Our healthcare coverage is the best in the world and it is the most expensive in the industrialized world. Until Medicare, healthcare was unaffordable to most seniors. People were healthy until they died. When they got sick they died. Until comprehensive healthcare plans, with groups, only people working for firms had health care coverage for hospitalization. Medicare and company-sponsored healthcare coverage made doctors wealthy and care did not deteriorate as threatened by the American Medical Association.
1) Medicare is a Single Payer system for seniors, funded through the payroll tax of 1.45% on unlimited income.
2) Every industrialized country in the world has a Single Payer system for all their citizens
3) Healthcare insurance has always been expensive and it is expensive today for employer and employee.
4) There are 267 million non-elderly Americans
a) 56% are covered through their employers and that coverage could range from $16,000 to $30,000 (est) per family. The majority of those covered pay a co-premium of 25% and many have high deductibles. This coverage is not inexpensive and premiums continue to increase
b) 18% are not insured
c) 21% receive coverage through Medicaid and other public programs
d) 6% have individual or family plans, not in groups
5) The ACA/ Obamacare has made coverage available to millions who cannot afford coverage
6) The ACA eliminated many so-called “cheaper” plans that had caps on coverage, exclusions for certain care and tests, and excluded people with pre-existing conditions. Many of the replaced plans were “inadequate” plans with fine print exclusions, of which, many policy owners were totally unaware of the contract limitations and the consequences.
7) Before the ACA, health care insurance premiums were going up at 2-3 times inflation each year. Since the ACA, health care costs experienced the lowest increase in 50 years since the passage of Medicare and Medicaid (1965).
8) Blue Cross and Blue Shield developed from 1929 through the 1940s. It covered Medical and Doctor related costs in a hospital. These group plans faced bankruptcy when in the 1980s, when they were left with covering the most vulnerable citizens. Individuals were always able to buy Blue Cross/Shield catastrophic care. The emergence of HMOs and PPOs doomed the old Blue Cross coverage options.
9) There was never coverage under Blue Cross for receiving a doctor at home or at his/her office
10) In the 1980’s comprehensive group plans became offered which covered Doctor’s within a certain designated plan-(HMOs, PPOs Oxford, Aetna, Humana, etc.) drug prescriptions and co-pays were added. One could also see a Doctor outside “network” and eventually, co-premiums for these company-sponsored plans were instituted to share the burden of coast from employer to employee. Also, as costs continue to rise for health care and health insurance, deductibles were offered. Many people have high deductibles (basically self-insuring up to a certain dollar amount) to keep the premium as low as possible. These plans caused the re-structuring of all the Blue Cross plans.
What is happening today:
A. The ACA or Obamacare provided health insurance for over 23 million Americans
B. Health care expenses are the single greatest cause of bankruptcy in America and in the industrialized world, where a Single Payer system (Medicare for all) exists in Japan, Israel, Canada and Western Europe, there are no healthcare caused bankruptcies. There have been many estimates on bankruptcies caused by medical expenses. One figure published is 643,000 in 2013. That number has declined because of the ACA and this figure has been basically justified by SNOPES.
C. The above number is broken down in the following age groups:
1. Below 25 2.3%
2. 26-34 18.7%
3. 34-44 29%
4. 45-54 26%
5. 55-64 15.8%
6. Over 65 8% (On Medicare)
What are the Options:
A. Continue with the ACA, make sure it is properly funded, and force the 19 Red States with Republican governors to have Medicaid recipients have access to the plans, creating a larger pool of younger people. Put pressure or incentives on insurance companies to remain I states where there is one carrier.
B. Have an alternate plan like the one just defeated in the House of Representatives, which was not properly funded, eliminated many benefits, would cause the loss of insurance to initially 14 million people, created tax incentives for folks who barely paid taxes and favored the well-off. Basically it went back to the period before the passage of the ACA. But with its provisions to limit pre-natal care along with other services, its passage would have definitely threatened the benefits currently offered in company sponsored health insurance plans, now serving 56% of the population.
C. Single Payer (Medicare for all). This plan would have to be first funded by the government and initially supplemented by a period of taxation on every American before it could be instituted. Unlike Medicare, which is funded by payroll taxes on every working America above the age of 18 until age 65, the government would have to create a “pool of money” to service people immediately when it came into service, replacing one’s current form of health insurance.
The Consequences of the Single Payer:
A. The health insurance company premiums would disappear. Employers would no longer have to offer insurance to their employees and pay 75% of the costs of between $16K and $30K (est) for each employee. This would save the employers hundreds of billions of dollars and make them more competitive with foreign companies and corporations. Employees could possibly benefit from not costing their employer between $12K and $22.5K (est) per year, and receive increased compensation.
B. The employee would not pay the co-premium of $4-$7.5K (est.) each year with a deductible ($200-$2,000 est.) The employee would be paying an increased payroll tax for each member of his/her family. It would increase when each child is added to a family. In most cases the costs for the employee would be much lower than the current combination of payroll taxes and co-premiums. Today a person pays a payroll tax of 1.45% of their gross income. An individual pays $725 on $50,000 and a family with a household income of $150,000 would pay $2,175 plus a $4000 co-premium with a $1,000 deductible. Therefore the average family pays out over $7,000 before they even see a doctor.
C. Therefore the payroll tax would go up significantly and people could also buy a “private” supplemental plan, in the same way people buy a Medicare supplemental plan, for Doctors who wish to be outside of the Single Payer system.
D. There are Doctors who do not except any private insurance plan or Medicare. The patient can seek re-imbursement (pre-waiver) from their private or group plan and in certain circumstances a person on Medicare, needing healthcare services from a provider that doesn’t accept Medicare, can get permission for a re-imbursement.
E. Doctor’s office would save considerable money regarding billing- one reimbursement like Medicare.
F. The bottom line is that health care expenses would be flattened, corporate expenses would be drastically lowered, health care would be for all Americans, healthcare costs for the average American would be the same, the pool of insured would expand greatly, especially with young adults who don’t need much care. There would be a need for more health care professionals: Doctors, Nurses, and PAs. There would be the end of healthcare insurance companies, their profits and overhead, unemployment would increase with these workers, but more Doctor’s office would open up and many of these people would be employed in that part of the private sector. People would pay a lot less over their working lifetime – 18 through 65.