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Neomalthusian

non-Liberal
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Everything posted by Neomalthusian

  1. "We" are a mixed bag whose interests are not always aligned. The Medicare-aged among "us" would probably celebrate dropping Medicare premiums and deductibles to zero, but that would necessarily increase the relative burden on the non-Medicare population, who additionally already have to pay a hell of a lot more for their own care and coverage as it is than the current Medicare-aged population ever did.
  2. My point wasn't "see? Medicare sucks." My point was that there is no sacred entitlement to any given level of Medicare benefit relative to any given level of cost. It's all determined by the federal government. "I paid in all my life!" is not a Actually that information is available, but I agree it should be more available, i.e. easier to find out than it sometimes is. This is kind of a reminder that a lot of health care isn't shoppable, and therefore provider competition on price is not likely to be a good cost controller, which will frustrate the libertarians and anarcho-capitalists. But the other thing is that if you're having a heart attack, you're very likely to owe your out-of-pocket maximum of up to $6,000 to $8,000, so you're not going to care what the actual cost is because you're going to owe the max, and your main focus is surviving, not being $6-$8k poorer.
  3. Taxes paid to the federal government are gone. Poof. What the federal government is willing to pay for on an ongoing basis is up to the federal government. Citizens don't have a sacred right to Medicare benefits. Their benefits will be what the federal government decides they will be. Their cost for those benefits will be whatever the federal government decides they will be. If CMS reduces what they're willing to pay for drug (x) such that the company won't let it go for that price, then that's what happens. If the feds increase the premiums for Part B and Part D, they can do that. If they want to raise the deductible for Part A and B, they can do that. People who "paid into Medicare" have no scared right to any particular level of benefit. They're entitled to whatever the federal government says they're entitled to, until or unless the federal government changes what they're entitled to.
  4. Means-tested copays fly in the face of what has been promised by Sanders and other devout MFA proponents, but cost-sharing is essential to 1) lessen the need for drastic tax increases and 2) it has some cost-controlling effect (patients overutilize care less when they share in some amount of its cost). So I'll give you credit for recognizing why cost-sharing is important. Marijuana taxes are too insignificant to be relevant. We could also open espresso stands in federal office buildings and say that revenue can help pay for MFA too. We're talking fractions of a fraction of a fraction of a percent of what would be needed to fund the nation's health care.
  5. You are claiming that "the progressive payroll taxes and corporate taxes" are more than $3-7 Trillion. What are you talking about?
  6. It doesn't matter, the article clarifies the misconceptions that have been created by unsupported claims like "insurance company overhead is 25%, Medicare's is 2%." That's a barely-true statement, and the 25% figure is especially misleading and requires citation. Self-insured companies usually use third party administrators (which are, you guessed it, insurance companies) under an ASO (administrative services only) contract. In effect, this makes self-insured plans ultra-high-deductible health insurance plans where the employer assumes the risk/responsibility for paying most of each beneficiary's ultra-high deductible.
  7. I know they're all regulated by ERISA and so your claim that companies profit off of premiums they charge employees is highly suspect. You made it sound like employer self-insurance is some unregulated shady underworld of the American health care system. That kind of claim lacks evidence. https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/publications/understanding-your-fiduciary-responsibilities-under-a-group-health-plan.pdf
  8. The 25% private insurance overhead figure requires citation. Otherwise, the popular claim about Medicare's efficiency is an arguable half truth. Explanation of that here: https://www.politifact.com/truth-o-meter/statements/2017/sep/20/bernie-s/comparing-administrative-costs-private-insurance-a/
  9. Health plan reserves for self-insured plans aren't "profit," they are health plan assets that can be used to offset future losses. Mustache-twirling monopoly man CEOs are not pocketing self-insured health plan dollars. These things are regulated by ERISA and are actually a way of partially removing insurance company middle-men from the equation of providing employee health benefits.
  10. Ordinary present-day Medicare isn't even administered entirely by a government agency. It's administered by an insurance company. Insurance companies are already in the business of managing care and utilization, processing claims and payments, for just about the entire nation. Government is basically a pass-through to the insurance companies, even when it comes to government coverage like Medicare. So instead of people paying insurance companies directly, they pay government who turns around and hands it to insurance companies, who turn around and hand it to providers when they provide care. The only way this theoretically changes under some MFA designs is global budgeting for hospitals, whereby the DHHS just sets the budget for hospitals and gives each its budgetary allowance within which it's expected to work. Hospitals would no longer charge for services. So instead of making more money by providing more billable services, they keep less of their budgetary allocation unless they stay within it. This obviously makes cost-control for hospital care theoretically easy, because the DHHS holds the purse strings. But if they don't control enough cost, they'll be criticized, as will MFA, but if they are too aggressive about global budgeting, access and quality suffer.
  11. Citation needed. It's not plausible that total government spending would increase by that much per year, at least not the $7 trillion figure. Total spending on health is $3.5 trillion (which includes government expenditure currently), and also includes our cost-sharing. Where would that extra money go?
  12. It doesn't require much evidence. We know total spending on health is about $3.5 trillion and we know there are about 320 million people in the country. A calculator does the rest.
  13. Corporate taxes are not only economically harmful policy, they're not effective in raising significant revenue even if rates are high, so corporate taxes in particular are just about the dumbest possible policy idea to raise revenue. Secondly, marijuana taxes will not raise any significant revenue relative to the cost of health care.
  14. What is "corporations' fair share," specifically? How much of MFA do you think can be funded by the corporate income tax?
  15. How is there no conceivable policy fix for that other than Bernie Sanders' Medicare For All? If the federal government can't fix glitches in its own health policies currently, and lets people slip through the cracks for years or even decades, that is a bad sign for how health care would be managed by that same federal government under single payer. If they can't do it now, how could they magically start doing it effectively just because they voted yes for a single payer bill? Will it? You 100% sure about that? How do you know this for certain? Just because Sanders wrote it in the bill doesn't mean it will happen. Historically it has been extremely difficult to pass massive tax increases (on anyone, wealthy or otherwise), and promising 100% comprehensive care for everyone for $0.00 cost-sharing means the tax increases would have to be massive to fully fund MFA, which increases the likelihood MFA would not be fully funded and instead would be significantly deficit-funded. This comes with its own set of risks and downsides. The easiest and smartest way to reduce the need to try to pass mind-bogglingly massive tax increases is to continue to include include premiums (monthly payments) and cost-sharing (deductibles and co-insurance), rather than promising all care will be free and only the rich will see tax increases. Politically that's easier too, because it's a lot easier to say to the middle/working class "we're standardizing your premiums/deductibles/coinsurance to keep it affordable and predictable for you" than it is to say to them "we're raising taxes on you." Theoretically there is no limit to the federal government's legal power to tax. But politically there are limits (Democrats defect because at some point they can't stomach the increase, because their constituents can't stomach the increase), and economically there are limits. Taxing corporations sounds lovely to progressive ideologues but it's actually widely understood that's it's economically harmful policy.
  16. You need a lot of money to retire at 65. The average life expectancy of a 65 year old is about 85, so $390k over 20 years is about $10k per person per year. Part B and D might make up $2,400 in premiums, and Part A and B deductibles add to about another $1,500, so about $4,000 per person per year pays Medicare B+D premiums plus Medicare A+B deductibles. In other words you need about $325,000 earning at least 2.5% interest per year on average to pay your Medicare premiums and deductibles for you and your spouse. If the data from your source are correct and that you really need about $10,000 per year available for health spending, then you need about $800,000 earning 2.5% interest per year, or $575,000 earning 3.5% interest per year, to cover all your and your spouse's health needs in perpetuity. If you have less than that, you'll have to consume the interest and the savings simultaneously, which is what a lot of people do. Medicare spends about $11,000 per beneficiary per year. If seniors (who as a group are currently the richest generation of seniors ever) can't afford to pay what they currently pay for Medicare, then the younger generations certainly can't afford to foot the bill for them either, because they already have to fully fund their own health care as well.
  17. Outlined by whom? A populist socialist running for President and making outlandish campaign promises? Marijuana legalization has no relevance to health care policy.
  18. That hasn’t been my claim. The US Government is the same as the US Government. And if the US Government is so inept as to be chronically unable to administer Medicare appropriately such that you refer to Medicare as being ”thrown under the bus,” that reflects very badly on your fantasy promises that that same government will administer MFA so magically and wonderfully for everyone for free.
  19. You have no idea “how MFA is.” No one does. Congress would never allow Bernie’s plan as imagined to reach the President’s desk. The design aspects would be fiercely debated and modified. There would very likely still be cost-sharing (as there should be, even with single payer), there would very likely be insurance company involvement in administration, and there would very likely be cost control measures that will affect someone or another adversely (in their opinion). Fantasy campaign promises are for intellectual children.
  20. You're the one referring to Medicare as being thrown under the bus, while clamoring for Medicare For All. Shall we start calling it Thrown-Under-The-Bus-For-All?
  21. So what? It’s government coverage. Medicare is single payer for old people. What’s so atrocious about it? Whatever is so allegedly horrible about government funded single-payer healthcare for old people, we can very easily assume that there will be similarly “bad” features of whatever MFA would end up being. The same government that you apparently think is “throwing people under the bus” by putting them on Medicare is the same government that would put everyone on Medicare (if you had your way). There are at least ten fundamentally crucial design features of any single payer overhaul that are altogether undecided. MFA hasn’t “agreed to” anything. MFA is a very generic term to describe a single payer overhaul of the US health system. Exactly how it is designed, what cost sharing there will continue to be, how taxes related to healthcare are structured and implemented, and about 7 to 10 other critically important but yet undecided design features are still completely open for discussion.
  22. That argument isn't aided by characterizing becoming Medicare eligible as being "thrown under the bus." The prospect of unions not having health benefits as a bargaining chip is a double-edged sword. Some union workers have opted for maintaining health benefit generosity over many years, and to wipe it away and replace it with whatever MFA ends up providing makes them uneasy. They're unlikely to buy your fantasies and promises about how health care will suddenly be free for everyone and/or that everyone will pay way less for way better and more available care. Those details have not been worked out yet. How do you know for sure that it will? Medicare policy could have accommodated them years ago. It didn't. If government can fail to adequately help these people within the current Medicare structure, it can certainly fail to help them under some new structure. Innumerable details would still need to be worked out about MFA before we'd know who would have a net benefit from it relative to the status quo, vs. who would have a net-detriment or net-cost. Yes, that's what you should have said in the first place.
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