Medicare for All versus single payer
Supposedly, (snort) "moderate" Republicans came up with a version of Ryancare that the Koch Freedom Caucus will vote for, so this post may be moot. Still, health care is so important, I am posting this anyway. I hope some of you can help me out.
Some people say "single payer" while some say "Medicare for All." Few, if any, who mention either "single payer" or "Medicare for All" give details or specifics. They just use one name or the other, as though they know specifically what they are talking about and they assume every one else will know specifically what they are talking about. Based upon my experience as a human who has conversed with other humans, that is unlikely. So, I have some questions, which are bolded below.
First, I loathe both (a) the Socratic method and (b) posting games, so full disclosure: IMO, we should use the term "Medicare for All." I also think we have to have a sliding scale for the cost of the monthly health insurance premium, right up to full cost, maybe even cost plus. I see no reason for the federal government to subsidize at all the cost of health insurance for David Koch or Warren Buffet or Bill Gates.
At the same time, there is some room between zero cost to the patient (as with Medicaid) and the amount that a middle class or wealthy person would pay. I think programs are so unfair if you get a full benefit for free if your income is $19,000.00 a year, but become totally ineligible if your income is $19,000.01 a year. And programs without sliding scales encourage fraud, in the form of underreporting income or disguising income. Fraud is a very bad habit for government to encourage in the populace if the system is mostly the honor system, as it with, for example, income taxes.
As for a nationalized health plan that is cost free to everyone, with government owning hospitals, hiring doctors, etc.: I don't think it will get one Senate vote, even in a Democratic Congress; and I'd like to be at least somewhat realistic.
Second, the following preface will ensure we are all starting from the same point:
As Medicare currently sits, it involves somewhere between two to four payers. First, a monthly amount is deducted from every check for Medicare coverage. That is the equivalent of a monthly insurance premium payment, if you will. Obviously, the patient/OASDI recipient pays the monthly premium. The amount of the premium may be very large compared with the amount of the monthly OASDI payment. However, the cost of the premium is also very small compared to the cost of private coverage and also very small compared to the actual cost of Medicare. So the government is not simply an administrator of Medicare, but also a payer. So far, that's two payers, the OASDI recipient and the government.
Next, is an annual deductible, also paid by the patient. Then, are deductibles in varying amounts for many treatments, procedures, etc., also paid by the patient. Often, the Medicare payment for a test or procedure is so small that the provider is taking a hit, even just based on the provider's prorated overhead costs. Heck, it hardly even pays a provider to put in to Medicare for a payment of around $2 for a certain blood test or whatever. Anyway, the provider is, in effect, an unwilling third payer, at least as to certain treatments, tests or procedures.
Often, OASDI recipients who can afford it buy a second health insurance to cover things Medicare does not cover. The second insurer, if any, is the fourth payer and the patient paying for two monthly premiums, two annual deductibles, and various deductibles for certain visits, procedures, etc. (And the provider is submitting paperwork to two insurers.)
People claim Medicare is bankrupting government. I can understand that because the ONLY population that Medicare currently covers consists of the elderly, the disabled, the widowed and children. The ones likeliest in that group to require the least medical care are younger widows. (Oh, and I also understand people lie. However, the liars are the ones who manage to sell their version to the voting public. We don't. And, again, I am trying to be at least somewhat realistic.)
1. Where or with whom did the name "single payer" originate? (No point at all to this question. I'm just curious.) If you don't know the answer to this question, please don't guess.
2. I didn't watch Leno much, but I saw clips of "Jaywalking" aired by other shows. Jay Leno would go to a public sidewalk and ask passersby who agreed to speak to him questions like "Who is the Vice President?" About nine out of ten people he stopped, sometimes ten of ten, would say they did not know or give some really clueless answer, like Nixon. Remember? Okay, with that in mind, try to imagine realistically before answering: What might happen if you asked ten random people if they would fight for, or even want given to them, "single payer" versus asking a different group of ten random people if they would fight for or like "Medicare for All?" With no explanation at all, do you believe that the "single payer" group would even know you were referring to government paying for at least a good portion of the cost of their health care?
3. Is there a difference in the program that you envision as "single payer" versus the program you envision as "Medicare for All?" If so, what is or are those differences? Cost? Coverage? For example, Given that Medicare currently involves somewhere between two to four payers, how would single payer work? No monthly premium at all, no deductible, etc? If so, how will that get sold to the American public? How will the CBO score it? How would it pass muster under the paygo requirement? On what are you basing your answer(s) to this question?
4. If there is little to zero difference between a single payer program and a Medicare for All program as you envision it, why did you choose to call the program you envision "single payer" instead of "Medicare for All," or vice versa?
Obviously, you don't need to answer all the questions, or even one.
Comments
I use the terms somewhat interchangeably because
I have not personally done an analysis to determine for myself which I would prefer, if there is a way to determine that at this point.
I think the primary point is to get the insurance companies out of the health care business and curtail the power of the big pharma and medical corporations by making health care a right, not an option. Both terms seem to serve that purpose for now and when I use those terms on this site I figure the people here know what I'm talking about. When talking to others I point out the high cost per capita, the declining overall average age of death, compare our system to socialized programs in Europe, the fact that health insurance companies are not needed, the fact that the U.S. is the only country on earth with a for profit health care system, etc. One could also use the term "socialized" health care to get that point across. We're so far from being able to implement something like that in this country I haven't felt the need to get into specific details.
Also, it's a misnomer that health care would be free under a socialized system. It would be primarily free for low income citizens, but the program would be paid for by taxes instead of health insurance premiums, etc., so it wouldn't be free. Like "free" college, nothing is free, except maybe the air, in some places. That definitely needs to be made clear to the average citizen.
That's a lot to unpack.
It's not about the term that you would prefer, but the one that would be the most accurate and readily understood by people, such as those described in #2 of the essay.
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As far as this site, every one here is for the concept, so it doesn't much matter which term you use here, as long as people know what you are referring to. Which name do you think is better to use when you try to "sell"* the program to people who know nothing about it? (See #2 in the essay.)
Not to sound like Demi Moore in A Few Good Men, which I recently saw again on TV, I strongly disagree. Right off the bat, the term sounds like you're talking about the health care itself, when you're only talking about payment for health care. We're talking about government and the patient--and maybe with some subsidy from the provider--picking up the bill for health care. That's not socialized health care. Medicaid and the existing version of Medicare are not socialized health care either.
The classic definition of socialism is government or some collective owning the means of production. In this context, that would mean government owning hospitals and clinics, hiring doctors, nurses, maintenance staff, etc. That would be what my essay referred to loosely as a "nationalized plan." So, off the bat, "socialized health care" would be open to being misunderstood. Second, many people have a visceral reaction against any form of the word socialism. Granted, 40% of Millennials seem to be okay with a socialist for President, but that's not good enough for something you want to sell* to every who does not already have Medicare or Medicaid. Why get into that territory when so doing is not necessary and possibly confusing?
I'm not sure where you were going with this? Most of my essay talks about who is paying for health care now under Medicare, namely, two to four payers, one of them being the government. Are you suggesting that telling people government will pay for X or Y requires reminding people that taxes fund everything for which government pays? If so, some people might feel their intelligence is being insulted. But, I guess a diplomatic way could be found to say it.
*By "sell" I mean only trying to get people excited about something, so that they start demanding it from their representatives.
Henry, it is hard to insult the intelligence of the average
citizen. Consider that fully one-third of our citizenry did not know (and still may not know) that the ACA and Obamacare were the same thing. Don't get overly concerned by fear of insulting people's intelligence. The intelligent person will know that this "over-explanation" is not meant for them because they are already aware of the rampant ignorance and/or stupidity of the populace. The ignorant might feel insulted by a careful explanation, no matter how worded, because people do not like having their own stupidity called out. Maybe a good P.R. person (read propagandist) can conjure a more palatable message that "there's no such thing as a free lunch". Even in countries with socialized health care, the taxpayers end up paying for it, no matter what you call it. We just don't need more aircraft carriers and MOABs to waste our money and peoples' lives, when we can spend it for the common good.
One other thing:
The government is setting a fine example for us all to emulate with their fraud. Fraud in procurements. Fraud in our alleged representative system of government. Fraud in our tax system (built in subsidies to the rich, passing the burden to the less well financially endowed). Fraud in our foreign policy...
The list of fraud is endless. I won't continue the litany.
Thanks for your views, AE.
Any thought about using "single payer" versus "Medicare for All" when trying to discuss the program with people who may be less informed than you are?
Doomed to failure, I'm afraid
The term "single-payer" is meant to describe, not the original
sources of the dollars, but rather the agency that actually receives and pays the invoice from the provider. Theoretically, the government could grant a regulated monopoly to a private, for-profit company to manage all payments of invoices, and that would constitute single-payer, regardless of how that agency received its funding. OTOH, it is not (in my own opinion) appropriate to use the term to describe any system in which a patient ever receives a bill for any fraction of actual services rendered, as opposed to a bill for generic, umbrella health-care service, except POSSIBLY some sort of "user fee" or "transaction fee" that goes, not to the provider, but to the single payer -- e.g., a (small) flat-rate per-prescription co-pay.
The significance of "single payer" rhetorically is that it is not necessarily "socialized medicine" in the sense of the government owning the clinics and employing the providers (a la the UK's NIH).
In any case, I'm fine with using Medicare for All, just because that's something all Americans can vaguely understand.
The earth is a multibillion-year-old sphere.
The Nazis killed millions of Jews.
On 9/11/01 a Boeing 757 (AA77) flew into the Pentagon.
AGCC is happening.
If you cannot accept these facts, I cannot fake an interest in any of your opinions.
Thanks. I'm glad you agree that most people would have at
least some familiarity with Medicare. At least, I think, they would recognize that it had something to do with health care. And, I think many may even associate it with a godsend for a parent, grandparent, aunt, uncle, etc. I think most patients recognize how lucky they are to have Medicare.
What is your basis for saying that?
That would seem to matter only to medical providers, like hospitals and doctors, who, under Medicare, must bill one or two insurers plus the patient. I'm sure they'd be happier sending one bill. However, that could be done without a single dollar in government subsidy of the cost of health care. But, how does that help the patient? I don't think cutting one check to pay medical costs, regardless of source of funds, is what people like Conyers have been advocating for for the past dozen years.
Sure. But, assuming it was necessary or desirable to farm out the work, only a contact between the federal government and the company would be needed, not a "regulated monopoly" like a cable company or an electric company. However, it would be very feasible for the government to perform that function itself, as I believe it already does for Medicare. If there's one thing the US government knows how to do, it's processing a lot of claims and cutting a lot of checks. And the government doesn't expect to make a profit. An private contractor would. So, having government do it is preferable, IMO.
i say that, because that is what "single-payer" actually means.
The term came into currency specifically to distinguish a Canadian-type system ( single-payer ) from a UK-type system ( socialized medicine ).
In practice the single payer is almost (?) always a government agency. Regardless, the most significant thing about single payer in principle is that the single payer sets the rates. There may be negotiation, but in the end the providers must choose to either take it or leave it -- and depending on the regulatory environment, choosing to leave any particular "it" might mean leaving medical practice altogether. This gives the single payer enormous cost-controlling power.
Note, BTW, that with respect to the doctor's paperwork, it's not about how many bills need to be sent for any particular service delivered -- it's about the need to navigate the complex billing (and benefits) systems of many different insurance providers for many different patients.
The earth is a multibillion-year-old sphere.
The Nazis killed millions of Jews.
On 9/11/01 a Boeing 757 (AA77) flew into the Pentagon.
AGCC is happening.
If you cannot accept these facts, I cannot fake an interest in any of your opinions.
I think we may be talking past each other.
You are talking about what single payer means, as in a dictionary definition. I am talking about which name is best to use when talking to uninformed people about government subsidizing payment or paying for their health care in the types of programs being contemplated for the U.S.
RyanCare still might not make it out of House
and DOA in Senate
Thanks, gjohnsit.
We'll see if House and esp. Senate Democrats are as persistent in blocking Ryancare as Republicans were about repealing Obamacare. Thing is, I believe Republicans are correct that Obamacare is not sustainable without change. So something has to give. But, whatever happens to Ryancare, I don't think my questions on this thread will be mooted.
If people on this board are not even willing to continue preaching the gospel of Medicare for All, what are they willing to do? (That falls under "Don't ask a question unless you really want to know the answer, whatever it may turn out to be.")
Excellent essay, HW--thanks! The best health care systems
that we have in the US, are being systematically dismantled.
For instance, the original Veterans' Choice Act which was signed into law in late summer of 2014, managed [by 2016] to deliver 25% of medical appointments to the private sector. (Don't know if there are more recent statistics.)
Last week, DT extended that toxic bill with an Executive Order. Today, he's slated to sign another executive order that further dismantles the employment protections of federal civilian workers. The 2014 Choice Act dealt only with SES (Senior Executive Schedule) federal employees, IIRC. Heard today on XM that this EO he's signing today at the VA, will extend to ALL federal employees working at the Department.
I've seen it before, it's a matter of 'the Camel's nose under the tent'--if Shulkin implements these (privatizing) policies at the VA, just watch--it will be policy for the entire federal system, in time.
I'm sorta curious--how many current or federal employees/retirees do we have in this Community--that don't mind admitting to being one.
I only ask because I'm wanting to post about the dismantling of the Merit System, and it would be helpful to have a resource who's 'currently' a federal employee--obviously, only if the individual(s) wouldn't mind identifying him- or herself.
Have a good one!
Mollie
"I think dogs are the most amazing creatures--they give unconditional love. For me, they are the role model for being alive."--Gilda Radner
"If there are no dogs in Heaven, then when I die, I want to go where they went."--Will Rogers
Everyone thinks they have the best dog, and none of them are wrong.
Thanks so much! I think it important to remember
how abysmal the VA system was during the Obama administration and how long Shinseki took not to improve it. People were literally dying untreated while waiting for an appointment to be seen. Worse, people within the system were falsifying records to make the system seem more responsive than it was. So, this was not an instance where something functioning reasonably well, such as the Post Office got privatized for the sake of privatizing. Lives were being lost and something had to be done ASAP.
I don't know if the system improved. However, vets are reasonably well organized. If this is not working for them, I think they will act.
I hate privatization. However, I have to say that this was an instance where I did not see another option.
Actually, the situation was waaaaaay overblown--
and that was for a reason--it's been a bipartisan consensus for many years that it would be advantageous to privatize the VA System. And, the Phoenix VA story was grossly embellished to achieve this goal. I've posted links to several papers, including the initial IG report, which stated that none those 40 deaths could be attributed to the scheduling delays.
(I posted very heavily on this topic at a blog that is pretty much inactive, today. I thought about reposting the essays, but, the search utility at the blog has been disabled, and it would be super tedious to relocate them. Maybe I'll reconsider.)
Believe me, since Mr M has lifetime VA medical privileges, I want only the best care for veterans. My personal medical (military) experience has been only at Air Force active duty facilities, though Mr M has been Medevaced, and received incredible surgical/neurological care at various facilities--including one of the top military (Army) medical centers in the nation. We've never received more excellent medical care, than that we received in the military active duty system.
Bear in mind, the vet organizations that are pushing for the privatization are mostly conservative and free market groups. Before long, no care beyond care for that for war wounds--TBI, PTSD, fitting of prosthetics, etc--will be offered through the VA. From what I've heard during some of the VA Committee hearings, the ultimate goal is to work toward voucherizing veterans health care, along with Medicare--allowing vets to purchase health insurance through the cr*p ACA Health Exchanges, or some similar mechanism.
Hey, A Few Good Men is one of my favorite movies (and I'm not generally into watching war or military movies). Anyhoo, aside from the fact that the actors--Jack Nicholson, especially--had some of the best performances that I've seen. I also thought that the storyline succeeded in demonstrating a couple of 'life's lessons' quite well.
It also strikes home for us, because, when I won a federal suit decades ago, the principal that I brought suit against, used almost the exact words that Colonel Jessup did in his rant.
Like Jessup, his over-the-top bellicosity helped seal his fate.
So, just for fun . . .
[video:https://youtu.be/5j2F4VcBmeo width:500 height:320]
[A Few Good Man "You Can't Handle the Truth"/PheasantBreezy]
To some extent, I've got some reservations about the use of the term 'Medicare-For-All.' But, gotta feed the yard critters before dark, so I'll swing back by later, to further put in my two cents.
Mollie
"I think dogs are the most amazing creatures--they give unconditional love. For me, they are the role model for being alive."--Gilda Radner
Everyone thinks they have the best dog, and none of them are wrong.
Good to have your take on it. Thank you.
Try this
Try using Google with site:theSiteName.com followed by your search targets. I've often used this when a particular site has a bad search or none at all. Example: site:caucus99percent.com Medicare for all might find this page and likely others. The mumbo jumbo limits the search to the specified site which helps thin out the results.
Thanks, MinuteMan--I tried it. So far,
haven't landed on my essays about The Veterans Choice Act, but a couple other ones came up that were sorta interesting to read--several years after the fact.
Mollie
"I think dogs are the most amazing creatures--they give unconditional love. For me, they are the role model for being alive."--Gilda Radner
"If there are no dogs in Heaven, then when I die, I want to go where they went."--Will Rogers
Everyone thinks they have the best dog, and none of them are wrong.
Thanks for the tip!
Great essay!
Great essay!
But might I suggest that we drop the Psychopaths That Be's long-running framing?
'The government' owns nothing.
Governing is conducted by groups of transient public servants, each temporarily holding a public office having powers delegated by the public in order to serve their (public) interests, with the salaries of public servants being paid by the public in order that they serve the public interest, which includes such things as the administration and maintenance of public properties and public services, all of this paid for by public funding.
Everything belongs to the public, not to 'the government', which merely exists to protect the public interest.
The country and government are commons, held - in perpetuity - among the public of that country, not 'owned' by whoever happens to be holding any particular public office during the period of their public service and definitely not theirs to dispose of as they/their sugar-daddies/mommies choose. Nor have they any right to 'dispose' of that public as they please, apart from the legal system dealing with those who have harmed/attempted to harm others, because any legitimate rule of law exists to protect society/the public from those who would predate upon them/their ecology/country/society.
The acceptance of the deceptive framing of the Psychopath's That Be that they are rulers over serfs rather than public servants charged with essential tasks in the public interest is what's enabled fascism to be imposed, corrupting a US democratic ideal never yet realized into a corporate/military nightmare rabidly consuming the world in a suicidally murderous frenzy of blind greed and lust for stolen power over others barely visible to many unable to perceive this through the steaming heap of propaganda forming Bullshit Mountain.
This is your country being destroyed; this is our Earth dying for the 'winner-take-all' profiteering' of the terminally ignorant, pathologically selfish and hopelessly stupid. Let's tell it like it is.
Psychopathy is not a political position, whether labeled 'conservatism', 'centrism' or 'left'.
A tin labeled 'coffee' may be a can of worms or pathology identified by a lack of empathy/willingness to harm others to achieve personal desires.
I take it these words from my essay
occasioned your post.
I do understand your point and have made the same point in other contexts. However, if government did own hospitals, the name on the deed would not be "the Commons" or the taxpayers of America, but the "United States of America." And if medicine were socialized (in the classic sense of "socialized"), it would be government officials or government agents hiring doctors, etc., not the taxpaying population of the US. So, I think the wording I used was correct in context.
Besides, government is supposed to be acting on behalf of all Americans and I think most people understand that government has no sources of money other than taxes, fees, fines and the like or borrowing. And the subject was not anything we actually have or expect to have in our lifetimes, but almost a throwaway comment.