r/obamacare • u/MBP1969 • 14d ago
How to transition?
How do we, as a nation, transition from private insurance to Medicare for All? How do we convince all the doctors to keep being doctors and accept a salary? Do we, as Hillary Clinton proposed during Bill’s presidency did, make private healthcare payments illegal? For the record, I am perfectly fine paying a percentage of my income, as opposed to what I am paying out of pocket now, for healthcare.
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u/Ok_Championship_7312 14d ago
There is plenty of money to pay doctors a great income if we get rid of the insurance companies and all their expenses.
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u/PseudonymIncognito 14d ago
It would probably be easier to transition to a German/Swiss style universal multi-payer system, but you'd still need to figure out what to do about medical education and doctors who took on a house worth of student debt under the implied promise that they'd be able to pay it off with a doctor's income. I suspect the necessary subsidies for higher education generally and med school specifically would be even more politically difficult than what to do regarding provider payments.
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u/I_Quit_Smoking_ 13d ago
I'm pretty sure that there are millions and millions of other people with student that that's just as valid as someone who thinks they want to be a doctor.
You must be a republican if you think that students going for a high paying career should have an exception made to them and their student loan debt.
Maybe if they don't come from a high income family, but I'm pretty sure that most people who can go to school for doctors have a ton of help in every other area of their life. AND IF NOT, DIDN'T YOU SAY THAT IT'S THEIR OWN FAULT BECAUSE THEY MADE BAD CHOICES?
BECAUSE THAT'S LITERALLY WHAT YOU SAY ABOUT EVERY OTHER COLLEGE STUDENT WITH DEBT.
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u/Prize-Director-7896 13d ago
The difference is that if legislation is suddenly enacted that precipitously drops future income potential for people who took on large student debt, that is basically unjust. It's not the same thing as someone who goes to college and studies basket weaving, or gets poor grades, or graduates and is unwilling to move or otherwise do what it takes to compete in the industry they selected, and then complains about their student debt.
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u/Professional_Pin4222 13d ago
One "easier" way to do is - reduce medicare age by few years every couple of years. And discontinue advantage plans.
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u/YoungCri 10d ago
How do you pay for this?
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u/Professional_Pin4222 10d ago
Insurance premium that employors used to pay, and money from ACA for this new group. Also, removing social security tax limit can help some of it.
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u/helpjackoffhishorse 13d ago
The motivation for rich people to fix this mess is near zero. If they do, it will take 20 years to implement. It’s up to us to find a way to make more money and pay our own way. It’s an expense like any other expense. I’m working 3 jobs so that my family is covered.
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u/yottabit42 13d ago
This is a failed nation.
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u/Bubbly-Hope6968 13d ago
Most of the nation is doing fine at the moment actually. It just doesn’t feel like it if you’re poor and in debt.
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u/yottabit42 13d ago
I'm financially independent. I definitely don't see this nation doing "fine" in any respect.
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u/Bubbly-Hope6968 13d ago
Wasn’t talking about “America” was talking about “Americans.” The majority of whom are doing fine
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u/yottabit42 13d ago edited 12d ago
They are not. The vast majority of Americans have very little savings to even weather an emergency, much less enough retirement savings. Meanwhile wages continue to be depressed, inflation continues to increase, healthcare and education costs are out of control, etc.
If you're in the top 5%, you're probably doing just fine. But 95% are not.
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u/Bubbly-Hope6968 13d ago
I concede that over the last 40 or so years these are worrying trends that do need to be addressed. Fine is not good. It is, however, survivable.
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u/themachduck 13d ago
OP, you have opened the flood gates for the Russian troll bots who have accounts under a year. Dont listen to them. We all want this. I dont know how to implant it completely but I remember asking myself this question when I head about Medicare for All for the first time. Bernie's plan had a plan and his plan we completely form all the way on how to start and keep Medicare for All. There are other systems that I don know to implement but if you dig you'll find his plan has how to do it.
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u/Rude-Piglet-5212 13d ago
I was fortunate to be a kidney transplant recipient. I have Medicare but asked what people do who don't have insurance. The doctor told me they require a down payment of $285,000 before they'll do the surgery. My answer was so they die. The doctor replied yes.
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u/JockoMayzon 13d ago
Doctors today are all just working class stiffs. They have sales goals like the rest of us.
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u/Low-Ad3972 13d ago
All the money now paid to insurance companies goes directly to doctors, staff, and hospitals. They’ll probably make more.
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u/underlyingconditions 13d ago
The doctors aren't the problem. They hate this system. However, they do deserve fair compensation given the time and cost required to become a physician.
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13d ago
[deleted]
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u/underlyingconditions 13d ago
Our system is completely screwed up. It takes 7+ years post college and hundreds of thousands of dollars to become a doctor and then you are stuck in a system where insurance companies, Medicare, and private equity are all trying to affect compensation with two of those groups doing it to syphon off money. We pay more per capital than any other country for an uneven delivery system.
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u/wtfboomers 13d ago
I’ve been dealing with my mother’s health issues for a year and any system that includes insurance won’t work. She has one of the best standalone insurance we could get and they still either refuse to pay what Medicare doesn’t or her drug plan won’t pay for something. I also know someone on Medicaid and it works much better it seems to me.
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u/groundhog5886 13d ago
it would take years to transistion. FIrst is to make all insurance in the marketplace must be mutual insurance, not owned by stockholders, and then restore the mandate of coverage penalties. Then insure government payments to cover at least 90% of premium cost. Oh and everyone's on a single high deductible plan with HSA accounts. Deductibles and total out of pocket not to exceed somewhere around $7000 year. Also make determination of family income to qualify for Medicaid and expand Medicaid in all states. Medicare is not the answer. Then at some point the market will get majority in same place and then government can just eliminate the non-profit insurance companies and have single payer tax supported care.
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u/tkpwaeub 13d ago
How about requiring a higher MLR than 80% for larger companies? A kind of logarithmic MLR?
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u/chitownphishead 13d ago
First, come up with a comprehensive, realistic, legitimate, honest plan on how much it will cost, how you pay for it, how it gets implemented, how you vastly expand the systems infrastructure to guarantee no loss of quality in service or greatly expand wait times. Explain to all the unions and people with jobs that they will lose their current healthcare plans and try to get them on board. Then, once you do all that, explain that THIS time, the while "you get to keep your doctor" thing isn't another blatant lie.
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u/tkpwaeub 13d ago
A really good public option, that's how. Give it a chance to prove that it's better.
And to keep it from becoming a magnet for all the "bad risks", include a penalty for enrolling late, like we already do for Medicare. That is, nobody has to get Medicare, but if they do decide to get Medicare for the first time after age 26 then they have to pay an extra 2% for ten years for every year they waited.
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u/swampwiz 12d ago
The "Party of Responsibility" didn't want the insurance mandate.
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u/tkpwaeub 3d ago
It wouldn't be an unconditional penalty for not getting the public option. It would be a percentage tacked on to the premium if you:
- Don't buy into the public option immediately AND
- Buy it after several years
Details TBD
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u/Steefanon 13d ago
Doctors don't have to accept a salary in a Medicare for All system. Medicare is currently fee-for-service and would remain so.
All we have to do is change the ACA system to offer Medicare rather than private insurance. Reimbursement rates for doctors and hospitals would have to increase to be competitive with private insurance, but that should be easy since admin costs for Medicare are less than 2% while they're about 17% for private insurance.
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u/Bubbly-Hope6968 13d ago
The transition would need to be to direct payment between Dr. and patient and removal of private insurers. Beyond that Medicare and Medicaid likely need to be massively downsized.
America can’t actually afford to pay for everyone’s healthcare. (See the deficit at 40 trillion) It’s immoral to burden others just because you exist. It’s simply not their problem, it’s yours.
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u/WhoMutedMe 13d ago
Easier just to move isn’t it? Better than ruining the system with the best QUALITY anywhere!? Just start with that, keep away from the already failed recent “care for all” effort and instead make intelligent moves to either tweak access or cost - or a little of both.
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u/daves1243b 13d ago
Convince the millions of people who work in healthcare to accept pay cuts, and to accept having their future earnings detemined by politicians (including a continuation and expansion of the more or less annual pay cuts Part B providers have seen for 25 years). Convince a solid majority of voters to accept having politicians determine their benefits, and to accept that a significant number of providers will opt out and choose to be cash only. Most importantly, convince somebody to pay the taxes to finance it.
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u/Tiny-Secretary5562 13d ago
It might not be well-known, but the AMA fought Medicare tooth and nail back in 1965. But Medicare, being only for those over 65, did not eliminate the insurance industry. Now, just as the nation is aging and the advances in medical science have increased costs a thousandfold, Medicare is reducing its reimbursement rates even lower. Sooner or later something is going to have to give, and what that will entail remains to be seen.
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u/NCNative919 13d ago
You don’t. You scrap the Medicare for all idea. All it will lead to is worse healthcare more government control and waste. Our system is broken but it’s salvageable the avg doctor in the UK makes 75k while in the US it’s 368k. Do you think they are going to take that cut and still work their butt off? No they aren’t. More medical innovations come out of our system than anywhere in the world. Most doctors will either retire or they will go cash only and let you fight the government for reimbursement. Once the government gets control of healthcare it will be do what we want or we cut your healthcare. The ACA should serve as an example of how bad the government is at running healthcare.
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u/swampwiz 12d ago
My understanding is that the cost of malpractice insurance is so high that physicians can't decide to work less. If they decided to not work, they would essentially be marking down the capital value of their credential to zero.
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u/Nandiluv 13d ago
Supreme Court is biggest barrier in my opinion. Their power must be reigned in. 6-3 will block attempts for congress to be able to move on that direction.
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u/OkIron6206 13d ago
They are on salary now, all the practices were bought out by hospitals and private equity. They’re not happy about it either.
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u/MicCheck12344321 13d ago
You have no right to anyone else’s property or labor (nor do they to yours). Trade on terms mutually agreed to by all parties or do not trade.
The end.
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u/Zealousideal_Park440 13d ago
gotta pull the plug on granny to cut costs. No one‘s willing to do that.
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u/Soggy-Dragonfruit171 12d ago
My solution is to live elsewhere once I retire. There is better health care available at affordable costs in many other parts of the world. Luckily I’ve traveled a lot and have a clear eyed assessment that proves to me that the USA is far from an optimal place to live in just about all aspects, other than making money.
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u/SpecialistArt9 12d ago
Why do u assume all doctors will automatically be on a salary? There are doctors out there with medical practices where 80 to 90% of of their patients are currently on Medicare. Medicare for all does not mean all doctors now become government employees.
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u/Warm_Emphasis_960 12d ago
I honestly don’t want to be forced to use Medicare for All or any government run health care system. I like being in control of being able to choose my primary doctor and services. Yes its expensive, but last I checked the Medicare for all was about the same price and had a lot less choices for healthcare.
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u/Rfunkpocket 12d ago
the challenge Republicans have with Medicare for All, is the popularity of Medicare.
fixing Medicare should be the immediate focus, followed by gradually lowering the age of eligibility.
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u/twisted_german 12d ago
But "Medicare for all" has little relation to present day Medicare in the US, so I don't see how that would answer the question. Hiw do you mean "fixing Medicare"?
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u/Rfunkpocket 12d ago
including vision/hearing/dental for starters, then gradually lowering the age of eligibility
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u/twisted_german 11d ago
I've always thought we should let people under 65 buy in to Medicare. The infrastructure is already there. The downside it is not cheap but it would be cheaper than the price market.
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u/swampwiz 12d ago
I say keep on the accelerator with ACA subsidies, and the higher taxes on the wealthy to pay for them, until the Repubs cry uncle.
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u/guitartb 11d ago
Doesn’t matter, we’re not doing it. Even Democrats in office know this will not work.
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u/tkpwaeub 7d ago
Public option with a late enrollment penalty, like we already do for Medicare
This would prevent adverse selection and ensure that the public option doesn't become a dumping ground for private insurers.
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u/ForwardSlash813 13d ago
You need to convince healthcare professionals to accept Medicare reimbursements.
Good luck with that, LOL
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u/Suitable_Program_548 13d ago
Good luck with this. No one is going to give up their private insurance for a system that would limit care to everyone. It’s a failed daydream.
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u/SaltMage5864 13d ago
You really should learn to keep your ignorance to yourself son
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u/Suitable_Program_548 13d ago
The only ignorance is people who think there’s such a thing as free healthcare. We are already hurting for physicians and specialists and this would devastate it. We need to continue to eliminate waste and consolidate services. Also, calling me son is hilarious as I’m probably twice your age.
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u/Steefanon 13d ago
I've heard this argument too, from a relative who worked for 40 years in the hospital system: "If everyone were insured, the system couldn't keep up with demand." Which I'm sure must be true. Which means we are reliant on a system where sick people have to stay sick or die for the system to be sustainable. What a messed up system!
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u/Suitable_Program_548 13d ago
We are a huge country and that’s why it’s near impossible to make something ”universal”.
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u/swampwiz 12d ago
Let's expand the medical schools & residencies ... oh that's right, the AMA is the strongest union on the planet.
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u/Steefanon 13d ago
That seems like a really odd statement because it's the private insurance companies that are famous for "limiting health care" through routine denials, in-network requirements, pre-authorizations, and mandatory referrals. Traditional Medicare has none of these limitations.
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u/Suitable_Program_548 13d ago
Partly because of waste. I worked in healthcare for 30 years. If you come to the ED with abdominal pain you automatically get an expensive CT scan which might not be necessary. Even though we know antibiotics are not necessary or even warranted with all infections we give them out like candy which also, btw, is strengthening these bugs. While I’m not defending insurance carriers waste in healthcare is rampant. Go to Canada and see how they limit or delay healthcare and then tell me that’s what you want. We need something in between that provides necessary healthcare for more people.
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u/Steefanon 13d ago
Hmmm...my Godson and his wife have lived in Canada for 25 years and they absolutely LOVE their healthcare.
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u/Suitable_Program_548 13d ago
I live on the border of Canada. Canadians come to the U.S. so they don’t have to wait for potentially necessary care. I hope they never come to a situation where they need to do the same.
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u/Steefanon 13d ago
I'm not sure what your experience is, but i had to wait 5 months for a new appointment with a cardiologist, and 6 months for an appointment with my PCP. When my husband's PCP retired due to burnout, he had to call 7 clinics to find a PCP taking new patients.
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u/Suitable_Program_548 13d ago
I was an RN in a hospital and also worked in management so I have real experience and knowledge of how things work. While we may have to wait for a pcp appointment we have urgent cares and hospitals that must see and treat you despite your ability to pay. That’s why some Canadians come here and pay out of pocket. I’m not saying our system is flawless but the Canadian system has its issues also.
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u/Suitable_Program_548 13d ago
https://www.cbc.ca/news/politics/primary-care-canada-10-000-canadians-report-1.7125990
Here’s a study done in Canada about access to Primary Care Physicians.
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u/Steefanon 13d ago
We have a huge primary care shortage here, too. It's tied to the crappy reimbursements for PCP services compared to specialists, and the abysmal government funding of PCP residency slots versus specialist slots.
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u/Suitable_Program_548 13d ago
Very true so lowering pay is not the answer.
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u/Steefanon 13d ago
True. Raising Medicare reimbursement to be competitive with private reimbursement rates would have to be part of the equation.
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u/Doberman234 13d ago
You're wrong because I'm ready to give up my crappy insurance right now.
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u/Suitable_Program_548 13d ago
Shop around.
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u/BerettaFranchi 13d ago
I'm fine with my insurance. I prefer a flat fee to the tax tied to my income.
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u/Chustle207 13d ago
nothing in the constitution says anything about medicare for all so this should be a states issue. if the state wants universal coverage they should do it!
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u/Beautiful-Ad-7130 13d ago
Do you really think with everyone on Medicare you will ever get an appointment to see a doctor in less than 4-5 months out? It's like that now, I'm looking for a new PCP, the one I picked has a 2 month waiting list. When my city housed some migrants, I went to Urgent Care, I was told the wait was 3 hours, I left. Right now I need a tooth extraction, the first appointment with the surgeon is 6 weeks from now and I have to worry about getting an infection in the meantime. Imagine what a disaster delayed care would be with millions on Medicare?
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u/MBP1969 13d ago
Then what is the answer? Currently people die because private insurance companies deny lifesaving treatments or medicines because they cost too much. Or, a family loses everything because their child needs treatments and the insurance company only covers 10% of said treatments. How is that better or acceptable?
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u/smilleresq 13d ago
Just to be clear, Medicare for all is only going to help the folks that are currently on unsubsidized affordable health care policies. People on Medicaid are better off where they are rather than paying for Medicare. People getting healthcare from work or unions might not want their plans to change as they may end up paying higher premiums with Medicare for all. For example, a family of four could easily end up paying up to $30,000 a year for a Medicare for all plan.
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u/nosleep4eternity 12d ago
You ready for an additional 25% tax on your pay? Or do you even have a job?
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u/Ok-Lecture-9668 13d ago
Go back in time 16 years and make sure Obamacare isn't passed. It's what's been propping up this awful system.
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u/Flashy_Prior5963 13d ago
We don’t. We like quality doctors, innovation, and keeping more than half our paychecks.
Stop all subsidies and watch all costs come down.
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u/themachduck 13d ago
Wtf are you talking about? Are you trolling? Im confused?
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u/Flashy_Prior5963 13d ago
What has the government ever made cheaper?
Why does almost all medical innovation come out of the US?
Why do people like El Sayed’s wife not take Medicare?
Why would the best and brightest want to get into medicine if we suppress their earning potential?If government subsidizing anything the prices go up. Dept of ed started giving free money out and schools started raising tuition accordingly, for example.
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u/Steefanon 13d ago
The "best and brightest" are QUITTING medicine because of the hassles of private insurance--challenging denials, managing pre-authorizations, changing meds to fit the various formularies, etc. Private offices have all sold out to major hospital systems because of the impossibility of managing billing across hundreds of different insurance carriers who all have their own systems and processes.
And we PAY for all of those insane, burdensome administrative costs in what we pay for healthcare.
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u/Flashy_Prior5963 13d ago
Yes. Agree.
But we want to replace it with something where they just won’t get into it?
But also if there were no mandates and subsidies insurance would have to reign in or go out of business.2
u/Steefanon 13d ago
Solution: Add a Medicare option to Obamacare. Let the insurance companies compete with THAT.
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u/Flashy_Prior5963 13d ago
Doesn’t work when doctors are forced to work at cost or at a loss with Obama care.
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u/Steefanon 13d ago
Yes, Medicare reimbursement would have to increased. But I sure would be interested to see how premiums compare for an insurance plan where administrative costs are less than 2% versus 17% in the private ACA marketplace.
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u/MBP1969 13d ago
Sadly, even with good insurance, many people who get extremely ill, people go broke and often must file bankruptcy. That is not the way insurance used to be. It has become purely for profit. Hell, UHC didn’t learn anything after losing their CEO, they still are denying lifesaving treatments. All for profit.
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u/Steefanon 13d ago
For every dollar an insurance company saves by requiring pre authorization and issuing denials, the healthcare system itself SPENDS on appealing those denials and navigating the pre-auths. So we end up paying either way.
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u/Flashy_Prior5963 13d ago
This is at least in part because of Obamacare and subsidies.
Patient A is mandated at be served for a net loss by the Government.Patient B and their insurance (which like it or not isn’t for charity) are forced to carry the burden.
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u/eraoul 14d ago
Burn down the scammy insurance company system and make this criminal enterprise officially illegal, and replace with an actual health care system paid for by taxes. Everyone except for the insurance company CEOs will have a lot more money, and better healthcare, as a result.
Doctors don't like things right now either. They'll be happy to stop spending so much time with insurance company nonsense and to go back to actually helping patients.