Medicare-for-all sounds great, until the bill comes due

Wednesday, January 23, 2019

During the debate — including a government shutdown — that led up to the passage of the Affordable Care Act, we remember hearing a millennial’s plaintive cry about the unfairness of the “individual mandate.”

“Why should I pay for something I don’t need?” That palm-to-the-forehead realization of a basic misunderstanding of the term “insurance” is bound to be repeated this election cycle, as the “Medicare-for-all” plank is inevitably nailed into the platform of the Democratic Party.

There’s some value in examining whether health “insurance” is actually insurance at all. Perhaps it’s better thought of as pre-payment for something that “will” happen — the need for medical care — rather than actual insurance against something that “might” happen, such as an accident.

A nonpartisan Kaiser Family Foundation survey sheds some light on the coming battle over the MFA issue, and the points that will have to be hammered home in order to defeat the concept.

Asked whether they support “Medicare-for-all” as first championed by Sen. Bernie Sanders in 2016, respondents favored the concept 56 to 42 percent, and that climbed to 71 percent when they were told it would guarantee health insurance as a right and 67 percent when told it would eliminate premiums and reduce out-of-pocket costs.

But when they were told a government-run system would lead to delays in getting care or higher taxes, support dropped to 26 percent and 37 percent respectively.

Those factors are hard to quantify since some studies estimate government spending would increase $25-35 trillion over a decade, but others estimated cost savings would cut the increase to $1.1 trillion in new taxes in the first year of the program.

A couple of other ideas found wide support in the survey, one which would allow people ages 50-t0-64 to buy into Medicare, the other to allow uninsured to buy into their state’s Medicaid program.

Another private survey found that the uninsured rate among U.S. adults rose 13.7 percent int he last three months of 2018, and has climbed 2.8 percent overall since 2016, translating into about 7 million more uninsured adults.

The issue is bound to come home for Nebraskans, who voted to expand the state’s Medicaid coverage under Obamacare, which has been thrown into question as a result of court rulings potentially gutting it because of the elimination of the individual mandate.

The Kaiser Health Tracking Poll was conducted Jan. 9-14 and involved random calls to the cellphones and landlines of 1,190 adults. The margin of sampling error for all respondents is plus or minus 3 percentage points.

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  • The holy grail of funding healthcare is a messy chase for someone else's money. There are three players:

    1. The insurers. Lets be sure of the definition of insurance: an unseen event of the future where a contract causes remuneration for that unseen event. So, it is not insurance if one is buying it to cover an ongoing event. So, MFA is really a bill paying service, guaranteeing adverse selection costs to be transferred to the loyally already insured. Indeed, the Affordable Care Act had it right to require all to be insured, so adverse selection does not unfairly transfer cost to the insured pool. It is too much like being guaranteed the right to buy life insurance for someone already at the morgue.

    2. The insured. Those insured seeking fair pricing should have an understanding that their claims cause higher premium. Out of that should come a sense of responsibility to follow doctor direction and seek an overall lowering of health claims. So, out of that, I support charging for high risk behaviors, somewhat like a high risk driver is charged for his auto insurance. Beginning here, I support higher premiums for high obesity, and even non compliant patients. Perhaps those two could be assessed the surcharge named "reckless patient-ing". Having skin in the game would cause better patient success, and offset their high claims ratios.

    3. The providers: Somehow, we must pay for medical innovations, doctor education, and facilities. Yet the gouging of the insurers for $6 oxycodone pills in a hospital when the cash price is $0.55 cash is repugnant. Medical devices are triple to 10 times higher in USA than other countries. Markups to insurers is a disgusting shell game, all driving premiums sky high.

    So, in summary USA must change the culture, the attitude of healthcare to that of teamwork. The patients must perform better, understanding that every claim drives up premiums. Providers must perform better to contain costs, understanding that any excess cost drives up premiums for all. Insurers then also need to perform in containing the bad behaviors of both patients, and medical providers, along with efficient claims payment. When can the citizens of America sign onto that teamwork, making the whole process much more efficient? Today, sadly, providers and patients view insurers as a nameless, faceless bill paying services, when insurers are just the many citizens being gouged with an accomplice called an insurer. That has to change for any future lowering healthcare costs.

    -- Posted by shredder09 on Tue, Jan 29, 2019, at 10:44 AM
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