The situation has gotten much worse in the past few years. Private equity firms have gotten into healthcare and are having a feast on whatever is remaining of the carcass. And since they have seen blood, they're not going to let go of it so easily...until nothing remains. This affects even those who have insurance, so I don't understand why people are so opposed to any form of a government system. Also, it irks me that whenever someone...Bernie...talks about universal healthcare, people talk about the cost, or more specifically, an increase in their taxes. I just don't understand how people think that they can get things for free. Besides, most of us already pay an enormous sum of insurance premium anyway. Why can't they realize that the insurance premium they already pay is a form of tax?
Absolutely! He got away with it because they made it seem like government benefits were going to 'undeserving' black ppl ("welfare queens"). So poor whites were happy to 'cut off their noses to spite there own faces'- hurt themselves in the course of trying to hurt the undeserving blacks. This roughly a generation or two after their parents/grandparents benefitted from the massive welfare handouts of the "New Deal" following the great depression and WWII. Credited with "creating the (white) middle class!" (Since the programs were Administratored by the states and not the Federal Government, the vast majority of blacks, including veterans of WWII, were excluded from those benefits and redlined into poor neighborhoods deemed "unworthy of investment". So as property values grew in white neighborhoods, and equity was used to start businesses, pay for college etc., homes in redlined communities did not and are still devalued to this day! But following the civil rights movement, when it became harder to discriminate against blacks, similar welfare programs, and the polititians that pushed for them, became the enemy.
Forget reparations for slavery, this is what reparations need to be based on, all those black veterans who were prevented from participating in the GI Bill by the federal government and the racist, discriminatory policies it instituted to prevent blacks from taking part. Imagine the family wealth created by the GI Bill, either through homeownership or college, that was passed down through the generations. This accounts for much of the disparity in wealth, between black and white middle class families. The federal government *owes* the descendants of black GIs who were prevented from taking part in the GI Bill by the federal government due to race. All those homeowners in redlined neighborhoods whose properties were devalued and sometimes abandoned for lack of capital to repair and improve, thus losing value. And unlike slavery, we CAN identify who those descendants are, we CAN calculate an estimated value based on what they would have accumulated in family wealth if they were allowed to by a home or if those who did manage to own property weren't redlined by the banks and lending institutions, with the support of the federal government.
Absolutely, but non veterans were also impacted. Black ppl couldn't participate in the housing policy that created the suburbs and made home ownership a reality for the soon to be (white) middle class. Blacks were redlined; placed in large housing projects (ghettos) and for the few that could buy hms they were limited to areas deemed unworthy of investment. Laws prevented homes, in white neighborhoods, from being sold to blacks. That doesn't account for the hiring discrimination, educational discrimination (poor neighborhoods yield poor schools), food and retail deserts because banks say the area is not worth of busi ess investment; the inability to buy hms or maintain hms after purchasing. I wish some one would verify my belief that a large percentage of those black communities are renting from some LLC that doesn't live in that neighborhood and has no interest in investing in the neighborhood (doesn't help their bottom line). This perpetuates the blight in those communities because renters aren't going to invest in improving someone else's property. They are only there because of limited options based on their financial situation. So no one makes the needed improvements and the little revenue that is there is siphoned out by slumlords and spent elsewhere. Many New Deal programs were designed to restore what was lost, so not very helpful to those who had little to nothing before. This is why a large percentage of the black community is still in poverty and only a small percentage (exceptions) are making it to the middle class or beyond. That is why successful blacks are the exception/minority and not the rule/majority. Their circumstance is due to many hurdles (including centuries of slavery, and Jim Crow- 'slavery light'), Not due to choice, laziness, lack of intelligence or lack of desire!
Now, All Americans are being taken advantage of by the wealthy and corporate interests that put profit over ppl. The tactics are the same ones used on black ppl in the past. So they don't want whites to know this history so it can be repeated. They also want whites to believe black ppl are where they are by choice and not due to the hurdles that were/are continuously places in front of them.
I agree, you're right, federal discrimination in GI Bill benefits followed the same pattern as what came before, discrimination in New Deal programs and benefits, that also did significant, measurable economic harm to blacks. That could be added to criteria for Federal reparations to black Americans. By allowing states to administer these programs, southern states run by racist democrats at the time, who are the predecessors of today's republicans, they were allowed to discriminate against black American citizens on the basis of race and deny them the economic opportunities they extended to whites. The resulting devastation resonated down through the generations and can also be quantified. Its incredible, the damage that was done in the name of white supremacy, that you can still see to this day, and yet you have self deluded people running around saying racism and discrimination against black people is no more, and that there is no systemic racism. That we even measure "black unemployment" as a separate metric for employment, and that it has consistently remained higher, at times twice that of the "white" unemployment rate, is an indicator of the institutionalization of racism and discrimination. We're even measuring it!
I totally agree and those of us who live in the Washington, DC metro area have to put up with the abomination from the Republican Congress which changed the name of Washington National Airport to the Ronald Reagan Washington National Airport. Then they constructed a monstrosity of a building in downtown DC that takes up an entire city block and is named for that scumbag crappy president who screwed the working people of this country time and again.,
Here's another factoid. I lived in Simi Valley California back in the early 90's and they had just completed construction on the new RR Presidential library. It was a monstrously oxymoronic monument to fascism, sitting high up on Madera road overlooking Simi Valley to the south.
The kicker was the admission fee they charged to enter that made it so republiconly fascist and hypocritically hostile to the tenets of free education and public access.
Oh by the way, in the mid 90s I worked as a technology consultant for a biopharmaceutical company in Thousand Oaks, and I did drive by that monstrosity before. I will always despise Reagan for the damaged he did to the working Americans and the benefit he gave to the employers to harm their workers. A more anti-Working American, I had never seen until that fat corrupt criminal Trump came along.
That is what the right wing Republican ChristoFascist Party is all about. They only want the right kind of people, not those horrible liberals and left wingers who want to spend money helping working Americans. And their motto about health care is still as it was back several years ago. "Don't get sick, but if you do, DIE quickly" They said it, and frankly they believe it. They would love to start up their Final Solution for all Liberals, and social aberrations like the LGBTQ+ folks and of course those brown, black, and other minority types.
Of course, he lost to Patrick Murphy who lost to little Marco Rubio. Talk about the "Dumbino effect."
Between Franken and Grayson, we lost half of the Liberal impetus that made up our collective progressive lifeboat!
Lastly, I embrace your use of the term 'Final Solution' the CONS actually embrace via their Machavellian legislation to describe the projection of republiCON enmity toward the dems, using the phrase "death panels" to describe the "small d" democratic agenda...as if!
Our healthcare system is more corrupt than portions of our government. There is a constant struggle between providing health care to those who need it and pure human greed. There are medical professionals that view patients as dollar signs more than human beings. I had back problems severe enough to warrant me seeking help from a qualified specialist. I was referred to a group that specialized in spinal problems. I had X-Rays taken and even an MRI of my lower back. One of the three doctors in the office told me I would need spinal injections the fix my problem. Trusting in their professional opinion I submitted to the procedure. It was no big deal aside from the discomfort experienced from having a 4-inch needle the size of a Dairy Queen straw shoved in my lower back. Days passed and I received a detailed list of charges my insurance company was being billed for my injection. I was so shocked I still have the bill, that single shot cost my insurance company $19,000.00 and the beauty of the whole ordeal was the shot did nothing to help my problem. Years ago I had a bad tooth that needed attention. I was told I would need a root canal and a crown. The dentist told me the cost would be $2,200.00. Years ago root canals were done by specialists, not dentists. My doctor had decided to do the procedure herself and reap the rewards. She fumbled through the pain-filled two-hour process and fitted me with a temporary one as the crown had to be made from the impression she took. Long story short I finally got my new tooth and the gold crown was outstanding. A few weeks passed and I began to experience some noticeable pain and swelling around my new molar. I made an appointment and had my mouth checked out. An X-Ray was taken and I was told I had an abscess and as a result, my new tooth would have to be extracted. My dentist broke one of the roots on the tooth she wasn't qualified to perform a root canal on. Not only did I lose my $2,200.00 initial investment but she charged me for pulling the tooth she messed up. Greed and incompetence permeate the medical industry and the insurance groups are forced to cover the cost of their legal thievery. Now I understand there are some very good doctors out there that don't deserve to be benighted but until the bad apples can be removed from the barrel we will have to suffer.
My dentist’s wife/hygienist took it upon herself to “fix” my bad bite by GRINDING DOWN my molars! The dentist then accused me of grinding my teeth while I slept. I told him his wife ground them down. He then removed her from his practice. Unfortunately, years later a periodontist told me that action had promoted my gum recession which she ‘would be happy to arrest for $10,000.00’ (another quote was $25,000).
I could write s book about the misdeeds of doctors, dentists and vets.
There are good doctors. My dad was one. When he died the entire church was filled. People came from all over. One former patient wrote my mother from Hawaii. He was the last of the “general practitioners” that made house calls. A good man.
First, thank you all for speaking out and for making this topic “visual”. Every time the republicons say privatize they mean Fascism. And most of them do not know anything about anything except how to greedily hang on to their loot. I am so sad that so many people are comfortable being uneducated. The republicons want to privatize you and me! We will work for them and they will suck up all . You my dear can drink from the “ trickle down” fountain. Oh, gosh, fountain dry!
We are letting the “rights of all” disappear because we are deaf to the meaning of “privatize”. It is a real dirty word kids! It is as dirty as socialism is to the republicons! A privatized housing market, healthcare, post office, school system, all spell Fascism.
And that my dear students is what many of your relatives fought against and gave their lives for to keep us free from. Fascism and elitism and greediness all have the same meaning: gimme gimme gimme! And do not try to regulate my greed. I will instead make up rules that you must live with.... no healthcare, no housing, no schooling, just “mine mine mine!” And if you don’t give me( maga) everything for nothing I will scream and scream !
Jean--It seems the Republicans feel if they can keep the Democrats in a state of discontent they will be easier to defeat and control. One thing I've learned about Republicans like Boebert, Greene, and Santos, the fog they live within never lifts.
The “good doctors” are those who like the longshoremen in 1934 will end privatized Insurance by refusing to have their careers concerning healthcare turned into “big business”and refuse to be controlled by insurance companies that privatize breathing! Doctors ( real ones) will be trained to help make people well. They will not need to be controlled by “ big business( Fascism). The AMA is a so called doctors union. What it controls is the high wage that many go after as they are never interested in healing anyone but their own pocketbook.
Doctors have always been better off financially than most of us. But now, they took the “health” out of care and added wealth care!
I too, had bad luck with General Practitioners that are trained by the hospital to direct a patient to a PROFESSIONAL $$$ to help you with your "problem" $$$.
Poverty is a policy choice. An essential banner-big picture-root fact that is missed or avoided by most analysts. What makes Professor Reich such an effective educator is that he keeps his students focused on a simple basic truth rather than getting overwhelmed in the noise. The simple fact is that the bigger the pool of payers the lower the cost of health care. One huge pool that everybody pays into is far less costly. It lowers the costs-huge costs of so many going without health care. Efficiency-economy of scale and equity. Highly schooled/specialized minds too often cannot see the Forest for the trees, let alone communicate essential basic uncomfortable truths like Poverty is a Policy Choice. Thinking skills are lacking at the highest levels of education. In fact, I argue that the more specialized and siloed we get the more we lose the capacity to see where we are going and what is the big picture? Iain McGilchrist argues thoroughly that we have become a society of technicians-failing to engage our whole brains that would keep our eyes on...the bigger pictures. Most needed today is the application of the metaphor-The emperor has no clothes....The Chicago School of Economics cleverly clothed the naked truth (ending poverty is affordable) in complete bullshit-neoliberalism from Reagan onward...just now and just some are seeing that the trickle-down theory described nasal drip better than how the economy works. What a waste. Lots of clever people out there-wisdom is scarce.
The problem is that we are allowing selfishness/selfish-interests, fueled gy culture wars, to distract us from those truths- that we are better together, that we have power-in-numbers (financial and political). This is by design, like in the Hunger Games. We fight eachother while the wealthy/powerful few at the top benefit from our division- as entertainment and as they gain more wealth/power, at our expense.
Just watch the Iowa opinion poll. RE" their thoughts about Trump's inditement.. It's like a Steven King horror story: "The Voters!" Very chilling, very scary.
People aren’t stupid, but like Dr Reich said if a policy cannot be easily explained, it can’t be sold. Also, people are more afraid to lose something than trust that a new system will be better. As a former small business owner (20 staff) we paid huge premiums for plans that had huge deductibles. I would have gladly paid a health insurance tax of same amount for Universal Healthcare AND would have come out ahead because I would have virtually no admin time spent choosing and administering health insurance EVERY year. Guaranteed we would have better coverage without the barriers of deductibles and premium cost sharing.
of course the average voter is uneducated, but so what? even if all voters were well educated that would not solve much. Congress answers to campaign funders, not the People.
Those of us on Medicare are getting a great deal. But the Medicare population is the high risk category -- the aged and the sick (people on SSID) If the base were broadened by adding more younger people, the risk would be spread, and part B premiums would drop.
Medicare Advantage is only an advantage if you are an insurance company and I am not. The insurance industry will be the death of all of us. We need Medicare For All yesterday. I too am on Traditional Medicare and when I am asked by the reception person if I have any other insurance and I answer no, they look at me like I am too stupid and too poor to take care of myself. I laugh all the way to the bank, as they used to say.
Last year, the government spent $20.5 billion overpaying private insurers for Medicare Advantage plans — and the industry’s aggressive lobbying campaign is kneecapping efforts by lawmakers to stop
Daniel, Thank you for this. As I wrote earlier. Medicare-Advantage plans are those privatizing our very fine “Medicare”! Beware of the word privatize... it simply means Fascism.
Yes, I too hate "outsiders" from wolfing down the money of Medicare. Insurance companies should have never given that 10% of Medicare when it was created. They are taking advantage of it now. BIG TIME.
back before the 2016 election, bernie had a study done that showed that the rise in taxes to support universal healthcare, or single payer, was LESS than most people's premiums and out of pocket costs. so it was a complete win. most people would ultimately pay less, especially if they had serious medical issues. but people are stupid, short-sighted, and afraid of "socialism" (unless it's for corporations)
And John Conyers proved that with his comprehensive bill HR-676 first submitted to the Congress in 2003. His bill was named "Expanded Medicare for All" and covered ALL necessary medical requirements, with NO out of pocket cost for the citizen coverage. Even Hillary Clinton attempted to bring a Universal Health Care program to the Congress but the rabid Republicans shot all of those efforts down. HR-676 was submitted to EACH NEW CONGRESS until 2017 when Conyers died so the last version of that bill was the 2017 version. I have copies of all of them from 2003 and no body has a better plan that Conyers. Bernie's was a partial copy of Conyers, but he still allowed the private for profit sector to continue to rape and pillage our people's health care. I have a copy of his initial plan document and it is nothing compared to the Conyers bill. I have the entire library of these bills in PDF files. Including Sanders bill!
A good place to learn about healthcare is bankruptcy court. Medical providers can't collect from patients who had lousy coverage that left them exposed to judgments. Some key insurers have gone belly-up. In a high percentage of cases, the debtors thought they were covered and were excluded.
Bull crap, Solomon, you don't know what you are talking about. I didn't think much of Bernie's plan, mainly because it used the points of Conyers, but added a load of crap in legalese wording and still charged patients a fee as well as allowing the for profit scumbags in the health care insurance world to continue to rape and pillage. The Conyers plan ended that bull, blocked the for profit insurance companies from participating at all, and allowed no for profit health care facilities to participate. They all had to convert to either not for profit or nonprofit. So, when you make assertions, you should ensure that there are not those of us out in the real world who have actually read those documents as well as other documentation for health care both in this country and in all the other developed countries that are kicking our asses in health care outcomes.
I supported Conyers in principle, but it was dead in the water and he couldn't get the unions, his base on board. To medical providers had a problem as a "taking" under the 5th Amendment. As I say, at the time, HMOs were huge. Many other Democrats like me wanted slowly dropping the Medicare eligibility rate every few years — first from 65 to 55, then from 55 to 45, until everyone qualified. Hilary-then the "co-president" killed the Conyers bill.
And I've never heard anybody else talk about "collateral sources."
America is the richest country in the world, yet US can't afford to give what every other developed country AND even some undeveloped countries give to their people????!!!
And THAT IRKS YOU because Bernie makes that point?!
You should be irked that he's right!! Bernie ALWAYS states how we need to TAX THE RICH.
That who you should be "irked" at!!
Bernie is only stating the truth: Inequality is at it's worst today than it's ever been & taxing the greedy rich would fix that.
Period.
With comments like yours, the greedy rich don't need lobbyists.
These are not health care organizations, they are For Profit Businesses. They place Profit over People; Over all else. The industry is controlled by Billionaires and corporate interest who seek more profit at the expense of the nation's health. Money IS power, and they have it, and use it, in spades! They use their money it to influence/control government policy that favors their profits. Same applies to News organizations and social media where they use their money/power to spout LIES & DIVISIVENESS (divide and conquer) that prevent us from using our power-in-numbers to control our Government's policies! Recent story @ Mother Jones addresses this- https://www.motherjones.com/media/2023/06/news-never-pays/
18% of the American economy may be devoted to healthcare but I was curious about this claim and found that Prof Reich’s own labor department counts approx 18% of the American workforce engaged in healthcare. Reducing the cost will also mean reducing employment in this sector.
Amen! "Private equity" firms should be called what they really are: VULTURE CAPITALISTS. Though that is an insult to actual vultures, lol. "Vampire Squid Capitalists" perhaps then?
We have the most expensive and least effective health system because of the health insurance industry. Money which should go to hospitals, medicine, and health care providers goes instead to health insurance stock holders and employees.
I trace a lot of this to 1994 when Blue Cross went from a "charity" to a for profit organization. I remember that at the time, HBOs looked like the least costly and most profitable alternative to pay per service. Soon the administration was promoting Hilarycare.
Maybe Robert can comment, as he was then Secretary, but this is now like water under the dam.
A lot of the rationale is based on the cost of litigation as a major aspect of the cost of medicine. I've been writing about the potential effect of elimination of the "collateral sources rule," which I think will cause the cost of litigation and thus insurance premiums to drop.
Friend, one doesn't have to be particularly healthy to do the sort of mind-numbing jobs America provides to most of its citizens. Just show up and screw the caps on the tubes of toothpaste.
In UK we hsve msny problems but we so proud of our FREE NHS the envy of the world. Yes we have shortage of nurses doctors but if I'm ill I know ilk be treated the same as a millionaire. Why can't US hsve free care?
That is an important question. If by "can't" you mean "why doesn't USA " this lecture is trying to answer that. However the short answer is " People who have power... and healthcare, choose not to give free care to others"
I believe the reason the US still does not have Universal Health Care Is because the people in the US don't make public policy. The sociopathic money hoarder class supports the politicians who do their bidding, which is to build a for-profit mechanism into everything. Yesterday I heard Tom Hartmann refer to the "predator cons." I think of them as the "Capitalism Gods." I don't care how many times I hear that the system is at fault, so there is no blame, I can't agree. There is blame because they rigged the system and continue to be parasites on the population. Now I'm going to listen to Professor Reich's "Wealth and Poverty" class eleven, again.
IMHO Big Pharma and Big Insurance own Congress. The only reason we do nor have expanded Medicare is saturation of propaganda. E.G. Republican diabetics are voting for higher insulin costs.
The stories I hear are strange.I don't need a special tablet.These tablets cost A$40,000 approx for 1 year .The govt pays.The maximum I pay is around $14 a month,not really sure,I don't need them.The specialist asks me every 6 months fill in the form for the expensive tablets Score 100 you get them.I score 12, no pain ,nothing.Why get the govt to pay that much when somebody else may need that money,I'm OK.
My doctor worked in the USA and tells me the state he worked in had a universal health care system,I forget the name of the state.He came to Australia as he is a great believer in universal healthcare.He says that he thinks those tablets would cost around US$ 50K in the US,he is not sure.The Australian govt would argue the price down,he said nobody would do that in the USA.
Charging that much for any medication is disgusting. Where do they think the money will come from, besides bleeding Medicare dry if you don't have the money??
While I am cycling I would usually listen to a podcast on my mobile phone,or music.on the phone.
My phone suggests comedy podcasts for me.A UK satirist called Jonathan Pie( stage name) came up.I dismissed it.Then I remembered,I have seen him on a satirical TV show here in Australia.Over to our UK reporter,Jonathan.He rants and raves for one or two minutes.First time I saw him ,no,not for me.Second time I can see his comedy,3rd and 4th time,very good.
I hunt around to bring the podcast back. Call Jonathan Pie.I listen,first 5 or 10 mins are very slow as he lays out the scene.I think,no,not for me,I'll turn it off Then a good line,I laugh.Give him 5 more minutes,I am hooked .Brilliant.A 10 part show of 30 minutes per show.Subjects that people rant and rave about on Facebook,radio etc.He sums it all up,comedy genius for me ,perhaps not for everybody.
Sometimes I have to concentrate on the bike to stop myself falling off laughing. BBC Radio 4,Call Jonathan Pie.
Depends how you think about it George .I won the lottery of life ,born in a first world country .I won the lottery of health,good health.In old age( now) I keep fit,I cycle 1600 klms ( 1,000 miles) a month.I live in a country that has excellent cycle paths,think of cycling down the coast of California but without the crowds.The govt worked out the baby boomers will get old,this will cost a fortune in pensions ,health care etc.I began to study investing and did it.
A pension in Australia is means tested,we get no pension ,that saves the govt ( the young people that pay for that ) $42,000 a year. The health care costs of people are different.Say a pensioner couple costs $100,000 a year for health care and pensions.We cost them nothing,then the tax on the investment income is paid.My contribution to the govt is over $100K a year.,pension saved and tax paid,I don't mind.I am very glad that I can contribute to people that need it more than me.
Obviously I do draw from the govt,I didn't pay for the thousands of miles of cycle paths I use,everybody else did.
One drug I know of costs $5 million for 1 dose,a huge breakthrough.The disease it treats is very rare,perhaps a dozen people in the world have it..The govt decided they would not pay for it,too expensive.I did the maths,12 million workers pay for a $5 million drug for perhaps 2 people in Australia,there is no problem there. Somebody in the govt perhaps saw the obvious,and it was decided they would pay.
Headlines would scream $10 million a year for 2 people,people would think that must be costing me a fortune,they don't do the maths either.I like a system where everybody pays for everybody else.Some people cost a fortune,some people cost very little,it is good that the costs are shared.
Perhaps it is best summed up by cyclist v motorist.People would call into radio stations,why should I pay my car taxes ,cyclists don't pay anything.What they never see is one less car on the road,eases congestion.I own a car and don't use,I still pay that tax.By keeping fit I save them money on my health care costs.I save them money.All they see is they are paying for something I use,the govt should make me pay.
Oh,forgot.We do also have an insurance based system.I own shares in one of the companies,Medibank private MPL..Try to break even on premiums,make money from the float.
Or collect in $5.2 billion in premiums,pay out $5.1 billion in claims.
The float $100 million is invested in the stock market,year after year,just the basics of it.The profit and dividends basically comes from the float,stock market investments.Scares the hell out of people when the profit plunges by $2 billion.Bit of a crash on the market,value of the portfolio went down,mark to market.Technical things insurance companies,spectacular failures when somebody gets something wrong once in a while.
I agree Jennifer.For some reason the UK seems to think,the envy of the world.
Most universal healthcare is funded the same.
Here in Australia universal healthcare sometimes has a co- payment.As a pensioner I would get 99% of specialist care free.
My doctor ( walk in and be seen) sent me to a specialist.The appointment was 4 days later.I got there,the cost is $200, but the govt gives me $100 back.I was surprised but paid .The doctor said it was urgent.I'm there for 10 minutes ,the specialist looking at the blood test results he had been sent.Everything looks OK but your doctor flagged one result.I'll send you for an MRI scan to make sure,call this number and I'll tell them it is urgent.I have to make the appointment time.Call them next day,yes we can get you in tomorrow.The MRI operates from 8.30 am until 6pm,you are urgent so it is an out of hours appointment,can you be here for 7.15 am for our small out of hours crew that work part time.Yes. In the machine for 40 mins,the technician says the specialist will get the results in 24 to 36 hours Call him.
I call,come in 2 days.Wake up next morning coughing.Call the specialist perhaps we should do a telephone appointment.Next morning the receptionist calls me.The phone call from the specialist will cost $50,credit card number please.
I get connected to the specialist after paying.Straight to the point,great news,you are cancer free,sorry I can't talk,very busy.
Go to my doctor,comment that is the first time I have been charged,my doctor look aghast,he charged you!.
I wrote on the referral cost free.
Same here,short of doctors and nurses.Unless operations are urgent in hospital then wait 3 months to 18 months depending what is needed.
My wife and I retired to France, and we are ecstatic that we did so - partially because of the excellent and inexpensive healthcare here. Just as an example, I recently had a cataract operation, and the cost to me was less than 100€ - and most of that was a surcharge for a private room. They even paid for my taxi ride home. To get nearly 100% coverage, my wife and I pay insurance premiums of about $350 a month for both of us - and we're both in our late 70s. Included in that is full dental, eye, hearing, surgery, all doctor visits (including having a doctor come to our home), physio therapy, and all prescriptions. If we're in the US visiting family, we're still covered. Don't pay a dime to Medicare.
As a couple in the US $350. Is the exact same amount that is automatically deducted from our Social Security each month for Medicare. I’m order to get the same services described as in France, we have no choice but to take a Medicare Advantage Plan. We would have co-pays and a much smaller pool of Doctors and services available to us under traditional Medicare. Yes. I fully understand that Medicare Advantage is not good for the overall traditional Medicare system, but unless you’re below the poverty line and can get assistance or far enough above the poverty line to afford the extra out-of-pocket costs, the Advantage plan is what works. At least, for those of us in the middle and that appears to be a very large portion of seniors. The best solution, aside from Medicare for All (the best solution), is to at least expand the current Medicare and eliminate the restrictions and costs involved.
The actual test is whether you accepted lifetime caps that limit the amount Advantage has to pay. Virtually everyone over age 65 in bankruptcy court are there because medical bills exceeded the cap.
Another reason not to buy Medicare Advantage is that it is not portable. Many of the companies are only registered to do business in certain states.
I don't know where you live, but where I live BC/BS (Florida Blue) has lists of medical providers who will waive copays. Medicare Advantage varies in coverage depending on location.
In the US, depending on family income, insurance costs are less than you pay. Lots of medical providers in the US waive co-insurance and co-pays for people on Medicare.
Not for full coverage. Doctor visits - free. Specialist visits - free. Hospitalisation (including intensive care) - free. Ambulance - free. Operations (including transplants and joint replacements) - free. Prescribed medication - free. Eye exam and eyeglasses - free. Dental care including extractions and surgery - free. Cancer care - free. Dementia care (including residence in a support facility if needed) - free. Remember, we are in our 70s. I've done the research, and full Medicare parts B, C, D and supplemental to cover everything we get here would cost double or more.
When we were first here, we had to have our own private insurance with a pretty high deductible. Cost for worldwide coverage (except US) was about $700 a month. To add US coverage TRIPLED the price. Dropped that coverage as soon as we were eligible for the French system.
As I said, Part B is based on income. The standard monthly premium for Medicare Part B enrollees is $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022.
Medicare doesn't have dental or vision but many medical providers waive co pays and deductibles.
Do the math - it’s $164.90 EACH or $329.80. About what we pay now for FULL coverage and no deductibles. We’re actually in a higher bracket, so Medicare Part B *alone* would cost us more than we’re paying now. There’s also a $226 deductible EACH before any coverage cuts in. And for Part A, you start paying out of pocket for stays longer than 60 days. If you want more coverage, you have to buy MediGap on top of that. For full coverage, premiums for MediGap run up to $759 a month. No, thanks.
There is a major cost difference between Traditional Medicare and Medicare Advantage(MA) and the coverage extended by each. It seems you are comparing MA with the French system. MA excludes many treatment options but costs the recipient much more than Traditional Medicare. One cannot really compare apples and oranges.
To get the coverage we get in France, I have to compare to Medicare Advantage to get even close to all the benefits we get with basic healthcare plus the top-up (called a Mutuelle here) for which we pay a monthly premium. Traditional Medicare is similar to the basic insurance offered by Securité Sociale here. If all you have is the basic health care card (Carte Vitale), you have to pay the difference out of pocket if you choose to go to a doctor who is outside the system or want to go to a private hospital. With our Mutuelle, we can choose any doctor or hospital we like and are 100% covered.
Absolutely single payer health care! Having lived and worked in Belgium 1989- 2016, I can attest to the fairness and quality of this system. A single mother friend with a part-time teaching job never worried about how she would pay for her and her son’s health care. I had a hip replacement that cost me zero - the waiting time was normal, a couple of months. My GP was always available for appointments on a day’s notice. Insulin, Epipen and other life-saving drugs are free to everyone under the mandatory national insurance.
People like Lindsey Graham seem to think that all of Europe is functioning like the stressed NHS - couldn’t be further from the truth, each nation has its own system! The NHS used to be a model of excellence until it became more privatised - and, it wasn’t originally set up for some of the more complex modern operations that have increased demands on the system. But apparently Lindsey doesn’t realise that there are many nations to the south and east of the UK who are managing their health care just fine? My European friends just look at me in disbelief when I tell them about the dysfunctional US “system” - as I’m sure is the reaction of many Americans now reading my comment! US friends always counter with “but you pay much higher taxes than we do!” Yes. And every European I know agrees that the health care of their friends and neighbors is worth paying for. It’s absolutely worth the investment that saves money in the long run, and benefits everyone - including yourself!
Yes, Medicare sets rates that are much lower than medical facilities will charge those with private insurance. But even those rates are two to three times higher than the rates paid by the single-payer government insurance plans in much of Europe. Also in Europe the single-payer plans set rates for all approved prescription medicines. Even if you don't have insurance, you pay the government rate. Just as an example, a month's worth of Eliquis - a common blood thinner taken by a large percentage of the elderly population costs 60€ a month. One of our children has to take it, and the pharmacies charge her insurance more than $400 a month!
It starts with the costs to train a doctor or nurse here in Europe - 1/10th what it costs to get a medical degree in the US. Doctors here don't feel compelled to charge outrageous fees because it didn't cost them an arm and a leg to be trained and licensed to practice. Doctors here also don't have to deal with outrageous malpractice insurance fees - because although you certainly can sue for malpractice, the awards are reasonable.
'Healthcare' in America has become another example of corporate greed. Medical schools are pretty much 'owned' by big pharma. Medical practices are mostly affiliated/controlled by large hospital complexes regardless of existing in other building addresses. Private practice is mostly a misnomer now, not what it once was. 'Best' doctors with generosity of spirit, time to listen, etc., are often found to be from and educated in another country.
There is a list of reasons healthcare is more expensive in the U.S. Each contributor to high healthcare costs argues it is "not their fault". However, the sum of the (bad) parts and bad actors lead to high prices. The reasons for high cost of healthcare include:
- Health care salaries in the U.S. are enormously higher than in other countries, including in advanced economy countries (example: Most physicians in Germany earn less than well-trained nurses in the U.S.).
- The American Medical Association makes it extremely difficult for a trained Dr. outside of the U.S. to practice medicine in the U.S, even if they have immigrated and become citizens. That leads to an unbalanced supply and demand for well-trained Drs. One of the reasons the AMA is protectionist is in the next point.
- Tuition for medical schools in the US are so high that Drs. feel they are entitled to high salaries, and restricting international Drs in the US maintains high salaries due to lack of competition. The AMA does not want to bankrupt Med Schools that would need to reorganize. In many countries there is either a very low or in some even no tuition for medical school training, so that the most talented get trained.
- The ability to sue for enormous sums for of money is unique to the US. This results in all kinds of added bureaucracies and expensive malpractice insurance for physicians. The government needs to make it very difficult to sue for large sums and to cap sums (many lawyers would see reduced income).
- Insurance companies add staff and bureaucracies, just to reject medical claims (part of the reasons are listed above and below).
- Last year’s bill passed stabilizing the cost of many medications. But all medications need to be open to competitive bidding from outside the U.S. (like Canada)
For each of the above points there is a lobby protecting the incomes of their stakeholders. Which politicians will have the courage to make changes?
A big part of the solution might be to by pass most of the above system. For example, initial consultation through enhanced telemedicine with Drs in other countries and shipping medical tests (blood etc.) to testing sites in the U.S. Being treated for expansive procedures outside the US. I imagine there will be insurances interested in these options. Congress needs to allow important of cheaper meds for all meds (e.g., from Canada). That could lead to a rapid competitive reduction in prices in the US. US medicine needs to be open to price competition up and down the ladder.
As an adjunct at the Sage Graduate School, I taught a course entitled "Comparative Health Care Systems" in the Health Services Administration Masters Program.
For 12 years, students compared nations around the world, and found that many nations have longer life expectancy, far lower infant mortality rates, and per capita costs 50% lower than the United States.
They also learned that Obamacare was not a step toward universal health care, but rather universal health insurance -- including all the limits and disincentives to provide care that come with it.
Wide mortality rate disparity within the US. Alabama, Kentucky, Mississippi, Oklahoma and West Virginia had the highest death rates in the U.S., States with the lowest death rates were California, Connecticut, Hawaii, Minnesota and New York. Death rate is calculated as the percent of a population that dies within a given time. https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a3.htm
Compared with urban residents, people in rural areas are more likely to be uninsured and have higher rates of poverty. Higher rural mortality rates can partially be explained by behavioral factors that increase the risk of chronic disease, such as smoking and lack of exercise.
I am helping a student from Iran giving her room and board and making her part of our family. Last week she had an accident and I took her to the emergency room. She has a broken arm. The bill was $ 8,100.- They gave her a temporary cast. Next week she will be operated.
My wife had a mini stroke in Germany. I took her to a hospital where she had an emergency operation, she was in great danger. She was in the hospital for a week. There was never any question about insurance until after the operation. The bill was $ 25,000.- which I paid with my credit cards.
After returning to the US I was told by experts at UCSF that the operation and hospital would have cost in SF a minimum of 250,000.- Dollars meaning 10 times the cost in Germany. The UCSF neurosurgeon was impressed by the quality of work. It was apparently a very risky procedure.
My wife is on Medicare and Medicare does not reimburse for overseas costs even though it is much cheaper than healthcare costs in the US. Many older US citizens would love to live overseas where Social Security goes a long way for good living. The fact that Medicare does not reimburse health related costs overseas is a big obstacle even though costs are way cheaper as illustrated in my wife’s case.
Because Doctors run the health plans and the hospitals and there goal is make the most money from our illnesses. If we let the AMA (in charge of of polio we would have chrome plated iron lungs that came with TV and cellphones but no cure for polio .
America is all about Rentier - class opulants extracted the blood from ordinary Americans. 4 TRILLION PLUS - that is the yearly drain on our society. As much as 40% gets drained off by "insurance". Oh, they know how to fix it
But INSTEAD, they all dip their spoons in and get as much Sugar as they can. Medicine makes defense spending almost seem managable.
Socialized medicine exists in the US and has for quite some time. Kaiser and military medicine are excellent examples. Both systems are "brick and mortar" HMOs. Both systems operate exclusive of private insurance (although the insurance companies are desperately attempting to insert themselves in these systems)
Kaiser and Military medicine have very little administrative overhead. They are nearly 100% vertically integrated, owning their buildings, pharmacies, labs etc.
These systèmes do not file claims, they do not appeal denied claims.
Most of their money goes into the exam room, as it should.
The HMO act was a great attempt to control costs. Kaiser and a few other Brick and Mortar HMOs fit the need perfectly.
Not to be outdone, all the private insurance companies added "HMO" to their names. This should not have been allowed. I will call them "Paper HMOs" (PHMO)
Fact is, the PHMOs are just fee for service.
Insurance company red tape does nothing to improve health care. Red tape only adds expense.
The US should gradually grow the Military medicine model, or the Kaiser model.
Both Kaiser and the Military have excellent quality. We can all cite examples of poor outcomes, but poor outcomes are universal to every system.
Kaiser and Military, because they are "free" to the user, encourage easy access to care, which has been proven to lower the cost of care as problems are solved before they grow.
The US must replace private health insurance with the proven quality of true HMOs such as Kaiser, or the socialized medicine of the Military health system
Better that the USA switch to the HR-676 plan that was written by House Representative John Conyers (D-Mi) from 2003 until his death in 2017. Each new Congress this bill was submitted to the appropriate committees and was placed in limbo by the corporate owned Congress critters. I have read, copied and stored, this legislative bill and know that it compares with the Best of the European programs and is better than the UK's NHS. I was a military brat, born with khaki diapers, and experienced the military health system. It was good, not great. Kaiser> my daughter can tell you her opinion (not good at all) based on the treatment she witnessed for her mother as her mother's caregiver. Kaiser and the other early HMOs started out good, then the profit greed began and now they are a step above the regular for profit health insurance plans but just barely.
HR-676 or whatever would seem unlikely to get passed if it threatened the profits of the big heath care companies. Maybe my understanding is mere unsubstantiated paranoid folk lore, but it appears to me that Congress rejects such reforms, and would never consider universal health care such as that pleaded for by Sen Sanders, because both parties are effectively owned by "donations" made to them by the big health care companies. further voters can do nothing about this. I wish people would stop and consider this and why voters never seem to manage to 'kick out the greedy bums' !
I respectfully disagree. Having been heavily involved
In the presentation discussions regarding 676 it was solely the Republicans who were shutting down the debates on 676, not the Democrats. While I accept that there are a very few democrats who are backstabbing scum, I point to Manchin and the former Senema of Arizona as examples of Republican in Democratic disguise the overriding majority of Democrats want beneficial legislation for all American citizens.
If you live in the U.S., don’t have a major illness or a major surgery before Medicare kicks in, even if you have employer-provided insurance.
I had a heart attack and abdominal surgery when I was 62 and 63, respectively. At that time I had employer-provided health insurance. They delayed paying providers up to the time I reached retirement age at 66 1/2.
When one reaches retirement age at the company I worked for, one is called in and told to provide a retirement date *that month*.
OF COURSE that’s illegal and unethical. Does anybody here believe companies are going to behave legally and ethically? If you believe that, I have some oceanfront property I’d like to show you in Kansas.
After I was “retired”, the company said I was no longer employed and refused to pay any health claims which were incurred while I was employed, leaving me with scores of thousands of dollars in medical debt.
America already HAS “death panels”. They’re called HEALTH INSURANCE COMPANIES.
Yep agree totally, especially the last sentence. My group of seniors also have a motto, we call it" Health Care is NOT a Consumer Product" and "We are Patients' Not Clients or Customers" Our groups are all in tune with the Conyers SPUHC program because it is the only thing that would bring our country and our people into parity with the best of the World's Develop Countries for Health Care.
The situation has gotten much worse in the past few years. Private equity firms have gotten into healthcare and are having a feast on whatever is remaining of the carcass. And since they have seen blood, they're not going to let go of it so easily...until nothing remains. This affects even those who have insurance, so I don't understand why people are so opposed to any form of a government system. Also, it irks me that whenever someone...Bernie...talks about universal healthcare, people talk about the cost, or more specifically, an increase in their taxes. I just don't understand how people think that they can get things for free. Besides, most of us already pay an enormous sum of insurance premium anyway. Why can't they realize that the insurance premium they already pay is a form of tax?
Do you want an answer to your question? Because people are stupid.
To be more accurate, Americans are stupid because they are generally under educated and don't know how to think clearly.
And this is the way the "owner class" of society likes it.
If the majority of Americans were capable of thinking do you really think they would put up with the gross inequality of wealth in this society?
Thank Ronald Reagan for that one. Traitor to the people of this country and his oath of office.
He killed free public education and community/state college by defunding it all.
He oversaw the biggest con to middle class extinction, this country has ever endured in its storied history!
Absolutely! He got away with it because they made it seem like government benefits were going to 'undeserving' black ppl ("welfare queens"). So poor whites were happy to 'cut off their noses to spite there own faces'- hurt themselves in the course of trying to hurt the undeserving blacks. This roughly a generation or two after their parents/grandparents benefitted from the massive welfare handouts of the "New Deal" following the great depression and WWII. Credited with "creating the (white) middle class!" (Since the programs were Administratored by the states and not the Federal Government, the vast majority of blacks, including veterans of WWII, were excluded from those benefits and redlined into poor neighborhoods deemed "unworthy of investment". So as property values grew in white neighborhoods, and equity was used to start businesses, pay for college etc., homes in redlined communities did not and are still devalued to this day! But following the civil rights movement, when it became harder to discriminate against blacks, similar welfare programs, and the polititians that pushed for them, became the enemy.
Forget reparations for slavery, this is what reparations need to be based on, all those black veterans who were prevented from participating in the GI Bill by the federal government and the racist, discriminatory policies it instituted to prevent blacks from taking part. Imagine the family wealth created by the GI Bill, either through homeownership or college, that was passed down through the generations. This accounts for much of the disparity in wealth, between black and white middle class families. The federal government *owes* the descendants of black GIs who were prevented from taking part in the GI Bill by the federal government due to race. All those homeowners in redlined neighborhoods whose properties were devalued and sometimes abandoned for lack of capital to repair and improve, thus losing value. And unlike slavery, we CAN identify who those descendants are, we CAN calculate an estimated value based on what they would have accumulated in family wealth if they were allowed to by a home or if those who did manage to own property weren't redlined by the banks and lending institutions, with the support of the federal government.
Absolutely, but non veterans were also impacted. Black ppl couldn't participate in the housing policy that created the suburbs and made home ownership a reality for the soon to be (white) middle class. Blacks were redlined; placed in large housing projects (ghettos) and for the few that could buy hms they were limited to areas deemed unworthy of investment. Laws prevented homes, in white neighborhoods, from being sold to blacks. That doesn't account for the hiring discrimination, educational discrimination (poor neighborhoods yield poor schools), food and retail deserts because banks say the area is not worth of busi ess investment; the inability to buy hms or maintain hms after purchasing. I wish some one would verify my belief that a large percentage of those black communities are renting from some LLC that doesn't live in that neighborhood and has no interest in investing in the neighborhood (doesn't help their bottom line). This perpetuates the blight in those communities because renters aren't going to invest in improving someone else's property. They are only there because of limited options based on their financial situation. So no one makes the needed improvements and the little revenue that is there is siphoned out by slumlords and spent elsewhere. Many New Deal programs were designed to restore what was lost, so not very helpful to those who had little to nothing before. This is why a large percentage of the black community is still in poverty and only a small percentage (exceptions) are making it to the middle class or beyond. That is why successful blacks are the exception/minority and not the rule/majority. Their circumstance is due to many hurdles (including centuries of slavery, and Jim Crow- 'slavery light'), Not due to choice, laziness, lack of intelligence or lack of desire!
Now, All Americans are being taken advantage of by the wealthy and corporate interests that put profit over ppl. The tactics are the same ones used on black ppl in the past. So they don't want whites to know this history so it can be repeated. They also want whites to believe black ppl are where they are by choice and not due to the hurdles that were/are continuously places in front of them.
I agree, you're right, federal discrimination in GI Bill benefits followed the same pattern as what came before, discrimination in New Deal programs and benefits, that also did significant, measurable economic harm to blacks. That could be added to criteria for Federal reparations to black Americans. By allowing states to administer these programs, southern states run by racist democrats at the time, who are the predecessors of today's republicans, they were allowed to discriminate against black American citizens on the basis of race and deny them the economic opportunities they extended to whites. The resulting devastation resonated down through the generations and can also be quantified. Its incredible, the damage that was done in the name of white supremacy, that you can still see to this day, and yet you have self deluded people running around saying racism and discrimination against black people is no more, and that there is no systemic racism. That we even measure "black unemployment" as a separate metric for employment, and that it has consistently remained higher, at times twice that of the "white" unemployment rate, is an indicator of the institutionalization of racism and discrimination. We're even measuring it!
Thank you and Spot on!
I totally agree and those of us who live in the Washington, DC metro area have to put up with the abomination from the Republican Congress which changed the name of Washington National Airport to the Ronald Reagan Washington National Airport. Then they constructed a monstrosity of a building in downtown DC that takes up an entire city block and is named for that scumbag crappy president who screwed the working people of this country time and again.,
Absolutely Harvey!
Here's another factoid. I lived in Simi Valley California back in the early 90's and they had just completed construction on the new RR Presidential library. It was a monstrously oxymoronic monument to fascism, sitting high up on Madera road overlooking Simi Valley to the south.
The kicker was the admission fee they charged to enter that made it so republiconly fascist and hypocritically hostile to the tenets of free education and public access.
In essence, they privatized acces to learning!
Oh by the way, in the mid 90s I worked as a technology consultant for a biopharmaceutical company in Thousand Oaks, and I did drive by that monstrosity before. I will always despise Reagan for the damaged he did to the working Americans and the benefit he gave to the employers to harm their workers. A more anti-Working American, I had never seen until that fat corrupt criminal Trump came along.
I was selling cars at Kemp Ford on T.O. Blvd around the same exact time!
Talk about Je Davu. lol.
That is what the right wing Republican ChristoFascist Party is all about. They only want the right kind of people, not those horrible liberals and left wingers who want to spend money helping working Americans. And their motto about health care is still as it was back several years ago. "Don't get sick, but if you do, DIE quickly" They said it, and frankly they believe it. They would love to start up their Final Solution for all Liberals, and social aberrations like the LGBTQ+ folks and of course those brown, black, and other minority types.
WOW! I finally found the other half of my brain! lol.
I remember the man, a hero in my view, Alan grayson who coined that phrase in 2009!
https://www.youtube.com/watch?v=-usmvYOPfco
Of course, he lost to Patrick Murphy who lost to little Marco Rubio. Talk about the "Dumbino effect."
Between Franken and Grayson, we lost half of the Liberal impetus that made up our collective progressive lifeboat!
Lastly, I embrace your use of the term 'Final Solution' the CONS actually embrace via their Machavellian legislation to describe the projection of republiCON enmity toward the dems, using the phrase "death panels" to describe the "small d" democratic agenda...as if!
Our healthcare system is more corrupt than portions of our government. There is a constant struggle between providing health care to those who need it and pure human greed. There are medical professionals that view patients as dollar signs more than human beings. I had back problems severe enough to warrant me seeking help from a qualified specialist. I was referred to a group that specialized in spinal problems. I had X-Rays taken and even an MRI of my lower back. One of the three doctors in the office told me I would need spinal injections the fix my problem. Trusting in their professional opinion I submitted to the procedure. It was no big deal aside from the discomfort experienced from having a 4-inch needle the size of a Dairy Queen straw shoved in my lower back. Days passed and I received a detailed list of charges my insurance company was being billed for my injection. I was so shocked I still have the bill, that single shot cost my insurance company $19,000.00 and the beauty of the whole ordeal was the shot did nothing to help my problem. Years ago I had a bad tooth that needed attention. I was told I would need a root canal and a crown. The dentist told me the cost would be $2,200.00. Years ago root canals were done by specialists, not dentists. My doctor had decided to do the procedure herself and reap the rewards. She fumbled through the pain-filled two-hour process and fitted me with a temporary one as the crown had to be made from the impression she took. Long story short I finally got my new tooth and the gold crown was outstanding. A few weeks passed and I began to experience some noticeable pain and swelling around my new molar. I made an appointment and had my mouth checked out. An X-Ray was taken and I was told I had an abscess and as a result, my new tooth would have to be extracted. My dentist broke one of the roots on the tooth she wasn't qualified to perform a root canal on. Not only did I lose my $2,200.00 initial investment but she charged me for pulling the tooth she messed up. Greed and incompetence permeate the medical industry and the insurance groups are forced to cover the cost of their legal thievery. Now I understand there are some very good doctors out there that don't deserve to be benighted but until the bad apples can be removed from the barrel we will have to suffer.
My dentist’s wife/hygienist took it upon herself to “fix” my bad bite by GRINDING DOWN my molars! The dentist then accused me of grinding my teeth while I slept. I told him his wife ground them down. He then removed her from his practice. Unfortunately, years later a periodontist told me that action had promoted my gum recession which she ‘would be happy to arrest for $10,000.00’ (another quote was $25,000).
I could write s book about the misdeeds of doctors, dentists and vets.
Mario--Who needs Boris Karloff to make a horror movie when we have the medical profession to stand in for the past legend.
There are good doctors. My dad was one. When he died the entire church was filled. People came from all over. One former patient wrote my mother from Hawaii. He was the last of the “general practitioners” that made house calls. A good man.
Mario--I was raised in an era where it was common practice for doctors to make house calls, and I did say there are some very good doctors out there.
First, thank you all for speaking out and for making this topic “visual”. Every time the republicons say privatize they mean Fascism. And most of them do not know anything about anything except how to greedily hang on to their loot. I am so sad that so many people are comfortable being uneducated. The republicons want to privatize you and me! We will work for them and they will suck up all . You my dear can drink from the “ trickle down” fountain. Oh, gosh, fountain dry!
We are letting the “rights of all” disappear because we are deaf to the meaning of “privatize”. It is a real dirty word kids! It is as dirty as socialism is to the republicons! A privatized housing market, healthcare, post office, school system, all spell Fascism.
And that my dear students is what many of your relatives fought against and gave their lives for to keep us free from. Fascism and elitism and greediness all have the same meaning: gimme gimme gimme! And do not try to regulate my greed. I will instead make up rules that you must live with.... no healthcare, no housing, no schooling, just “mine mine mine!” And if you don’t give me( maga) everything for nothing I will scream and scream !
Jean--It seems the Republicans feel if they can keep the Democrats in a state of discontent they will be easier to defeat and control. One thing I've learned about Republicans like Boebert, Greene, and Santos, the fog they live within never lifts.
Dear Donald,
The “good doctors” are those who like the longshoremen in 1934 will end privatized Insurance by refusing to have their careers concerning healthcare turned into “big business”and refuse to be controlled by insurance companies that privatize breathing! Doctors ( real ones) will be trained to help make people well. They will not need to be controlled by “ big business( Fascism). The AMA is a so called doctors union. What it controls is the high wage that many go after as they are never interested in healing anyone but their own pocketbook.
Doctors have always been better off financially than most of us. But now, they took the “health” out of care and added wealth care!
Jean--Well said, After graduation they all take the "hypocritical" oath.
Absolutely, and I am feeling discontent!!🤪😱👏🏻🤗
I too, had bad luck with General Practitioners that are trained by the hospital to direct a patient to a PROFESSIONAL $$$ to help you with your "problem" $$$.
George--I have lots of pain but very little $$$
Poverty is a policy choice. An essential banner-big picture-root fact that is missed or avoided by most analysts. What makes Professor Reich such an effective educator is that he keeps his students focused on a simple basic truth rather than getting overwhelmed in the noise. The simple fact is that the bigger the pool of payers the lower the cost of health care. One huge pool that everybody pays into is far less costly. It lowers the costs-huge costs of so many going without health care. Efficiency-economy of scale and equity. Highly schooled/specialized minds too often cannot see the Forest for the trees, let alone communicate essential basic uncomfortable truths like Poverty is a Policy Choice. Thinking skills are lacking at the highest levels of education. In fact, I argue that the more specialized and siloed we get the more we lose the capacity to see where we are going and what is the big picture? Iain McGilchrist argues thoroughly that we have become a society of technicians-failing to engage our whole brains that would keep our eyes on...the bigger pictures. Most needed today is the application of the metaphor-The emperor has no clothes....The Chicago School of Economics cleverly clothed the naked truth (ending poverty is affordable) in complete bullshit-neoliberalism from Reagan onward...just now and just some are seeing that the trickle-down theory described nasal drip better than how the economy works. What a waste. Lots of clever people out there-wisdom is scarce.
The problem is that we are allowing selfishness/selfish-interests, fueled gy culture wars, to distract us from those truths- that we are better together, that we have power-in-numbers (financial and political). This is by design, like in the Hunger Games. We fight eachother while the wealthy/powerful few at the top benefit from our division- as entertainment and as they gain more wealth/power, at our expense.
Just watch the Iowa opinion poll. RE" their thoughts about Trump's inditement.. It's like a Steven King horror story: "The Voters!" Very chilling, very scary.
The BeLuved UnEds . .even if they are Germ Infested . . .
People aren’t stupid, but like Dr Reich said if a policy cannot be easily explained, it can’t be sold. Also, people are more afraid to lose something than trust that a new system will be better. As a former small business owner (20 staff) we paid huge premiums for plans that had huge deductibles. I would have gladly paid a health insurance tax of same amount for Universal Healthcare AND would have come out ahead because I would have virtually no admin time spent choosing and administering health insurance EVERY year. Guaranteed we would have better coverage without the barriers of deductibles and premium cost sharing.
of course the average voter is uneducated, but so what? even if all voters were well educated that would not solve much. Congress answers to campaign funders, not the People.
The
I've been saying people are stupid for years. That's not the same as being ignorant. Ignorance can be corrected with information, but stupid can't.
Exactly right.
Those of us on Medicare are getting a great deal. But the Medicare population is the high risk category -- the aged and the sick (people on SSID) If the base were broadened by adding more younger people, the risk would be spread, and part B premiums would drop.
Have to distinguish between Medicare and "Medicare Advantage" which has been depleting the Medicare trust fund. https://www.npr.org/sections/health-shots/2022/12/12/1141926550/medicare-advantage-plans-overcharged-taxpayers-dodged-auditors
Medicare Advantage is only an advantage if you are an insurance company and I am not. The insurance industry will be the death of all of us. We need Medicare For All yesterday. I too am on Traditional Medicare and when I am asked by the reception person if I have any other insurance and I answer no, they look at me like I am too stupid and too poor to take care of myself. I laugh all the way to the bank, as they used to say.
Last year, the government spent $20.5 billion overpaying private insurers for Medicare Advantage plans — and the industry’s aggressive lobbying campaign is kneecapping efforts by lawmakers to stop
https://portside.org/2023-06-01/20-billion-scam-heart-medicare-advantage
Daniel, Thank you for this. As I wrote earlier. Medicare-Advantage plans are those privatizing our very fine “Medicare”! Beware of the word privatize... it simply means Fascism.
Yes, I too hate "outsiders" from wolfing down the money of Medicare. Insurance companies should have never given that 10% of Medicare when it was created. They are taking advantage of it now. BIG TIME.
back before the 2016 election, bernie had a study done that showed that the rise in taxes to support universal healthcare, or single payer, was LESS than most people's premiums and out of pocket costs. so it was a complete win. most people would ultimately pay less, especially if they had serious medical issues. but people are stupid, short-sighted, and afraid of "socialism" (unless it's for corporations)
And John Conyers proved that with his comprehensive bill HR-676 first submitted to the Congress in 2003. His bill was named "Expanded Medicare for All" and covered ALL necessary medical requirements, with NO out of pocket cost for the citizen coverage. Even Hillary Clinton attempted to bring a Universal Health Care program to the Congress but the rabid Republicans shot all of those efforts down. HR-676 was submitted to EACH NEW CONGRESS until 2017 when Conyers died so the last version of that bill was the 2017 version. I have copies of all of them from 2003 and no body has a better plan that Conyers. Bernie's was a partial copy of Conyers, but he still allowed the private for profit sector to continue to rape and pillage our people's health care. I have a copy of his initial plan document and it is nothing compared to the Conyers bill. I have the entire library of these bills in PDF files. Including Sanders bill!
Both of those were half-assed, lobbyist directed and deserved to die. Most 2003 HMO s have failed. Many of the major providers like Columbia Medical Center, run by the Frist family, were IMHO criminal enterprises. https://www.politifact.com/article/2010/jun/11/rick-scott-and-fraud-case-columbiahca/
A good place to learn about healthcare is bankruptcy court. Medical providers can't collect from patients who had lousy coverage that left them exposed to judgments. Some key insurers have gone belly-up. In a high percentage of cases, the debtors thought they were covered and were excluded.
Bull crap, Solomon, you don't know what you are talking about. I didn't think much of Bernie's plan, mainly because it used the points of Conyers, but added a load of crap in legalese wording and still charged patients a fee as well as allowing the for profit scumbags in the health care insurance world to continue to rape and pillage. The Conyers plan ended that bull, blocked the for profit insurance companies from participating at all, and allowed no for profit health care facilities to participate. They all had to convert to either not for profit or nonprofit. So, when you make assertions, you should ensure that there are not those of us out in the real world who have actually read those documents as well as other documentation for health care both in this country and in all the other developed countries that are kicking our asses in health care outcomes.
I supported Conyers in principle, but it was dead in the water and he couldn't get the unions, his base on board. To medical providers had a problem as a "taking" under the 5th Amendment. As I say, at the time, HMOs were huge. Many other Democrats like me wanted slowly dropping the Medicare eligibility rate every few years — first from 65 to 55, then from 55 to 45, until everyone qualified. Hilary-then the "co-president" killed the Conyers bill.
And I've never heard anybody else talk about "collateral sources."
Yes well said..............it does mean paying higher taxes. But here in France we are happy to do this.
Yes, I remember how easy it was to get care there...even in a small village that we lived in.
America is the richest country in the world, yet US can't afford to give what every other developed country AND even some undeveloped countries give to their people????!!!
And THAT IRKS YOU because Bernie makes that point?!
You should be irked that he's right!! Bernie ALWAYS states how we need to TAX THE RICH.
That who you should be "irked" at!!
Bernie is only stating the truth: Inequality is at it's worst today than it's ever been & taxing the greedy rich would fix that.
Period.
With comments like yours, the greedy rich don't need lobbyists.
These are not health care organizations, they are For Profit Businesses. They place Profit over People; Over all else. The industry is controlled by Billionaires and corporate interest who seek more profit at the expense of the nation's health. Money IS power, and they have it, and use it, in spades! They use their money it to influence/control government policy that favors their profits. Same applies to News organizations and social media where they use their money/power to spout LIES & DIVISIVENESS (divide and conquer) that prevent us from using our power-in-numbers to control our Government's policies! Recent story @ Mother Jones addresses this- https://www.motherjones.com/media/2023/06/news-never-pays/
18% of the American economy may be devoted to healthcare but I was curious about this claim and found that Prof Reich’s own labor department counts approx 18% of the American workforce engaged in healthcare. Reducing the cost will also mean reducing employment in this sector.
Amen! "Private equity" firms should be called what they really are: VULTURE CAPITALISTS. Though that is an insult to actual vultures, lol. "Vampire Squid Capitalists" perhaps then?
I have been told that poor and middle class white people have no qualms about giving up self interest to undermine the minorities in this country.
PE Hedge Funds buying up all the homes in America as well, causing rents to double and triple with homelessness increasing at an exponential rate!
We have the most expensive and least effective health system because of the health insurance industry. Money which should go to hospitals, medicine, and health care providers goes instead to health insurance stock holders and employees.
I trace a lot of this to 1994 when Blue Cross went from a "charity" to a for profit organization. I remember that at the time, HBOs looked like the least costly and most profitable alternative to pay per service. Soon the administration was promoting Hilarycare.
Maybe Robert can comment, as he was then Secretary, but this is now like water under the dam.
A lot of the rationale is based on the cost of litigation as a major aspect of the cost of medicine. I've been writing about the potential effect of elimination of the "collateral sources rule," which I think will cause the cost of litigation and thus insurance premiums to drop.
I live in Australia where we find American policy insane on too many levels to comment. Health policy being a number way up there though.
How is a person productive if they are not healthy enough to contribute to production. It aint rocket science.
Australians have figured this out. Less inbreeding.
Friend, one doesn't have to be particularly healthy to do the sort of mind-numbing jobs America provides to most of its citizens. Just show up and screw the caps on the tubes of toothpaste.
In UK we hsve msny problems but we so proud of our FREE NHS the envy of the world. Yes we have shortage of nurses doctors but if I'm ill I know ilk be treated the same as a millionaire. Why can't US hsve free care?
Peter,
That is an important question. If by "can't" you mean "why doesn't USA " this lecture is trying to answer that. However the short answer is " People who have power... and healthcare, choose not to give free care to others"
Because we allow investor owned insurance companies to siphon off a massive amount of our health care dollars. And we get worse care because of that
I believe the reason the US still does not have Universal Health Care Is because the people in the US don't make public policy. The sociopathic money hoarder class supports the politicians who do their bidding, which is to build a for-profit mechanism into everything. Yesterday I heard Tom Hartmann refer to the "predator cons." I think of them as the "Capitalism Gods." I don't care how many times I hear that the system is at fault, so there is no blame, I can't agree. There is blame because they rigged the system and continue to be parasites on the population. Now I'm going to listen to Professor Reich's "Wealth and Poverty" class eleven, again.
IMHO Big Pharma and Big Insurance own Congress. The only reason we do nor have expanded Medicare is saturation of propaganda. E.G. Republican diabetics are voting for higher insulin costs.
Own is a perfect word, Daniel S.
The stories I hear are strange.I don't need a special tablet.These tablets cost A$40,000 approx for 1 year .The govt pays.The maximum I pay is around $14 a month,not really sure,I don't need them.The specialist asks me every 6 months fill in the form for the expensive tablets Score 100 you get them.I score 12, no pain ,nothing.Why get the govt to pay that much when somebody else may need that money,I'm OK.
My doctor worked in the USA and tells me the state he worked in had a universal health care system,I forget the name of the state.He came to Australia as he is a great believer in universal healthcare.He says that he thinks those tablets would cost around US$ 50K in the US,he is not sure.The Australian govt would argue the price down,he said nobody would do that in the USA.
Charging that much for any medication is disgusting. Where do they think the money will come from, besides bleeding Medicare dry if you don't have the money??
While I am cycling I would usually listen to a podcast on my mobile phone,or music.on the phone.
My phone suggests comedy podcasts for me.A UK satirist called Jonathan Pie( stage name) came up.I dismissed it.Then I remembered,I have seen him on a satirical TV show here in Australia.Over to our UK reporter,Jonathan.He rants and raves for one or two minutes.First time I saw him ,no,not for me.Second time I can see his comedy,3rd and 4th time,very good.
I hunt around to bring the podcast back. Call Jonathan Pie.I listen,first 5 or 10 mins are very slow as he lays out the scene.I think,no,not for me,I'll turn it off Then a good line,I laugh.Give him 5 more minutes,I am hooked .Brilliant.A 10 part show of 30 minutes per show.Subjects that people rant and rave about on Facebook,radio etc.He sums it all up,comedy genius for me ,perhaps not for everybody.
Sometimes I have to concentrate on the bike to stop myself falling off laughing. BBC Radio 4,Call Jonathan Pie.
Depends how you think about it George .I won the lottery of life ,born in a first world country .I won the lottery of health,good health.In old age( now) I keep fit,I cycle 1600 klms ( 1,000 miles) a month.I live in a country that has excellent cycle paths,think of cycling down the coast of California but without the crowds.The govt worked out the baby boomers will get old,this will cost a fortune in pensions ,health care etc.I began to study investing and did it.
A pension in Australia is means tested,we get no pension ,that saves the govt ( the young people that pay for that ) $42,000 a year. The health care costs of people are different.Say a pensioner couple costs $100,000 a year for health care and pensions.We cost them nothing,then the tax on the investment income is paid.My contribution to the govt is over $100K a year.,pension saved and tax paid,I don't mind.I am very glad that I can contribute to people that need it more than me.
Obviously I do draw from the govt,I didn't pay for the thousands of miles of cycle paths I use,everybody else did.
One drug I know of costs $5 million for 1 dose,a huge breakthrough.The disease it treats is very rare,perhaps a dozen people in the world have it..The govt decided they would not pay for it,too expensive.I did the maths,12 million workers pay for a $5 million drug for perhaps 2 people in Australia,there is no problem there. Somebody in the govt perhaps saw the obvious,and it was decided they would pay.
Headlines would scream $10 million a year for 2 people,people would think that must be costing me a fortune,they don't do the maths either.I like a system where everybody pays for everybody else.Some people cost a fortune,some people cost very little,it is good that the costs are shared.
Perhaps it is best summed up by cyclist v motorist.People would call into radio stations,why should I pay my car taxes ,cyclists don't pay anything.What they never see is one less car on the road,eases congestion.I own a car and don't use,I still pay that tax.By keeping fit I save them money on my health care costs.I save them money.All they see is they are paying for something I use,the govt should make me pay.
Oh,forgot.We do also have an insurance based system.I own shares in one of the companies,Medibank private MPL..Try to break even on premiums,make money from the float.
Or collect in $5.2 billion in premiums,pay out $5.1 billion in claims.
The float $100 million is invested in the stock market,year after year,just the basics of it.The profit and dividends basically comes from the float,stock market investments.Scares the hell out of people when the profit plunges by $2 billion.Bit of a crash on the market,value of the portfolio went down,mark to market.Technical things insurance companies,spectacular failures when somebody gets something wrong once in a while.
Yes. Hartmann and Wolff are good guys, and on YouTube.
Because we can’t have nice things here. Those things are reserved for the Rich who have inherited it. ......Oh ‘cuse me, who have “earned” it.
I don't think your system is the 'envy of the world' my son who lives there had to wait 2yrs to see a psychiatrist!
We are doing fine in France but also a shortage of doctors.
I agree Jennifer.For some reason the UK seems to think,the envy of the world.
Most universal healthcare is funded the same.
Here in Australia universal healthcare sometimes has a co- payment.As a pensioner I would get 99% of specialist care free.
My doctor ( walk in and be seen) sent me to a specialist.The appointment was 4 days later.I got there,the cost is $200, but the govt gives me $100 back.I was surprised but paid .The doctor said it was urgent.I'm there for 10 minutes ,the specialist looking at the blood test results he had been sent.Everything looks OK but your doctor flagged one result.I'll send you for an MRI scan to make sure,call this number and I'll tell them it is urgent.I have to make the appointment time.Call them next day,yes we can get you in tomorrow.The MRI operates from 8.30 am until 6pm,you are urgent so it is an out of hours appointment,can you be here for 7.15 am for our small out of hours crew that work part time.Yes. In the machine for 40 mins,the technician says the specialist will get the results in 24 to 36 hours Call him.
I call,come in 2 days.Wake up next morning coughing.Call the specialist perhaps we should do a telephone appointment.Next morning the receptionist calls me.The phone call from the specialist will cost $50,credit card number please.
I get connected to the specialist after paying.Straight to the point,great news,you are cancer free,sorry I can't talk,very busy.
Go to my doctor,comment that is the first time I have been charged,my doctor look aghast,he charged you!.
I wrote on the referral cost free.
Same here,short of doctors and nurses.Unless operations are urgent in hospital then wait 3 months to 18 months depending what is needed.
My wife and I retired to France, and we are ecstatic that we did so - partially because of the excellent and inexpensive healthcare here. Just as an example, I recently had a cataract operation, and the cost to me was less than 100€ - and most of that was a surcharge for a private room. They even paid for my taxi ride home. To get nearly 100% coverage, my wife and I pay insurance premiums of about $350 a month for both of us - and we're both in our late 70s. Included in that is full dental, eye, hearing, surgery, all doctor visits (including having a doctor come to our home), physio therapy, and all prescriptions. If we're in the US visiting family, we're still covered. Don't pay a dime to Medicare.
This is what sanity looks like.
I like it. But if you can't come up with the $350 a month you are screwed? I don't know..
As a couple in the US $350. Is the exact same amount that is automatically deducted from our Social Security each month for Medicare. I’m order to get the same services described as in France, we have no choice but to take a Medicare Advantage Plan. We would have co-pays and a much smaller pool of Doctors and services available to us under traditional Medicare. Yes. I fully understand that Medicare Advantage is not good for the overall traditional Medicare system, but unless you’re below the poverty line and can get assistance or far enough above the poverty line to afford the extra out-of-pocket costs, the Advantage plan is what works. At least, for those of us in the middle and that appears to be a very large portion of seniors. The best solution, aside from Medicare for All (the best solution), is to at least expand the current Medicare and eliminate the restrictions and costs involved.
Penny wise pound foolish.
The actual test is whether you accepted lifetime caps that limit the amount Advantage has to pay. Virtually everyone over age 65 in bankruptcy court are there because medical bills exceeded the cap.
Another reason not to buy Medicare Advantage is that it is not portable. Many of the companies are only registered to do business in certain states.
I don't know where you live, but where I live BC/BS (Florida Blue) has lists of medical providers who will waive copays. Medicare Advantage varies in coverage depending on location.
In the US, depending on family income, insurance costs are less than you pay. Lots of medical providers in the US waive co-insurance and co-pays for people on Medicare.
Not for full coverage. Doctor visits - free. Specialist visits - free. Hospitalisation (including intensive care) - free. Ambulance - free. Operations (including transplants and joint replacements) - free. Prescribed medication - free. Eye exam and eyeglasses - free. Dental care including extractions and surgery - free. Cancer care - free. Dementia care (including residence in a support facility if needed) - free. Remember, we are in our 70s. I've done the research, and full Medicare parts B, C, D and supplemental to cover everything we get here would cost double or more.
When we were first here, we had to have our own private insurance with a pretty high deductible. Cost for worldwide coverage (except US) was about $700 a month. To add US coverage TRIPLED the price. Dropped that coverage as soon as we were eligible for the French system.
As I said, Part B is based on income. The standard monthly premium for Medicare Part B enrollees is $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022.
Medicare doesn't have dental or vision but many medical providers waive co pays and deductibles.
Do the math - it’s $164.90 EACH or $329.80. About what we pay now for FULL coverage and no deductibles. We’re actually in a higher bracket, so Medicare Part B *alone* would cost us more than we’re paying now. There’s also a $226 deductible EACH before any coverage cuts in. And for Part A, you start paying out of pocket for stays longer than 60 days. If you want more coverage, you have to buy MediGap on top of that. For full coverage, premiums for MediGap run up to $759 a month. No, thanks.
There is a major cost difference between Traditional Medicare and Medicare Advantage(MA) and the coverage extended by each. It seems you are comparing MA with the French system. MA excludes many treatment options but costs the recipient much more than Traditional Medicare. One cannot really compare apples and oranges.
To get the coverage we get in France, I have to compare to Medicare Advantage to get even close to all the benefits we get with basic healthcare plus the top-up (called a Mutuelle here) for which we pay a monthly premium. Traditional Medicare is similar to the basic insurance offered by Securité Sociale here. If all you have is the basic health care card (Carte Vitale), you have to pay the difference out of pocket if you choose to go to a doctor who is outside the system or want to go to a private hospital. With our Mutuelle, we can choose any doctor or hospital we like and are 100% covered.
Depends on the individual and whether the medical providers accept Medicare without charging for co insurance and copayments.
Out of pocket for stays longer than 60 days may apply in Medicare Advantage, but there are no caps in the real thing.
You tell them, John V.
And the insurance costs a ton of money in the US.
Absolutely single payer health care! Having lived and worked in Belgium 1989- 2016, I can attest to the fairness and quality of this system. A single mother friend with a part-time teaching job never worried about how she would pay for her and her son’s health care. I had a hip replacement that cost me zero - the waiting time was normal, a couple of months. My GP was always available for appointments on a day’s notice. Insulin, Epipen and other life-saving drugs are free to everyone under the mandatory national insurance.
People like Lindsey Graham seem to think that all of Europe is functioning like the stressed NHS - couldn’t be further from the truth, each nation has its own system! The NHS used to be a model of excellence until it became more privatised - and, it wasn’t originally set up for some of the more complex modern operations that have increased demands on the system. But apparently Lindsey doesn’t realise that there are many nations to the south and east of the UK who are managing their health care just fine? My European friends just look at me in disbelief when I tell them about the dysfunctional US “system” - as I’m sure is the reaction of many Americans now reading my comment! US friends always counter with “but you pay much higher taxes than we do!” Yes. And every European I know agrees that the health care of their friends and neighbors is worth paying for. It’s absolutely worth the investment that saves money in the long run, and benefits everyone - including yourself!
Actually, in the US, Medicare costs less than those of private insurance. In some cases, 50% less per service.
Yes, Medicare sets rates that are much lower than medical facilities will charge those with private insurance. But even those rates are two to three times higher than the rates paid by the single-payer government insurance plans in much of Europe. Also in Europe the single-payer plans set rates for all approved prescription medicines. Even if you don't have insurance, you pay the government rate. Just as an example, a month's worth of Eliquis - a common blood thinner taken by a large percentage of the elderly population costs 60€ a month. One of our children has to take it, and the pharmacies charge her insurance more than $400 a month!
It starts with the costs to train a doctor or nurse here in Europe - 1/10th what it costs to get a medical degree in the US. Doctors here don't feel compelled to charge outrageous fees because it didn't cost them an arm and a leg to be trained and licensed to practice. Doctors here also don't have to deal with outrageous malpractice insurance fees - because although you certainly can sue for malpractice, the awards are reasonable.
You wouldn't know that if you looked at the barrage of TV ads pushing Medicare Advantage. Despicable!
I live in Belgium, too. No one in America seems to value the Peace of Mund, knowing that you won't be bankrupted by illness!
Great comment Judy!
Because the US is terrified of liberal socialism!
'Healthcare' in America has become another example of corporate greed. Medical schools are pretty much 'owned' by big pharma. Medical practices are mostly affiliated/controlled by large hospital complexes regardless of existing in other building addresses. Private practice is mostly a misnomer now, not what it once was. 'Best' doctors with generosity of spirit, time to listen, etc., are often found to be from and educated in another country.
In a deregulated capitalist society like America there is no money to be made from the poor.
The rules of American capitalism:
1) Underpay the workers so they can barely survive.
2) Extract what little money the workers have to further enrich the 1%.
3) When the workers get sick let them die once all their money has been extracted.
4) Rinse and repeat. (Actually repeating isn't necessary but it uses more product.)
In the U.S., despite our high-flown rhetoric, people don't matter. People with money matter; and people with lots of it.
As the "card player" said to Sundance in the opening scene of "Butch Cassidy and the Sundance Kid", "you can die; you can both die..."
Good one Thomas; deregulation is the key word here... Capitalism WITHOUT regulation is greed gone wild. This is what we have now.
There is a list of reasons healthcare is more expensive in the U.S. Each contributor to high healthcare costs argues it is "not their fault". However, the sum of the (bad) parts and bad actors lead to high prices. The reasons for high cost of healthcare include:
- Health care salaries in the U.S. are enormously higher than in other countries, including in advanced economy countries (example: Most physicians in Germany earn less than well-trained nurses in the U.S.).
- The American Medical Association makes it extremely difficult for a trained Dr. outside of the U.S. to practice medicine in the U.S, even if they have immigrated and become citizens. That leads to an unbalanced supply and demand for well-trained Drs. One of the reasons the AMA is protectionist is in the next point.
- Tuition for medical schools in the US are so high that Drs. feel they are entitled to high salaries, and restricting international Drs in the US maintains high salaries due to lack of competition. The AMA does not want to bankrupt Med Schools that would need to reorganize. In many countries there is either a very low or in some even no tuition for medical school training, so that the most talented get trained.
- The ability to sue for enormous sums for of money is unique to the US. This results in all kinds of added bureaucracies and expensive malpractice insurance for physicians. The government needs to make it very difficult to sue for large sums and to cap sums (many lawyers would see reduced income).
- Insurance companies add staff and bureaucracies, just to reject medical claims (part of the reasons are listed above and below).
- Last year’s bill passed stabilizing the cost of many medications. But all medications need to be open to competitive bidding from outside the U.S. (like Canada)
For each of the above points there is a lobby protecting the incomes of their stakeholders. Which politicians will have the courage to make changes?
A big part of the solution might be to by pass most of the above system. For example, initial consultation through enhanced telemedicine with Drs in other countries and shipping medical tests (blood etc.) to testing sites in the U.S. Being treated for expansive procedures outside the US. I imagine there will be insurances interested in these options. Congress needs to allow important of cheaper meds for all meds (e.g., from Canada). That could lead to a rapid competitive reduction in prices in the US. US medicine needs to be open to price competition up and down the ladder.
At least in the US, the nurses do the bulk of the doctor's work And the lifting! So they DO deserve more money.
As an adjunct at the Sage Graduate School, I taught a course entitled "Comparative Health Care Systems" in the Health Services Administration Masters Program.
For 12 years, students compared nations around the world, and found that many nations have longer life expectancy, far lower infant mortality rates, and per capita costs 50% lower than the United States.
They also learned that Obamacare was not a step toward universal health care, but rather universal health insurance -- including all the limits and disincentives to provide care that come with it.
World wide we are No 75. https://www.cia.gov/the-world-factbook/field/death-rate/country-comparison
Wide mortality rate disparity within the US. Alabama, Kentucky, Mississippi, Oklahoma and West Virginia had the highest death rates in the U.S., States with the lowest death rates were California, Connecticut, Hawaii, Minnesota and New York. Death rate is calculated as the percent of a population that dies within a given time. https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a3.htm
Compared with urban residents, people in rural areas are more likely to be uninsured and have higher rates of poverty. Higher rural mortality rates can partially be explained by behavioral factors that increase the risk of chronic disease, such as smoking and lack of exercise.
I'm sure there is an educational variant amongst those States too.
what did you argue were the key drivers of per capital costs of health care?
I am helping a student from Iran giving her room and board and making her part of our family. Last week she had an accident and I took her to the emergency room. She has a broken arm. The bill was $ 8,100.- They gave her a temporary cast. Next week she will be operated.
My wife had a mini stroke in Germany. I took her to a hospital where she had an emergency operation, she was in great danger. She was in the hospital for a week. There was never any question about insurance until after the operation. The bill was $ 25,000.- which I paid with my credit cards.
After returning to the US I was told by experts at UCSF that the operation and hospital would have cost in SF a minimum of 250,000.- Dollars meaning 10 times the cost in Germany. The UCSF neurosurgeon was impressed by the quality of work. It was apparently a very risky procedure.
My wife is on Medicare and Medicare does not reimburse for overseas costs even though it is much cheaper than healthcare costs in the US. Many older US citizens would love to live overseas where Social Security goes a long way for good living. The fact that Medicare does not reimburse health related costs overseas is a big obstacle even though costs are way cheaper as illustrated in my wife’s case.
Because Doctors run the health plans and the hospitals and there goal is make the most money from our illnesses. If we let the AMA (in charge of of polio we would have chrome plated iron lungs that came with TV and cellphones but no cure for polio .
J.
America is all about Rentier - class opulants extracted the blood from ordinary Americans. 4 TRILLION PLUS - that is the yearly drain on our society. As much as 40% gets drained off by "insurance". Oh, they know how to fix it
But INSTEAD, they all dip their spoons in and get as much Sugar as they can. Medicine makes defense spending almost seem managable.
Socialized medicine exists in the US and has for quite some time. Kaiser and military medicine are excellent examples. Both systems are "brick and mortar" HMOs. Both systems operate exclusive of private insurance (although the insurance companies are desperately attempting to insert themselves in these systems)
Kaiser and Military medicine have very little administrative overhead. They are nearly 100% vertically integrated, owning their buildings, pharmacies, labs etc.
These systèmes do not file claims, they do not appeal denied claims.
Most of their money goes into the exam room, as it should.
The HMO act was a great attempt to control costs. Kaiser and a few other Brick and Mortar HMOs fit the need perfectly.
Not to be outdone, all the private insurance companies added "HMO" to their names. This should not have been allowed. I will call them "Paper HMOs" (PHMO)
Fact is, the PHMOs are just fee for service.
Insurance company red tape does nothing to improve health care. Red tape only adds expense.
The US should gradually grow the Military medicine model, or the Kaiser model.
Both Kaiser and the Military have excellent quality. We can all cite examples of poor outcomes, but poor outcomes are universal to every system.
Kaiser and Military, because they are "free" to the user, encourage easy access to care, which has been proven to lower the cost of care as problems are solved before they grow.
The US must replace private health insurance with the proven quality of true HMOs such as Kaiser, or the socialized medicine of the Military health system
Better that the USA switch to the HR-676 plan that was written by House Representative John Conyers (D-Mi) from 2003 until his death in 2017. Each new Congress this bill was submitted to the appropriate committees and was placed in limbo by the corporate owned Congress critters. I have read, copied and stored, this legislative bill and know that it compares with the Best of the European programs and is better than the UK's NHS. I was a military brat, born with khaki diapers, and experienced the military health system. It was good, not great. Kaiser> my daughter can tell you her opinion (not good at all) based on the treatment she witnessed for her mother as her mother's caregiver. Kaiser and the other early HMOs started out good, then the profit greed began and now they are a step above the regular for profit health insurance plans but just barely.
HR-676 or whatever would seem unlikely to get passed if it threatened the profits of the big heath care companies. Maybe my understanding is mere unsubstantiated paranoid folk lore, but it appears to me that Congress rejects such reforms, and would never consider universal health care such as that pleaded for by Sen Sanders, because both parties are effectively owned by "donations" made to them by the big health care companies. further voters can do nothing about this. I wish people would stop and consider this and why voters never seem to manage to 'kick out the greedy bums' !
I respectfully disagree. Having been heavily involved
In the presentation discussions regarding 676 it was solely the Republicans who were shutting down the debates on 676, not the Democrats. While I accept that there are a very few democrats who are backstabbing scum, I point to Manchin and the former Senema of Arizona as examples of Republican in Democratic disguise the overriding majority of Democrats want beneficial legislation for all American citizens.
Then let's all get Military insurance and kick the greedy bums out.
If you live in the U.S., don’t have a major illness or a major surgery before Medicare kicks in, even if you have employer-provided insurance.
I had a heart attack and abdominal surgery when I was 62 and 63, respectively. At that time I had employer-provided health insurance. They delayed paying providers up to the time I reached retirement age at 66 1/2.
When one reaches retirement age at the company I worked for, one is called in and told to provide a retirement date *that month*.
OF COURSE that’s illegal and unethical. Does anybody here believe companies are going to behave legally and ethically? If you believe that, I have some oceanfront property I’d like to show you in Kansas.
After I was “retired”, the company said I was no longer employed and refused to pay any health claims which were incurred while I was employed, leaving me with scores of thousands of dollars in medical debt.
America already HAS “death panels”. They’re called HEALTH INSURANCE COMPANIES.
Mark C. I like your last sentence of death panels. That is EXACTLY what insurance companies are. They are the un-needed "middle man".
Yep agree totally, especially the last sentence. My group of seniors also have a motto, we call it" Health Care is NOT a Consumer Product" and "We are Patients' Not Clients or Customers" Our groups are all in tune with the Conyers SPUHC program because it is the only thing that would bring our country and our people into parity with the best of the World's Develop Countries for Health Care.