Comments by "Xyz Same" (@xyzsame4081) on "CNBC Television"
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If you live in a country where they have single payer (like I do) the propaganda is UNBELIEVEABLE. The likes of eHealth and their CEO or their sales agents * add nothing to the DELIVERY of care or necessary (lean) administration of healthcare services. No wonder it costs double in the U.S. of what it should cost.
* 30,000 per year - is not much for a sales agent, but is still unproductive work, that should become obsolete as soon as possible, these people could do something worthwhile.
Also: lobbyists (paid by the likes of eHealth) make sure Medicare IS rendered complicated. If only the wellbeing of citizens would be on the agenda the public non-profit agency could keep things simple, and streamlined (Medicare agency still has only 2 or 3 % admin overhead, while private insurers have plus 20 %).
Single payer country - I know the system of Austria well: you have a NEW job, the company announces you to the insurance agency on day one, the mandatory payroll tax for everyone who has more than 500 USD per month is 3,8 %.
That is matched by the employer (they must, small or large companies). But not more than 2,400 USD per year for employee and the same maximum amount for the company.
(so the cap is for a yearly wage of 60,000 USD)
The mandated contribution is modest so it is very affordable (also for companies), the rest comes from general tax revenue. But the government still has to subsidize LESS per person than the U.S. government because the system is so much more cost-efficient - of course the likes of eHealth must not be financed. It is mostly non-profits (hospitals) or small actors (like small companies) = pharmacies and doctor practices.
Signing up on the first day in a new job is mandatory, it takes 5 minutes. Name, address, SS number, the same for dependent family members (they are included w/o extra costs). No healthcare questions, of course not. Preexisting conditions or health status do not matter.
If people apply for retirement or disability, unemployment or maternity leave ... the insurance is a sidenote, it is included in the package. Retired persons pay a contribution from their pension (what is called SS in the U.S.) all the others get coverage for free. They stay in the same pool, have the same insurance card. Nothing changes.
Done.
Since the public non-profit insurance agency is such a dominant player, all hospitals and at least 80 % of doctor practices have a contract with the agency. So there are plenty of choices for patients. Although your doctor will often refer you to hospitals (when this is about a speciality). Or the ambulance team or the emergency doctor decide where you go. Which usually means you are not in good shape to make the decision.
When it is a generic not too dramatic injury (broken bone, burns, cuts) it does not matter where you decide to show up.
When you go to the doctor or hospital you show your insurance card. If you have insurance you have FULL coverage. The same as millions of other people. so it is very easy for the doctors and gives a lot of political ! leverage to the citizens / insured / voters.
Wealthy and low(er) income people meet in the same facilites. so no party makes hay by attacking the system.
Everyone gets a certain treatment (if the doctor recommends it) or no one. So all that is warranted in a first world country IS included (see political leverage) - free at the point of delivery.
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"On average we spend 600 USD to get a patient, but we earn 1000." - Yeah, and every wealthy single payer country got GOOD healthcare for ALL done by spending USD 4,900 - 5,900 * per person in 2017, while the U.S. spent 10,260 (high costs for individuals, companies and still the need for high government subsidies to keep the overpriced, dysfunctional system afloat).
The very typical range (data is from 2017) is from 5,000 - 5,500. The overwhelming majority of wealthy countries are in it. The differences are mainly caused by average AGE of the population, and overall cost of living. Which impact wage levels.
Labor is an important cost factor for healthcare so if you compare the numbers of Norway or Switzerland with other countries you have to make concession because of their higher costs of living / higher wage levels *. Germany had 5,900 USD (they have the second oldest population of all wealthy countries).
Switzerland spent almost 8,000 USD per person in 2017, it is not only their wage levels. they are the only other wealthy country that I know of that also rely on private for-profit healthcare insurers. They are IMPOSSIBLE to regulate for a service like healthcare insurance.
Regulation works partially: they cannot play games with the insured, patients - so the experience of the insured patients if they need care is good.
BUT: cost control does NOT work.
That said: even Switzerland beats the U.S. (78 % of U.S. spending and like all European countries with a much older population).
Japan has the oldest population on the planet - BUT with them you see the advantages of eating healthy. They have terrific numbers, they spent 4,900 USD per person.
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Leeches like this company are the exact reason why the U.S. healthcare costs are so out of control. Because the predators have MADE THEIR paid and bought for politicians render something that should be for all, simple, straightforward, cost-efficient and non-profit very, very COMPLICATED.
So complicated that retired persons have even a problem navigating the system without the help of a profiteer - who sucks resources out of the system while doing NOTHING to make delivey of care better or helping with necessary (= lean !) administration.
Those retired persons are finally covered by the public non-profit (which is much better) - but the coverage is not comprehensive and funding is NOT enough: so private insurance companies are handed over a part of a SAFE niche. The niche for a service where consumers cannot refuse to buy if they want good healthcare. Which is not just a nice-to-have luxury, but a life and death issue.
A single payer agency is a public non-profit and usually the laws in the countries defines them as autonomous entity (although they need subsidies from the government, the modest payroll tax is not enough).
So "government run" does not apply. Governments are voted in and out - the agency (and leadership) stays the same.
They have a board of directors where I live (Austria): representatives of corporations and labor (the latter usually with ties to unions) are on the board of directors. The labor has one board member more.
The reasoning is that the unions / labor affiliated organistions are there to help the little guy and gal. Part of the funding comes from mandatory wage related contributions (these contributions are modest so very affordable and the mandate is not resisted).
In the U.S. the president can fire the head of agencies at will, that means every 4 years there could be "unrest". Not with the agencies here, also not for the Social Security agency. They are not only the single payer agency that is responsible for healthcare insurance coverage. They also are responsible for retirement, disability, ... the payroll taxes for retirement, healthcare, etc. are earmarked.
No one "loves" the insurance agency, citizens are O.K. with them, and have lttle to do with them. Patients are attached to doctors, or the friendly staff of a station at a hospital - especially when they were in need of major medical help.
Healthy people do not even think about healthcare insurance, it is a given. Nor do they care much about doctors as long as they do not need them.
The insurance agency hums along in the background and they quietly do a solid job with low administrative overhead * - as they are expected to do.
* Internationally 2 - 4 %, Medicare does good in that range, they are closer to the 2 %.
ACA was supposed to limit the overhead of of the for profit healthcare insurers (but of course they found ways around that, overhead includes benefits for management, lobbying, marketing and profits !)
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The largest block among people eligible to vote are those who do not vote. Disproportionally young, minorities or not wealthy. Guess who has the largest volunteeer organisation, does well with exactely those demographics (as to be seen in the primary results).
The Republicans have a ceiling in how much support they have in the population. They turn out their voters at higher numbers, and they are more often single issue voters. Trump tapped into the pool of disaffected non-voters. But Trump has a ceiling too - especially ! in the states that will decide the outcomes.
The apathetic voters will not jump at the lame "Cuba" / "socialist" smears.
But they MIGHT be motivated by the high energy of his campaign. Even if he only gets M4A and an investment in renewable energy with JOBS in the U.S. through. That would be a major improvement.
The right has used the label "Socialist" too much, it is worn out, they called Obama a Socialist and even Pelosi (don't we wish ! - in both cases)
Sanders did some jiu jitsu and embraced the label - the right wingers are used to Democrats folding with a whimper when accused of being a Socialist.
Technically speaking Sanders isn't a Democratic Socialist (I guess he understands that, he was more like one in the 1970s). But neither the right wingers, nor Corporate Democrats, the Corporate or Independent media, or the electorate are into the nuances of political science.
Marketing wise it was a smart move, I must admit I did not fully realize how smart when he self-identified as Democratic Socialist in 2015.
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