"Start over and do health care reform right this time."

[lightcameron]

Some variation of that quote is constantly used as a right-wing talking point.

My response: "Okay, you got it. Let's scrap the ACA and pass a very simple one-page bill repealing the age and disability requirements (barriers) to Medicare. The system is already in place. Health care providers already know how to deal with them. Let people keep whatever insurance plan they have, but allow anyone to buy into Medicare at the current monthly premium. That will also help shore it up fiscally, far into the future."

This is what I thought they should have done all along anyway. I mentioned this to my doctor last week and she said that was her view, too, along with many other doctors she knows.

Anyway, I'm going to start using that as a rebuttal when I hear a right-winger say some version of the post title. I doubt they'd come anywhere close to agreeing, of course, because they don't have a plan and never will.

[CreekDog]

1. you've just repealed Medicaid expansion, then, so no, your idea is not well thought out

opening up Medicare is a great idea, but scrapping all the health reforms too?

forget it. think harder.

[Cleita]

2. If you had full coverage on Medicare, which Bernie Sanders is

trying to get to happen in the future, and then lowered the eligibility age to 0, you won't need Medicaid. Think about this way of doing it.

[CreekDog]

3. but that's not part of the OP's bill

and again, if you repeal all the other reforms you've allowed caps on private medical insurance (for those with employer provided health insurance).

if you repeal, you lose protections for preexisting conditions.

and the list goes on.

why do you want me to give this person's idea a chance? it's nonsense. the person obviously didn't think very much about it or they wouldn't have gotten things so factually wrong.

[lightcameron]

5. I posted a bill? (EDIT)

I think I posted a general idea that would be used in a hypothetical debate with a right-winger.

As for the caps and pre-existing conditions aspect, why do you think private insurance wouldn't try to compete with Medicare? Surely you have at least some grasp of how markets work, don't you? If private insurance retained those aspects, they'd lose.

[Cleita]

9. Well, I'm of the school that thinks insurance shouldn't be part of

health care. They are nothing but a parasitical industry that skims the cream off the top of health care dollars leaving the patient and health care provider paying for it. Physicians For A National Health Plan have laid it out how it would work. Everyone would be 100% covered and they estimate for half the cost if there was no insurance there in the middle.

[CreekDog]

10. I'm for single payer, as you are, but the OP is just proposing to repeal ACA and...

...open enrollment for Medicare.

that's a horribly incomplete idea.

[Cleita]

11. I thought the OP was about a retort to right wingers who want

to repeal the ACA, what the alternative could be, not an agreement to actually repeal it.

[lightcameron]

13. It was. Looks like most understood that.

[CreekDog]

14. the problem is it leaves out all the bad things that would happen if ACA were repealed

the reforms to the private insurance industry would be undone as well as Medicaid expansion repeal would harm as many as it would help initially.

and i support single payer, but not like that.

[demwing]

43. you're not listening (or reading, rather)

Simply repeating the same objection - despite multiple attempts to clarify the OP - is really weird!

[lightcameron]

12. Don't spend too much time on this one.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4154985

That post (and most of the thread) will tell you who you're "discussing" things with. Pretty good consensus there.

But I, for one, appreciate your input.

[lightcameron]

7. Exactly. It's almost a given.

[jeff47]

18. Medicare's still only 80%. Need Medicaid or similar for that 20%. (nt)

[Cleita]

19. I addressed that. Bernie Sanders is working on providing the

additional 20% or full coverage. Did you not read my post? Also, as a Medicare recipient myself, I know that the Medicaid gap coverage is useless, in my area anyway. No doctors will accept it unless they are the old drugged out alcoholic, who can't get other patients except the poor and elderly poor. The rest will accept Medicare with the AARP Medigap or similar plan. We need Medicare to cover 100% and the fee schedule needs to be one that compensates doctor and hospitals adequately so they continue to make it worth their while to operate. It could be done if we weren't confronted with the health care obstructionists in Congress.

[jeff47]

21. Misread it as extending coverage but not percentage of coverage. (nt)

[geek tragedy]

25. Medicare A+B are not adequate for poor people.

Medicare A+B without a supplement is actually pretty crappy insurance.

[Cleita]

29. As crappy as it is, it's gold compared to junk insurance, which I had before

I was able to get Medicare. That was in 2005. I had to pay $300 a month for a $3000 deductible that no doctor would accept. I would have to submit the bills myself to meet the deductible, which I never did because BC would only credit part of the payment, and I never met my deductible. So essentially I was paying the doctor out of pocket and paying the insurers for nothing.

Although I have to buy Medigap and prescription coverage, at least I get what I pay for. This is what Bernie Sanders is trying to do, close these gaps in coverage so it covers 100%.

[geek tragedy]

31. no doubt. nt

[lightcameron]

4. Easy fix.

If we did the Medicare expansion correctly, we could do the Medicaid expansion correctly this time, too. As of now, that's not working out so well for many people. Unless we wanted to keep it in place because it's good enough. Or something.

https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/
Some states are not expanding their Medicaid programs starting January 1, 2014. In these states, some people with limited incomes may have fewer coverage options.

If you live in a state that isn’t expanding Medicaid you may not qualify for either Medicaid or reduced costs on a private insurance plan. It will depend on where your income falls.
However, the Medicaid program provides health coverage to millions of lower-income individuals and families today. Even if your state doesn’t expand Medicaid coverage, you should still apply. You may qualify under your state’s existing rules. Use the “Get state information” menu at the bottom of this page to get contact information for your state Medicaid office. The office can tell you whether you qualify.
To find out if your state is expanding Medicaid in 2014, use the same “Get state information” menu below.
States are continuing to make coverage decisions and they could expand Medicaid in the future.

[Bandit]

6. Establish Government Clinics with Government paid Doctors and Nurses and place them in

every city in the USA with over ten thousand people. People could keep their private insurance and see their private doctors just as they do now but anyone that wants or needs could go to a Government clinic and recieve free health care. There should also be some Government hospitals located in the more populated areas,in case one needed hospitialization. This would work EXACTLY like Veterans Clinics and Hospitals all across America.

[lightcameron]

8. A good addition that I'd support. Thanks.

[DevonRex]

48. See HRSA.gov

They already have Federally-funded clinics all over the U.S. and even a uniformed health service. They hire and pay doctors, dentists & nurses. They even Noah for their education in return FIR working in underserved populations. Oh, and they also run all clinics on tribal lands.

[Bandit]

49. Yes they do but they are not open to the general public

It would be a very easy fix to just add to what is already existing. They have clinics for native Americans in other places than tribal lands as well. In fact all throughout Alaska, where there are no "tribal lands" per se because there are no reservations in Alaska. There are however lots of natives here, and they all enjoy free Government health care, just as I do with Veterans care.

[DevonRex]

50. HRSA clinics are all over and are open to everyone.

Just go to HRSA.gov and click on find a health center.
http://findahealthcenter.hrsa.gov/Search_HCC.aspx
You pay according to what you can afford. If we had decent health care, it'd be free. But for now this is the best the agency can get out of Congress.

[Hoyt]

15. I would like Medicare for all; however, I wonder what folks think the monthly premium would be?

I don't think it would be as cheap as many think.

Some other problems, we'd have to deal with (although certainly not insurmountable):

-Coinsurance is a lot, without a supplement.

-There is no out-of-pocket cap without a good supplement or signing up for a Medicare Advantage Plan (private insurer).

-You and providers would still be dealing with insurance companies (you as a beneficiary and your doctor have very little contact with anyone other than the insurance companies that administer Medicare, and insurance companies that provide Medicare Advantage Plans to 28% of Medicare beneficiaries, drug coverage, supplemental insurance).

-Many docs would gripe to heck if all their reimbursement were at Medicare rates, although they wouldn't have much alternative and it's better than Medicaid.

-I suspect Medicare for all would require some severe restrictions on drugs, providers, treatments, etc., to make it viable long-term -- Restrictions that many people would not readily accept.

-Those patients moving from Medicaid would represent a hefty increase in payments to hospitals, doctors, etc.


Again, there is nothing that can't be worked out (with Republican cooperation), but Medicare would require some changes to turn it into what many think it would be if required for everyone. And it would not be a whole lot cheaper than private insurance offered through the ACA, if any. You might squeeze out a 10 to 15% savings, which -- while substantial -- would still leave a lot of folks saying "I still can't afford it." Pretty quickly, you'd have to put restrictions on providers ordering services/tests/treatments they profit from. Getting the profit out of health care would be good long-term, but the short-term whining . . . . . . .

With all the problems, Medicare for all would allow the government to manage health care for what is best for society. Problem is the griping over what would have to be done to make it affordable, efficient, and effective would be really loud, and not just from Rethugs.

[Cleita]

20. I crunched some numbers that indicated an average of $90 a month

per person in today's dollars. The sticky wicket is where to get the money for the children, elderly, disabled and unemployed. I say a transaction tax on Wall Street trades would be more than enough.

[Hoyt]

22. Would love to see calculation of $90/month. Wish it would he that low, but I doubt it.

The $104 or so that elderly pay for Part B is only part of cost for Part B services (about 33% I think), and Hospital costs are in the hundreds of dollars per month, but get paid through taxes. If you suddenly put everyone under Medicare whose Medicare payroll taxes have been going to paying the hospital costs of Medicare beneficiaries, taxes would have to go up substantially. Not against it, but I don't think it is anywhere near $90/month.

[Cleita]

24. See my post 23. It was meant for you. n/t

[Hoyt]

30. Ypu are right, those a very rough calculations and assume profits and excess

will be removed from system. Will be glad to pay my $90, or even 5 times that, when Congress enacts it and providers yield

[Cleita]

23. Well, in round figures we spend $7500 a year per capita on health care.

I'm being conservative. Some stats say it's more. Our Canadian neighbors and other nations are able to deliver the same quality and quantity of health care for half that or about $3750 per capita because they have cut out the profit and waste. So let's see if we can halve our costs too. If we do then we need to deduct the two thirds that is spent on the elderly, children, and disabled that should be funded separately as they are most likely not to be able to buy in anyway. We already have that. Two thirds of our health care is government provided. It leaves approximately $1100 per year of spread out risk for those who are mostly healthy and between the ages of 18 and 65. It should only cost approximately $90 a month that would be paid out of pocket.

These are all rough and approximate figures so they aren't exact but it could give a ball park figure of what could be done.

[nyquil_man]

16. That's what they say, sure.

What they mean is that they want to do nothing.

Tort reform and interstate insurance is about all I hear from them. Anything more than that won't meet their standard of "rightness."

[eomer]

17. It's a bit more complicated than that.

Most of the cost of Medicare Part A is funded by payroll deductions of working people, not by the premiums of Medicare participants. So you can't just sign everybody else up at the current monthly premium. You would need actuaries to calculate the premiums to charge new participants, probably in age bands.

[Warren DeMontague]

26. Translation: trash an idea that originally came from the heritage foundation, because

If successful it will go down as an achievement under a Democratic president.

When they say "start over" they really mean, go back to letting insurance companies deny coverage to sick people.

[JimboBillyBubbaBob]

27. I still support...

...single payer, straight and simple.

[geek tragedy]

28. In order to have Medicare provide decent coverage (parts A and B alone are

not as good as a lot of private plans) you'd need to do a lot more revamping, such as enacting a Part C plan universally.

And, not to mention the very, very, very large tax increase that would be necessary.

[Cleita]

32. That very large tax increase is a right wing talking point.

We could cut the cost of delivering health care in half by eliminating the insurance companies and the administrative inefficiencies that come with multiple hands in the pot. Other countries have done just that. Money that was wasted in the past with for profit health care was repurposed to deliver health care efficiently and universally to all.

[geek tragedy]

33. As you probably know, Medicare itself is administered by insurance companies to whom

the government outsources the processing, claims, etc.

Sure, there would be big savings . . . down the road. But transitions almost always require upfront costs that take time to pay for themselves.

That people would be saving more money because they wouldn't have to pay premiums doesn't change the fact that it would still require a tax increase to pay for the system. And tax increases certainly can and do get demagogued.

[Cleita]

34. They are only paid to do the paper work within

the framework of Medicare. They don't decide on how it will be done or who gets paid. I do wish the government would go back to doing their own paperwork. I don't know when this happened but I'm suspicious it was under a Republican president or Congress.

[geek tragedy]

36. You're right, but that raises the question of how easy it would be to put the insurance

companies out of business when we depend on them to administer current federal programs.

Personally, I think the transitional step, via the ACA, will be to effectively convert insurance companies into public utilities.

[Cleita]

37. You think they would go out of business?

Sorry if I laugh my ass off. Insurance companies will always find some way to part those fearful of losses from their money. The rank and file worker will probably be hired by the government to carry the extra work load doing what they already are doing with probably better benefits. As far as the execs, oh boo hoo, I guess they are going to have to go collect that socialist unemployment check.

[geek tragedy]

38. The government would need to build out the technical capability to process those records

quickly and efficiently.

Short of nationalizing the insurance companies (and boy howdy that would be expensive) not sure how they would do that in a relatively short time period.

[Cleita]

39. They already have the bones of a system with Medicare and the VA.

It's not like they have to do it from scratch, just build on it. The Federal government still processes claims in certain places and for certain medical facilities.

[geek tragedy]

40. Not quite from scratch, but still a MASSIVE undertaking.

Look at the website issues. They needed the insurance companies to come in and bail them out on that one--it didn't get fixed until a bunch of private sector people came in to fix it.

[Cleita]

41. Everything is massive nationwide, but we can do it

if the obstructionists get out of the way. All huge tasks are really a bunch of small tasks tied together.

[geek tragedy]

42. "if the obstructionists get out of the way"

That's gonna be key

[Cleita]

44. Yeah, and it's gonna be up to us to make sure they

are not elected again and are preferably sent to the Smithsonian next to the Dodo bird exhibit.

[Hoyt]

45. Actually, the government has not done claims adjudication and administration since at least 1970s.

At best going to Medicare right now will save 10 to 15% off premiums you see on exchanges in shortrun (like next 10 to 20 years) . That's good, but it won't stop people from griping about the cost. And are you going to tell 28% who prefer Advantage Plans to traditional Medicare that they'll have to give them up?

[Cleita]

46. I don't understand why they don't dump those lack of Advantage plans

just for being junk. My husband got talked into one and it cost him more because of their denial of claims than a Medigap insurance would have for several years. Longish story so I won't bore you with it. However if Medicare closed the gaps in coverage like Bernie Sanders is trying to do, the Medicare Advantage plans wouldn't be so attractive.

[Hoyt]

47. But right this minute, 28% of beneficiaries (and it's growing) choose Advantage Plans because

they save money on drugs, medigap, coinsurance, etc. Considering it only started in 2003, lots of beneficiaries are choosing Advantage Plans.

Yes, it would be nice if gaps in traditional Medicare were filled, and there was a limit on out-of-pocket costs without going to a supplement. But, there is not and I don't see any movement to do that.

[Cleita]

51. In my area not a single doctor accepts those plans, so

if you are essentially uninsured because you signed away your Medicare rights, what's the advantage?

[Proud Liberal Dem]

35. McCain's epic "blank sheet of paper"

The ACA is (largely) THE Republican plan. Their only remaining alternative(s) are..........nothing (nothing that will make any sort of difference) . The funny thing is that- according to Ryan's Medicare plan- they think an ACA-like program is o.k. but only for seniors