Medicare-for-all. Do we want a Cadillac or a Chevy

https://www.urban.org/urban-wire/dont-confuse-changes-federal-health-spending-national-health-spending

Tip of the hat to Bobrsmith for pointing me to this work on Medicare-for-all done by the Urban Institute. They have studied several Medicare-for-all options.

One plan can be called the Cadillac Plan. It would be far more generous than current Medicare. It would cover dental, hearing, vision and long term care that Medicare does not cover. It would eliminate premiums and co-pays. And, it would cover every person living in this country bringing in 25.6 million legal residents and 10.8 undocumented residents. This Cadillac plan would increase National spending by $7 Trillion over 10 years increasing it from $52 Trillion to $59 Trillion.

They also worked with a Chevy plan. This would essentially extend current Medicare benefits, premiums and co-pays to all people legally resident in this country. Even though this plan covers 25.6 million people with no coverage currently it will REDUCE National spending by $2 Trillion over those ten years.

68 thoughts on “Medicare-for-all. Do we want a Cadillac or a Chevy

  1. Isn’t the “Cadillac Plan” Bernie’s plan?

    The idea of a “public option” continues to grow on me. M4A could be the ultimate result, but incremental change is what people would find more palatable. – IMHO.

    Liked by 1 person

    1. @Adam
      The public option – too late for half measures. IMHO. It would end up being where for-profit insurance companies dump bad risks and sick people. A viable insurance system requires that all risks – good and bad – be in the same pool.

      Liked by 1 person

      1. …”too late for half measures”… I disagree. A public option is where to start. It is the primary reason I cannot support Sanders or Warren. The plans themselves make the two of them unelectable to the general electorate. Obamacare was the original jumping off point. Instead of trying to repeal it, the GOP and the Dems should have found a way to improve it. Instead the GOP focused only on repealing it with no real viable plan put forth and debated to replace it.

        Liked by 1 person

        1. @Adam

          I respectfully disagree with your premise that Medicare-for-all makes Sanders or Warren un-electable. The benefits to the country and especially to individuals are enormous. Young people and part time workers especially are crying out for this solution.

          Obviously, it is an easy target for demagogues. And they will try to demonize it as they did Social Security and Medicare back in the day. It is up to the nominee to make the very strong case and not be cowed by the corporate media and special interests.

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          1. I’m not saying the ultimate goal is bad. I am thinking about who’s plan is more palatable to the middle, the voters needed to win election in November. It has nothing to with with being a demagogue. It has to do with removing Trump from office at the ballot box.

            Liked by 1 person

    2. RE: “A viable insurance system requires that all risks – good and bad – be in the same pool.”

      That is the worst thing we could do. An insurance system that covers a high number of risks with probabilities of occurrence at 100% becomes more vulnerable to collapse (insolvancy) than one where few risks have high probabilities of occurrence. In effect, risks that are certain to occur are not risks at all, but known expenses. Such a system wouldn’t be insurance but a welfare program.

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        1. RE: “You support the idea of ending or increasing the cost of coverage for pre-existing conditions.”

          I didn’t say so. It should be obvious, though, that insurance cannot work for pre-existing conditions.

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          1. When you get dropped from your insurance because you develop a major medical issue (or ANY medical issue that your current carrier refuses to cover), it would not be possible to get insurance from a new carrier, under your thought process. Good luck with that.

            Liked by 1 person

      1. @Roberts

        Well, I grant you that it is hard to buy fire insurance for a building that is on fire. If there is another point there somewhere, it is not obvious what it might be.

        I would note that one of the most popular forms of insurance – life insurance – is pays on something that is 100% certain. Death. But life insurance companies are not only stable and solvent, they are very profitable. Which kinda sorta refutes your claim that 100% probability of payout leads to insolvency. Obviously, it is a question of price as well as risk.

        Liked by 1 person

        1. I’m going to stop suggesting that “idiot” is the appropriate appellation.

          It’s increasingly apparent that heartless, clueless, greedy, jerk, is more apropos……

          Liked by 2 people

        2. RE: “I would note that one of the most popular forms of insurance – life insurance – is pays on something that is 100% certain. Death.”

          Don’t be silly. Life insurance premiums are based on the probability of death occuring during the period the premium covers. The inevitable certainty of death is not a factor in the model.

          Liked by 1 person

          1. @Roberts
            You must not have bought life insurance lately. One selling point frequently encountered is that the premiums won’t rise and the policy can never be cancelled. The seller KNOWS that eventually he will have to pay so he sets his prices accordingly. Like I said “Obviously, it is a question of price as well as risk.”

            But no matter, I brought in life insurance simply to point out the flaw in your logic. I could have brought in many other examples of insurance that is available in very risky situations. There, too, it is a question of both risk and price and insuring high risks can be, and, in fact, is very profitable.

            Liked by 1 person

          2. You seem to ignore the difference between Term life (which you describe) and Whole life, which pays when the insured dies, regardless of the time frame. (Provided premiums are paid).

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          3. RE: “One selling point frequently encountered is that the premiums won’t rise and the policy can never be cancelled.”

            You’re describing “whole life insurance”, but the model is the same. The premium is calculated for each year the policy will be in effect, then averaged for the number of years of life expectancy from start to finish. Whole life insurance policies automatically renew under the original contract terms each year the annual premium is paid.

            There’s nothing wrong with my logic. If you take out a whole life insurance policy when you are young, your premiums will be disproportionately “high” in terms of your probability of dying in the current year, but if you maintain the policy until old age, your premiums will become disporportionately “low” in the same terms.

            The point to grasp is that insurance companies cannot make money by covering “sure things.”

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          4. I recommend you consider a MUTUAL insurance company for your whole life needs. I worked for Northwester for a couple of years. Dividends have been paid on their life insurance policies since they first started selling them in the late 1800’s.

            I get it, though. You believe that ANY insurance is just a scam. Too many conspiracy articles in your past.

            Liked by 1 person

  2. Can’t I have a Chevy and load it up with Cadillac amenities?

    The answer is “yes”, and the result is that everybody is happier and won’t buy an insurance policy from some schlock company that covers only one of the three sessions necessary for effective chemotherapy because they didn’t have a lawyer read the policy first.

    Wait, that’s what I have now, Medicare and a Plan F supplement. I’m happy. Unitedhealcare is happy. My doctors, ever last one of them that I have had for year are happy, and I believe that someday I will leave an estate without huge medical debts to my heirs and not to Sentara.

    Hey! Do these studies include the savings from a reduction in bankruptcies?? After all, a clear 1/3 of all bankruptcies are caused by medical debts — 530,000 families every year. How much does that cost??

    (BTW, don’t tell Doc, but Dental Insurance is a ripoff.)

    Liked by 3 people

  3. It doesn’t matter which M4A proposal you pick. All of them are based on snake-oil economics.

    The snake oil is the “lottery problem,” which refers to the structure of the financing model. The structure is a many-pay/few-benefit arrangement that is inherently unstable.

    There are many sources of the instability. One is that you need a centralized authority to manage the arrangement, but it is literally impossible for that authority to possess sufficient information to manage the arrangement effectively and to the satisfaction of all participants. Another is that risks and liabilities are only predictable until they are not. Another is that beneficiaries inevitably lose control of their own fates/lives.

    In other words, M4A cannot work for the same structural reasons that health insurance, generally, cannot work. It cannot work for the same reasons that socialism/communism cannot work.

    The many-pay/few-benefit model of financing always fails eventually, and never delivers on its original promises.

    The smart thing is to accept that we don’t have the technology to give everyone the health care they may want and that lottery systems which only move money around can’t provide it.

    Liked by 1 person

    1. Here is the “real lottery”.

      If a person does not bother with insurance such as health, automobile, homeowners, life, etc. he is putting himself and his family at risk for financial catastrophe. And since we have a system in which emergency health care cannot be denied, then that burden is place upon the rest of the country if the assets are not enough to pay for the care.

      So ti becomes a matter of responsibility to make sure you and your family have adequate resources or buy insurance. And in our country with a median family income of around $60K, there is no way to cover with cash the lack of insurance. Even a fender bender that has some impact injuries could easily wipe out your resources.

      We all pay, through taxes, for a lot of services most of us don’t need. Most people don’t use the police or fire departments. Or the courts. Or the Coast Guard. Or any myriad of services and structures that we have developed for a civil, industrial society.

      Insurance has been around for centuries. Investors will require it for risks that might damage their returns. Lloyds of London provided such service to shippers and traders. Without their approval, you couldn’t get a dime from investors.

      If you own a boat and take out the family and friends, but don’t have safety equipment like life jackets and fire extinguishers, you would be not only irresponsible but you may be criminally liable. Wasting money on a fire extinguisher that you never need? In you analogy, “winning” would be a fire onboard so you got your money’s worth. Or sinking the boat so you “paid” for the life jackets.

      There are a lot of problems with our insurance for health, no doubt. But none of them are good arguments for not having coverage.

      Again, people who are independently wealthy may make a choice to not carry health insurance because they can take care of their responsibilities with personal resources. But they are generally in the top 5%. And you can bet they still carry insurances of all kinds so they can protect their wealth.

      I know these points will not sway you or those who think insurance is a lose/lose deal. All I can say to that is I hope you can cover catastrophic medical bills should they occur. If not, I and millions of other Americans will have to bear that cost.

      Liked by 3 people

      1. RE: “If a person does not bother with insurance such as health, automobile, homeowners, life, etc. he is putting himself and his family at risk for financial catastrophe.”

        That’s the standard illusion. The reality is more complex. Health insurance, for example, doesn’t prevent injury or disease. It may ease the burden of paying for treatment, but injury and disease have consequences of their own beyond the cost of care. No amount of insurance can change or ameliorate those consequences.

        RE: “I know these points will not sway you or those who think insurance is a lose/lose deal.”

        Insurance doesn’t have to be a lose/lose deal. There is a narrow range of circumstances in which insurance can be useful and effective, but that range is typically defined by risks which have both of two features: 1) low probability of occurrence and 2) limited (i.e., predictable) cost of occurrence.

        The problem is, people think insurance works in ways that in fact it doesn’t. As a result, it is almost impossible to have rational discussions about it. For example, it should be obvious that insurance can’t work for health care, because health care doesn’t fit within the range of circumstances which insurance can address. Injury and disease have both 1) high probabilities of occurrence and 2) non-limited (i.e., unpredictable) costs.

        The non-insurability of health care is nobody’s fault. It is simply a consequence of the immaturity of medical science and technology. But too many people just won’t take No for an answer. They insist that the insurance financing model — which in fact cannot work — actually can and does work and must be expanded.

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          1. Did or did you not you support Trump’s Tax “reform”? If so, then you bought the trickle down theories as put forth by Reagan, Bush and Trump. If you say you didn’t, I say I don’t believe you, unless you can prove me wrong.

            Yeah, that’s what I thought.

            Liked by 2 people

  4. @Roberts

    With all due respect, your “analysis” is rubbish. Insurance is not inherently flawed as you claim. There is no “lottery problem.” Insurance has been a vital and successful part of commercial and personal life for centuries. None other than Benjamin Franklin founded the first Life Insurance Company in North America. Insurance for trading vessels goes back to the 14th century.

    Liked by 1 person

      1. @Roberts

        Cute! But gambling is not “vital.” Gambling is not “successful.”

        Do you really not understand that rational people want to protect themselves from financial disaster through the purchase of insurance? And, that when properly regulated, it works?

        Liked by 1 person

      2. RE: “But gambling is not ‘vital.’ Gambling is not ‘successful.'”

        Most people don’t know how to gamble, and so they lose. Successful businesses, on the other hand, often make informed “gambles.” It’s a question of context and approach.

        RE: “Do you really not understand that rational people want to protect themselves from financial disaster through the purchase of insurance?”

        A rational person should take the trouble to ask what they get for a life’s worth of insurance premiums. Most will find that they pay far more in premiums than they ever get in covered benefits. For those who can figure out a way to do it, self-insurance is a vastly superior financial strategy.

        RE: “And, that when properly regulated, it works?”

        My point is that it doesn’t. People tell themselves all sorts of lies about insurance so that they can feel smart about having it. And, to be fair, purchased insurance can be a rational choice for some people.

        The problem is all the people who don’t understand how insurance works who then insist on everyone else subscribing to their fantasy.

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        1. Do you have life insurance? How about auto insurance? Health insurance? Homeowners? Please let me know so if I am in a car accident with you, I know you won’t be responsible. And the next time it snows, I’ll be sure to walk up your icy sidewalk, bust my ass and you will have to pay for that. And I hope your heirs are financially well off so they can afford to bury you, unless you have prepaid for that (A good idea regardless). Then their is your debts when you pass away. Will your family have enough to settle those?

          Your reasoning for the pay as you go is a lot more bogus than the insurance questions asked. Unless of course you are part of the 5% that can afford to pay as you go.

          Liked by 1 person

          1. RE: “Your reasoning for the pay as you go is a lot more bogus than the insurance questions asked.”

            Ask yourself: If insurance is a good way to pay for things, why not use it for food, clothing and shelter?

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          2. Here is the mustard for your pretzel logic.🥨🥫

            Insurance as defined by merriam-webster.com : coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril

            Insurance PROTECTS food (on a commercial level) clothing and shelter on a personal one.

            Liked by 1 person

          3. RE: “Insurance PROTECTS food (on a commercial level) clothing and shelter on a personal one.”

            You’re dodging the question. Maybe you don’t understand it, so I’ll put it a different way: If collecting a little bit money from a lot of people is a good way to pay for health care needed by just a few people, why not use the same approach to giving people food, clothing and shelter?

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          4. I did not doge the question. You changed it. But because you believe that insurance is just a 100% scam, I can’t help you. The reasonable man approach doesn’t work with you.

            And if you believe that not everyone will need health care at some time in their lives, you are apt to purchase a bridge between Manhattan and Brooklyn. Tell me someone who is ten foot tall and bullet proof and will never need health care and I will introduce you to a DC Comics character.

            Liked by 1 person

      3. @Roberts

        Leaders of successful businesses do not run unnecessary risks. They may “gamble” on a new technology or new ad campaign or a new store but they do not gamble on avoiding financial disaster through luck. They buy insurance.

        The fact that self-insurance can make sense for a few people or a company with very deep pockets does not alter the fact that insurance is vital for those without such means.

        It is not clear why you would call a rational person buying, say fire insurance, as someone who is subscribing to a fantasy? Who is it that you think do not understand how insurance works? It is really not a secret. You pay some money to avoid having to pay a lot more – often more than you have – if you are unlucky.

        Liked by 3 people

        1. RE: “Leaders of successful businesses do not run unnecessary risks.”

          Neither do successful gamblers.

          RE: “The fact that self-insurance can make sense for a few people or a company with very deep pockets does not alter the fact that insurance is vital for those without such means.”

          Of course. And wealth is vital for poor people. Why not just take it from the rich?

          RE: “You pay some money to avoid having to pay a lot more – often more than you have – if you are unlucky.”

          In a different context, that’s called playing the lottery. It’s nice when you get back more than the price of your ticket, but for that to happen, a lot of other people have to lose the price of their tickets.

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  5. Of course Paul overlooks basic assumptions to arrive at his conclusions that UI pointed out. Primarily that doctors and hospitals will agree to drastic cuts in reimbursements among many others. In other words fat chance. I refer back to my other comment that Obamacre promised an insurance savings of $2500 a year. That didn’t happen and it didn’t cost $60 trillion to find out that lie. Or was that $80 trillion or…well who’s counting…

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    1. @BobR

      Whose counting? Well, that’s obviously not you since you are still pretending that the cost of Medicare-for-all is $60 Trillion when, in fact, it is projected to be $7 Trillion over ten years if the Cadillac plan is adopted. Or, minus $2 Trillion for the Chevy plan.

      What is this “Obamacare” you refer to? We have been living with Trumpcare for three years now. And, in case you missed it, Trumpcare gutted some of the key components that Obamacare required to deliver the planned results.

      The question of “drastic cuts” is addressed in the details and in the sensitivity analysis. The base numbers assume that providers will be paid at rates similar to Medicare rates. That assumption accounts for about $230 billion of projected savings annually or about $3 Trillion over the ten year period. So, sure, it is an issue but hardly a deal breaker. As the authors make clear over time they expect the reimbursement rates to be at equilibrium levels where the supply offered meets the demand.

      Here is the document containing the sensitivity analysis (page 13) . . .

      Click to access from_incremental_to_comprehensive_health_insurance_reform-how_various_reform_options_compare_on_coverage_and_costs.pdf

      Liked by 2 people

      1. Oh please. 60 Trillion represents an increase of 7 Trillion in spending with drastic assumptions. That also represents an increase of $34+ trillion in government spending to try to cover it. Where does all of this money come from? We all know. Oh yeah, but MAYBE companies will give employees raises so the government can soak them more in taxes???? Your radicalism will not fair well in the election. You will see.

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        1. @BobR

          I have done my best. You continue to ignore clearly laid out facts from this study. Rather than considering the facts rationally, you choose to rant. Len says “You are smarter than that.” I see no evidence along those lines.

          Liked by 1 person

        2. RE: “Oh please. 60 Trillion represents an increase of 7 Trillion in spending with drastic assumptions.”

          The drastic assumptions are the key. They are outlandish, of course, because the central planning authority cannot really control prices.

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    2. When I still had my business, I subscribed to Anthem for private health insurance for my wife and me. The last premiums paid were about $1500 for both policies with $2500 deductibles. That was around 2012 or so.

      Before Obamacare, premiums were going up at double digits most years since the 90’s. And it is important not to forget the egregious abuses from health insurance companies such as delays, denials, dropped coverages, rescissions and pre-existing conditions exclusions. And, of course, after the recession, millions had no health insurance from their employers and private insurance was a huge problem.Those are why Obama ran on the health insurance platform

      I don’t know what the math would be exactly, but 10%/year on my $1500 for the last 8 years would have been pretty hefty. So it is possible that Obamacare would have saved me at least $2500/year.

      ACA was work in progress. The headwinds from so many quarters made some real sausage that, frankly, most lawmakers acknowledged that improvements and tweaks would be needed.

      Personally, I am of the “catastrophic insurance with HSA’s”. No need to file claims for sniffles or cuts. But even the catastrophic coverage would need near universal participation to make it affordable. Any insurance plan needs to have young and healthy premiums payers. M4A does this by the payroll tax.

      There are other ways to achieve universal coverage. Germans do it with private plans that cannot make a profit on basic coverages, but they can sell options and bells and whistles for a profit. They do very well.

      The Swiss make it against the law not to buy insurance.

      The facts are that we spend more than any other industrial country in the world on healthcare and we don’t show results that makes it worthwhile. We pay the highest drug prices. We pay the highest medical device prices. Our diagnostics are through the roof.

      And according to Kaiser Foundation, a family of 4 is paying about $20K year for insurance, plus copays, deductibles, AND a payroll tax of 3% for Medicare on top of that. If employed, the employer picks up about 1/2 or a bit more, but that is still the cost of hiring an employee as far as the employer is concerned.

      https://www.kff.org/health-costs/report/2019-employer-health-benefits-survey/

      Marketing crappy insurance with caps and all kinds of exclusions is not a way to reduce costs or increase access to quality healthcare. And that is the agenda of the present administration and the GOP.

      So without undue accusations and insults, I have given you my opinion on healthcare in the US.

      Liked by 2 people

      1. I keep challenging you on who pays this $20k for insurance but you dodge it every time. That figure is based on employer provided health care plans of which the employer pays most of it therefore the consumer actually pays more in the area of $7k a year for a family of 4.

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        1. Bob, I know you are smarter than that. If the employer pays part (which, BTW, I dId point out), that is still the cost of health insurance for a family of four. You think the employer doesn’t take that into account when establishing compensation. That money is not printed in the back room. It comes from the revenues of the company.

          I owned my own studio for over 4 decades, with a payroll.

          Or to put it another way: if I hire someone with a family of four for $50K I have to consider SS and Medicare, unemployment insurance, workman’s comp., and if I have health insurance, maybe as much as another $13K on top of that. That person is going to cost me closer to $67-70K. That is money the employee won’t see in his paycheck and eats into my profit.

          So if we take the median household income at around $60K, that $20,000 plus 3% Medicare plus copays and deductibles can be well over 1/3 of that income. That’s a lot of money going to one sector of the economy from a single employee’s compensation.

          The best way to pay for M4A, if that is the route, is through a payroll tax increase. Perhaps 10% instead of 3%. That would be about $6,000 instead of $20,000 plus Medicare. Even a family income of $180,000 would save money.

          Liked by 3 people

      2. RE: “But even the catastrophic coverage would need near universal participation to make it affordable.”

        Nope. As a rule, premium calculations don’t include a factor for number of participants. They don’t need to, because the number of participants doesn’t change the odds that a covered event will happen to any individual participant.

        The idea that expanded participation makes insurance cheaper is one of the enduring myths of insurance. In reality, expanded participation adds to the risk of insolvency for the insurance company because larger participation equals larger liability which, in turn, means greater vulnerability to “black swan” events which can drain the company’s coverage resources.

        RE: “Marketing crappy insurance with caps and all kinds of exclusions is not a way to reduce costs or increase access to quality healthcare.”

        It is, however, the only way insurance can be used to create access to health care. That is the inherent limitation of the insurance model.

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        1. “… number of participants doesn’t change the odds that a covered event will happen to any individual participant.”

          Sure it does. If your company has only middle aged and elderly with a lot of medical issues, you might have a point. That is why universal coverage is key. It is important to have younger, healthier clients paying. And as they get older and start having issues, the next generation helps to support them.

          And at the same time the younger, healthier are still covered when serious illness or accidents occur despite their age.

          You are assuming a static population.

          Liked by 1 person

  6. Those of you arguing against this are aware that single payer exists and is well-liked in every other developed country on Earth, right? I understand that you have a reflexive disdain for people you consider less than you and you object to social goods, generally; but arguing against the logistics of how such a system could be implemented seems…dumb…

    Liked by 3 people

    1. RE: “Those of you arguing against this are aware that single payer exists and is well-liked in every other developed country on Earth, right?”

      Socialism exists and is well-liked in other countries, too, but that’s not a good argument for wanting more of it here.

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      1. Buzzword usage. Well played.

        Social democratic programs work just fine in capitalist countries across Europe. They can work here just as well if people such as yourself and El Prezidente would understand the differences between social democrats in Europe versus Totalitarian socialism in Venezuela.

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        1. You are, of course, correct that he is grasping at straws, as usual, but let’s be careful not to concede right-wing, imperialist talking points. I don’t think Venezuela can rightly be considered either “totalitarian” or “socialist.”

          Liked by 2 people

  7. …single payer exists and is well-liked”… Not just in other countries, but right here in the good ol’ US of A. Tricare, VA, Medicare are all single payer systems SPONSORED by the government. My favorite folks are those that scream at the government to “keep their hands of my MEDICARE ( and Social Security)”.

    Liked by 2 people

    1. Who are you trying to fool? Tricare and the VA are no where near a single payer system. They are veterans benefits paid for with the defense budget, you should know that and be honest. Although I have paid into Medicare forcefully my entire life, I don’t know if I will be able to use it because it is almost broke. There are currently 3 paying workers for every recipient, down from 50+ at it’s inception.

      Liked by 1 person

      1. VA is NOT in the defense budget. Tricare yes, VA no.

        BTW, the VA is exactly what you hate — government owned hospitals, the staff and doctors are government employees and the government negotiates for pharmaceuticals, which they get at 40% of what Medicare pays.

        Liked by 1 person

      2. You continue to prove your ignorance. Tricare, while paid for out of DOD funds, and contracted out (Government Sponsored) to Humana (UGH!) it functions as a single payer system. I also pay my monthly premiums and co-pays. But by definition it IS single-payer.

        The VA as its own budget, and it is they who pay the doctors and other staff, maintains the hospitals and handles all of the outsourced services now provided for those not in close proximity to VA clinics.

        Liked by 1 person

        1. I will give you the funding of the VA which sucks in a bad way but Tricare is NOT a single payer system. You DON’T pay for it. You chose prime so you pay a small offset, deductibles and copays but must use military hospitals at least initially. I chose select,choose my doctors and pay nothing. I do have secondary to cover copays and deductibles but Tricare is a veterans insurance benefit not a single payer system. Sorry. If you want to sell socialized medicine, the VA is your WORSE model to point to as a success. Keep that shit and stuff it.

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          1. You apparently don’t know shit. And you continue to prove it.

            I have a PCM. All referrals are sent to Portsmouth first and then farmed out because there are enough active duty folks and their families using the hospital first (as they should).

            As far as the VA, yes there are issues. That I was why I chose to stay with Tricare. More choice, but the care my brother gets through the VA is just fine by him.

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  8. Adam first says I don’t know shit then proves I am right. He has a Tricare Prime Primary Care Manager who queries PNH first for availability then outsources when there is none. If there is availability he is required to use government hospitals. The VA sucks beyond belief necause they cant find any doctors to accept their low pay. It took a full YEAR for me to get a simple procedure and approval from them. The bureaucracy will blow your mind and everyone you talk to tells you something different. That is government run health care liberals claim is so great. Exactly what is it that is incorrect in my statements?

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    1. @BobR
      People like to cite the VA as evidence that the government cannot do healthcare. Of course, such people totally ignore Medicare which is efficient, effective and popular. It is far more efficient than for-profit insurance companies who employ armies of bureacrats whose mission is to find ways to NOT pay.

      The VA is actually not a Single Payer system. It is a Single Provider system that is NEVER adequately funded and has as its clientele a disproportionate number of sick and older people with particularly difficult health problems. Those who cite it either do not understand the difference between single payer and single provider or they choose to ignore this highly relevant fact. You seem to be in the first group.

      Liked by 1 person

      1. Yeah, so it must be a myth that fewer and fewer doctors are accepting Medicare patients. Such an efficient system….Kmart of health care…

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      2. Btw, I am not the one who claimed the VA was a single payer system. Thanks for setting your all knowing, dog whispers, socialist, boy Adam straight. I knew we could agree on something for once.

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        1. The name calling is unnecessary, Trump-butt munching, bigoted, intolerant woman.

          And what is the difference between single payer and single provider? The VA is outsourcing care in the way Tricare does. Paul sees a difference that is only a surface one at best.

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          1. @Adam

            “Paul sees a difference that is only a surface one at best.”

            Uh, no. The difference is quite real. A Single Provider is not an insurance provider, it is a service provider. The best example of a country with a single provider system is the UK whose basic healthcare is provided by the NHS – an organization that operates hospitals and clinics and hires doctors and nurses. The VA is like that rather than like an insurance company even if it sometimes farms out work.

            And, you have been in error to call Tricare or any other insurance organization as a Single Payer. In a Single Payer system there is a – wait for it – a single payer. Tricare is just one of many payers.

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    2. My experience has been that every single time I have been referred for something by my CIVILIAN PCM, PNH sends it out due to availability. With the exception of my sleep study, done with PNH (but treatment is through a civilian provider) , everything else has been outside the PNH umbrella.

      While I acknowledge issue with the VA, as I stated, my brother has been happy with his experiences there.

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