Comments by "Xyz Same" (@xyzsame4081) on "Bernie Sanders"
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@__Andrew No duplicative coverage would be allowed under the Sanders bill. Like in all single payer nations ! (it is a necessary condition especially in the U.S.) - A doctor or hospital CAN refuse to have a contract with the public non-profit agency (in the U.S. Medicare)
- but IF they offer a treatment that would be covered by the Medicare for All Plan - then the patients must pay out of pocket. There will be no insurer that offers a plan for it, they are banned from doing so.
So technically it is not outlawing private healtcare insurers - but making them irrelevant.
As they should be.
They can offer supplemental insurance for extras, but nothing more.
Cash payment is a deterrent for doctors and hospitals. Especially when it gets very expensive (typically it would be for things like expensive dental, while basic is covered by the public agency, or specialities like accupuncture, ...)
I live in a single payer country and all hospitals (which are non-profits anyway, they are run by the state or cities) and 80 % of doctor practices have a contract with the agency. And accept their rates and the patients covered by them.
If you outlaw duplicative coverage it is harder for doctors to get patients- and "private only" services will be limited to the not so expensive, not essential treatments / services.
that has an effect on the rates of "private" doctors as well, their rates tend to be reasonable - or they would not attract enough patients. (they have to make do w/o the patients that are covered by the public agency).
That means that if you want to go to the doctor with the good repuation in accupuncture - you will be able to afford it. And you will likely pay for that out of pocket.
Although supplemental insurance often covers that, but their premiums are so high, that I never grasped the reason to have supplemental. If you can afford thpse premiums you can afford to pay out of pocket, if and only if you want extras.
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@Tman20rox The Scandinavian countries are small if successful examples. How about Germany (85 millions), Netherlands (30 millions), France, Austria, Belgium, Switzerland, ....even less wealthy nations like Italy, Spain, Portugal.
even the U.K despite the neoliberal attacks have more holidays and universal healthcare (at 42 % of spending per person of the U.S. - which is admittedly not enough, the usual range is 49 - 55 % of the U.S. spending levels).
Thainland has a good universal healthcare system. Or Russia, Mexico, Cuba.
And free education (at least Russia and Cuba). The other benefits are likely not as good but they are not nearly as rich as the U.S.
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@__Andrew the basic principle. The public non-profit insurance agency (like Medicare under the Sanders plan) is a middle man with enormous negotiating power (very much needed power, considering how weak the position of consumers is when it comes to healthcare). They use that almost monopoly power (as buyers of medical services) on behalf of the consumers and for the good of society.
For profit healthcare insurers are also glorified middleman. Their goal is to maximize profits, not to serve the public. The goal of the insurance agency is to make healthcare happen: for everyone and at a reasonable price.
The insurance companies are scared of single payer: no one would miss them
if the Medicare agency is properly funded ! and coverage is comprehensive (like in all other wealthy single payer countries)
Doctors and hospitals have the voters on their side to get sufficient but well negotiated rates - they can appeal to the court of public opinion if the agency squeezes them too tight and they could not make do with the revenue they would be getting. It helps of course that hospitals are non-profits (and in most cases public non-profits, meaning run by cities and states).
The large and powerful players are non-profits (insurance agency, hospitals).
Everyone is covered with a very affordable income related MANDATORY contribution. people w/o or with very low income are included for free (Children, students, unemployed, disabled, stay at thome parents).
So it is universal. Doctors rarely encounter "uninsured" persons.
Coverage and places to get treatment are the same for all - even wealthy people. THAT ensures quality. The wealthy are not putting up with crap, and the MASSES of voters would not tolerate it if they have bad experiences.
That means SUFFIECIENT funding - and the payroll taxes are not enough (they are kept affordable as to not be a burden, so that everyone can have coverage - universality). The rest comes from general tax revenue.
One size fits all - means also a lot of political leverage for the insured and patients. If a treatment would be denied to one patient - it means no one gets it. Time for the pitchforks.
In the U.S. some people will be lucky and have good insurance, and others detect that their plan does not cover all, that they are denied treatments have to pay out of pockets. - or they have no insurance at all. They are FRACTURED. Divide and conquer.
people in single payer countries cannot chose what their plan covers, nor do they care about that. Single payer means you are assigned to an agency (in reality there are often more single payer agencies in one country, Does not matter is they organize it per province or state, under the umbrella of one head agency or whatever).
People assume that they will get first world medicine when they need it - and no one knows what treatments will be available in 10 years anyway.
Signing up takes 5 minutes (first day in a new job), the employer deducts payroll tax and usually matches it. Done.
You show your insurance card at the doctor and hospital and are in. In emergencies the default assumption is that the person is covered The doctor has no hassle either. If you do have cover at tall, he can pick for you from the whole menu. And they get the money for their bills and on time. Plus billing is streamlined. No phone calls of doctors or nurses with the insurance agency, why would they. The framework has been negotiated and the doctors make the individual decisions.
Even under the best of circumstances healthcare in a first world country is expensive. See 0:40 most nations spend USD 5,000 per person and upwards (6,000 would be the high end of the average for a first world country, most are in the range of 4,900 - 5,500 - 2017 Kaiser foundation).
Population is ageing and that means disproportionte more spending - so that pressure to stay within the budget also straigthens out the players. They have to cut out inefficiencies to keep up.
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J. Muller I guess you mean you have worked 55 years, so you are at least 70 years old - or 75 if you started with 20. In the U.S. - or any other first world country - you have consumed a lot of benefits.
In the U.S. Medicare (the payroll deductions are NOT enough to fund it, same for SS). - People were diligent even before your era, that alone does not get people up the ladder, if the economy at large is not doing well.
Germans in the 1920s and early 1930s were as industrious and technically savvy as they were after WW2 - the circumstances and the political framework (austerity versus Keynsian economics) had changed.
If you are born in the 1950s then you benefitted a lot from MASSIVE government spending.
For instance from free college, even if YOU never went, these graduates helped the economy, helped everyone.
Also from the Interstate highway or the electrification of the rural regions - that infrastructure helped not only those who used it - it had ripple effects on the whole economy.
Or the massive government spending for electronics, the Race to the Moon. Which led to processors, computers, PCs, touchscreens, WiFi.
I recommend the video: Capitalism did not create the iPhone you iMbecile on the channel of Current Affairs, 8 minutes, entertaining and informative.
Then they had high taxes for the rich and fairly high taxes for businesses if they made good profits. Companies made good money, the only way to avoid taxation was good wages and investing.
U.S. DEBT was very high after WW2, the highest federal debt EVER (ratio debt : GDP). Government continued to spend after WW2 - so they had to make sure the money came back. In form of taxes.
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