… We have ample evidence that we do know how to control health costs. Every other advanced country does it better than we do — and Medicaid does it far better than private insurance, and better than Medicare too. It does it by being willing to say no, which lets it extract lower prices and refuse some low-payoff medical procedures.
Ah, but you say, Medicaid patients have trouble finding doctors who’ll take them. Yes, sometimes, although it’s a greatly exaggerated issue. Also, middle-class patients would surely be unhappy if transferred from the open-handedness of Medicare to the penny-pinching of Medicaid.
…. So, I’m not proposing that we turn the whole system into Medicaid any time soon. But what I take from the data is that if and when we feel the need to make tough choices — really, really make tough choices, not use the rhetoric of tough choices to justify what conservatives wanted to do in any case, namely privatize everything in sight — health cost control won’t turn out to be that hard after all.
American Medicare is expensive compared to, say, Canadian Medicare (yes, that’s what they call their system) or the French health care system (which is complicated, but largely single-payer in its essentials); that’s because American-style Medicare is very open-ended, reluctant to say no to paying for medically dubious procedures, and also fails to make use of its pricing power over drugs and other items. So Medicare will have to start saying no; it will have to provide incentives to move away from fee-for-service, and so on and so forth. But such changes would not mean a fundamental change in the way Medicare works.Now, Canadian health care isn’t perfect — but it’s not bad, and Canadians are happier with their system than we are with ours in the United States. So anyone who tells you that Medicare as we know it — a single-payer system that covers everyone over a certain age — is unsustainable is ignoring the clear evidence that other countries somehow manage to make similar systems quite sustainable.
A single payer system is better for patients and better for doctors. Canada spends $1000 less per capita on health care than the U.S., but delivers more care and greater choice for patients.
Canadians patients have an unrestricted choice of doctors and hospitals, and Canadian doctors have a wider choice of practice options than U.S. physicians.
Canadians get more doctor visits and procedures, more hospital days, and even more bone marrow, liver and lung transplants than Americans.
Have you noticed all the poor and homeless with missing teeth? (You will now that I’ve mentioned it.) That’s because in order to “control costs” in 2009, Medicaid (Medi-Cal here in CA) simply eliminated dental services for adults. Don’t worry though – they still pay for the teeth to be pulled before these people die of infection (generally).
[BREDESEN:] Well, um, I certainly don’t want anyone and don’t blame anyone who’s going to die as a result of any of this.
[CRUZ:] Look, Rush, Obamacare, as you know, is the biggest job killer in the country, and the wheels are falling off of this thing.
[CRUZ:] [ObamaCare's] intent is to destroy the private insurance business, to cause people to lose their private health insurance and be forced, essentially, to move to single-payer, government-provided health insurance, which was Nancy Pelosi and Barack Obama’s plan from day one.
[CRUZ:] On January 1st, the subsidies are scheduled to kick in, and President Obama’s strategy is very simple. He wants to get as many Americans as possible addicted to the subsidies, addicted to the sugar, because he knows that in modern times, no major entitlement has ever been implemented and then unwound.
[CLINTON:] I’ll give the President a chance to talk about all the good stuff that’s happened, but I just want you to know one thing. In the last three years, just as we started doing this, inflation in health care costs has dropped to 4 percent for three years in a row for the first time in 50 years. Fifty years. (Applause.) Before that, the costs were going up at three times the rate of inflation for a decade.
Actuaries at the Centers for Medicare and Medicaid Services, who don’t answer to the White House, said yesterday in the journal Health Affairs that costs eased because of the economy, not Obamacare. … The report also contradicts independent economists who had attributed spending reductions more to the Affordable Care Act and changes in the health system, such as shifts in employer benefits. The CMS actuaries, who track medical spending by the government, individuals and insurers, examined 50 years of data and found no evidence of costs deviating much from the economy.
[CLINTON:] But I will close with a story. I told you all this morning that the employee that our health access program lost in the Kenya mall shooting was a Dutch nurse. And we spend a lot of time in the Netherlands; we get a lot of support there. Oxi is one of the biggest insurance companies in Europe. They’re one of our partners here. I went to celebrate their 200th anniversary with them. They started as a fire insurance company with 39 farmers, 200 years ago.
And we were out there in this big farm field in a tent in the shadow of a 13th century church and a big Dutch windmill. And I asked the chairman of the company, I said, do you write health insurance? Because in the Netherlands there’s no Medicare and no Medicaid, everybody is on an individual mandate and you just subsidize people based on their incomes.
Bottom line: The most important point for single payer advocates is that every country with universal coverage has a non-profit insurance system. …. Sickness or social insurance funds do not operate like insurance companies in the U.S.; they don’t market, cherry pick, set premiums or rates paid to providers, determine benefits, earn profits or have investors, etc. In most countries, sickness funds pay physicians and hospitals uniform rates that are negotiated annually (also known as an “all-payer” system). ** Many countries are tinkering with how sickness funds operate (e.g. Germany). The most extreme change is in the Netherlands, which since 2006 has allowed the non-profit regional sickness funds to become for-profit insurance companies, and new insurance companies to form, in the hope that “competition” would control costs. After just one year of experience, the country has experienced 1) a wave of anti-competitive mergers of the insurers 2) emergence of health plans that “cherry pick” the young and healthy and 3) loss of universal coverage and the emergence of 250,000 residents who are uninsured and 4) another 250,000 residents who are behind on their insurance payments. All of the positive data from the Netherlands (on costs, infant mortality, quality, etc) is based on the system pre-2006 (personal communication, Hans Maarse).
[CLINTON:] He said, yes, I write it; we all do. And he looked at me and he said, but we don’t make any money on it. And he said, we shouldn’t. This guy is running a huge — can you imagine somebody saying that in America? (Laughter.) He said, we shouldn’t. If I can’t make money on this business doing traditional insurance business, I’ve got no business in the work. He said, look, health care is a public good and you’ve got to find a way to finance it for everybody. (Applause.) And he said, it’s just an intermediary function that somebody has to handle. But in the end, it’s how it’s delivered, how it’s priced, and how healthy you can keep your people.
[OBAMA:] People generally don’t like to be told you’ve to get health insurance. And employers don’t like to be told you’ve got to give your employees health insurance. But as a society what we cannot do is to say you have no responsibilities whatsoever but you’ve got guaranteed coverage.
[OBAMA:] I can tell you right now that in many states across the country, if you’re say a 27-year-old young woman, don’t have health insurance, you get on that exchange, you’re going to be able to purchase high quality health insurance for less than the cost of your cellphone bill.
So just think about that. Knowing you can offer your family the security of health care –- that’s priceless. And now you can do it for less than your cell phone bill. That’s what change looks like.
Government could mandate Americans to make deposits in or buy bonds or shares issued by financial institutions like Citibank or Goldman Sachs if, because of the next financial crisis, they don’t seem to have enough money. So, there’s plenty of experience to suggest that if the Obamacare mandate is upheld, we could find ourselves entering a strange new world where the word “contract” — traditionally meaning mutual agreement – comes to signify all sorts of things people don’t want to do.
The role of the state is to determine which provider shall collect rents for delivering a service to consumers.***
Democrats point out that Obamacare’s implementation schedule wasn’t an accident. It was purposefully designed to begin in an off-year. That way there would be a year to work out the worst kinks, and by the time of the actual election, Democrats could point to millions of people getting insurance, running ad after ad highlighting constituents who now have coverage. If implementation didn’t begin until October 2014, all voters would know about Obamacare would be the early glitches, as insurance coverage wouldn’t begin until January 1, 2015.
In the latest CNN poll, 54% of respondents opposed Obamacare, but of that group, 16% opposed it because they thought the bill was not liberal enough. There is a core group of progressives who do not like the bill because they feel it did not go far enough, which is, to a degree, hurting the president’s cause.