Sunday, December 27, 2015

"BernieCare" single payer vs Republican Rube Goldberg free market based health care model.

It's interesting to note that the government already "pays about half of the nation's health care bills." That said, Sen. Bernie Sanders wants to go all the way, with an all inclusive government run system.

Real Freedom and liberty: It's easy to sell this too, which begs the question why Democrats don't run with this; No more surprise bills in the mail, no more paperwork, every doctor is your doctor, every hospital is your hospital, and dental is finally included. Say goodbye to outrageously high long term care insurance policies. A yearly premium for someone making $40,000 equals about one monthly premium in our current system.

Bernie's Plan - Breaking it down to the basics:
(It puts) the $3.2 trillion-a-year U.S. health care system in the hands of the federal government, with states acting as administrative subcontractors.
1. Eliminate such things as insurance premiums, deductibles and copays. In their place would be taxes ... a new 2.2 percent "health care income tax," with higher rates for upper-income earners.

2. Sanders would incorporate Medicare and Medicaid into the new system, promising that patients would have no gaps in coverage.

3. You could go to the doctor or spend two weeks in the hospital and not worry about getting a bill.

4. No insurance premiums, deductibles, cost-sharing or copays, even for brand-name medications. Gone would be worries about being penalized for seeing an out-of-network doctor.

5. Long-term care would be covered, whether in a nursing facility or one's own home.

6. Most dental care would be covered, too.

7. For drugmakers, the single-payer system means government-set prices, a reality they must endure in other countries.
WHAT ABOUT INSURERS? Economic changes, new technologies, and globalization have disrupted many industries. People in the United States have learned to live with fast-paced change, even if they don't like it. Under Sanders' plan insurers would be relegated to selling supplemental coverage for services not covered under the single-payer plan. States could hire them to help administer coverage. But hundreds of thousands of jobs would disappear. Billions of dollars in shareholder equity would evaporate. Sanders has proposed a transition plan for workers displaced by the conversion to single-payer. That plan, too, would have to be paid for with taxes.
1. Administrative savings would come from doing away with layers of insurance company bureaucracy. Those would be offset somewhat because the government bureaucracy would grow.

2. As with Medicaid, states would be expected to cover part of the cost of new system. How much remains to be determined.
Crazy Rube Goldberg Ideas from the Right: Adding to the convoluted GOP list of plans is Dr. Ben Carson, who should know better. Take his plan for Medicare; we already know a seniors ability to manage finances drops dramatically as they get older, so forcing them to shop for health coverage is insane:
Medicare itself would be restructured, providing beneficiaries with a fixed payment for a private insurance plan of their choice. His proposal relies largely on tax-sheltered personal accounts, 'Health Empowerment Accounts," opened for every citizen at birth, to promote patient choice, and foster competition among private insurers ... The tax-sheltered accounts would be paired with high-deductible major medical insurance. Routine costs could be covered from the accounts, which would build up balances with time. Carson would also gradually increase the Medicare eligibility age to 70 from the current age of 65.  
I included Carson's Medicare plan because it's similar to the "free market" GOP vision for health care in general, and the "market oriented" systems in Singapore and Switzerland, which is god awful. Singapore takes a whopping 20% out of your paycheck to pay for in patient health care, but not outpatient, which you pay for on your own. Ouch!

Remember, Bernie Sanders' plan takes only 2.2% out of your paycheck.

You'll notice "cost-efficiency" touted below, but that applies to the government, not to us. We get soaked, leaving our economic security up for grabs. It's a convoluted nightmare. The Atlantic:
Socialized medicine saves money, relative to the American system. Switzerland and Singapore  provide powerful examples of how market-oriented health care systems are more cost-efficient than socialized ones.

In Switzerland, there are no government-run insurance plans, no "public options" ... the Swiss get subsidies, much like "premium support" proposals for Medicare reform or the ACA exchanges, from which Swiss citizens buy health care from private insurers. The subsidies are scaled up or down based on income. Switzerland is high on the league tables in terms of government health spending  ... combining high-deductible insurance with health savings accounts for routine expenditures.

THE SINGAPORE MIRACLE?: Singapore has the most market-oriented system in the world. Singapore's comparable (if not higher) health outcomes, and spends an absurdly low amount on health care relative to the West. The key to the Singapore system is mandatory health savings accounts ... like our Social Security system, Singapore takes mandatory deductions from workers' paychecks--around 20 percent of wages--and deposits them into health savings accounts called Medisave. Medisave accounts are used mostly for inpatient expenses, but ... Singaporeans are expected to pay most of their outpatient expenses with non-Medisave cash.

On top of Medisave, Singapore has a government-run catastrophic insurance program called Medishield. Singaporeans can opt out of that plan and buy private catastrophic insurance. Premiums for Medishield can be paid for using the Medisave health savings accounts.

Then there is Medifund, a safety-net program for the bottom 10 percent of income earners, and Eldershield, a private insurance program for long-term care for those with old age-related disabilities. On top of these government-sponsored programs, Singaporeans can buy supplemental insurance for things like outpatient expenses.

It incorporates the central idea behind free-market health care: that health-care spending is most efficient when that spending is executed by individual patients, rather than third parties. It's easy to waste other people's money. But if that money is your own, you are going to try your best to spend it wisely.
No, it's actually called self rationing, which is never a good idea:
Singapore, of course, isn't a democracy--which allows the government to install sweeping changes that wouldn't be realistic here.

The Swiss and Singaporean models wouldn't be perfect models for America...
Check out this ridiculously biased Cato Institute report on universal care vs market based: 2008 paper by Michael Tanner.) The report points to 4 arguments against single payer, and two of them are the same; long lines and rationing. Really, we don't have waiting periods here to see a specialist, and people that can't pay or are dropped for preexisting conditions isn't rationing?