your head. Doc says you need an MRI . . . just in case and gives you a number to call. It's November 1 and the scheduling office says, "We're scheduling March now, how does the 15th work for you?"
Why is that? Because that budgeting agency figured that to stay within budget, our hospital could perform up to 12 MRIs per day and those slots get filled up.
So Ann says, "But, but, but, my doctor said I should get this done as soon as possible." And the scheduler says, "Yes. Of course, Ms. Althouse. Just tell your doctor that the 15th IS the soonest possible. Ooops! That spot just got taken, can I put you down for the 16th?"
"But, but, but, if there a problem in my head I might not make it 'till March." And the scheduler replies, "Oh my! I'm so sorry. Now, please make sure someone lets us know if you're not going to keep this appointment so we can offer the spot to someone else.
In other words, one way or another, there will be rationing . . . . In place of today's implicit rationing (some can afford it; some can't), it will be more explicit as in, too bad, you're missing the required endorsement. Oh, and you're too old, or too sick to get one.
The good news . . . as the Dem pols explain, no co-pay, no deductable when you see the doctor. The bad news . . . we have no freaking idea when you'll get to see her.
Anyway, that's what I think.
"Experts say". In other words, "We're just making s**t up, but you have to believe us because we've got credentials".
So Ann says, "But, but, but, my doctor said I should get this done as soon as possible." And the scheduler says, "Yes. Of course, Ms. Althouse. Just tell your doctor that the 15th IS the soonest possible. Ooops! That spot just got taken, can I put you down for the 16th?"
"But, but, but, if there a problem in my head I might not make it 'till March." And the scheduler replies, "Oh my! I'm so sorry. Now, please make sure someone lets us know if you're not going to keep this appointment so we can offer the spot to someone else.
All Anne has to do is pay attention to Canada.
At one time, pets were getting MRIs faster than humans. This was in the early 2000s.
She can look it up.
She can also look up wait times for procedures since (some of) their provinces publish that information.
If she was curious.
Did Liz include the millions that will undoubtedly flow to Hunter and other prominent Democrats in her cost projections?
It is obscenely immoral to prohibit you from paying for your medical care out of your own pocket. These people are evil.
option 2 is a nonstarter. Even assuming the ridiculous premise that costs will be roughly the same over 10 years, then why completely upend our current system and go through all that trouble and difficulty? So a bunch of illegals can get free health care, too? So Elizabeth Warren can be in charge of something? No thanks. Health care is too important to put the government in charge of it.
Ann Althouse said...
"Better in what ways?"
My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do, (1) that if the government ran everything, it would control costs (but would still be subject to political pressure and couldn't really hurt us too much), and that (2)it's a horrible burden on people to figure out insurance matters and to feel anxiety about what to pick and how to pay for it, and that (3) it's screwy to have it connected to employment (given that children and sick people are especially in need of health care and are not in the best position to be employees). I understand the concept of a free market, but it's already not a free market, and it can't be a free market for a number reasons because the product relates to health, and relates inversely to the ability to get money to pay for it.
11/1/19, 10:06 AM
Ann, did you actually read what you wrote? I expect better from you, really.
(1) When has ANYTHING the Government took over cost less? Hell, they can't even run the VA well. You want your ONLY healthcare option to be a nation wide VA?
(2) Yep, being an adult and making choices and stuff is hard, HARD! So much easier to let other credentialed administrators make all your choices for you.
(3) I agree, and you know who DID that? Government, that is who. My insurance is NOT tied to my job. I have a private plan. The guy I work for gives me some toward it cause I am not on his plan. My plan has its trade-offs but they are trade-off I picked, not my employer and it goes where ever I go and is a LOT cheaper / better (for me at least) than those that he was able to offer. What is stopping most of those employed from doing the same? Don't like the office plan, go get your own.
As others have said, name ONE thing the government does better/cheaper than private enterprise?
Robert Cook: That was because Obama was compromised from the start by catering to the health insurance providers: ACA is basically a delivery system of a captive audience to the insurance providers.
It wasn't "compromised". What you describe is what it meant to be. From the get-go.
He never invited or allowed any advocates of single payer to participate in any so-called "town meetings" held to discuss how to improve our healthcare system.
It wasn't just the single-payer advocates who were locked out. Nobody advocating actual reform (as opposed to the tweaking of the existing system to implement what you describe above) was given a hearing. Look at Dr. K's comments on this blog, for example.
That is, the immigrants won't cost more. They'll provide more revenue.
The conviction that mass Third World immigration is going to be the salvation of the First World's social-welfare-financing troubles is one of the most, if not *the* most, extraordinary of all the collective delusions cherished by its current governing caste.
he knew he has to collapse the system, and you couldn't get to single payer in one step, he admitted to that to select audience in 2007-9, including a conference by Jacob hopper,
"option 2 is a nonstarter. Even assuming the ridiculous premise that costs will be roughly the same over 10 years, then why completely upend our current system and go through all that trouble and difficulty?"
That's an excellent point.
"If the so-called "Medicare for all" was ever passed, it could be (and hopefully would be) redesigned from the ground up, using existing models in other countries as guidance to build in known strengths and exclude known weaknesses, insofar as possible."
Yes indeed, Cook. And this monstrous redesign of our health care and employment and financial systems that would impact the lives of every American (and non-American on an unauthorized visit) will be legislated, implemented and managed by our current political class - elected and un-elected.
Count me out.
It reminds me of the two conflicting ideas that Glenn Reynolds keeps pushing:
1. We have the worst political class in out history.
2. We should call a Constitutional Convention of the States to allow this political class to re-write the Constitution.
The risk of a complete failure are too great to justify a change of this magnitude.
"1) that if the government ran everything, it would control costs (but would still be subject to political pressure and couldn't really hurt us too much)"
These are the same politicians that Althouse (rightly) called out for their impeachment madness. Yet somehow, magically, she counts on them to be responsible when it comes to healthcare.
I like to believe she just hasn't thought this out.
The conviction that mass Third World immigration is going to be the salvation of the First World's social-welfare-financing troubles is one of the most, if not *the* most, extraordinary of all the collective delusions cherished by its current governing caste.
I said it before, they are going to pay for it because they are all going to be in the one percent!
This stuff is so easy! She already said that only the rich are going to pay for this, so you can therefore deduce that the illegals made legal are all going straight to the top and pay for it through wealth taxes!
What I find fascinating about the proposed single pay scheme is do they first propose a legal scheme that passes a constitutional smell test?
Althouse may not be interested in how the schemes are to be paid for but as a law professor I wonder if she has an interest on how this proposed scheme passes the constitutional examination. Has anyone made a legal memo explaining where the federal government has the constitutional authority to nationalize an industry and compel all employees and contractors and suppliers to accept only the government's compensation?
Althouse may not be interested in how this scheme will be paid for but I suspect that if it were passed and the economy inevitably goes into a 1930 style depression when her investments get trashed and her pension plan gets trashed then she will most definitely be interested.
One of Warren's typically stupid remarks is that by eliminating private insurance the overhead of those companies will eliminated and thus the savings. She fails to explain how CMS is any different in most of its aspects from an insurance company. Both process claims, both pay claims, both review procedures for approval but only one has a financial incentive to investigate fraud and only one has a financial incentive to expedite information in medical malpractice cases. Under Warren's scheme the bulk of health insurance company employees will wind up doing mostly what they doing but doing it for CMS at government wages and benefits.
To paraphrase Everett Dirksen...."A trillion here, a trillion there, and pretty soon we're talking about real money!!"
AARP
Americans Against the Republican Party
I again offer a variation on the Joseph Sobran plan for hunger in the US, back when hunger was the "liberal" cause if jour (i.e., another scheme to increase the power of the State and pick your pockets). Sobran proposed giving all destitute people a chit reading, "Good for One Free Meal, Payable by any Liberal." We could, with some imagination, work out a similar deal so that any medical procedures, medicines, etc., would be paid by "liberals."
Medicare pays discounted rates for most (all?) services. Providers charge non-Medicare patients (i.e, those with private insurance) higher fees to make up the difference. A markup of 5X or 6X is not uncommon, esp with emergency room services. Insurance companies constantly haggle with providers over these blatantly inflated prices. Medicare's enrollment is steadily growing - both in overall numbers and as a share of the population - which means more costs get shifted every day to non-Medicare patients. That's steady and significant upward pressure on insurance premiums and deductibles.
If you assume that *everyone* pays the price-controlled Medicare rate (which is what "Medicare for All" assumes), providers not willing to accept the discounted prices will leave the market, and you'll quickly have a shortage of services. It's not rocket science, but it's apparently beyond the grasp of too many voters who think the government can magically order up as much service as it wants at its preferred price. Markets don't operate that way. Medicare for All will mean rationed care, and price controls on medicine kill any profit motive to invent and innovate.
Medicare already spends far more than it collects in tax revenues, and will empty its "trust fund" in less than 10 years. Moving the entire country to that price-controlled model will just accelerate its collapse.
The only Federal agency that actually worries about costs is the census bureau. The census faces competition from private companies that also do data collection. So it has to be competitive.
The census bureau is the most unusual government agency. Once every 10 years it takes the national census. Those who conduct the census are not ongoing government employees. There are about 400,000 citizens hired to do the census. Right now the census is in the process of hiring those 400,000. After the decennial, all the 2020 offices close, everyone working on it leaves. All the equipment to run it goes to sleep for another 9 years. In a way the model is the same as militia, citizens who come together for a purpose, do it, and then go home. Since the decennial has been taken for over 200 years, its roots are deep in history.
There is another band of census employees, also unusual. Many employees of the census are field representatives. They work from their homes. Only 6 regional offices coordinate them via computers. Field representatives are only paid the hours they actually work. None get holidays. None are considered full time even if they work 40 hours a week. Unless they work more than 240 hours a quarter they do not get any benefits, like vacation or sick leave. They must be flexible. If you complain, you get no new assignments.
These employees do the data collection for many surveys for other Federal departments, who take credit for the data, but have done nothing to actually collect the data. Since the census faces competition, it actually has to worry that someone else might put in a cheaper bid. These field representatives also do the data collection of the ongoing samples related to what used to be the long form census questionnaire.
Doctors used to be a single office, individual practice. Today, many are hired servants working for a large "non-profit", where they may have no input into what patients they see, just say "next". Some new doctors are just employees who may work for several different employers, "Today is Tuesday, it must be Kaiser."
This is one of the hidden dangers, turning doctors into unionized workers. Their dues used to support the left. You see that already in the nurses unions. I suspect this is part of the deep danger/plan, to turn a class of educated professionals into wage slaves dependent on government for their work.
Regarding shelter not being under government. In leftist enclaves the reason housing prices are so high is government. A major development can take years to gain approval, and after spending millions in plans and city fees, be turned down. It is amazing anyone still takes the risks, although it has become "who you know",not "what you know". They limit the supply of land, driving up the cost, "open space" keeps thousands of acres from having homes built, increasing costs. (This is just the tip of what would be a 40 page paper on how the left drives up housing costs.)
PresbyPoet asserts: This is one of the hidden dangers, turning doctors into unionized workers. Their dues used to support the left. You see that already in the nurses unions. I suspect this is part of the deep danger/plan, to turn a class of educated professionals into wage slaves dependent on government for their work.
AMEN, AMEN, AMEN!!! And I don't know a doctor who would argue with that. The CEOs have taken the autonomy away from medical professionals. That and the electronic medical records system will drive away more doctors than we can attract to medical school to replace them. I would estimate that, in my county, nine of every ten physicians are foreign born so I guess that's the solution. :-(
"Althouse may not be interested in how this scheme will be paid for but I suspect that if it were passed and the economy inevitably goes into a 1930 style depression when her investments get trashed and her pension plan gets trashed then she will most definitely be interested."
While I can't do anything about our pension plan I do control our investments. I am watching closely to see if Warren, or any other Democrat and their cockamamie plans, have a chance of actually winning. If they do we and our investments are headed for the exits. It'll be a bum rush, but ya gotta save what you can. Actually made a portfolio change today to make this easier to pull off if need be.
Private spending cannot be exchanged one for one with public spending and have zero effect.private spending is efficient and public spending is not. The immediate and long lasting effect would be strongly negative for the economy.
"My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do, that if the government ran everything, it would control costs"
Apparently, women's intuition is not all it's cracked up to be.
The key in analyzing financial claims is to look at the assumptions. Here, Warren's financial analysis is predicated on the assumptions that the government can pay doctors 30% less than they are paid today and pay pharmaceutical companies 70% less for patented drugs. Also that Medicare's overhead costs will only be 1/3 of what the experts say it needs to be. If these strike you as unreasonable assumptions, welcome to the club.
Were it not for obesity and addiction there would be no health care crisis.
Were it not for deplorables, their would be no obesity and addiction.
Economic rules are simple:
"There is no free lunch".
"That which is seen, and that which is unseen"
Economic ignorance is rampant these days. Even our hosts assumes there are "cost savings" to having the govt set prices and wages. Surely she remembers Nixon?
BIGGEST PROBLEM
Offering an unlimited free supply shifts the demand curve.
British Politician Blevin, on bringing about their Socialied system:
"I stuffed their mouths with gold."
Elizabeth Warren:
"The best plan is #MedicareForAll—the only plan that gives everyone in America full coverage, with the freedom to see any doctor, with no premiums, copays, and deductibles—so getting sick doesn’t mean you go broke. No restrictions, no surprises, no more bills."
No Restrictions.
A never ending fountain of services available at your whim.
Until it isn't.
That is why Health insurance HAS copays. That is why Health Insurance has so much paperwork - fraud, and limiting service. This does not go away because the govt becomes the sole payer and price setter. It means that Health will be THE ONLY political issue from now on. And who promises free stuff on the money printing credit card?
"There is no free lunch"
None of this will pass Congress unless the public makes another mistake like the Obama election that gave us Obamacare. Moot discussion.
> Were it not for obesity and addiction there would be no health care crisis.
There is no simple solution.
Another economic truism:
Capital is mobile
Why didn't the Rolling Stones live in England?
Soaking the rich means the rich will increasingly find some way out. Soaking coproation raises prices, or causes tax favored malinvestment reducing your retirement fund returns.
Google "Double Irish with a Dutch Sandwich" for the Apple / Google IP multi-billion IP move.
Trump actually repatriated money by making overseas income realized during the tax year.
The Seen and the Unseen.
The blue states have failed
CA, NY, IL have over-promised and under-delivered
Socialized medicine takes the blue state model to the Federal level
Where the credit card never runs out
Next Dem will bail out the blue states with your money
Let me make a simple observation that seems to have eluded everyone except the 10% of workers who are self-employed and pay for their own insurance without a subsidy:
Obamacare was nothing more than tripling the medical expenses for the 10% of self-employed workers who are self-supporting and transferring that money to the 10% of people without medical insurance from work who earn, by lifestyle choices, less than 40-50K (based on family size) per year but aren't poor or fertile enough to qualify for Medicaid and aren't ill enough for disability Medicare.
For example, artsy types. People searching for themselves. People who want "meaningful" lives. Meanwhile, the other 80% who receive insurance from their jobs, unions, government, were not affected at all. The lobbyists made sure of that.
This was a directed financial gang rape of responsible self-employed people who happen to have to buy their own insurance so that people who'd rather pursue graduate degrees or play in bands at 40 could buy platinum insurance with scant deductibles for less than $100 a month while responsible middle class self-employed people now pay a minimum of $600 - $800 a month each for plans that don't kick in until you've hit your $8,000 out of pocket maximum, which usually happens after you've spent about $12,000 out of pocket. It's even called Platinum care for the lazy and Bronze for the thrifty and hard-working. Nice, that.
Warrencare with bring this goat-rope to the rest of you. Welcome aboard. Non-performance artists and baristas are in the Bronze section. Watch your step. You can't afford to sprain your ankle.
I also think you would care a lot more about this if you had ever had to work in an industry that wasn't subsidized luxuriously by taxpayers. There's an unreality factor among academicians and other government workers who have never had to make the hard choices non-taxpayer-subsidized workers must make. We're paying for your luxury to be disinterested in the math, and no, the fact that it works (out) well for you doesn't mean it will work at all if we all get to board the yacht we currently pay for, then wave at from the shore.
Factor in summers off, the chance (even if not taken) to dial it in for decades after tenure kicks in, a workload foundationally lighter than the private sector, and a system so historically unsustainable that is it now being eliminated except for those lucky few golden parachuted in and out, and it smacks of deep insult to injury to casually comment that you don't care much about whether some politician's plan does or doesn't destroy the finances and access to healthcare of many more of us because you've got yours. Subsidized by ours.
Unfortunately, this is a very common attitude.
"My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do..."
Replace "insurance companies" with "law firms," as a thought experiment. What lawyers do is also complex and reliant on special knowledge and terminology (and indeed accounts for MUCH more of the cost of legal services than insurance companies' share of the cost of health care services). Should lawyering therefore be a single-payer system? When you need a will or a contract or a lawsuit, should you go to the government for it, simply because you yourself don't understand the ins and outs of what you need? Truly, everyone is conservative about what they know best.
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