Which 2028 Presidential Candidate Would You Vote For?

[baltimorened]

I thought the definition for all people was "a government offered insurance option that would still leave private insurance in place".

That was my definition, here's what wikipedia says:

I don't have any problem with that if it would 1. lower prices and 2. allow fair competition, and 3. not require government funding of any sort.

Hospital/doctor costs are what they are. If the government can administer a program cheaper than Signa, for example, why not? But the government can't stack the debt with subsidies, or other competition killing benefits.

But isn't that, in basic form what the ACA does? Except the government doesn't run its own "insurance company"?

 

[scotchtiger]

Explain to me how why other countries can provide Universal Healthcare for their entire population at much lower costs than the US currently spends, but it's just not feasible for our country to make a change.

The United States government already spends more per capita than other countries that cover all of their citizens. And gets worse outcomes nearly across the board. No politician in ANY of those countries would run on converting their country to a US-style system.​

Government (public) health spending per capita measures the average amount of money a country’s government allocates to health care for each person, including both compulsory and voluntary health financing. Below are the latest available figures (2024 estimates in USD, PPP-adjusted) for selected countries Statista:​

Country	Public Health Spending per Capita (USD)
United States	12,402
Germany	8,079.8
Norway	8,078.8
Netherlands	7,016.8
Luxembourg	6,937.4
Switzerland	6,771
Sweden	6,741.5
Austria	6,408.2
France	6,219.3
Ireland	6,067.8
Denmark	5,899.5
Belgium	5,722
Iceland	5,650.6
United Kingdom	5,345.7
Australia	5,013.5
Canada	5,300.6
Japan	5,526.6
New Zealand	6,096.6
Italy	4,284
Spain	4,020.7
Poland	3,133
Greece	3,607.1
Brazil	2,309.4
Mexico	1,587.7
Costa Rica	1,935.4
Colombia	1,877.3

Country	Universal?	Spending​	Wait Times	Overall Health Outcomes
United States	No	Highest​	Mixed (often faster for specialists/elective care, but access depends on insurance)	Below most peers
Canada	Yes	Much lower​	Longer	Better overall
United Kingdom	Yes	Much lower​	Longer	Better overall
Germany	Yes	Lower​	Generally shorter than Canada/UK	Better overall
Netherlands	Yes	Lower​	Generally good	Better overall
France	Yes	Lower​	Generally good	Better overall

Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System

Mirror, Mirror 2024 compares the health systems of 10 countries on five domains: access to care, care process, administrative efficiency, equity, and outcomes.

www.commonwealthfund.org

Are you both suggesting that the lack of government funded universal healthcare is the sole reason for these figures?

Because I see things quite differently. The biggest problem we have in the US is lifestyle and diet. 40%+ obesity is an alarming statistic. Our EU counterparts providing universal healthcare don't have that working against them. They generally sit in the teens, substantially below the US. And we know the dramatic effect of obesity on inflammation, chronic conditions, heart disease, joint replacements and even cancer. All massive - no pun intended - drivers of boh cost and poor health outcomes. And don't get me started on our food supply.





The US also subsidizes global innovation with medical devices, pharmaceuticals and other healthcare innovations. What happens when this isn't as lucrative in the US?

If you look at who spends the most, it also generally tracks with wealth statistics by country. I think there's a diminishing return for excess spending that exacerbates these figures.

I'm not saying there aren't ways to improve US healthcare. There absolutely are. But thinking that the shift from the current system to government funded universal healthcare is the silver bullet to cure all of our ills is incredibly naive and generally ignorant of the variety of factors that contribute to current costs and health outcomes.

 

[gohawks50]

Are you both suggesting that the lack of government funded universal healthcare is the sole reason for these figures?

Because I see things quite differently. The biggest problem we have in the US is lifestyle and diet. 40%+ obesity is an alarming statistic. Our EU counterparts providing universal healthcare don't have that working against them. They generally sit in the teens, substantially below the US. And we know the dramatic effect of obesity on inflammation, chronic conditions, heart disease, joint replacements and even cancer. All massive - no pun intended - drivers of boh cost and poor health outcomes. And don't get me started on our food supply.


View attachment 1379417


The US also subsidizes global innovation with medical devices, pharmaceuticals and other healthcare innovations. What happens when this isn't as lucrative in the US?

If you look at who spends the most, it also generally tracks with wealth statistics by country. I think there's a diminishing return for excess spending that exacerbates these figures.

I'm not saying there aren't ways to improve US healthcare. There absolutely are. But thinking that the shift from the current system to government funded universal healthcare is the silver bullet to cure all of our ills is incredibly naive and generally ignorant of the variety of factors that contribute to current costs and health outcomes.

I agree obesity is part of the problem. But it doesn't explain everything. Countries like Australia, New Zealand, and even Chile also struggle with high obesity rates, yet they still have better overall health outcomes than we do while spending much less on healthcare. That suggests our healthcare system itself is part of the equation, not just how healthy Americans are.

 

[OnlyTheObscure]

US spends twice as much per capita on healthcare than most countries.

guessing providers charging a lot is a big reason.

guessing doctors and nurses get paid more in US.

US also as way more equipment at the ready than other countries. Look at MRI machines per capita.

Would enjoy reading proposals they are fully funded and how they are funded that would cover everybody. I suspect research has been done and politicians know promoting such plans is an election loser.

 

[gohawks50]

US spends twice as much per capita on healthcare than most countries.

guessing providers charging a lot is a big reason.

guessing doctors and nurses get paid more in US.

US also as way more equipment at the ready than other countries. Look at MRI machines per capita.

Would enjoy reading proposals they are fully funded and how they are funded that would cover everybody. I suspect research has been done and politicians know promoting such plans is an election loser.

Doctors, hospitals, drugs, and medical services generally cost more here. We also have good access to advanced technology like MRI machines. But despite all that spending and technology, we still don't get better overall health outcomes than many comparable countries. That's the part I think is worth asking why.

Country	MRI units per million people​
Japan	~57​
United States	~38​
Greece	~37​
South Korea	~36​
Germany	~35​
Italy	~33​
Norway	~31​
Australia	~18–20​
France	~17​
New Zealand	~14​
United Kingdom	~7–8​
Canada	~11​

Proposal	Type	How it's funded
Medicare for All Act (Bernie Sanders)	Single payer	Combination of payroll taxes, higher taxes on high-income households, taxes on investment income, and redirecting current federal, state, employer, and household healthcare spending.
Medicare for All Act (Pramila Jayapal)	Single payer	Similar approach: replaces most private insurance with publicly financed coverage funded through taxes and redirected healthcare spending.
Medicare for America Act	Universal public plan with employer option	Employers continue contributing, plus federal revenues and premiums for some higher-income participants. Most people transition automatically into the new plan.
Healthy America Program (Urban Institute)	Mixed public/private	Payroll contributions, income-based premiums, federal funding, and automatic enrollment. Designed to achieve near-universal coverage. (Congressional Budget Office)
Public Option proposals	Government plan competing with private insurance	Financed through premiums and federal subsidies while leaving employer insurance largely intact. (Congressional Budget Office)

 

[scotchtiger]

Doctors, hospitals, drugs, and medical services generally cost more here. We also have good access to advanced technology like MRI machines. But despite all that spending and technology, we still don't get better overall health outcomes than many comparable countries. That's the part I think is worth asking why.

Country	MRI units per million people​
Japan	~57​
United States	~38​
Greece	~37​
South Korea	~36​
Germany	~35​
Italy	~33​
Norway	~31​
Australia	~18–20​
France	~17​
New Zealand	~14​
United Kingdom	~7–8​
Canada	~11​

Proposal	Type	How it's funded
Medicare for All Act (Bernie Sanders)	Single payer	Combination of payroll taxes, higher taxes on high-income households, taxes on investment income, and redirecting current federal, state, employer, and household healthcare spending.
Medicare for All Act (Pramila Jayapal)	Single payer	Similar approach: replaces most private insurance with publicly financed coverage funded through taxes and redirected healthcare spending.
Medicare for America Act	Universal public plan with employer option	Employers continue contributing, plus federal revenues and premiums for some higher-income participants. Most people transition automatically into the new plan.
Healthy America Program (Urban Institute)	Mixed public/private	Payroll contributions, income-based premiums, federal funding, and automatic enrollment. Designed to achieve near-universal coverage. (Congressional Budget Office)
Public Option proposals	Government plan competing with private insurance	Financed through premiums and federal subsidies while leaving employer insurance largely intact. (Congressional Budget Office)

I think asking “why” is a good start. I provided a couple of reasons above and there are plenty more. Immediately thinking it’s because of a lack of government provided universal healthcare is not a good place to start from.

Of those options, the only reasonable one is the public option proposal, IMO. And I would only consider supporting it if it is cost neutral for the federal government and doesn’t require any additional personal taxes on families like mine.

 

[gohawks50]

I think asking “why” is a good start. I provided a couple of reasons above and there are plenty more. Immediately thinking it’s because of a lack of government provided universal healthcare is not a good place to start from.

Of those options, the only reasonable one is the public option proposal, IMO. And I would only consider supporting it if it is cost neutral for the federal government and doesn’t require any additional personal taxes on families like mine.

What reason other than obesity, which I addressed in a reply to you, did you provide?

 

[FLaw47]

You have a great point, but forcing someone past menopause to take out pregnancy insurance doesn't appear to make sense. I understand the logic, but all it does is raise the cost, when what we really want to do is the opposite.

I would wager that covering maternity care reduces overall Healthcare spending. At the end of the day, we all pay for coverage for things that will never affect us. I don't lose sleep over it for maternal care.

 

[FLaw47]

I don't have any problem with that if it would 1. lower prices and 2. allow fair competition, and 3. not require government funding of any sort.

Hospital/doctor costs are what they are. If the government can administer a program cheaper than Signa, for example, why not? But the government can't stack the debt with subsidies, or other competition killing benefits.

But isn't that, in basic form what the ACA does? Except the government doesn't run its own "insurance company"?

A few things. Hospital costs aren't some fixed thing. Part of the idea is that bigger insurers have better leverage to negotiate rates (I know we can't just pay Medicare rates for everything).

But no, I don't think that's what the ACA did at all. A public option wouldn't have a profit incentive so, all else being equal, it'd be like 10% cheaper.

Besides, if the ACA and a public option were basically the same thing, Joe Lieberman wouldn't have pitched a fit and killed the public option.

 

[baltimorened]

A few things. Hospital costs aren't some fixed thing. Part of the idea is that bigger insurers have better leverage to negotiate rates (I know we can't just pay Medicare rates for everything).

But no, I don't think that's what the ACA did at all. A public option wouldn't have a profit incentive so, all else being equal, it'd be like 10% cheaper.

Besides, if the ACA and a public option were basically the same thing, Joe Lieberman wouldn't have pitched a fit and killed the public option.

Flaw, to be fair, neither of us have a handle on exact costs for the ACA. But, It is my firm opinion that forcing people to pay for something they don't need may not affect overall costs, as you hypothesiz, but it certainly drives up the cost for the person paying the monthly premium. That, in my opinion, is where the ACA falls flat. I understand the logic to the requirement, but if your trying to drive down the cost per individual, you allow them to determine what they want to pay for.

I think that we made a major mistake by starting the ACA debate on a footing of forcing everyone to be covered for "everything" (an exaggeration I know). But just one thought..we debate over the fact that no one should go bankrupt over healthcare costs - probably universal agreement on that.

If we want to focus on lowering the cost to individual/families that should be the starting point, not forcing folks to pay for what they don't need.

I think the ACA was a great starting point for our healthcare debate - I don't like everything obviously - but we don't need to throw it away. Rather, we need to adjust it. Lots of things have changed since 2010, and lots of promises made haven't come to fruition. But, that's life. None of us knows for certain what is going to happen in the next 15 years, we should be able to show some flexibility.

 

[FLaw47]

Flaw, to be fair, neither of us have a handle on exact costs for the ACA. But, It is my firm opinion that forcing people to pay for something they don't need may not affect overall costs, as you hypothesiz, but it certainly drives up the cost for the person paying the monthly premium. That, in my opinion, is where the ACA falls flat. I understand the logic to the requirement, but if your trying to drive down the cost per individual, you allow them to determine what they want to pay for.

I think that we made a major mistake by starting the ACA debate on a footing of forcing everyone to be covered for "everything" (an exaggeration I know). But just one thought..we debate over the fact that no one should go bankrupt over healthcare costs - probably universal agreement on that.

If we want to focus on lowering the cost to individual/families that should be the starting point, not forcing folks to pay for what they don't need.

I think the ACA was a great starting point for our healthcare debate - I don't like everything obviously - but we don't need to throw it away. Rather, we need to adjust it. Lots of things have changed since 2010, and lots of promises made haven't come to fruition. But, that's life. None of us knows for certain what is going to happen in the next 15 years, we should be able to show some flexibility.

I'll note upfront that I'd like your thoughts on my public option comments specifically but I do have a rebuttal to your thoughts on maternal Healthcare coverage.

Do you believe that all citizens should pay taxes for public school or that only parents of kids in public school should? If you think only parents should pay then fair enough, I'd think you're unbelievably wrong and there'd be no point it further discussion. If you're amenable to your taxes supporting schools, how is maternal care so different? I do appreciate your concerns about the impact to individual's premiums but I am, candidly, more interested in the overall cost impact. (For clarity, I think everyone chipping in for maternal care is materially different than everyone paying more to keep premiums down for smokers).

 

[scotchtiger]

A few things. Hospital costs aren't some fixed thing. Part of the idea is that bigger insurers have better leverage to negotiate rates (I know we can't just pay Medicare rates for everything).

But no, I don't think that's what the ACA did at all. A public option wouldn't have a profit incentive so, all else being equal, it'd be like 10% cheaper.

Besides, if the ACA and a public option were basically the same thing, Joe Lieberman wouldn't have pitched a fit and killed the public option.

It wouldn’t be 10% cheaper. Health insurers operate at a 2-5% margin on average. Their ACA business is worse, usually between 1-4%, but sometimes operating at a loss. I work with health insurance companies and have for 16 years. Operating in ACA profitably is hard. Centene (the largest ACA payor) shed 2M members last year because they were bleeding financially. There isn’t as much to squeeze out as you think.

 

[UrHuckleberry]

Flaw, to be fair, neither of us have a handle on exact costs for the ACA. But, It is my firm opinion that forcing people to pay for something they don't need may not affect overall costs, as you hypothesiz, but it certainly drives up the cost for the person paying the monthly premium. That, in my opinion, is where the ACA falls flat. I understand the logic to the requirement, but if your trying to drive down the cost per individual, you allow them to determine what they want to pay for.

I think that we made a major mistake by starting the ACA debate on a footing of forcing everyone to be covered for "everything" (an exaggeration I know). But just one thought..we debate over the fact that no one should go bankrupt over healthcare costs - probably universal agreement on that.

If we want to focus on lowering the cost to individual/families that should be the starting point, not forcing folks to pay for what they don't need.

I think the ACA was a great starting point for our healthcare debate - I don't like everything obviously - but we don't need to throw it away. Rather, we need to adjust it. Lots of things have changed since 2010, and lots of promises made haven't come to fruition. But, that's life. None of us knows for certain what is going to happen in the next 15 years, we should be able to show some flexibility.

Is the idea behind insurance in general not to spread out the cost/risk amongst as many people as possible? Are you saying women of a child bearing age should just all pay more?

 

[scotchtiger]

What reason other than obesity, which I addressed in a reply to you, did you provide?

You acknowledged it, but even those stats don’t really mean much. We’re 21% fatter than even those porky countries and only have 4.6% lower life expectancy, which isn’t a comprehensive gauge of health anyways.

Other factors include:

Physician compensation. Even compared to a wealthier country like France, US doctors make significantly more. $350K+ in the US compared to $95-$150K in France. And our specialists can make $500K or $1M or more.

Universal healthcare won’t all of a sudden slash physician comp by 1/3. At least I hope not! If I need someone to operate on my heart or brain, I want the best and brightest dude pulling $1M per year. Not someone with basic talent making a basic wage.

I also mentioned innovation. Our for-profit model drives innovation in pharma, med device and other categories. Again, I WANT the best and brightest to be financially motivated to innovate and develop new capabilities to improve healthcare delivery. As with national defense, other countries ride our coattails here and depend on US healthcare system funding.

Demographics. Some demographics are more susceptible to health issues than others. For example, black Americans have worse health outcomes than others. We can argue why, but it drags down averages. More homogeneous countries may benefit statistically.

And none of this touches the tax issue. I just had chatGPT run a quick analysis. I would pay 50%+ more in taxes under France’s system. As I mentioned before, the US would need to boost tax revenue by nearly 50% to pay for UHC, so this makes sense. I have absolutely zero interest in a tax hike of that sort (or any increase in taxes, for that matter).

So even if you can attribute some improvement in health outcomes to UHC, you still have to find a way to pay for it. How will you do that without dramatically increasing the financial burden on some people?

 

[FLaw47]

It wouldn’t be 10% cheaper. Health insurers operate at a 2-5% margin on average. Their ACA business is worse, usually between 1-4%, but sometimes operating at a loss. I work with health insurance companies and have for 16 years. Operating in ACA profitably is hard. Centene (the largest ACA payor) shed 2M members last year because they were bleeding financially. There isn’t as much to squeeze out as you think.

Fair enough, I overstated. It's still leaving money on the table and I don't think we're in a place where we can "save 30% with this one simple trick!" We almost certainly have to pile up a bunch of single digit savings and the profit generated by insurers is non value added for the consumer, under every definiton of that word.

If they're able to out perform a government option while maintaining a profit then good on them, the market succeeded.

 

[baltimorened]

I'll note upfront that I'd like your thoughts on my public option comments specifically but I do have a rebuttal to your thoughts on maternal Healthcare coverage.

Do you believe that all citizens should pay taxes for public school or that only parents of kids in public school should? If you think only parents should pay then fair enough, I'd think you're unbelievably wrong and there'd be no point it further discussion. If you're amenable to your taxes supporting schools, how is maternal care so different? I do appreciate your concerns about the impact to individual's premiums but I am, candidly, more interested in the overall cost impact. (For clarity, I think everyone chipping in for maternal care is materially different than everyone paying more to keep premiums down for smokers).

We might be talking past each other. It's not that everybody is paying, it's that people on ACA are paying.

It seems to me that if one o f the reasons people are not signing up for ACA - still have 28 million without health insurance - is the cost, then it might appear that maybe there might be an option for people who aren't going to get pregnant to opt out and save money. If you're going to force everyone to have every potential option covered by insurance then you're going to have higher cost.

On your school question..not everyone pays to support schools. These are normally funded through property tax and not everyone pays those taxes..not even people who might have kids in school

 

[baltimorened]

Is the idea behind insurance in general not to spread out the cost/risk amongst as many people as possible? Are you saying women of a child bearing age should just all pay more?

please see my response to Flaw.

 

[FLaw47]

We might be talking past each other. It's not that everybody is paying, it's that people on ACA are paying.

It seems to me that if one o f the reasons people are not signing up for ACA - still have 28 million without health insurance - is the cost, then it might appear that maybe there might be an option for people who aren't going to get pregnant to opt out and save money. If you're going to force everyone to have every potential option covered by insurance then you're going to have higher cost.

On your school question..not everyone pays to support schools. These are normally funded through property tax and not everyone pays those taxes..not even people who might have kids in school

Would you agree that your proposal would make insurance more expensive for women? If not, how would that be?

 

[hawkeyetraveler]

It wouldn’t be 10% cheaper. Health insurers operate at a 2-5% margin on average. Their ACA business is worse, usually between 1-4%, but sometimes operating at a loss. I work with health insurance companies and have for 16 years. Operating in ACA profitably is hard. Centene (the largest ACA payor) shed 2M members last year because they were bleeding financially. There isn’t as much to squeeze out as you think.

Independent think tanks have studied this exact point and the consensus (as I understand it) is at least a 10% efficiency gain because those profit margins are hiding a bunch of costs on both sides that aren’t necessary. All the people employed by those insurers that you don’t need (sales, people negotiating rates, all the executives, IT folks). Plus the people employed by providers to manage through insurance bureaucracy. You don’t get all of it of course because you have to staff up people under Medicare, but not nearly as many. The stuff I’ve seen has shown that 10% is conservative if anything.

Now you may disagree, but you can’t just look at the profit and say that is the only aspect we can save. That ignores the biggest lever which is economies of scale.

 

[gohawks50]

You acknowledged it, but even those stats don’t really mean much. We’re 21% fatter than even those porky countries and only have 4.6% lower life expectancy, which isn’t a comprehensive gauge of health anyways.

Other factors include:

Physician compensation. Even compared to a wealthier country like France, US doctors make significantly more. $350K+ in the US compared to $95-$150K in France. And our specialists can make $500K or $1M or more.

Universal healthcare won’t all of a sudden slash physician comp by 1/3. At least I hope not! If I need someone to operate on my heart or brain, I want the best and brightest dude pulling $1M per year. Not someone with basic talent making a basic wage.

I also mentioned innovation. Our for-profit model drives innovation in pharma, med device and other categories. Again, I WANT the best and brightest to be financially motivated to innovate and develop new capabilities to improve healthcare delivery. As with national defense, other countries ride our coattails here and depend on US healthcare system funding.

Demographics. Some demographics are more susceptible to health issues than others. For example, black Americans have worse health outcomes than others. We can argue why, but it drags down averages. More homogeneous countries may benefit statistically.

And none of this touches the tax issue. I just had chatGPT run a quick analysis. I would pay 50%+ more in taxes under France’s system. As I mentioned before, the US would need to boost tax revenue by nearly 50% to pay for UHC, so this makes sense. I have absolutely zero interest in a tax hike of that sort (or any increase in taxes, for that matter).

So even if you can attribute some improvement in health outcomes to UHC, you still have to find a way to pay for it. How will you do that without dramatically increasing the financial burden on some people?

I disagree with looking only at how much taxes would increase. The U.S. already spends about $14,900 per person on healthcare. That money is coming from taxes, employer and employee premiums, deductibles, copays and other costs.

Just as a simple example, suppose $6,000 of that $14,900 already comes from taxes and the rest from employers, premiums and out-of-pocket costs. If universal healthcare cost $11,000 per person—which would still be more than any other comparable country spends—we could pay $6,000 through existing taxes and $5,000 through new taxes that replace much of what we're paying now in premiums and other costs. Taxes went up $5,000, but healthcare didn't cost $5,000 more. We changed how we paid for it.

So yes, depending on how the taxes were structured, some high earners could pay more and others would pay less. But we don't have to raise enough new taxes to pay the entire cost of universal healthcare because we're already paying that money now.

I'd also be interested in seeing the ChatGPT analysis that showed you'd pay 50% more in taxes under France's system. Did it subtract what you and your employer currently pay for insurance, along with deductibles and other out-of-pocket costs? That's the comparison I'd want to see.

 

[baltimorened]

Would you agree that your proposal would make insurance more expensive for women? If not, how would that be?

not neccesarily. It's kind of like home insurance..you can buy basic coverage, deductibles, tornado or hurricane insurance and you pay a rate for what you buy. I, on the other hand, don't need tornado insurance so I don't buy, or I want a higher deductable. That doesn't mean you're automatically paying more, I'm just paying less because I'm willing to assume more risk.

 

[baltimorened]

Independent think tanks have studied this exact point and the consensus (as I understand it) is at least a 10% efficiency gain because those profit margins are hiding a bunch of costs on both sides that aren’t necessary. All the people employed by those insurers that you don’t need (sales, people negotiating rates, all the executives, IT folks). Plus the people employed by providers to manage through insurance bureaucracy. You don’t get all of it of course because you have to staff up people under Medicare, but not nearly as many. The stuff I’ve seen has shown that 10% is conservative if anything.

Now you may disagree, but you can’t just look at the profit and say that is the only aspect we can save. That ignores the biggest lever which is economies of scale.

you might be overlooking the other side of the equation...the use of the care. If the law of supply and demand has any value, if you add another 28 million people to the roles without increasing the capacity of care, you end up with longer wait times, and potentially higher costs.

One other side is the reimbursement rates. The system can't function if Medicare reimbursement rates are used

 

[gohawks50]

On your school question..not everyone pays to support schools. These are normally funded through property tax and not everyone pays those taxes..not even people who might have kids in school

Not everyone pays property taxes directly, but property taxes aren't the only source of school funding. Schools also receive state and federal tax dollars, which come from income taxes, sales taxes and other sources. Even renters indirectly help cover property taxes through their rent. So everyone helps pay for public education.

 

[hawkeyetraveler]

you might be overlooking the other side of the equation...the use of the care. If the law of supply and demand has any value, if you add another 28 million people to the roles without increasing the capacity of care, you end up with longer wait times, and potentially higher costs.

One other side is the reimbursement rates. The system can't function if Medicare reimbursement rates are used

Agreed. My preferred form of Medicare for all would be for catastrophic and preventative care only. Elective procedures come with a serious moral hazard. For that I would allow people to buy into private supplemental insurance. That way grandma can still get her Botox if she values that and buys the right plan.

In my concept everyone has a safety net in case things go very wrong (e.g. cancer) and they get the preventative care needed to catch an issue before it requires super expensive care. This also means the poor don’t need to consume ultra expensive emergency room resources because now they can go to a family doctor like the rest of us for basic prevention.

 

[baltimorened]

Agreed. My preferred form of Medicare for all would be for catastrophic and preventative care only. Elective procedures come with a serious moral hazard. For that I would allow people to buy into private supplemental insurance. That way grandma can still get her Botox if she values that and buys the right plan.

In my concept everyone has a safety net in case things go very wrong (e.g. cancer) and they get the preventative care needed to catch an issue before it requires super expensive care. This also means the poor don’t need to consume ultra expensive emergency room resources because now they can go to a family doctor like the rest of us for basic prevention.

you might be on to something. It's the catastrophic part which is critical ..that's what drives people into bankruptcy.
The only thing I see, which can be worked around, is spreading the cost. if the government provides catastrophic, there has to be enough of a financial pool to cover the cost. Otherwise the government could end up with a significant bill.

 

[FLaw47]

Agreed. My preferred form of Medicare for all would be for catastrophic and preventative care only. Elective procedures come with a serious moral hazard. For that I would allow people to buy into private supplemental insurance. That way grandma can still get her Botox if she values that and buys the right plan.

In my concept everyone has a safety net in case things go very wrong (e.g. cancer) and they get the preventative care needed to catch an issue before it requires super expensive care. This also means the poor don’t need to consume ultra expensive emergency room resources because now they can go to a family doctor like the rest of us for basic prevention.

What counts as catastrophic? I had to have ACL reconstruction last year, is that an out of pocket expense in your mind or is it covered?

 

[FLaw47]

not neccesarily. It's kind of like home insurance..you can buy basic coverage, deductibles, tornado or hurricane insurance and you pay a rate for what you buy. I, on the other hand, don't need tornado insurance so I don't buy, or I want a higher deductable. That doesn't mean you're automatically paying more, I'm just paying less because I'm willing to assume more risk.

What you're proposing is shrinking the risk pool for that sort of coverage. How does that ever result in lower overall costs and especially how does it reduce costs for women of childbearing age?

I think it's worth keeping in mind that literally every one of us exists because a woman got pregnant and carried us to term. Acting like this is a "women's issue" is kind of gross to me.

 

[tarheelbybirth1]

Are you both suggesting that the lack of government funded universal healthcare is the sole reason for these figures?

Because I see things quite differently. The biggest problem we have in the US is lifestyle and diet. 40%+ obesity is an alarming statistic. Our EU counterparts providing universal healthcare don't have that working against them. They generally sit in the teens, substantially below the US. And we know the dramatic effect of obesity on inflammation, chronic conditions, heart disease, joint replacements and even cancer. All massive - no pun intended - drivers of boh cost and poor health outcomes. And don't get me started on our food supply.

No argument with any of that. You might want to take a look at the bolded part.

The US also subsidizes global innovation with medical devices, pharmaceuticals and other healthcare innovations. What happens when this isn't as lucrative in the US?

Are we getting value for that? When you look at our health metrics versus the countries that supposedly mooch off US innovation, it's rather amazing that they get much better outcomes.

The US also subsidizes Big Agribusiness to value profit over everything. That's how we get a grocery store filled with ultra-processed, high calorie, low nutrient food. That's how we get food deserts.

Perhaps a focus on subsidizing primary care for everyone - like "our EU counterparts" - would yield a greater benefit for Americans over funneling money to corporations far more interested in dollars and shareholder value.

If you look at who spends the most, it also generally tracks with wealth statistics by country. I think there's a diminishing return for excess spending that exacerbates these figures.

I'm not saying there aren't ways to improve US healthcare. There absolutely are. But thinking that the shift from the current system to government funded universal healthcare is the silver bullet to cure all of our ills is incredibly naive and generally ignorant of the variety of factors that contribute to current costs and health outcomes.

We are getting what we pay for with our govt dollars. We're spending far, far more than our counterparts - we just spend it to create value for wealthy people. We get expensive tech and drugs, we get the aforementioned piss-poor food supply, and we get an obese population where millions have little or no access to a primary care doctor.

 

[hawkeyetraveler]

What counts as catastrophic? I had to have ACL reconstruction last year, is that an out of pocket expense in your mind or is it covered?

That’s a good question - I guess that should be up for debate.

Keep in mind that third party studies pretty consistently show that Medicare for all under any form will drive substantial cost savings. So potentially those savings could be used to extend coverage for medically necessary, but non life threatening procedures like your reconstruction. Potentially it could be returned to people in the form of higher salaries that would help make supplemental insurance more affordable which could also cover it.

Net net, either way on average we pay less.

 

[TC_Nole_OX]

Though I generally loathe elected centrists, there are a few exceptions. JB Pritzker is one of them That's probably because my Illinois MAGA relatives are always crashing out over him on FB. In my frequent visits to the state, it seems to be well run. I am curious to see how he does in the primaries.

 

[scotchtiger]

I disagree with looking only at how much taxes would increase. The U.S. already spends about $14,900 per person on healthcare. That money is coming from taxes, employer and employee premiums, deductibles, copays and other costs.

Just as a simple example, suppose $6,000 of that $14,900 already comes from taxes and the rest from employers, premiums and out-of-pocket costs. If universal healthcare cost $11,000 per person—which would still be more than any other comparable country spends—we could pay $6,000 through existing taxes and $5,000 through new taxes that replace much of what we're paying now in premiums and other costs. Taxes went up $5,000, but healthcare didn't cost $5,000 more. We changed how we paid for it.

So yes, depending on how the taxes were structured, some high earners could pay more and others would pay less. But we don't have to raise enough new taxes to pay the entire cost of universal healthcare because we're already paying that money now.

I'd also be interested in seeing the ChatGPT analysis that showed you'd pay 50% more in taxes under France's system. Did it subtract what you and your employer currently pay for insurance, along with deductibles and other out-of-pocket costs? That's the comparison I'd want to see.

Would you propose a flat $5000 tax on everyone? Because 70-75% of the country pays less than $5000 in federal income tax today.

If not, you are going to ask a small percentage of us to subsidize everyone else. No thank you.

My health insurance and medical costs are a very small fraction of what I pay in taxes, so it wouldn’t affect the math very much. The increase was well over 6 figures in additional taxes, for context.

 

[baltimorened]

What you're proposing is shrinking the risk pool for that sort of coverage. How does that ever result in lower overall costs and especially how does it reduce costs for women of childbearing age?

I think it's worth keeping in mind that literally every one of us exists because a woman got pregnant and carried us to term. Acting like this is a "women's issue" is kind of gross to me.

I'm not so sure anyone made this a woman's issue....it's an insurance issue. Besides these days, if I'm understanding "your team" is telling us men can also become pregnant....only razzing you

That’s a good question - I guess that should be up for debate.

Keep in mind that third party studies pretty consistently show that Medicare for all under any form will drive substantial cost savings. So potentially those savings could be used to extend coverage for medically necessary, but non life threatening procedures like your reconstruction. Potentially it could be returned to people in the form of higher salaries that would help make supplemental insurance more affordable which could also cover it.

Net net, either way on average we pay less.

I don't want to be a downer, but when was the last time any of these studies actually got it right? If I recall the ACA was going to save us $2500 year. My costs have gone UP by more than that since 2010...most likely everybody else's have also.

 

[hawkeyetraveler]

I'm not so sure anyone made this a woman's issue....it's an insurance issue. Besides these days, if I'm understanding "your team" is telling us men can also become pregnant....only razzing you

I don't want to be a downer, but when was the last time any of these studies actually got it right? If I recall the ACA was going to save us $2500 year. My costs have gone UP by more than that since 2010...most likely everybody else's have also.

Well the ACA as envisioned had a low cost public option that was eliminated to get the bill pased. Other price mechanisms were also eliminated to get the bill passed. The public option in particular was meant to create a market based incentive to keep the private insurance options more affordable.

So the concept I’m proposing is much closer to that public option that never passed under ACA. So the ACA is quite different than what I propose and I don’t think we can use that comparison as a result.

Either way, I would like Congress to at least propose something like this. Allow for public debate. Go on the record with pros and cons, etc. Instead they are not doing ANYTHING. On ANY topic.

 

[gohawks50]

Would you propose a flat $5000 tax on everyone? Because 70-75% of the country pays less than $5000 in federal income tax today.

If not, you are going to ask a small percentage of us to subsidize everyone else. No thank you.

My health insurance and medical costs are a very small fraction of what I pay in taxes, so it wouldn’t affect the math very much. The increase was well over 6 figures in additional taxes, for context.

Please explain your insurance situation and costs. Do you have employer provided insurance? If your employer pays for your insurance do you know how much is the monthly premium? Do you contribute at all to paying the premium if you have employer insurance? What is your deductible? Co-pays?

You seem to be saying if we had universal healthcare it would cost you much more because of higher taxes, but you don't seem to be considering the savings of no longer paying premiums, deductibles, or co pays. Yes, taxes would be higher, but many other healthcare costs would be eliminated.

 

[dpic73]

"I’m suing the Trump Administration to prevent them from jacking up your health care costs.

Last year, Donald Trump and Congressional Republicans refused to extend the ACA tax credits — as a result, more than 170,000 Pennsylvanians have been forced to drop their coverage because they can no longer afford it.

Now, the Trump Administration is attempting to let insurance companies charge you even more. We’re suing to stop them."

 

[TC_Nole_OX]

Centrist gonna centrist

 

[baltimorened]

Well the ACA as envisioned had a low cost public option that was eliminated to get the bill pased. Other price mechanisms were also eliminated to get the bill passed. The public option in particular was meant to create a market based incentive to keep the private insurance options more affordable.

So the concept I’m proposing is much closer to that public option that never passed under ACA. So the ACA is quite different than what I propose and I don’t think we can use that comparison as a result.

Either way, I would like Congress to at least propose something like this. Allow for public debate. Go on the record with pros and cons, etc. Instead they are not doing ANYTHING. On ANY topic.

I have zero problem with anything you posted, I just would prefer we don't "blow up" our current system. If we want debate on a public option, go for it. My caveat has been ...as long as no federal funds are paying for it, as was promised in the ACA.

And I agree 100% that just doing nothing as has been the case since 2010, should not be an option. The WH or Congress, either chamber, should put forward a bill that addresses the problem. Let's have a national debate

 

[scotchtiger]

Please explain your insurance situation and costs. Do you have employer provided insurance? If your employer pays for your insurance do you know how much is the monthly premium? Do you contribute at all to paying the premium if you have employer insurance? What is your deductible? Co-pays?

You seem to be saying if we had universal healthcare it would cost you much more because of higher taxes, but you don't seem to be considering the savings of no longer paying premiums, deductibles, or co pays. Yes, taxes would be higher, but many other healthcare costs would be eliminated.

Not sure on exact details, but I pay less than $1k per month in premiums. Honestly not sure if it’s closer to $600 or $900. High deductible plan. Max out HSA and don’t use it. Keep it as a medical retirement account.

But I pay hundreds of thousands of dollars per year in taxes. Math says the country needs nearly 50% more in tax revenue to fund UHC. Most of that will come from <10% of the population. Let’s be super conservative and say my federal income taxes “only” go up 25%. Using ballpark figures, that could cost me $75,000.

Let’s say I spend $20,000 on healthcare today between insurance premiums and out of pocket. UHC won’t eliminate everything and in any scenario, supplemental health policies will be required to match current coverage. So perhaps I realize a net savings of $10,000.

So now I’m looking at $65,000 in additional net expense on a conservative basis and potentially double that depending on how aggressive the feds address the tax issue. And will the quality of healthcare available to my family improve or decline in this new structure? Certain doctors and medical practices already refuse to participate in government funded healthcare due to low reimbursement rates, so I don’t see how being lumped into a mass government health program will improve things for my family.

I’m open to the public option suggestion. I’m not open to blowing up the current system. I’m also not open to any models that result in additional net expense to my family. The hundreds of thousands of dollars I already contribute should be plenty. If anything, we should be focused on how to reduce overall government spending. Not finding new ways to confiscate more money from hardworking families.

 

[bdgan]

Newsone/AOC currently lead with 63% of the votes. This board seems to be filled with takers who want the rich to pay for more free stuff.

 

[Huey Grey 2]

Newsone/AOC currently lead with 63% of the votes. This board seems to be filled with takers who want the rich to pay for more free stuff.

Like golden ballrooms and golden airplanes from Qatar?