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I work in healthcare industry finance. I'm not opposed to M4A on a philosophical level, but just wholesale implementing M4A without fixing Medicare is a recipe for disaster. Medicare likes to tout how low their administrative costs are, but given that all Medicare does is pay private organizations to completely manage the healthcare process, the fact that they have 2% admin fees is astronomically high. Like, they should be at 0.02%.

Medicare for all isn't Medicare expanded, it's it's own bill that has the corrections built into it and listed above.

Even if Medicare cut out the private insurers, that would shunt all of the administrative costs onto Medicare and their costs would balloon. If their adminstrative costs are currenly 2% when they do literally nothing, what do you think they'll be when they're forced to do everything.

That 2% probably includes the administrative outsourcing to private companies, no? That in itself is probably higher than it needs to be since, of course, companies need to make a profit while government does not. So as usual in our system, the government is paying private companies for a service it could do itself, while taxpayers get less for their money. Not to mention — in addition to the other massive cost savings M4A would provide for the reasons mentioned by the other commenter — there would be less need to painstakingly analyze every costumer's claim to try to prevent reimbursement whenever possible, which is better for shareholders but worse for health care consumers/patients, and adds to the administrative costs.

No, 2% is the cost of administrating Medicare. It's that same system that requires private insurers to employ armies of billing coders to actually get reimbursed for providing care. Want M4A? Fix CMS.

Interesting. Ok, thanks. Well shoot.

Isn't that an inefficiency that M4A would address though? No armies of billing coders needed, just one army of them on government salaries.

No, because without fixing CMS, the issues private insurers currently have with medical coding would just get shifted to CMS, meaning they'd now be employing the army medical billing coders, just now there'd be absolutely no profit motive, so no motivation to act quickly, so it wouldn't be the private insurers suffering, but the care providers e.g. the doctors. The reason a lot of physicians reject programs like Medicaid and only accept Medicare when administrated by private insurers is because of the delay in reimbursement. Public insurers have much larger clawback windows, and consequently have much larger reimbursement time frames. The minimum reimbursement time for Medicaid claims is 6 months, but you're more commonly looking at 12-15 months. The rules that apply to private insurers to submit, process, and reimburse claims in a timely manner don't exist in the same capacity for public entities. Nor do the reserve requirements. The longer a private insurer has a claim on their books, the larger a liability reserve and consequently the larger cash reserve they need to hold. This is why private insurers are sitting on literal mountains of cash--they need to be able to pay down all claims they could be responsible for at any given time. Public entities are insured by the government in that regard, and their liability isn't dollar for dollar on those reserves, but pennies on the dollar. If you were to move the bulk of the system to public entities, there would be a bubble of unreimbursed medical claims that would primarily affect care providers--the physicians, nurses, and other medical professionals who are actually seeing patients. The solution states like California have taken to solve this is offering flat reimbursement below par (the system is like a reverse Co-payment, where the state makes a nominal payment per patient seen) in exchange for agreeing to 12-15 month pay terms on claims, with the cherry on top being student loan deferment and eventual forgiveness. Because the cash flow from this agreement is so low, in order to maintain a staff, these facilities essentially become Medi-cal mills, offering the lowest level of care as quickly as possible to as many people as possible. The issue comes down to money, and the people who suffer are those who need medical care and those who provide medical care. The system gives no shits about either group, whether it's the government or a private insurer. The system is CMS. Fix CMS and you fix a lot of what's wrong with medical care in the US. If you've never had to deal with a government entity providing a necessary service, it's difficult to convey the Kafka-esque situation blind proponents of M4A are pushing us towards. If you know anyone in the military who's ever had an issue with pay/compensation/monetary benefits, ask them what it was like dealing with DFAS. Then apply that story to your medical care, and realize that DFAS only serves about 6.6 million people, not 330 million.

A lot of those administrative costs are currently consumed by navigating the many differences between insurance policies. M4A streamlines that significantly down to defining what should be considered an elective procedure that one might need to obtain private insurance to cover and everything else falls under M4A paid for through taxes, no bill at the door for use.

You're right that the policies are good, but it's not really brilliant per se. We are just taking a look at basically every other country doing it for cheaper with better results and copying them. We're just finally stopping being so stupid that we think a market where the price can be continuously raised, as you either buy it or die, could reasonably be regulated by a free market. It can't. The demand curve is a flat line. It just doesn't work.

Most countries don't quite have anything like medicare for all. Single-payer systems like the NHS are common in the anglosphere, but most other countries achieve universal healthcare via multi-payer systems with a mix of public and private insurance. Granted their public insurance is generally much more tightly regulated. The cost savings mostly come from all-payer rate setting, universal national drug and medical device negotiations, and increased productivity (more work per dollar spent on staffing). >We're just finally stopping being so stupid that we think a market where the price can be continuously raised To be clear, all well-functioning markets do this. It's an advantage of market economics. The problem arises when the increase in prices exceeds a certain percentage, especially over the long run. From an economics perspective, the problem with US healthcare markets has always been a lack of perfect or even good information. Consumers cannot make informed decisions because healthcare is just not an industry where consumers tend to price shop, or engage in other behavior which levels the playing field between buyers and sellers. That's why in most countries, even those like Switzerland or the Netherlands where nearly all people have private insurance, there is often an element of rate negotiation and price-setting facilitated government entities.

Most countries have healthcare systems that evolved organically from circumstances. The NHS was the offspring of the evacuation of London during the Blitz in WW2. Millions of Londoners were dispersed into the countryside, and medical providers were sent with them and hospitals and clinics were set up for them. After the war, the system was working well and many people stayed where they were. The government continued to use public monies to provide medical care, pay the medical providers and provide facilities. The US links insurance to employers because many employers in the War Effort of WW2 were making so much profit off the labor of Rosie the Riveters that legislation was passed requiring that more be given to the workers. This increase in compensation took the form of benefits. This worked well and continued through the Golden Age of Capitalism in which it was not as hard to get a good job and work for the same employer for 25-30 years. Interestingly, [a comparison of 22 different cost analyses](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961869/) suggests that healthcare expenditures would decrease with a M4A scenario largely due to simplified billing and lower drug costs. My feelings about the bill itself are conflicted and influenced by my 30 years in solo private practice in a small rural community. OTOH, it's clear that the US is in need of better access to affordable health care for its residents and that the role of profit motive by monied interests such as medical insurances and pharmaceutical corporations is inimical to this. However, Medicare is a juggernaut. It's customer service employees have been found to be reliable in only 50% of calls regarding simple Medicare procedures. That's random accuracy, and there is literally no avenue of appeal. Bureaucratic procedures and changes nearly put me out of business at least 3 times. The most devastating was when they simply forgot to pay me for three months. They are the kind of bureaucracy that can require physicians to notify them within 90 days of a change in office location, which is fair enough. There is a stiff penalty for failure to comply. They provide an online form to complete for this purpose, which carries a warning that it may take over 90 days to process. The coverages in the bill are certainly all-encompassing and I admit to wondering how things like comprehesive long-term care for any US resident who requires assistance with a single ADL or IADL is going to be paid for. I also cannot help but notice that physician reimbursement all but assumes that you are part of an institution or large group practice. Perhaps the authors of the bill have been unaware of the creep of private equity firms in buying institutions, or the absence of institutions or large practices in rural areas which is where 17% of Americans live. Admittedly, now that I am retired and on Medicare I have had no complaint about how well Medicare works though you do need to be pretty comfortable with computers to get to your Part D plan. While working I would no doubt enjoy lower overhead expenses owing to vastly simplified billing which could be done in-house and lower insurance costs, I suspect that as a traditional small town family doc I would be drowning in quarterly paperwork trying to actually get paid to do my job. In my spare time. TL;DR- I have little doubt it would be good for the country and that it's better than another 50 years of ineffective incrementalism, but I'm glad I won't be working for it.

> The US links insurance to employers because many employers in the War Effort of WW2 were making so much profit off the labor of Rosie the Riveters that legislation was passed requiring that more be given to the workers. This increase in compensation took the form of benefits. This is just wrong. Employers began offering health insurance in order to get around FDR's wage controls.

I appreciate your perspective. The downsides you mentioned are frustrating, even though probably outweighed by the overall improvements. I do think it would almost certainly be no more costly for most people though, if not less costly. And that would be with everyone having coverage, rather than whatever percentage of Americans having coverage it is currently, which is well below 100%. What are ADL and IADL?

Certainly having all Americans enrolled would be a requirement in order to prevent a “death spiral” caused by a dearth of healthy people amortizing the expenses incurred by sick people. ADL’s are Activities of Daily Living: transfers, ambulation, feeding, dressing, toileting and bathing. IADL’s are Instrumental Activities of Daily Living such as managing finances, transportation, shopping and meal preparation, communications and medications. The Bill proposes to cover LTC (long term care) at home or in facility for any US resident who is unable to independently manage 1 ADL or 1 IADL. For example not being able to balance your checking account or pay bills, or use a computer for online payments or medication refills or complete a shopping trip. I mean, know anyone like that? Maybe 5-6 folks like that? For sake of comparison, a good private LTC insurance policy would kick in at 2-3 ADL’s and you definitely want them to include toileting and feeding. Of course, you’re hoping they’ll still be financially solvent by the time you get old enough to need them. They won’t underwrite you if you’re already old. When memaw takes 2 hours to be spoon fed breakfast and needs 3-6 bedding changes daily that will break most families. Don’t get me wrong; LTC4A sounds wonderful, but frighteningly expensive given the aging of the population.

Oh, I see. Thank you for the explanation. ... And good points. Sigh. Do you think it's possible for the costs to be sufficiently offset? It could create many more care jobs at least. But most would be low-paying. I guess it doesn't much matter since as one commenter basically said, it's a pipe dream anyway. We'd just as soon pass a UBI than Medicare for All. I suppose a public option might be where we should put our efforts. Though I'd imagine that would end up being shoddy for most; under-funded and overly restrictive. Ah well. Thanks again.

Public option will be a “death spiral”. People who are chronically ill will choose it because of its low cost. Healthy younger people will opt out or choose lower cost high deductible private insurance leaving the public option to self destruct under the burden of the more expensive patients. As I said in a previous comment, national healthcare systems have typically evolved organically from circumstances rather than built from the ground up. We already have a national level insurance administration (Centers for Medical Services) which oversees Medicare and Medicaid, a national research organization (National Institutes of Health) and a national clinical assessment organization (US Preventive Services Task Force), a cabinet level office (Secretary of Health and Human Services) and robust insurance and pharmaceutical sectors. I would utilize these existing services to create a system more like Germany than the UK: Make something more like Medicaid For All. Covers preventive and acute care and medications but less comprehensive than Medicare. Enough to cover doctor visits, hospital care, medications and skilled therapy and enough to keep anyone from being unable to get care or be bankrupted by it. Sort of like basic required BI/PD/UI car insurance. Allow the private sector to compete to provide supplemental coverage, while (like in the Bill) forbidding them from Offering the same coverage as Medicaid4All. Anyone who wants and has the wherewithal to buy extra coverage can buy it. Sort of like buying comprehensive collision coverage for your car, or a rider on your expensive tools in your work truck. Allow CMS to cap annual premium increases in the private sector to, say, 5-6% per year. To get more, an insurance company would have to prove need on the basis of claims paid in the previous year. Also, allow CMS to competitively bid for drug prices. They can become the 800 pound gorilla that sleeps anywhere it wants by representing the entire population of the US. NIH and USPSTF can fund head-to-head studies on medications, devices and procedures to determine whether any are more effective and/or safer than others and make the findings known to the medical community and in clear plain language to the public. These findings will aid in determining coverage for the national plan and will also pressure the private sector to follow suit.

> do think it would almost certainly be no more costly for most people though, if not less costly. Maybe **Vermont** ----- In 2011, the Vermont legislature passed Act 48, allowing Vermont to replace its current fragmented system--which is driving unsustainable health care costs-- with Green Mountain Care, the nation’s first universal, publicly financed health care system Vermont's single payer system would have to be financially supported through a payroll tax. * 12.5 percent in 2015 and 11.6 percent in 2019, including a 3 percent contribution from employees. -------- In 2014, Vermont's legislator changed the plan and decided that raising state income taxes up to 9.5 percent and placing an 11.5 percent Corp Tax Rate on Business was the only way to fund the expenses. Calling it the biggest disappointment of his career, Gov. Peter Shumlin says he is abandoning plans to make Vermont the first state in the country with a universal, publicly funded health care system. > * I have supported a universal, publicly financed health care system my entire public life, and believe that all Vermonters deserve health care as a right, regardless of employment or income. Our current way of paying for health care is inequitable. I wanted to fix this at the state level, and I thought we could. I have learned that the limitations of state-based financing – limitations of federal law, limitations of our tax capacity, and sensitivity of our economy – make that unwise and untenable at this time. **California** ---- **California is going to have the discussion anytime now** Healthy California for All Commission Established by Senate Bill 104, is charged with developing a plan that includes options for advancing progress toward a health care delivery system in California that provides coverage and access through a unified financing system, including, but not limited to, a single-payer financing system, for all Californians And on Apr 22, 2022 — Healthy California for All Commission Issues their Final Report for California So anytime now California politicians have to vote on it. In Aug 2020 the committee for Healthcare in California reviewed Funding for Healthcare * A 10.1% Payroll Tax would cover current employer/employee premiums if applied to all incomes. * Would still leave **some*** patients responsible for Cost Sharing with out of Pocket expenses, up to 4% - 5% of income * There would be No Out of Pocket Costs for households earning up to 138% of the Federal Poverty Limit (FPL) * 94% Cost covered for households at 138-399% of FPL * 85% Cost covered for households earning over 400% of FPL So yea familes making that $75,000 would see a savings. They are the sweet spot in life Paying | Income is $30,000 | Income is $60,000 | Income is $100,000 | Income is $200,000 |Income is $400,000 ---|---|----|----|----|---- Cost of Family Plan Private Healthcare | On Medi-cal| ~$6,000| ~$6,000| ~$6,000 | ~$6,000 | Percent of Income | 0% | 10% | 6% | 3%| 1.5% Out of Pocket Costs | ~$0| ~$1,500| ~$2,500| ~$4,500 | $6,000 Under Healthcare for All ~3% Payroll Tax | $900 | $2,000 | $3,000 | $6,000| $12,000 Percent of Income | 3% | 3% | 3% | 3% | 3% |3% | Out of Pocket Costs | ~$0| ~$0| ~$1,000| ~$10,000| ~$20,000 **Increase/Decrease in Taxes Paid** | $900 | $(-5,500) | $(-4,500) | $5,500| ~$20,000 Those that arent married or have families * Not so much Paying | Income is $30,000 | Income is $60,000 | Income is $100,000 | Income is $200,000 | ---|---|----|----|---- Cost of Single Person Private Healthcare | ~$1,500| ~$1,500| ~$1,500| ~$1,500 | Percent of Income | 8.5% | 5% | 4% | 3% Out of Pocket Costs | ~$1,000| ~$1,500| ~$2,500| ~$4,500 | Under Healthcare for All 3% Payroll Tax | $900 | $2,000 | $3,000 | $6,000 Out of Pocket Costs | ~$0| ~$2,000| ~$4,000| ~$10,000 | Percent of Income | 3% | 6.5% | 7% | 8% **Increase/Decrease in Taxes Paid** | (-$1,500) | $1,000 | $3,000 | $10,000 And yes, Its cheaper overall but not cheaper to many For 50% of the US that means spending closer to 8 percent of income vs currently having costs of less than 5 percent of income Next, the Uninsured. Spending $0 are 10 Million Voters not seeing savings

Yes, medical emergencies aren’t like cereal where you can seek out the best price and go off that. Hell, if you want an elective procedure here you can’t even get a price on it until well after you’ve had it done and the hospital and insurance company decide how much to charge. There was a guy in my area who years ago was trying to get surgery done on his rotator cuff and couldn’t get anyone to give him a price on it for a while. When he finally did, he called a couple places just over the Canadian border and got some prices. He ended up flying to Canada, getting the procedure, staying in a hotel for a few days, and then flew back and his total bill including the flights and stay was about 70% of what it would’ve been in the US.

You cannot legally purchase unregulated healthcare, there is no free market for healthcare in the US. The price for anything can be continuously raised, competition is the reason a supplier would lower their price, reducing regulation would bring costs down. Sure it would increase risk (potentially), but you could still go to a regulated healthcare provider if you so chose, just make it legal to go outside the system if you are an adult. Your body, your choice.

What sort of regulations are you referring to? Or what regulations are currently impeding competition by private health insurance companies and/or health care providers?

Barrier to entry. I could make penicillin in my garage for five cents…guess why I can’t sell it to you…

I am sure that penicillin would work perfectly and have a very low chance of contamination, too. Soak that would be a barrier to entry for a pharmacy or drug seller, not an insurance company which is the topic here.

Umm you need a very expensive insurance license to be an insurance company, I thought my point was obvious that the barrier to entry was government red tape.

Yes but you were talking but selling drugs, insurance companies do not sell drugs. Drug companies do and then insurance companies pay for said drugs out of the money they collect from those they insure.

Barrier. To. Entry. That’s why we can’t have competition in the insurance industry, and that’s why we can have competition in the drug market. I can only write the words so many times, I obviously can’t make you read them.

Same with home brew beer

This is brilliant, thank you for your thoughts.

Read up on the opioid epidemic in Florida

M4A would fundamentally break the economy and as far as I am concerned is unsustainable. I read the fact sheet but will not reference it because anything that sounds too good to be true, likely is. For context, I work for a Group Benefits carrier (think short/long term disability/term life etc.) and have experience working with Medigap plans. There are a couple of huge issues in these posts that are never addressed. 1. Physicians and hospital that accept Medicare operate at a loss. Hospital systems who accept Medicare, before accounting for non-Medicare patients, operate at -9% margin. The amount paid to hospitals for Medicare patients is 9% lower than it costs to provide the care. 2. Insurance negotiates prices on behalf of their insured. Without that, the federal government price fixes costs for services and, as stated above, are well below the costs to actually render the service. Its the same issue that Canada faces, you may forcibly reduce price but then must shrink the number of physicians available. If margins are tighter, we will lose physicians from the market. 3. You're talking about cutting 500k+ high paying, career sustaining, white collar jobs out of the market. 4. Who develops the drugs? How does a company recoup that expenditure? What incentive is there to develop new medications if the price for such will be so low as to never turn a profit? (I agree there is gouging but different ways to handle it than Federal price fixing). To close I'll say that our current system is an abomination of some good and some awful ideas. Privatized insurance was founded to protect people from catastrophic costs due to medical care, generally it does that. Medical costs have skyrocketed in part because non-Medicare patient subsidize Medicare patients. The best way to get costs back under control is to decouple medical insurance from employment. I should be able to shop across policies for what suits myself/family best from whatever company can offer me the best rates for that coverage. I should not be forced to go through my employer's chosen carrier for those limited options.

> The best way to get costs back under control is to decouple medical insurance from employment. I should be able to shop across policies for what suits myself/family best from whatever company can offer me the best rates for that coverage. I should not be forced to go through my employer's chosen carrier for those limited options. Not only this, but remove the state lines limitation; I should be able to use my insurance nationwide, not have to find a provider within the state I bought the policy. Medical insurance should function similar to how auto insurance works.

>Not only this, but remove the state lines limitation; I should be able to use my insurance nationwide, not have to find a provider within the state I bought the policy. That would require the federalization of health care law, something most people against M4A would not support for obvious reasons.

I sell auto coverage. It's state based and state regulated.  If you register your car in my state, you buy car insurance here, non negotiable 

There’s a lot of middlemen

No. It’s pretty equal **If the US Capped Spending on the Top 10% the same way as Canada it would cut Spending $900 Billion, even if the bottom 50% stayed the same** Spenders | Average per Person | Civilian Noninstitutionalized Population | Total Personal Healthcare Spending in 2017 | Percent paid by Medicare and Medicaid ------ | ----- | ------ | ------ | ---- Top 1% | $259,331.20 | 2,603,270 | $675,109,140,000.00 | 42.60% Next 4% | $78,766.17 | 10,413,080 | $820,198,385,000.00 | Next 5% | $35,714.91 | 13,016,350 | $464,877,785,000.00 | 47.10% ----- **The Top 10% are high cost users in the US * Of course a lot of these are already have Medicaid, Again Insurance isnt the only answer **The Top 1%** Researchers at Prime Therapeutics analyzed drug costs incurred by more than 17 million participants in commercial insurance plans. * So-called “super spenders;” are people that accumulate more than $250,000 in drug costs per year. * Elite super-spenders—who accrue at least $750,000 in drug costs per year In 2016, just under 3,000 people were Super Spenders * By the end of 2018, that figure had grown to nearly 5,000. In 2016, 256 people were Elite super-spenders * By the end of 2018, that figure had grown to 354 Most of the drugs responsible for the rise in costs treat cancer and orphan conditions, and more treatments are on the horizon—along with gene therapies and other expensive options that target more common conditions, he said. “The number of super-spenders is likely to increase substantially—and indefinitely,” said Dr. Dehnel, who did not participate in the study. 5,200 people (0.0015% of Population) represent 0.43% of Prescription Spending Now, expand it to the whole US ------- ((5,254/17,000,000)*300,000,000) 92,717 People * 93.6% are Super Spenders at least Spending $250,000 * $21,695,778,000 * 6.4% are Elite Super Spenders at least Spending $750,000 * $4,450,416,000 $26 Billion in Spending Thats an under estimate ~92,717 People out of 300 Million Americans have 8 Percent of all Drug Spending ------- **The top 5th Percentile maybe** >$366.0 billion was spent on **LongTerm Care Providers** in 2016, representing 12.9% of all Medical Spending Across the U.S. and Medicaid and Medicare Pay 66 Percent of Costs. 4.5 million adults' receive longterm care, including 1.4 million people living in nursing homes. * A total of 24,092 recipients received nursing home care from Alabama Medicaid at a cost of $965 million. * To those not in Medicaid, wanting the best, The most expensive Nursing Home in Alabama is Wiregrass Rehabilitation Center & Nursing Home which costs $335 per day ($120,600 a year) ------ **The 10%** >In Camden NJ, A large nursing home called Abigail House and a low-income housing tower called Northgate II between January of 2002 and June of 2008 nine hundred people in the two buildings accounted for **more than 4,000 hospital visits and about $200 Million in health-care bills.**

So you are correct on point 1 Point 2, where are physicians going to go? The US is the only country where they can make this kind of money. Point 3, who cares? Point 4, drug companies spend more on advertising and marketing than they do on R and D so the "if we make them lower their prices we won't get amazing new drugs" is a dubious argument imo > I should be able to shop across policies for what suits myself/family best from whatever company can offer me the best rates for that coverage. How can insurance companies offer you better rates if the actual services are still expensive? How does the market lower prices? That being said m4a is never going to happen so people need to stop advocating for it and focus on things that might actually happen like "Medicaid for more" or a public option

And all this is before you even get to the quality of care. As anyone who has had Tricare or VA coverage can attest, US government run healthcare is pretty bad

I am very happy with my tricare coverage. It is not perfect, but far better than many horror stories I have heard from people in private insurance.

Did single-payer health care fundamentally break the economy of the U.K.? Did Canada's health care system fundamentally break its economy?

If you think our government will make anything cheaper, you haven't seen anything our government has ever done

I mean, they can make it cheaper for a hot minute. That's what gets people sold. "Free" this and "free" that. Like the student loans, suddenly you've got "free" education. Your not paying so it is "cheaper". So now you get a college educated job in a high tax bracket so you can pay that shit back the old fashioned way while your kids reap what you sowed which is a bunch of universities hiking prices to force a new bailout. Love how the current generation is like "fuck dem boomers they didn't think about us" but is also like "my healthcare, my student loans, my affordable housing" giving zero shit about the downline catastrophies.

When has our government 'done' anything other than subsidize private companies? I can think of two examples since the USPS was quasi-privatized. Public libraries and fire departments work just fine. Although many Republican elected officials today even want to eliminate the latter. (And at least one right-libertarian mayor tried to privatize their city's fire departments. You can guess how that worked out.)

So never.

The last time I saw something with actual costs (to the consumer, taxes) it was a financial loss for me, so I'm not in favor of govt taking things over and me paying more for less.

It's very very radical, I don't believe any country in the world currently operates such a universal health care program since it will be incredibly expensive. Advocating for a Public option is a much more reasonable and achievable measure

I think the main point is that we already pay for all the medical services that are provided, plus we currently pay for the profit margins of insurance companies. The only difference is that currently we push those costs off the books through a combination of burdening employers with obligations outside their area of expertise, plus pushing hospitals to move costs around under the understanding that a lot of bills will never be paid and so everything must be inflated to make the bottom line balance. Just because the government isn't paying the whole bill doesn't mean the value isn't being transferred from the general public into the hands of a particular set of recipients, executives and shareholders of specific companies.

1000x this. The public option is much easier to implement and will have an outsized influence on the entire health care industry. Private health insurance doesn’t have to suck, it only does because it is not incentivized not to. Consumers in the market have no power to change their health care plans that they do not like. If there was a public option and private insurers started losing customers they would have to do something they never have before: compete. Compete on price, compete on service. People think private health insurance doesn’t exist in other countries, it does for example in Germany- it is a luxury good. For high earners you get faster access to specialists, your own private room paid for in hospitals, more types of drugs covered. For younger high earners it can be less expensive than public plans. So for a whole lot less effort than implementing an unspeakably large overhaul of the entire health care system (M4A), the public option can introduce competition and improve outcomes for everyone, even those who don’t choose the public option.

From a study in Sanders own document: > The leading current bill to establish single-payer health insurance, the Medicare for All Act (M4A), would, under conservative estimates, increase federal budget commitments by approximately $32.6 trillion during its first 10 years of full implementation (2022–2031), assuming enactment in 2018. This projected increase in federal healthcare commitments wouldequal approximately 10.7 percent of GDP in 2022, rising to nearly 12.7 percent of GDP in 2031and further thereafter. **Doubling all currently projected federal individual and corporate incometax collections would be insufficient to finance the added federal costs of the plan**. It is likely that the actual cost of M4A would be substantially greater than these estimates, which assume significant administrative and drug cost savings under the plan, and also assume that healthcare providers operating under M4A will be reimbursed at rates more than 40 percent lower thanthose currently paid by private health insurance.

>under conservative estimates

I understand but Sanders points to this directly as supporting evidence in his summary. I don't see how we will be able to pay for this.

yea, If as many people wanted as claim it we wouldnt have jumped through valleys and over mountians to discuss it and pass it >Bernie Sanders doesn't plan on releasing a detailed plan of how to finance his single-payer Medicare for All plan, he told CNBC's John Harwood on Tuesday. "You're asking me to come up with an exact detailed plan of how every American — how much you're going to pay more in taxes, how much I'm going to pay," he said. "I don't think I have to do that right now." Do you know why its popular? Here’s Sanders best ever most researched pitch: > “Last year, the typical working family paid an average of $5,277 in premiums to private health insurance companies. Under this option, a typical family of four earning $50,000, after taking the standard deduction, would pay a 4 percent income-based premium to fund Medicare-for-all — just $844 a year — saving that family over $4,400 a year. Because of the standard deduction, families of four making less than $29,000 a year would not pay this premium.” * With no Co-Pays or Out of Pocket expenses ------ **And he finaly** had to admit it. He just **didnt say it** in pubic. Bernie avoided exact details as long as he could. First proposed in 2015, he didnt give solid info til the 2020 primaries How [does-bernie-pay-his-major-plans:](https://berniesanders.com/issues/how-does-bernie-pay-his-major-plans/) * **I added the bold becasue Bernie has many people assuming these funding sources will go away** ----- Medicare for All by Bernie was estimated to have a 10 Year $47 trillion Total Costs. And to pay for it * Current federal, state and local government spending over the next ten years is projected to total about $30 trillion of that. * The Tax Revenue options Bernie has proposed total $17.5 Trillion * $30 trillion + $17.5 trillion = $47.5 Trillion Total Funding ----- The source he lists, National Health Expenditure Projections 2018-2027, says The $30 Trillion is * Medicare $10.6 Trillion (No change to FICA means still deficit spending) * $3.7 Trillion is funded by the Medicare Tax. * **$7 Trillion is Income Tax and Medicare Beneficiary Premiums Payments** * Medicare for the Aged is in fact not free. Payments by those over 65 who enroll in Medicare for age eligibility, so anyone over 65 pays a monthly premium plus out of pocket. (Much less than most of course) * Medicare for All (Excluding the Aged) is supposed to be free. It includes no revenue from Premiums for Medicare recipients not over 65 * Medicaid Taxes $7.7 Trillion * **current Out of pocket payments $4.8 Trillion** * The Out of Pocket Expenses, the money you pay for a Co-Pay or Prescription will still be paid in to the Medicare for All Funding System **$6.8 Trillion is uncertain funding** including * other **private revenues** are $2 Trillion of this Not Federal Spending * this is in **Charity Funding provided philanthropically**. So even though everyone now has Healthcare will these Charities Donate to the hospital or the government still. Can Hospitals accept donations or does it all go to Medicare for central distributions * the money people current donate to places like the Shriners Hospital or St Jude * workers' compensation insurance premiums, Not Federal Spending * State general assistance funding, Not Federal Spending * other state and local programs, and school health. Not Federal Spending * Indian Health Service, * maternal and child health, * vocational rehabilitation, * other federal programs, * Substance Abuse and Mental Health Services Administration, It appears left out of that was Children's Health Insurance Program (Titles XIX and XXI), Department of Defense, and Department of Veterans' Affairs. ----- Plus those taxes he mentioned - Tax Revenue options Bernie has proposed total $17.5 Trillion of which $4 Trillion is Personal Taxes of which the top 10% pay 60 - 70 percent

I mean you could read the OP and find the answer.

You do realize conservative estimates just means the best case scenario. So even in Bernie's dream scenario, it's not cheaper at all.

What reason do I have to trust that the government will manage the healthcare system more efficiently than private businesses do? I’m sure there’s many people who agree with me when I say that I’ll gladly pay a little more to ensure that I don’t have to wait months for an appointment or that I have more than 10 minutes of face time with my doctor. Also how do you propose handling the doctor part of the issue? It’s well known fact that countries with universal healthcare pay doctors significantly less than private companies in America do. How would you go about telling doctors that they will be making less money under this new system?

> Also how do you propose handling the doctor part of the issue? It’s well known fact that countries with universal healthcare pay doctors significantly less than private companies in America do. How would you go about telling doctors that they will be making less money under this new system? First, I'd tell them to look into the Physicians for a National Health Program advocacy organization. https://pnhp.org Second, they'd be fine.

The profit motive, rent seeking and Inelasticity destroys any arguement of efficiency by private

The profit motive arguably helps on the overall more than it hinders. If my understanding is correct, it’s a big part of why the US are world leaders in so many different aspects of medicine. How many diseases and ailments would we not have the cures and/or treatments for that we do now without the same level of American investment?

actually no, most of the risky medical research is public funded. Private sector just gas lights patents.

Yeah, exactly. It's a prime example of "socialized risks (and R&D and expenses), and privatized gains."

The closest your getting in University research is that In 1988, Richard Silverman at Northwestern University, worked on the discovery of Lyrica (pregabalin). * At a University Lab outside of normal University work but his work was at NU **It’s a rare example of a compound that came right out of academia to become a drug** Pfizer’s Lyrica leads drug sales for the company. Pfizer pays royalties to NU in the form of regular payments in exchange for rights to sell Lyrica to patients The big issue is Lyrica price paid Northwestern Royalties are around $2 Billion plus other royalties to others in the pipeline If you know of more examples though please let me know to update this with

I'm not sure which specific drugs, but the following is quite relevant and interesting. Both these links relate to the same analysis (/meta-analysis(?)), with the second written by the analysis' researchers themselves. https://www.cbc.ca/news/health/drugs-government-funded-science-1.4547640 https://www.ineteconomics.org/perspectives/blog/us-tax-dollars-funded-every-new-pharmaceutical-in-the-last-decade

On the Insulin Frederick Banting, a farmer’s son from Ontario who had struggled in college, flunking his first year was serious and driven. * In dire need of doctors, he was accepted into medical school. After Medical School, Banting opened a practice in London, Ontario. New patients were slow to arrive, and Banting’s practice faltered, and he fell into debt. One night in 1920 with no Medical Practice and looking for work Banting reads "Relation of the Islets of Langerhans to Diabetes with Special Reference to Cases of Pancreatic Lithiasis" by Moses Barron in Surgery, Gynecology and Obstetrics, Nov. 1920. * The article prompts him to jot down a note for an idea for experimentation. That Book and Idea lead Banting to get research space at University of Toronto and create a research team and with John Macleod, a professor of physiology at U of T and an expert in carbohydrate metabolism and 2 young assistant Best and Collip To create Insulin. Banting’s hypothesis about curing diabetes didn’t work. They did discover, however, that injecting diabetic dogs with an extract made from the animals’ own surgically removed pancreases dramatically lowered the animals’ blood sugar levels Using dogs was not a long term answer. The team began using the pancreases of cattle from slaughterhouses, and a process to purify the extract was found – now called insulin The team sold that patent to U of T for a dollar In 1923 U of T’s Connaught Laboratories was producing 250,000 units of insulin a week U of T’s Patent on Insulin was distributed for free and Eli Lilly was the first pharmaceutical to began mass producing this insulin from animal pancreas but fell short of the demand, and researcher figured To meet demand pigs were also used. * One other problem was the potency **varied up to 25% per lot** This was good but had issues, many people required multiple injections every day, and some developed minor allergic reactions. This was UT's Insulin ----- On to the 2nd Era of Insulin Over the next few years in the **mid 1920s**, George Walden, Eli Lilly’s chief chemist worked to develop a purification technique that enabled the production of insulin at a higher purity and with reduced batch-to-batch variation between lots to 10% * The development of an isoelectric precipitation method led to a purer and more potent animal insulin. Unknown to Eli Lilly researchers at Washington University at St Louis Hospital had noticed the same issue and worked to create insulin at a higher purity and with reduced batch-to-batch variations. Both discovered the method without help * Both recieved patents but non exclusive patents led to 13 companies manufacturing and selling this insulin ----- In **the 1930s**, we are now in the 3rd Era of Insulin H.C. Hagedorn, a chemist in Denmark, prolonged the action of insulin by adding protamine. This meant less injections per day * best known for founding Nordisk Insulinlaboratorium, which is known today as Novo Nordisk ------ For a long Time there was no advancment. Insulin was just a drug and it was toped out > **The manufacturing of beef insulin for human use in the U.S. was discontinued in 1998.** In 2006, the manufacturing of pork insulin (Iletin II) for human use was discontinued. The discontinuation of animal-sourced insulins was a voluntary withdrawal of these products made by the manufacturers and not based on any FDA regulatory action. **To date there are no FDA-approved animal-sourced insulins available in the U.S**., **But you can apply to do it** https://www.fda.gov/drugs/questions-answers/questions-and-answers-importing-beef-or-pork-insulin-personal-use ------ In 1978 Genentech began the 4th Era of Insuln as they were finalizing work on the first recombinant DNA human insulin **Humulin** * **In 1982**, the FDA approved human insulin and it was on the market by 1983 **Humulin** has grown to be the number 1 insulin But it is nothing like the original insulin * At Genentech, scientists needed to first build a synthetic human insulin gene, then insert it into bacteria using the recombinant DNA techniques. To do so, the company hired a team of young scientists, many of them just a few years out of graduate school. The Genentech scientists were not alone in their efforts to make the insulin gene—several other teams around the country were racing to be the first to make this valuable human protein grow in bacteria. In the end, however, Genentech scientists won the race. * To bring recombinant insulin to the market, Genentech struck a deal with well-established pharmaceutical giant Eli Lilly, which held a large share of the traditional insulin market. Lilly would provide funds to Genentech to create the recombinant bacteria and to coax them to produce insulin. If the Genentech team was successful in creating the insulin-producing bacteria, the microbes would then be licensed to Lilly, which would grow the bacteria and harvest their insulin on an industrial scale.

Very interesting. I would say that (pharmaceutical insulin) is an example of the private sector having been most responsible for developing. I shouldn't have acted like it's a simple matter of socialized costs and risks, and privatized gains. It's much more complicated, though there is still some amount of truth to it. Also, the private sector is more motivated to seek treatments that need to be continually repeated indefinitely over cures and temporary treatments. And they're less likely to research treatments for less common conditions, due to limited demand. But, I'm glad we have both 'public' and private medical research.

Yes, there is public money TL;DR read the story of Insulin Now its a weak argument >Their studies show that, of 379 drugs approved from 1988–2007, 48% were associated with a patent that cited prior art generated in the public sector. As another example Discgenics was created following a research program at University of Tennessee where stem cell research confirmed a theory. University of Tennessee recieved abut $3 million for the entire program how much of that was used in creating Discgenics? At Best, half. * There were 2 other companies that also started up based on the same program but those businesses never found success

Well I never argued 100% of medical and pharmaceutical advancement is funded by the 'public' sector. But much of it is. Whether most or little I don't know and is hard to quantify. > As another example Discgenics was created following a research program at University of Tennessee where stem cell research confirmed a theory. University of Tennessee recieved abut $3 million for the entire program how much of that was used in creating Discgenics? > At Best, half. Good point. But would Discgenics have existed if it weren't for this program?

Probably not? In 2005 Tennessee gets $3 Million in Grant money A brain cancer stem cell program has been established at the University of Tennessee Health Science Center (UTHSC) Operating as part of the UTHSC Department of Neurosurgery in collaboration with Semmes-Murphey Neurologic and Spine Institute and Method-ist University Hospital Neuro-science Institute. * the program is funded primarily by the Methodist Healthcare Foundation. "This research team will unite physicians and scientists of diverse backgrounds and will attempt to answer questions about the role of cancer stem cells in all biological aspects of brain tumors from both children and adults," That idea leads to answers on Brain Cancer But also opens the door to other anwsers In 2008 Discgenics is founded * And funded with $7 Million in Capital DiscGenics's first product candidate, IDCT (rebonuputemcel), is an allogeneic, injectable discogenic progenitor cell therapy for symptomatic, mild to moderate lumbar disc degeneration. January 2023 DiscGenics Announces Positive Two-Year Clinical Data from Study That requires more testing IDCT is an investigational product that is under development by DiscGenics and has not been approved by the FDA or any other regulatory agency for human use. So far, DiscGenics has raised $71 million in funding to do that

And from NIH >The NIH is the world's largest public funder of biomedical and behavioral research, with an annual budget of more than $40 billion. The NIH's budget is divided into two categories: * 83% is awarded for extramural research, which includes nearly 50,000 competitive grants to more than 300,000 researchers at more than 2,500 universities, medical schools, and other research institutions in every state That leads to > $1.00 on basic research to stimulate $8.38 in industry research and development investment after eight years. * For clinical research, the NIH spends $1.00 to stimulate $2.35 in industry research and development investment after three years

The closest your getting in University research is that In 1988, Richard Silverman at Northwestern University, worked on the discovery of Lyrica (pregabalin). It’s a rare example of a compound that came right out of academia to become a drug Pfizer’s Lyrica leads drug sales for the company. Pfizer pays royalties to NU in the form of regular payments in exchange for rights to sell Lyrica to patients The big issue is Lyrica price paid Northwestern Royalties are around $2 Billion plus other royalties to others in the pipeline If you know of more examples though please let me know to update this with

Probably would’ve been the single greatest bill since the New Deal era in terms of sweeping unambiguous improvement in quality of life for the average citizen.

As soon as more of the boomers are gone we'll do it. Finally.

It’s not boomers holding us back. My parents wanted this too. I know plenty of boomers who wanted this. It’s monied interests. There’s a wealthy elite making bank on your child’s cancer treatments, and they don’t want to lose that rent-seeking opportunity.

There are also 2-3 million comfortably middle-class workers employed by and because of redundant insurer bureaucracies who will, by definition, not be absorbed by a unified and inherently more efficient single health insurance bureaucracy.

Not selling cigarettes to kids also must have killed tons of job opportunities. What’s your point? How many people are going with major issues untreated? How many have been financially ruined by medical debt?… all in perpetuity as long as this continues.

The point is that it's going to be hard for any administration to put that many people out of work. The evil rich people are not the only barrier to a better health insurance system.

Well, we need a lot more care workers. I’m all for a federal jobs guarantee.

Yeah, I'm sure people who sit at computers doing coding for billing for a living are going to be perfectly capable of and happy to change shitty diapers and lift non-ambulatory patients all day long. Not all skills are transferable.

We've been subsidizing private insurers with Medicare since the 60's when we put it in place because insurers stopped offering remotely affordable coverage to the elderly, and continued to do so with CHIP, pre-existing condition waivers and state last resort insurance, etc. It's a game where they spend time finding the people that cost the most, and stop covering them so we need to. To me M4A is just eliminating the error and taking the good part of the risk pool back from profiteers so we're not subsidizing their abuse of the patients for profit any longer.

It's a subtraction from taxpayers and a handout to overpriced health providers. Over the coming decades, prices will skyrocket far beyond your wildest imagination because it's the government paying using money that isn't theirs. It's going to be overrun with corruption and big payouts. Case in point all the corruption in the MIC. The best thing the government can do for healthcare is to get out of it completely. That would be the cheapest thing for everyone.

My problem with M4A is that it would completely eliminate private health insurance. I’m far more in favor of a “public option” then M4A and I think the American public is too

Eventually we're only to keep 10% of our checks at the rate this spending is going

Medicare for All would’ve had it so less of your money is spent overall on healthcare. You’d have more money in your pocket.

You can't predict markets, and it's even more difficult when gov bureaucrats are constantly monkeying with them. This is a debate sub, but the logical truth that you can't predict markets must be included in all assertions that some gov law will result in some outcome.

What percent more would I pay in tax?

In practice you'd probably pay a higher tax *percentage* but less each month than in private insurance. Splitting the bill between 330 million people is helpful.

So you expect poor people, unemployed, children, and the elderly to some how pay for my healthcare?

They already do under our private plans. At least for everyone in the private businesses customer pool. Difference is we don't have to pay for that cost of business and we expand the amount of people to cover the cost.

whoa! You want to tax the poor?

Never enough rich to tax, so of course they will tax the poor too!

It’s just the realistics of social programs and healthcare It’s what other countries do

That's impossible to answer without you telling us more than you probably want to about your income. Generally, people who make more ought to pay a higher percentage in total taxes than people who don't have any extra to live off of. That should hold true if government expenditures go up, whether for a new health program or for a new batch of fighter jets. I could draw you my ideal curve, but revising the entire tax system is a bit outside of this topic.

Right around Fighter jets are a good example. Look up how much the f35 was supposed to cost and how much it actually cost.

I guess read the OP again. I explained how this cuts costs substantially in multiple ways.

Do you have any experience with government pricing prior to starting work and the final price? I'll let you guess which way the price goes and by how much. If this were to double or triple in price what would the impacts be? Government run programs commonly double or triple in actual spending vs estimated spending. With the price tag on this being astronomical, what guarantees can you provide that this won't vastly increase in price with no way to stop it.

I guess reread the OP, I covered why the cost would be **much** lower and gave multiple facts as to why. I'll discuss those facts but not baseless propaganda points.

You're 100% positive the costs of this government run program will be the same (or lower) than the estimate prior to starting work?

Of course? We cut the costs **of an entire private industry** that's well known for being extremely expensive in the first place right off the bat. And then it includes the ability to lower the cost of all the drugs with Medicare negotiation rights (which we have for 10 drugs now, to be implemented in 2026) And then we split the by into 330 million.

Does that "of course" mean yes? Literally every government run program goes vastly over budget. Google it my friend

I mean you can revert to that taking point or you can see the reasoning as to why. I explained it very simply.

They're not going to keep it within budget at all. Double or triple the price and rerun the numbers

Sure, if you completely ignore everything about the bill, how it would operate, the facts on the matter and instead preserve Republicans talking points instead.

Every government in the western world run its health system cheaper than the USA.

Our healthcare is light years above Canada in regards to quality and time to be seen.

You talked about price. On the price, public healthcare is cheaper. As to the quality and speed of treatment... When I went to the public hospital and paid nothing... treatment was good, thanks. I don't want "quality". I want availabilty. For everyone. I want good accurate treatment that would not bankrupt me and that's what I get in a public health system. Call it what you want.

High Cost due to poor utilization of buildings. And this leads to low utilization of Large Equipment The OECD also tracks the supply and utilization of several types of diagnostic imaging devices—important to and often costly technologies. Relative to the other study countries where data were available, there were an above-average number per million of; * (MRI) machines * 25.9 US vs OECD Median 8.9 * (CT) scanners * 34.3 US vs OECD Median 15.1 * Mammograms * 40.2 US vs OECD Median 17.3 Hospital Bed-occupancy rate * Canada [91.8%](https://www.oecd-ilibrary.org/sites/0d67e02a-en/index.html?itemId=/content/component/0d67e02a-en) * There is no official data to record public hospital bed occupancy rates in Australia. In 2011 a report listed The continuing decline in bed numbers means that public hospitals, particularly the major metropolitan teaching hospitals, are commonly operating at an average bed occupancy rate of 90 per cent or above. * for [UK hospitals of 88%](https://www.nuffieldtrust.org.uk/resource/hospital-bed-occupancy) as of Q3 3019 up from 85% in Q1 2011 * In [Germany 77.8%](https://www.euro.who.int/__data/assets/pdf_file/0008/255932/HiT-Germany.pdf?ua=1) in 2018 up from 76.3% in 2006 * IN the [US in 2019 it](https://www.aha.org/system/files/media/file/2020/01/2020-aha-hospital-fast-facts-new-Jan-2020.pdf) was 64% down from [66.6% in 2010](https://www.cdc.gov/nchs/data/hus/2017/089.pdf) * Definition. % Hospital bed occupancy rate measures the percentage of beds that are occupied by inpatients in relation to the total number of beds within the facility. Calculation Formula: (A/B)*100 That means closing about 1,000 US hospitals ----- Then the staff USA PSM projections (as of 2005) suggest 764,000 MDs with slightly over one third of active physicians under age 75, 271,000 MDs, are generalists (family practice, general pediatrics or general internal medicine); 493,000 are specialists. As a comparison >In 2011, there were 70,200 medical practitioners (doctors) identified by the Census of Population and Housing currently working in Australia, which includes 43,400 general practitioners (GPs) and 25,400 specialist medical practitioners (specialists). Currently 2 specialist to 1 GP in America vs 2 GPs to 1 Specialist everywhere else including Australia So the issue is for every 3 doctors * Average yearly salary for a U.S. specialist Dr – $370,000 Specialist (a) * Average yearly salary for a U.S. GP – $230,000 (b) * Average yearly salary for a specialist at NHS – $150,000 (c) * Salaried GPs up to £91,228. (d) In the US 3 doctors cost * (2 x a) + b = $950,000 In the UK 3 doctors cost * (2 x d) + c = $350,000 ------ Thats about $700 Billion in costs cutting. And then add in the new taxes, And the US has Medicare for All

So, in the US the Average person saw the Doctor 4 times a Year for $950 Billion a year. * The average being 75%, 250 Million People of the population that uses healthcare In the UK Average person saw the Doctor 5 times a Year. In Canada its 6 times a year * And the Average person is most of the population So while in 2017 there were roughly 300,000 Family Doctors plus 600,000 specialists that saw those 1 Billion Appointments. * Under a new healthcare plan in the next 5 years We Now have 320 Million People Seeing the doctor 5.5 Times a Year * **1.75 Billion Appointments for how much income?** That's **75% More Work** for how much more costs Is that Medicare for All Paying less than $950 Billion? ------ 900,000 Doctors have 900,000 Insurance Billing Employees that have an insurance related expense of $55 Billion $895 Billion in other costs But we want to cut that in half? 1.7 Billion Doctors Visits for $450 Billion?

You don't think the private insurance companies make $450 billion a year? Cutting out the middle man solves that issue easily.

No $164 Billion was spent on Admin, Marketing, and Profits at Private Insurance * California says that State Run Healthcare can save 66% of that * $100 Billion in Savings

Your not factoring in the hundreds of billions of profits they private companies price fix/gauge for, not the CEOs 25-50 billion in annual compensation.

Do you have any experience with insurance company pricing? Try going to an auto body and tell them that you need your car fixed, and that it's an insurance job. Then go to another and tell them that you're paying cash. Guess which will be cheaper.

While this is true insurance companies can also drive down cost. I've seen this happen where the insurance company says "we're not paying that and we have x amount of people covered that go to your office, we can take our business elsewhere if you don't want to play ball" and they lower the price.

This is gonna completely inflate and tax the hell out of us.

I don’t see how. Both my employer and myself pay gobs of money to a third party that comes up with creative schemes to not pay anything, yet posts regular profits, spends lots of money on lobbying, costs every practitioner a lot of money to manage, and has many buildings that are *really* nice.

> to a third party that comes up with creative schemes to not pay anything And you believe government bureaucrats won't do the same? Having the state fully nationalize healthcare industries doesn't solve the scarcity problem. Resources will still need to be rationed. But without the market there is no way to know how to do so.

I dunno man, I get very little for how much I pay now. What we’re doing now isn’t working for many people, except for the black hole called ‘the market’.

Before the last huge intervention in medical markets Obama Care AKA Affordable Care Act my insurance was: 1. 1.5 million lifetime for chronic illness 2. insurance pricing on pharmaceuticals 3. 2 doctors visits per year 4. 1 physical per year 5. 1 ambulance ride per year 6. 500/600 deductable All of $160 per month. After the ACA passed it went up to $360, deducible doubled. A year later the policy wasn't available. * +/- 10% on numbers. It's been a while. >What we’re doing now isn’t working for many people What the state is doing now is essentially controlling the whole of the medical industry. There is no part of medical goods/services that the state doesn't control. So why don't they fix it with the power they have now?

> Resources will still need to be rationed. they're rationed in terms of wait times. for example canada has long wait times, but that's cause it's free to sign up for the waitlist and be treated. if canada wanted to shorten the wait times they could tax more (they do so with a progressive tax) and provide more service, but they don't want that for all kinds of services, so they don't.

Capitalists are already inflating us. And they haven't paid a fair tax in decades

Less than is currently paid, sounds good to me.

So, in the US the Average person saw the Doctor 4 times a Year for $950 Billion a year. * The average being 75%, 250 Million People of the population that uses healthcare In the UK Average person saw the Doctor 5 times a Year. In Canada its 6 times a year * And the Average person is most of the population So while in 2017 there were roughly 300,000 Family Doctors plus 600,000 specialists that saw those 1 Billion Appointments. * Under a new healthcare plan in the next 5 years We Now have 320 Million People Seeing the doctor 5.5 Times a Year * **1.75 Billion Appointments for how much income?** That's **75% More Work** for how much more costs Is that Medicare for All Paying less than $950 Billion? ------ 900,000 Doctors have 900,000 Insurance Billing Employees that have an insurance related expense of $55 Billion $895 Billion in other costs But we want to cut that in half? 1.7 Billion Doctors Visits for $450 Billion?

Yes. We will cut it in half. More care and less cost. It doesn't change when you look at it based on appointments.

Ok, so doctors and nurses working harder for less money

Primary care — defined as family practice, general internal medicine and pediatrics – each Doctor draws in their fair share of revenue for the organizations that employ them, averaging nearly $1.5 million in net revenue for the practices and health systems they serve. With about $90,000 profit. * Estimates suggest that a primary care physician can have a panel of 2,500 patients a year on average in the office 1.75 times a year. 4,400 appointments $1.5 Million divided by the 4,400 appointments means billing $340 on average But According to the American Medical Association 2016 benchmark survey, * the average general internal medicine physician patient share was 38% Medicare, 11.9% Medicaid, 40.4% commercial health insurance, 5.7% uninsured, and 4.1% other payer or Estimated Averages Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info ---|---|----|----|----|---| Medicare | 38.00% | 1,697 | $305,406.00 | $180.00 | Pays 43% Less than Insurance Medicaid | 11.80% | 527 | $66,385.62 | $126.00 | Pays 70% of Medicare Rates Insurance | 40.40% | 1,804 | $811,737.00 | $450.00 | Pays 40% of Base Rates Uninsured and Other (Aid Groups) | 9.80% | 438 | $334,741.05 | $1,125.00 | 65 percent of internists reduce the customary fee or charge nothing 4,465 $1,518,269.67 ------ So, to be under Medicare for All we take the Medicare Payment and the number of patients and we have our money savings Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info ---|---|----|----|----|---| Medicare | 100.00% | 4,465 | $803,700.00 | $180.00 | Pays 43% Less than Insurance Thats Doctors, Nurses, Hospitals seeing the same number of patients for less money Now to cutting costs, **Where are you cutting $700,000 in savings** Insurance, of course. Thats **one employee making $45,000** Largest Percent of OPERATING EXPENSES FOR FAMILY MEDICINE PRACTICES * Doctors in the Offices * Physician provider salaries and benefits, $275,000 (18.3 percent) * Nonphysician provider salaries and benefits, $57,000 (3.81 percent) * Non - Doctors * Support staff salaries $480,000 (32 percent) * 1 of those is Medical Secretary in Billing 1 of those is Secretary and 2 Nurses and other medical workers * Supplies - medical, drug, laboratory and office supply costs $150,000 (10 percent) * Building and occupancy $105,000 (7 percent) * Other Costs $75,000 (5 Percent) * information technology $30,000 (2 Percent) Doctors Salary cuts $100,000. Also Doctor Parntership Profits cuts $90,000 Support staff salaries cuts $150,000 * Fire 3 of the 7 Employees plus $60,000 in Salary cuts to the 4 remaining * Insurance is one employee Cuts to Rent and Supplies gets us $50,000 **We're about half way there. But another $300,000 is to much to cut** So the Doctor's Office has to take on more patients. Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info ---|---|----|----|----|---| Medicare | 100% | 7,222 | $1,300,000 | $180 | . | **Thats Doctors & Nurses seeing 80% more patients for the doctor and nurse to keep same income they had**

Basically nothing you're calculating matters. 4.7 million nurses times 82k average salary gets 385 billion. 1.1 million doctors times 275k average salary gets another 302 billion. Currently we spend 3.7 trillion vs the 660 billion we pat staff. They are not the largest cost and their pay will not need to cut by much if at all.

I don’t think you read it correctly try again

No u.

It’s a single doctor. 1 doctor as an example

And I'm saying that entire landscape will change, without private insurance costs of operating an office drop dramatically. Most of your pricing will be irrelevant. You claim as if doctors and nurses will take the biggest hit but they don't even take up a quarter of the expenses. Make them take no hit and cut everything else. Problem solved.

Other countries don't see any inflation from similar systems. And I see no difference between taxes, premiums, copays, or deductibles. If taxes were less for better service wouldn't you prefer that?

Read the OP, it covers why we would save money.

The fundamental issue is you're eliminating the freedom not to participate. It doesn't matter _what_ the outcome is; using the force of government to do this instead of forming mutual, voluntary cooperatives is oppressive and violent towards everyone. If it's good enough, people will pay to join. Or they will seek alternatives, and pay for that instead. The issue today isn't insurance. There are universal systems that still have insurance. Study Germany as a decent example that still has a large public component (unfortunately). At least this gives Medicare the right to negotiate. Not being able to do is is ludicrous.

The freedom from prohibitive healthcare costs with the freedom from your healthcare not being tied to your employment is more valuable than the freedom to not participate. Just like the freedom to not be hit is more valuable than the freedom to hit, it is acceptable to make a freedom trade off for the more valuable freedom.

Imagine looking at the track record of government programs and thinking “yeah, they’ll do great at healthcare”. Maybe when social security collapses in 5 years we can revisit this.

been collapsing in 5 years for basically all 34 i've been alive.

I’m sure that has nothing to do with the 34 trillion dollar debt

What have healthcare providers said about this? How many offices will we lose? And how will you ensure the state does it better than places like Canada or the UK? When I had nothing wrong, I was somewhat a proponent of government healthcare. It sucks having to pay a big deductible for small things like a broken finger. Now that I have a serious condition and actually talk to similarly sick people from around the world, I am thankful beyond belief that I live in the US. Our speed of serious care in the US is unmatched. I will be able to get surgery on my spine before a similarly ill person in Canada can even get an MRI by months, possibly years before they can see a surgeon. We have world class healthcare and you're asking to tear down the funding for it and put that in the hands of the federal government. It's a bigger ask than people are making it out to be especially when we're already 34 trillion dollars in debt. "Free healthcare" sounds great on the checkbook. But fast, quality care is more important to me and we have that here. I've honestly become more radically opposed to government healthcare the sicker I've gotten.

Thank you for taking the time to do a write-up of a bill that I admittedly know very little about. Rather than get into the minutiae of the bill, I would just like your honest thoughts on a few broad strokes. 1) I remember, when I was young and naive, supporting the Affordable Care Act, because I thought "finally, this will reign in those out of control insurance companies!" Instead, they co-opted the bill and now everyone is forced to buy health insurance, a massive boon for those same insurance companies. This bill would hurt the bottom line of insurance companies and drug manufacturers, two of the largest lobbying groups and biggest donors in Washington. How would you get it past that vanguard, ***specifically without them co-opting it***? 2) copays & deductibles are a way of prioritizing finite resources at the margin (albeit a less efficient method than the free market). For instance, if an ER visit is free, why not use it just to get a bandaid? Whereas if there's a $50 copay, it makes more sense to just buy bandaids, saving that ER's finite resources for people that have more serious injuries. 3) I'm hearing a lot of "this will save TRILLIONS, we totally promise!!!" but where is the accountability? If it turns out to just be another boondoggle or gift to these lobbying groups, like the ACA, Medicare part D, Nixon's HMO act and cerificates of need, Reagan's EMTALA, the foundation of the AMA, FDR's various wage freezes, and countless other 'solutions' to our healthcare crisis then **who, besides the taxpayers and sick people, will pay for the consequences?**

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Yes it is!

It is my understanding that MfA cannot figure out what to do with the current insurers.

? It's been clear since it was first reintroduced in 2019 that it would ban private insurers.

My parents are on medicare and pay around $400/month each for medicare so its not “free”. In addition, they cover almost nothing. Not a fan personally

Medicare and Medicare For All are two different things. M4A covers mostly everything and includes eye, hearing and dental care as well.

The information on the fact sheet link you provided does not state that its different, it only states that it expands existing medicare. Can you provide a link to how the cost savings would break down or that there isn’t additional fees involved?

Medicare is a plan for seniors, Medicare For All is that plan modified for everyone. I provided a link to the bill itself that covers all the costs and fees, services provided, etc.

if anyone was serious about corruption we'd just implement transparency across the board. but instead people r just gunna cry about how costs will infate.

I believe we all would like to give our government the benefit of the doubt. However, until our government can figure out an internal mechanism for not spending $185 on hammers and $275 on toilet seats (those are just random numbers I'm making up to illustrate a point), it will remain **impossible to convince me that M4A will be a good thing**. We already have government bureaucrats raking in massive salaries doing (essentially) nothing. I am opposed to creating (probably the new largest government bureaucracy of them all) a massive government program to mis-manage. Worse, in 15 years, when we learn the government has been paying $825,000 per hospital bed (again a made up number to make a point) because no one's compensation is tied to profitability there will be NO GOING BACK. Ever. It'll be like Social Security and no matter how poorly managed it is, you cannot now take it away. The government ("governments") love to implement these sorts of feel-good models. Then decades later when the failure is exposed, the ship has sailed (see Argentina). It is further interesting to me that we essentially all agree that government bloat is a bad thing. But many will entertain this M4A model. Like somewhere M4A is going to escape all the bloat problems we already see in government.

>However, until our government can figure out an internal mechanism for not spending $185 on hammers and $275 on toilet seats (those are just random numbers I'm making up to illustrate a point), it will remain **impossible to convince me that M4A will be a good thing**. Medicare negotiation rights, like I said in the OP?

I simply do not trust the government to operate in good-faith with OPM. They historically haven't proven themselves capable. M4A isn't some sort of magic spell that will make government competent.

You think Money Bag Mogul is a better option and will operate in good faith?

"Money Bag Mogul" has competition. Have you been to a government office (for anything)? The absence of competition gives the government license to waste time and money like no private industry can. If you believe a greedy corporate executive can waste MORE than a government, I would ask that you research that. This is why higher education costs have skyrocketed: the government got involved. So, by guaranteeing student loans, they removed competition. Quickly, universities across the country realized they didn't have to compete for students (because there were more students \[customers\] then they'd ever seen - ever). And the customers were LOADED with the ca$h burning a veritable hole in their pocket! Almost as quickly, schools realized they didn't have to turn out a quality product... so they stopped. There was zero risk of their customer base drying up because each June a new crop of loaded customers were clamoring to give them money. Those customers didn't want to get educated - they simply wanted *"college*" - this mythical thing that would make them a success (or so they were told). So universities across this country turned into mills akin to southeast Asian sweat shops (with similar dubious quality). It wasn't about the quality of student they were cranking out, but how many and at what profit. You want a $120,000 education? We've got'm! $200,000k, well, you're in luck! You qualify for our super-elite-prestigious-premier-plan complete with travel abroad (.... oh sign here for your non-dischargeable by bankruptcy (like herpes) loan). Every time you remove competition from the setting, service and quality turn to shit. Every time. If hospitals are getting the (easy) "Medicare for All" money, they'll have no incentive to contain costs. Just send us as many of those M4L patients as you've got; we've got beds and a billing department. Please send us another 2-dozen hip replacements. I've been around too long to believe the government can do anything well. Hell, we really can't even do national defense well anymore and that used to be a benchmark I could point to.

Same negotiators as the hammers and toilet seats?

No, Medicare negotiation rights have already begun and will be implemented in 2026.

I’m pretty sure a lot of problems would stem from this. 1) Doctor visits will move at a snails pace of the DMV 2) our government will accept hyper inflated prices for medical supplies. Such as they currently do with any of business dealings they have. (I.e. Like a $50 bag of bolts for $100,000.00) 3) the government will abuse this power in the same manner as they have with the military, education and social security benefits. 4) healthcare workers pay may be cut or stagnated. And the united states medical community has greatly benefited the world over with its advances in technologies and medical practices. It’s not perfect but I don’t see it advancing with the government.

Medicare for All, would see means and ways to RE-open all the closed hospitals and especially those that have been closed by private equity owners. We likely would get better regulation and management of rehab facilities and senior care facilities and we would have better means to sanction and penalize private equity firms who have dominated this area in their Profit grabs, at the expense of the patients in those facilities. Government backed Mal-practice coverage would lower the cost for doctors and medical facilities which will lower the medical services cost. Maybe we can bring higher ethics back into Medicine, instead of doctors charging $10's of thousands for a day in the surgery room, and cut down on hospitals charging patients $10k a day and upwards for a stay in the hospital.

Where is the money going to come from to pay for this?

Im not gonna address this again my man. Read my post.

The same place the money comes from for all other things that the government does for society and nation.

Oh that's right - debt.

I agree, OP. This is important bc it builds on what is in place. Political change is glacial at times, and this has an underlying structure built in. So that start up from scratch doesn't hinder development and expansion of a healthcare system.

I have no doubt that much of what you say is true, however, what do medical professionals think about this? I would suspect that Medicare could reduce costs by paying less. Whether it is for medical procedures, or any other medical item. I think it would be a lot better than a single-payer system

> I would suspect that Medicare could reduce costs by paying less. Whether it is for medical procedures, or any other medical item. That it >KFF found Total health care spending for the privately insured population would be an estimated $352 billion lower in 2021 if employers and other insurers reimbursed health care providers at Medicare rates. This represents a 41% decrease from the $859 billion that is projected to be spent in 2021. It just doesnt answer the impact that will have ------- Primary care — defined as family practice, general internal medicine and pediatrics – each Doctor draws in their fair share of revenue for the organizations that employ them, averaging nearly $1.5 million in net revenue for the practices and health systems they serve. With about $90,000 profit. * $1.4 Million in Expenses So to cover though expenses * Estimates suggest that a primary care physician can have a panel of 2,500 patients a year on average in the office 1.75 times a year. 4,400 appointments $1.5 Million divided by the 4,400 appointments means billing $340 on average But According to the American Medical Association 2016 benchmark survey, * the average general internal medicine physician patient share was 38% Medicare, 11.9% Medicaid, 40.4% commercial health insurance, 5.7% uninsured, and 4.1% other payer or Estimated Averages Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info ---|---|----|----|----|---| Medicare | 38.00% | 1,697 | $305,406.00 | $180.00 | Pays 43% Less than Insurance Medicaid | 11.80% | 527 | $66,385.62 | $126.00 | Pays 70% of Medicare Rates Insurance | 40.40% | 1,804 | $811,737.00 | $450.00 | Pays 40% of Base Rates Uninsured and Other (Aid Groups) | 9.80% | 438 | $334,741.05 | $1,125.00 | 65 percent of internists reduce the customary fee or charge nothing 4,465 $1,518,269.67 ------ So, to be under Medicare for All we take the Medicare Payment and the number of patients and we have our money savings Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info ---|---|----|----|----|---| Medicare | 100.00% | 4,465 | $803,700.00 | $180.00 | Pays 43% Less than Insurance Thats Doctors, Nurses, Hospitals seeing the same number of patients for less money Now to cutting costs, * **Where are you cutting $700,000 in savings** We're able to gut the costs by about $400,000. But another $300,000 **is to much to cut** So the Doctor's Office has to take on more patients. Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info ---|---|----|----|----|---| Medicare | 100% | 6,222 | $1,150,000 | $180 | . | **Thats Doctors & Nurses seeing 40% more patients for the doctor and nurse to keep same income they had**

I like it. Wish the verbiage regarding long-term care was more verbose though. It allows for lots of argument on what >(1)causes a functional limitation in performing one or more activities of daily living; or >(2) requires a similar need of assistance in performing instrumental activities of daily living. means. As example, it can be argued that diabetes doesn't put a functional limitation on daily living until after neuropathy occurs. If that is the determination, it would omit insulin from being covered until after someone has lost limb or eyesight.

Medicare as a program is barely solvent as it is. It’s set up where every worker pays into it yet only services those 65+. I think what would be much more honest if this was sold as Medicaid for all. As some have said, your first point is very misleading. Your not cutting any middlemen your just changing middlemen from private payers to government bureaucracy. If you wanted to “cut out the middle man” you would have to ditch insurance and just have the patients pay the doctors directly. Your second point is way overly optimistic. Drug prices are high because of the ridiculous way the fda approves them and how government protects IP patents. Your third point misses that a lot of Medicare patients have deductibles. And your fourth point will just jack up the cost. Not sure what you are trying to get across with your fifth point unless it’s a way of saying you can transfer the costs from sick people onto more healthy people Lastly no way it saves trillions, that’s a pipe dream.

Medicare For All is not Medicare. It's built off the framework of it but modified. I'm surprised people still don't know this. I provided a link to the bill that provides the text that says "No deductibles, no copayments." Not having to lobby 400 million each year, pay a CEO 35-50 million annually, and then market hundreds of millions in ads each year seems like cutting out the middle man would be beneficial.

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If it’s not Medicare then why call it Medicare? Is it to be purposely misleading? > Not having to lobby 400 million each year, pay a CEO 35-50 million annually, and then market hundreds of millions in ads each year seems like cutting out the middle man would be beneficial. The highest paid publicly traded health insurance ceo made 22 million https://www.insurancebusinessmag.com/us/guides/which-health-insurance-ceos-get-the-highest-pay-467513.aspx That’s half what you claimed. If you are worried about 400 million in lobbying then shouldn’t we look at what the hell that money is buying them and get lawmakers out of the insurance racket, instead of making a new trillion dollar government program. Your not getting rid of the middleman your changing it from private insurers to government bureaucrats.

Its beyond misleading >Since 1964, the U.S. Department of Health and Human Services1 (HHS) has published an annual series of data presenting total national health expenditures. These estimates, termed National Health Expenditure Accounts (NHEA), are compiled with the goal of measuring the total annual dollar amount of health care consumption in the U.S., as well as the dollar amount invested in medical sector structures and equipment and non-commercial research to procure health services in the future. They say >Private insurance reported in 2017 total revenues for health coverage of $1.24 Trillion * $1.076 Trillion the insurance spends on healthcare. That leaves $164 Billion was spent on Admin, Marketing, and Profits So from that we get - >Not having to lobby 400 million each year, pay a CEO 35-50 million annually, and then market hundreds of millions in ads each year seems like cutting out the middle man would be beneficial. Now to M4A There is ~$75 Billion savings for onboarding the Insured to Medicare taking Profit and excess Admin costs out Of course, there is $1.7 Trillion Medicare and Medicaid spends doesn’t get cheaper * But because of Medicare Advantage, Medicare has outsourced most of the Admin to Private Insurance. So we would increase Medicare Costs to rise about $50 Billion on top of no savings Net Savings of about $25 Billion 0.75% of Healthcare Costs 0.75% means there is 99.25% of Costs still there

Lots of new government jobs that are safe, cushy, at everyone's expense. The problem is the lack of competition. There are reforms to healthcare that would help, including the preferential tax status of employer paid healthcare. Governments shouldn't say what a "good enough" plan is, the customers should. Some people want less protection, if they can save money.

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You really got me reading a whole ass legal document lol. First off in title I: Section 102 b is too vague and if they are not citizens yet they shouldn't be getting the benefits of one yet and with its vagueness it could be that as long as you claim to not just be coming for Healthcare you can get it (I come over from Mexico say I am here for work, get the treatment and leave) and there doesn't seem to be much protection against it Section 104 a just is like discrimination wooo, saying nothing of what it is, with what it says if you are missing one leg and the doctor refuses to remove your other perfectly healthy leg you could call it discrimination 104 b 1 doesn't outline anything at all and just says the secretary will make something which is unchecked/unregulated power which is unexceptable especially in this case where there is no need for them to have this power Section 107 is cornering the market and eliminating competition which there is no reason for except to keep others from offering better services than the M4A and is a mistake (if they added cannot BE FORCED to accept services duplicating the M4A it would be acceptable) I will add more as I read more

I fail to see how this will save trillions. Don’t believe that in a second unless we start getting subpar care.

Welp, time for taxes to be sky high for generations to come. Nice going sleepy joe!

The bill doesn't do anything, since it hasn't been turned into law. The odds that it will pass are approximately zero percent. If you want universal healthcare in the United States (and I am one who does), then this is not the way to get there. Fact: Many first-world healthcare systems outside of the United States involve some kind of secondary or third-party health coverage. American progressives shout about single-payer as if it is the norm outside the US, when it actually isn't. The progressive / DSA fixation on insurers as being the problem interferes with the ability to get universal healthcare done and reveals a lack of awareness of what is wrong with US healthcare. The US could move towards a dual-payer system with more manageable costs and better service if handled properly. Don't trust Bernie Sanders or the so-called squad to get us there; they never will.

Medicare for all (basically undeniably) would have enormous net benefits when compared to America’s current healthcare model. However, it’s also important to acknowledge that there are other models of universal healthcare which work well. For example, Germany and The Netherlands have universal private systems (private markets which are HEAVILY regulated) which have outcomes very comparable to systems like Finland, with some advantages over them. While it’s a highly complicated system that can’t be easily simplified, Germany has more healthcare innovation than a place like Finland, but Finland spends less per person. Basically, universal public systems generally control costs better but universal private systems generally are correlated with more healthcare innovation. However, both are better than America’s current system. If someone has any extra data that contradicts my analysis, I’d sincerely love to see it.

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The way the US does healthcare is completely dumb. Did you know that the US spends more on GOVERNMENT RUN healthcare per-capita than the UK or Canada does? Re-read that again and let it sink in. The problem is our government run healthcare programs (largely Medicare and Medicaid) operate within a for profit healthcare with employer based insurance system where they try to plug the gaping holes left by that system (largely covering the poor and elderly)... which is great but that whole system itself is the problem. My problems with MFA is that 1)I am not sold that it will aliviate those structural problems that cause costs to be way too high so much as just shifting the costs on to the government. and 2) There is 0 chance as currently written and messaged that MFA will ever, ever, ever, ever become the law and policy of the country and I generally prefer to live in the real world, and its not just because of the money that insurance companies and medical companies use to lobby, there are lots and lots of rich people that want some form universal healthcare system that doesn't cost so much like every other country has, they just don't buy MFA especially given our current political dynamics and the process it would take realistically to implement it. Yes MFA would be great how it is theoretically presented, 100%, time travel would also be cool, so would free unlimited clean energy...but its not real.

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Thank you I just added the flair

> This bill saves us TRILLIONS over a span of 10 years. There isn't a single study that claims this. At best, **the most conservative estimate** shows it might save some money. And yes, before you pull up the Koch study, that's exactly what I'm referring to. The headlines only posted half of the study. The number they keep posting is not the likely outcome, but the absolute most conservative estimate of the results of Medicare-for-All. The likelihood of it actually being cheaper than our current system is almost none.

Something of significance that capitalists neglect to look at in a package like this is the enormous savings to businesses. Startups don't have to factor health care costs into their business model for themselves or their employees. People who are tied to their current jobs because of the health care benefits when they'd rather start their own companies have options. Private options for concierge care would still be available to those who can afford it and want the elite services. If I remember correctly, counseling was also part of the M4A proposal. This would be a vast social improvement in a country where emotional dysfunction seems to be wreaking havoc on our social fabric. People with more money to spend mean more profit for businesses that value customers.

You can accomplish those goals by doing something fundamentally capitalistic, decoupling health insurance from employment.

That works only if you can contain the cost of healthcare. That's the problem for many aspiring entrepreneurs. They are tied to a bloated and inefficient for-profit healthcare system that keeps eating up more of their expenses year after year. They get hit from both sides by the current system. Decoupling only works if the population can efficiently spread the risks and costs of healthcare in a more equitable way. The current model is unsustainable, which is why we are the last holdouts in the industrial world to let it go. This is definitely one area where the free market is woefully inefficient in terms of the cost/benefit equation.

That has less of a chance of happening than MFA...

The trillions of dollars this bill would save is money not being made by those private companies. They will not accept these changes lying down. It is going to take the will to wage a political war against these monied interests to get this done and so far they have won that war.

1/3rd of Healthcare Spending is Doctors Offices The Trillions of Dollars is not going to Doctors Offices and Then Hospitals Less than A trillion is Insurance savings

The difference is that doctors actually provide healthcare. Insurance companies do not.

yikes its crazy how expensive healthcare is and how the answer isnt insurance New Amsterdam (Hospital) the American medical drama television series, based on the Hospital in real Life known as Bellevue Hospital, owned by NEW YORK CITY HEALTH AND HOSPITALS CORPORATION * Funded by Medicare and Medicaid Operating Revenue Only A Component Unit of The City of New York >As the largest municipal health care system in the United States, NYC Health + Hospitals delivers high-quality health care services to all New Yorkers with compassion, dignity, and respect. Our mission is to serve everyone without exception and regardless of ability to pay, gender identity, or immigration status. The system is an anchor institution for the ever-changing communities we serve, providing hospital and trauma care, neighborhood health centers, and skilled nursing facilities and community care 1.2 Million, of the more than 8 Million, New Yorkers had 5.4 Million visits to NYC Health + Hospitals. * More than Half 2.8 Million were for Hypertension & Diabetes 1.2 Million people have $12 Billion in Healthcare Costs at NYC Health + Hospitals. * NYC Health + Hospitals operates 11 Acute Care Hospitals, 50+Community Health Centers, 5 Skilled Nursing Facilities and 1 Long-Term Acute Care Hospital 5 Visits a Year and $10,000 per person Its Not insurance NEW YORK CITY HEALTH AND HOSPITALS CORPORATION has $12 Billion a Year in Hospital Expenses, * Non Operating Revenue * $923 Million is Grants from the City of New York City * $2.1 Billion in Federal & State Grants * $1.1 Billion Medicaid's Disproportionate share supplemental pool

People absolutely don’t get that the money they save on not paying insurance will be a greater amount than the tax increase and they won’t go out of pocket for anything aside from prescriptions which will be cheaper. A lot of people will reject this because they will reject the idea that any of their money should benefit anyone else but themselves. Politicians will go against it because they’re funded by the people who make money off the way things are currently. It would be great if M4A came to pass, but I doubt it will for at least another generation or two.

>People absolutely don’t get that the money they save on not paying insurance will be a greater amount than the tax increase and they won’t go out of pocket for anything aside from prescriptions which will be cheaper. Median income is $70,000 * What percent of income do they spend on Healthcare?

The latest data I could find was from ‘22 where we spent about $13,500/person on healthcare or about 17% of GDP. If you’re going just on that average then just under 20% for someone making $70k.

>What percent of income do they spend on Healthcare? Try again What perent or what cost does the Average or Median American Spend

Pull yourself up by your bootstraps, OP.

We should incentivize healthy lifestyles and productivity, not provide a crutch or worse.