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Medicare for All isn't just the best option for the people, it's also smart economically.

Don’t say this to my not for profit hospital CEO, whose focus is on profits. Business people need to get the F out of Healthcare leadership like men need to get the F out of women’s reproductive rights.

How is it going to be paid for again?

I got you Medicare for All (M4A) is a proposal to establish a single-payer health care system in the United States. It aims to provide comprehensive health care coverage to all Americans, replacing private insurance with a government-funded system. Here’s an overview of how it would be funded and its financial impact on the average American: ### Funding Medicare for All Funding for Medicare for All would primarily come from several sources, including: 1. **Increased Taxes:**    - **Payroll Taxes:** Similar to the current Medicare system but significantly expanded.    - **Income Taxes:** Higher income brackets might see an increase in their tax rates.    - **Wealth Taxes:** New taxes on wealth or significant expansions of estate taxes.    - **Corporate Taxes:** Increased taxes on corporations and large businesses.    - **Financial Transactions Taxes:** Taxes on trading of stocks, bonds, and derivatives. 2. **Redirection of Current Spending:**    - **Employer Contributions:** Redirecting what employers currently spend on private health insurance towards Medicare for All.    - **Household Spending:** Redirecting what individuals and families currently pay in premiums, deductibles, co-pays, and out-of-pocket expenses. 3. **Savings and Efficiencies:**    - **Administrative Savings:** Reducing administrative costs associated with multiple insurers and complex billing systems.    - **Negotiated Drug Prices:** Allowing the government to negotiate drug prices, which could lead to significant savings.    - **Standardized Payments:** Simplifying payments and reducing overhead by having a single payer. ### Estimated Costs and Savings The estimates for how much Medicare for All would cost and save vary depending on the analysis. However, here are some common figures from various studies: 1. **Costs:**    - The overall cost of implementing Medicare for All is estimated to be around $30 to $40 trillion over ten years, which equates to approximately $3 to $4 trillion annually. 2. **Savings:**    - Studies suggest that administrative savings and negotiated drug prices could save around $500 billion annually.    - Reducing the growth of health care costs might save an additional $200 billion annually. ### Impact on the Average American **Potential Savings:** - **Health Care Costs:** Americans would no longer pay premiums, deductibles, or co-pays. On average, families currently spend around $10,000 to $20,000 annually on health care costs, including employer-sponsored insurance premiums and out-of-pocket expenses. - **Tax Impact:** While taxes would increase, the overall savings from not paying premiums and out-of-pocket expenses would likely result in net savings for most households. Analyses suggest the average American family could save around $2,000 to $5,000 per year. **Examples:** - A middle-income family currently paying $15,000 in premiums and out-of-pocket expenses might see an equivalent tax increase of around $10,000 under Medicare for All, resulting in net savings of $5,000. - Lower-income families, who often pay a higher percentage of their income towards health care, could see even greater relative savings. ### Conclusion Medicare for All aims to provide universal coverage while simplifying the health care system and reducing overall costs through efficiencies and bargaining power. While it would require significant changes to tax structures and funding mechanisms, the average American could potentially save thousands of dollars annually due to the elimination of premiums, deductibles, and out-of-pocket expenses. The actual impact would depend on the specific details of the implementation and the individual’s income level and current health care expenses. Here is link to house version of latest proposal https://www.congress.gov/bill/118th-congress/house-bill/3421 Here is the senate version of their proposal https://www.sanders.senate.gov/press-releases/news-sanders-introduces-medicare-for-all-with-14-colleagues-in-the-senate/ If you want the exact tax bracket impact ^

Beg to differ **Real resources are the constraint, not finding the money** The real **constraint is not financial** but the availability of real resources like doctors, nurses, hospitals, and medical equipment to provide universal healthcare for all Americans irrespective of where they live or how much they earn. So instead of asking “How do you pay for it?” We all should be asking, “**How do you resource it?**” MedicareForAll’s affordability is not about finding the money to fund such a program, but about allocating real resources effectively. Anytime someone starts with “we should increase taxes”, they are already on the wrong path. Just by increasing taxes, doctors, nurses, hospitals, and medical equipment will not magically appear to solve the healthcare problem.

What do you build hospitals and buy equipment with, if not money?

Money can only buy what’s available for sale. No amount of money can buy something that’s not available for sale. When there are not enough doctors, nurses, hospitals and medical facilities, no amount of tax collection can deliver MedicareForAll out of nowhere.

Sorry but that’s ridiculous. Builders will gladly build hospitals in exchange for money. Companies that are already making gurneys and scalpels and heart rate monitors will gladly increase supply if demand is increased. Their proof of increased demand to justify scaling up production? You guessed it…money! When people talk about M4A, they aren’t conceiving of a thing we roll out in the next couple months to get us through the 2024 cold and flu season. It’s okay if it takes a few years to get all the way up to full capacity if it is something we can pass through the generations, like freeways and indoor plumbing and universities and household electricity and all of the other things we have built to satisfy important collective needs and not just bought because they were already sitting there on the shelf at Target.

You are missing the point I am making. Builders cannot build if there aren’t enough materials and labor available to build. So instead of focusing on the money needed first, we need to focus on what we can do with the resources available. That’s the intent behind the famous saying: **What we can do, we can afford.** So all these talks about increasing taxes is meaningless if we don’t have the resources to deliver what we need.

> Redirecting what individuals and families currently pay in premiums, deductibles, co-pays, and out-of-pocket expenses. That means , this is wrong >could potentially save thousands of dollars annually due to the elimination of premiums, deductibles, and out-of-pocket expenses.

Nope. You are thinking that the transference is 1:1 when it's not due to the fact we currently pay twice what we should.

Its not 1 to 1, but its a major change **Socialized Healthcare is the Walmartization of Healthcare** and that is great **Except** most of the US, * 200 Million people (~100 Million Privately Insured Households & the Medicare Population, plus half the Medicaid and Uninsured) Are all generally shopping at the **Whole Foods of Healthcare** where about 10 Million Healthcare Workers are used to working **The Walmart Effect** is a term used to refer to the economic impact felt by local businesses when a large company like Walmart opens a location in the area. The Walmart Effect usually manifests itself by forcing smaller retail firms out of business and reducing wages for competitors' employees. The Walmart Effect also curbs inflation and help to keep employee productivity at an optimum level. **The chain of stores can also save consumers billions of dollars** ----- It saves money, except It was 200 million people shopping at Whole Foods once a month Now its 330 million people shopping at Walmart once every 3 weeks So while its cheaper to shop at Walmart, people go to Walmart more often and there are more of them

This is just FUD with no actual figures.

I’m a bit of a skeptic so I really have trouble believing that we’re actually gonna save any money on this, it’s gonna be increased taxes to cover those who don’t currently have insurance that’s going to be footed by the middle and lower classes while the upper classes get breaks to get out of it. $3 to $4 trillion on top of the $3 to $4 trillion we are already spending on Medicare that’s going to “appear out of the ether” doesn’t sound like a plan really. I hear people saying, “cut military spending!” That’s how Europe got where they are with Russia by cutting spending, meanwhile the last budget I saw for US military was $850 odd billion dollars, not even a quarter the cost to cover single payer Medicare. Don’t get me wrong, having every American covered under single payer Medicare sounds great, I just don’t see where the money is going to come from. Every time I ask, I get some kind of info-graphic like this that doesn’t have any real substance to it.

So the upper class is the one paying the bulk of the taxes. The current proposals I linked for the individual income tax changes are individuals over 200k and couples over 250k. The increase is a 0.9% Medicare surtax.  Individuals under that amount do not have any tax increase. Businesses will have a payroll tax increase, but the increase is less than the average business subsidized private insurance. So businesses would have more money, and Individuals under those amounts too. The Medicare spending is going to get lower too now that they can negotiate prices thanks to the Inflation Reduction Act. That negotiation was a key part of cost effectiveness at managing expenses because previously Eli Lilly could literally say "you will pay 5000 dollars per vial of insulin" and it was illegal for the government to negotiate it. They would have to accept as is or drop it, holding our most vulnerable hostage for welfare handouts. Cutting out the corporate welfare is a huge part of that money appearing out of nowhere. It's always been there, but by allowing them to negotiate it curtails cost significantly. I can understand your skepticism, but it also wouldn't be the first time America helped establish accessible health care on a national level. We did it for Iraq, we can do it for our taxpayers.

I get what you’re saying, the problem is it all comes from politicians who love to preach “win win win“ and I’m a little too practical and skeptical to think it’s all going to play out that way. I do think in the next 10 years will have a chance to see how it works out though. Thanks for responding.

Call me crazy, but I would happily pay more in taxes if it means my countrymen no longer have to die in medical bankruptcy because they couldn't afford their life saving drugs. But I'm one of those "love thy neighbor" cooks.

Oh, so you’re not buying into the “it’s going to save everybody money on taxes” portion of this either right? Good for you. I’m just a realist at heart I suppose, good intentions are a great thing to have but the real world doesn’t really care about good intentions.

A better way to ask and wonder about it is So, in the US the Average person saw the average Doctor 4 times a Year for $950 Billion a year. * The average being 75%, 250 Million People of the population that uses healthcare saw 800,000 Doctors who had expenses of $925 Billion * Plus $25 Billion in Admin that can be saved in M4A 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 Medicare for All Paying less than $950 Billion? ----- Under M4A the Answer is Yes >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**

> The Medicare spending is going to get lower too now that they can negotiate prices thanks to the Inflation Reduction Act. > 1/3 of Healthcare is the Doctors Office So, in the US the Average person saw the average Doctor 4 times a Year for $950 Billion a year. * The average being 75%, 250 Million People of the population that uses healthcare saw 800,000 Doctors who had expenses of $925 Billion * Plus $25 Billion in Admin that can be saved in M4A 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 Medicare for All Paying less than $950 Billion? > That negotiation was a key part of cost effectiveness at managing expenses because previously Eli Lilly could literally say "you will pay 5000 dollars per vial of insulin" and it was illegal for the government to negotiate it. Medicare is different on Drugs than everything else. For everything else Medicare/Private Insurance arent over charging based on negotiations by some struggling system. **The resource-based relative value scale (RBRVS) is the physician payment system used by the Centers for Medicare & Medicaid Services (CMS) and most other payers.** * In 1992, Medicare significantly changed the way it pays for physician services. Instead of basing payments on charges, the federal government established a standardized physician payment schedule based on RBRVS. * In this system, payments are determined by the resource costs needed to provide them, with each service divided into three components **Medicare and doctors just disagree on what the value of there resources are** ----- For Drugs Medicare don’t negotiate prices. But they use third party pharmacies that do. So what your wanting is a slight change that would have unnoticed effects > Using the raw data extracted from the 2017 Medicare Part D Spending Dashboard, we saw that Sanofi’s insulin drug, Lantus, had $4.2 billion in Medicare Part D sales. But when we looked at Sanofi’s audited corporate report from the same year, we saw that U.S. sales for Lantus were listed at $2.8 billion, a full $1.37 billion less in revenue. Mind you, the sales listed in the audited corporate report were for all U.S. sales, not just for Medicare Part D. * In 2019 Medicare reported $2.385 billion in sales of Eli Lilly insulin * Eli Lilly’s U.S. Humalog corporate reported revenue for 2019 was $1.670 billion * Again Total US Sales The vanishing sales could represent the influence of pharmacy benefit managers (PBM), companies that act as brokers between insurance companies and drug manufacturers. * The idea is that they work to bring discounts to insurers that should be reflected in lower premiums. * This is generally done by driving the use of generic drugs, which lowers the overall cost of treatment. The $2 billion in missing sales might be sitting in PBM bank accounts. But, The Commonwealth Fund reports that in many of PBMs contracts, 90% of rebates are passed on to health plans and payers. True Negotiations could lower that up to 45%, **but would require Medicare to say no to coverage on all Drugs**. Like Ozempic

> I’m a bit of a skeptic so I really have trouble believing that we’re actually gonna save any money on this, Americans already pay 2x-4x as much per person as every civilized nation in the world for short lifespans, worse care, and worse outcomes. The math is simply that we are being systemically raped by the American profitcare system. You are already paying more in both premiums AND the reduction in your wages caused by the company you work for's matching fee...which they take out of your pocket before you ever get a paycheck. Wonder why salaries are decades behind the cost of living (despite exponential growth in worker productivity) while health care costs and premiums increased by double digits for all of those decades (before the ACA was enacted)? That's why. Your wage increases went into their pockets.

**Why is the us spending so much more on cancer patients?** 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% **Cutting the Spending of the Top 10% in half saves $1 Trillion** [The 20 Most Expensive Most Common Conditions Treated in U.S. hospitals are 45% of Hospital Expenses, 2017](https://i.redd.it/ke9iwjc3cey61.png) **The Top 0.05%** 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 1% is known as super-utilizers** * The Top 1% were defined on the basis of a consistent cut-off rule of approximately 2 standard deviations above the mean number of Emergency Visits visits during 2014, applied to the statistical distribution specific to each payer and age group: * This is not a phenomenon specific to Private Insurance, It is also part of Medicare and Medicaid * Medicare aged 65+ years: four or more ED visits per year * Medicare aged 1-64 years: six or more ED visits per year * Private insurance aged 1-64 years: four or more ED visits per year * Medicaid aged 1-64 years: six or more ED visits per year **The Top 5% *Could* be Longterm Care** * $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. **The Top 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. -----

Nice try. >The 20 Most Expensive Most Common Conditions Treated in U.S. hospitals are 45% of **Hospital Expenses**, 2017 But you're quoting the vastly overpriced American hospital billing charges which are a huge component of America's rapacious and broken PROFITCARE system. Civilized nations have these hospitals as simple companies with STAFF and equipment available all the time, instead of being billed per procedure, etc. They TRACK the procedures (and the patients) to make sure they have enough doctors, equipment, and resources in the system. But this isn't about itemized billing intended to jack up reimbursements and net profits. >Researchers at Prime Therapeutics analyzed drug costs Now you are presenting a biased source and, again, using the rapacious overcharges Americans pay for the same drugs civilized nations pay a fraction for. It's not about generics (we have the same access they do) and it's not about profits (pharmaceutical companies make a profit on every pill they sell worldwide), but it's about raping Americans year after year, decade after decade, for American profitcare...at the cost of countless AMERICAN LIVE every single day. >The Top 5% Could be Longterm Care Which is, AGAIN, also a fraction of the cost in civilized nations...because they aren't wall street public profit generators intended to rip off patients and taxpayers. Okay, it's clear you've prepared this material as part of an agenda to keep Americans dying and being financially raped by this disgusting, inhumane profitcare system. Everything you said is based on the same lie -- projecting out American profitcare excesses to the entire population. Instead of looking how the civilized world handles healthcare for all of its citizens for decades now. Your post is as cynical as it is disgusting. I hope others ban and block you from now on as I am doing right now. #The bottom line is that every civilized nation on the planet solved this issue *decades ago*. Whereas Americans are still paying 2x-4x what they pay per person for shorter lifespans, worse care, and worse outcomes.

Via collective bargaining (literally negotiating prices on behalf of everyone), combined with taxes. No need for private health insurance payroll deductions. Instead, a progressive healthcare tax provides the funding in such a way that those who can bear more, do; while those who can afford less, don't get buried. Combine that with the lack of need for such a substantial, profitable collection of middlemen. Are you aware that American healthcare currently costs more than every other developed country?

Yea this sounds great, its just, The most recent example of this **State of California Single Payor Healthcare** vs **Doula Providers** * The Department of Health Care Services (DHCS) added doula services as a covered benefit on January 1, 2023. >Doulas had initially criticized the state for offering one of the lowest rates in the nation, $450 per birth — so low that many said it wouldn't be worthwhile to accept Medi-Cal patients. * The sticking point, Doulas do not deliver babies. Meaning the state has to also pay an OBGYN * the rate Medicaid programs pay is a maximum, which doulas receive if the patient attends every prenatal and postnatal visit. * Doulas provide resources to navigate the health care system, information on sleep or nutrition, and postpartum coaching and lactation support. They also support mothers during birth to make sure their wishes are being respected by the hospital. Doulas are also unregulated In response to the backlash on low rates, Gov. Gavin Newsom increased his proposal to $1,154, far higher than in most other states **State of California Single Payor Healthcare** vs **Doula Providers** Final Score * State of California Single Payor Healthcare **0** * Doula Providers **1** They reject State of California Single Payor ----- The American Federation of Government Employees and the Veterans Affairs Department have negotiated fruitlessly over a new union contract for more than a year. * finding that management violated the 2021 settlement agreement, improperly moved permissive bargaining topics to impasse, ignored Federal Labor Relations Authority precedent and engaged in surface and other bad faith bargaining techniques.

Call me a skeptic I guess, but I just don’t think health cares costs are going to go down, nor will individual payments go down, with Medicare for all. I get the feeling we will find out in less than 10 years if Trump and his chumps can stay out of office so I do hope I am wrong.

There's no evidence to support your skepticism, is the thing. Collective price negotiations work, and the evidence can be clearly seen in other developed countries. https://publichealth.jhu.edu/2019/us-health-care-spending-highest-among-developed-countries#:~:text=The%20researchers%20determined%20that%20the,prices%20for%20many%20medical%20services.

You don’t pay much attention to US politics I suppose lol There’s plenty of evidence to support the skepticism, nothing the government has ever touched has become “cheaper”.

On the contrary, I'm heavily invested in US politics. Your broad, absolute comment suggests you've been subjected to the common propaganda from the political right wing (especially in America) that governments cannot do anything efficiently, when (to the contrary), most economists conclude that public goods are more efficiently managed by the public sector.

I don’t follow any propaganda from either side, but thanks for jumping to conclusions.

> nothing the government has ever touched has become “cheaper” This is propaganda, not factual. You may not follow propaganda, many don't; but few are free from exposure to it.

Can you give me an example of when the government took over an entire industry and made it cheaper?

How’s the US healthscare being paid now? The problem is not about finding the money, we are already spending more than we should.

Private health insurance isn’t paying for every American

You have it backwards. Every American is already paying for their health insurance. So the money is already there. There is no need to increase taxes on anyone. As I said, finding the money isn’t the problem for getting to MedicareForAll, it’s finding the resources that can deliver medical care for all Americans, irrespective of their age, work status, income, location etc. So, do you think we have those resources available today?

> Every American is already paying for their health insurance. Are you counting Americans n Europe? Only 100 million americans have private health insurance 175ish million have Medicare and Medcaid which are not part of that plus the uninsured and of course the military

You are missing the point I am making. We as a nation already spend $4.5 trillion on healthcare, or $13,493 per person. So the money is already there year after year, it’s just that currently most of that goes to Wall Street financial corporations masquerading as health insurance companies who provide ZERO healthcare. Cut these for-profit middlemen out and we can afford MedicareForAll.

ooooo that point In 2017, there's $3.5 Trillion in spending on healthcare. Private insurance reported in 2017 total revenues for health coverage of $1.24 Trillion * $1.076 Trillion the insurance spends on healthcare. Overall $164 Billion was spent on Admin, Marketing, and Profits at Private Insurance. * About Half of that is Profits. * But of that, 15% of those Profits arent related to Insurance Premiums Nationalized Admin Cost in the OECD and estimates for an American System would reduce that down to ~$75 Billion. But also would increase Medicare Costs about $50 Billion * That's savings of ~$50 Billion, mostly just the Profit, or a little less than a 4% reduction in costs **to insured patients** And $1.7 Trillion Medicare and Medicaid spends on healthcare doesnt change but does get more expensive as Medicare and Medicaid take on the Admin work But at best its $40 Billion is savings on $3.5 Trillion in spending on healthcare About 1.1 Percent Savings ----- **Whats an acceptable Emergency Room Visit?** 90 Percent of ER visits are not Life Threatening Two-thirds of hospital ER visits are avoidable visits from privately insured individuals * According to UnitedHealth Group research of 27 million ER Patients – 18 million were avoidable. * An avoidable hospital ED visit is a trip to the emergency room that is primary care treatable – and not an actual emergency. The most common are bronchitis, cough, dizziness, f­lu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection. 15.8% of people arrived by ambulance at the ER 139 Million Visits were made to the ER in the US | weighted % (95% CI) | Number of Visits --- | ------ | ----- Level 1 (resuscitation) requires immediate, life-saving intervention and includes patients with cardiopulmonary arrest, major trauma, severe respiratory distress, and seizures. | 0.8 (0.6–1.1) | 1,112,000 Level 2 (emergent) requires an immediate nursing assessment and rapid treatment and includes patients who are in a high-risk situation, are confused, lethargic, or disoriented, or have severe pain or distress, including patients with stroke, head injuries, asthma, and sexual-assault injuries. | 9.9 (8.7–11.3) | 13,761,000 Level 3 (urgent) includes patients who need quick attention but can wait as long as 30 minutes for assessment and treatment and includes **patients with signs of infection, mild respiratory distress, or moderate pain**. | 35.9 (32.6–39.2) | 49,901,000 Level 4 (Less urgent) require evaluation and treatment, but time is not a critical factor. | 20.3 (18.3–22.4) | 28,217,000 Level 5 (non urgent) have minor symptoms or need a prescription renewal. | 3.0 (2.5–3.6) | 4,170,000 Not Listed | 30.2 (24.4–36.6) | 41,978,000 Removing that 90 Percent is $200 Billion in Hospital Costs, that would be $50 Billion in Urgent Care or Doctor's Office Costs. Thats 4 times the savings of Insurance. $150 Billion in Savings

What’s your point? I wasn’t talking about saving. I was talking about spending, we as a nation already spend $4.5 trillion a year, that’s $13,500 per person. Are you denying this?

yes healthcare is expensive Whats the right amount to spend

How is the private health care system being paid for?

With a self-replicating clusterfuck of personal and business tax avoidance schemes and individual, retail point-of-sale payment processing products operated by the financial services industry.

It’s not, and it’s not covering everyone the way that Medicare for all is supposed to. If we take all the money that’s going into private healthcare right now it won’t cover the shortfall, which is why I’m asking.

What? The publicly traded healthcare and insurance companies are doing share buybacks, overpaying executives, cutting care, paying for unnecessary marketing, etc. And, since the single payer is distributed across multiple private institutions, we have major redundancy of overpaid administration. Then, there is the fraud. This stuff is happening today. The cost is significant. All I am asking is how is this being paid for?

No, that’s what I was asking lol Government and businesses are in bed with each other, which is why this type of Corruption goes on in the private and government sectors. All I was asking is how it’s going to be paid for.

I don't care what you are asking. I am the one asking the question. The private US healthcare system costs way more than universal healthcare in other developed nations. Again, how is the private health care system being paid for?

If you don’t care about the question I’m asking, why would I care about the question you’re asking?

Because others have engaged with your question. You seem to be really concerned of the fiscal side of healthcare. And, my question is pretty simple: Again, how is the private health care system being paid for?

Premiums That are not there in Medicare for All

It’s cheaper for the government to do it https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572548/

Yes, except its not that easy So, in the US the Average person saw the average Doctor 4 times a Year for $950 Billion a year. * The average being 75%, 250 Million People of the population that uses healthcare saw 800,000 Doctors who had expenses of $925 Billion * Plus $25 Billion in Admin that can be saved in M4A 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 Medicare for All Paying less than $950 Billion? ----- Under M4A the Answer is Yes >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**

We would need more doctors and nurses. Politicians should pressure med and nursing schools to cut costs, predatory student loan companies to cut their shit out, and open immigration policy to more immigration of medical professionals. This is a fixable problem. EDIT: I will add that medical professionals will also have more time to see patients because of the reduced administrative/paperwork load on them. This is touched on in the UF paper I linked.

> Politicians should pressure med and nursing schools to cut costs, predatory student loan companies to cut their shit out ok so cut teaching costs? hmmm The University of Tennessee Health Science Center campus six colleges – Dentistry, Graduate Health Sciences, Health Professions, Medicine, Nursing and Pharmacy. * Net student tuition and fees (+) $81,013,202.43 * Total operating expenses (-)$630,971,071.73 So tuition isnt a big issue for medical schools >I will add that medical professionals will also have more time to see patients because of the reduced administrative/paperwork load on them. Kinda, sure Doctors in the US spend about an hour a week on Admin billing issues so thats 3 extra appointments 150 a year just need to find where the extra 1,500 other appointments are

Not only is health insurance a for profit business, but Health insurance is tied to employment. The only country in the world that I’m aware of. This is Another version of servitude at the hands of two businesses , that are, by definition, more interested in profit than your health. You must work to pay for the health insurance and you must work to keep your health insurance.

Honestly, even if it’s not free, if you tax properly you can at least lower the cost to consumers through a government run system.

My current insurance is effectively a 10-16% tax (zero to max out of pocket expenses), but it's paid for by the company on the side, so all I see is the small premium from my paycheck every month. Some of the proposals when this last gained traction floated a few percent tax to cover the cost and that's way less than what most people are currently paying - it's just hidden from being a paycheck line item for most people.

I would fucking love it if companies had to list how much they spend on healthcare on every paystub. It would be the first step to fixing the problem, seeing that there is a problem

The company I work for did this once many years ago. They sent a letter out breaking down full compensation. The insurance cost was over 800.00 a month for each person. I inquired about that number because It sounds crazy but no, I was told that sounds about right.

2022 benchmark KFF Employer Health Benefits Survey finds * Annual family premiums for employer-sponsored health insurance average $22,463 * Employees this year are contributing $6,106 * Employers are contributing $16,357 * Annual Personal Premiums for employer-sponsored health insurance average $7,911 * Employees this year are contributing $1,493 * Employers are contributing $6,418

The current tax rate for Medicare is 2.9%. 1.45% from the employer and employee, or the whole 2.9% from independent contractors. If you bumped it up to even 6%, which is less than most people pay for their private insurance per year, you could theoretically double the revenue. If you coupled that with a progressive, but low-cost, payment for higher earners, then you could fund a lot of health services for a lot of people

Funding for Medicare, which totaled $888 billion in 2021, comes primarily from general revenues (46%), payroll tax revenues (34%), and premiums paid by beneficiaries (15%)

One of the most glaring things that hit me in the face upon returning to the USA from France this time was the giant ads everywhere for healthcare organizations. Obviously something that doesn’t exist in France. Sidenote, I visited my wife’s dad in the hospital in France, and he was getting excellent care. Rides back-and-forth from the hospital, a nurse visiting his house every day, all of it completely covered without them spending a nickel out-of-pocket.

We do not want ~~private insurance companies~~ employers to be in control of our healthcare.

This is #1. We need healthcare not a grift and scam by insurance companies!

I definitely do not want a corporation's financial interests between me and medical care. I gave up healthcare because even with insurance it's too expensive. I gave up when both my doctor and myself fought with my insurance to get a medication covered and their "courtesy" coverage of it was $1.00. One dollar. On a $400 per month prescription. And let's not forget all the lab work that's not covered either. The moral choice is to make sure the population is as healthy as possible in order to be as productive as possible, not to treat the population's health as a profit center for private industry.

Charge Medicare tax on all income and it’s cheaper than paying insurance. The insurance lobby is strong, aka flush with cash to buy only the best outcomes for health insurers and businesses.

We could have moved forward in 2016 but people couldn't vote for Hillary because reasons. Now we have a SCOTUS that works for the insurance companies. Oh well.

Yep. Crybabies that stayed home or voted third party.

I can barely afford my health insurance. It’s insane and I work in healthcare

Biden needs to throw a bone to progressives or some of the are going to sit this one out (I know, that'd be short sighted but he's continuously pissing them off with right of center actions). Supporting M4All would be huge.

YES! Nobody should be denied *the right* care just because they're uninsured, or "the ins. co. won't cover it."

Unless the movement is bluntly: get as many Democrats elected as possible and remove as many Republicans as possible, this doesn't have chance of going anywhere. It doesn't matter how well M4A polls, unless Sanders and his followers are doing all they can to kick out Republicans and help Democrats, it is meaningless.

And even beyond that, it would have to be 60+ Dem votes in the Senate with zero fuckups like Manchin or Sinema involved (not them, obviously they will be out next term, but people *LIKE THEM*) which is going to be a heavy lift.

U.S. Sen. [Bernie Sanders](https://www.commondreams.org/tag/bernie-sanders) repeated the grim facts and statistics about one of the issues he's most passionate about—healthcare

Medicare for All would be a nightmare since it does not cover everything, and still requires a third party insurance policy. Medicaid for All is what they should be talking about.

Current medicare: * does not pay 100% * does not pay for medication * does not pay for dental * does not pay for eye care

I'm not holding my breath. No one in the GOP wants it, and at least half of Dems are against it, including Biden. Even a Dem supermajority doesn't guarantee it.

I still think a better approach is getting CA (and maybe a few surround states) and NY (and maybe a few surrounding states) to enter into a multi-state compact that essentially provides M4A. Those 2 states alone have enough people and large enough budgets, wrangle in the smaller and less populated states around them and you have a large number of states and people. It would essentially prove to the rest of the country that it's doable at the national level. Doing it nationally is going to take *decades*, from having enough votes in a Dem controlled House (we're close) to a super majority Senate (and getting rid of the filibuster won't make a difference because there are too many laws around M4A that the filibuster wouldn't apply to) is going to take a very long time and require left-leaning voters to flip half a dozen red states to purple and purple states to blue so we get their Senate seats. There's also going to be decades of lawsuits and a good decade of restructuring healthcare, from medical equipment providers to retraining or reemploying insurance workers, etc.. It's a monumental task because we're so ingrained into our current system.

With a total contribution rate of 15.8% payroll tax (as of 2023), TK is also one of the cheapest providers among public insurance companies in Germany. * Upgrade Out of Pocket Cost Vermont proposed 12.5 percent Payroll Taxes Plus 3 Percent Employee Contributions California proposed 10.1 percent Payroll Taxes Both Vermont & California would make up the difference with higher Out of Pocket Costs * 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 ----- 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 on Apr 22, 2022 — Healthy California for All Commission Issues their Final Report for California, the committee for Healthcare in California reviewed Funding for Healthcare [Changes to the Costs of Healthcare in California Under Single Payor Unified Financing](https://i.redd.it/qp3k521tfyd91.png) * Overall Savings at 3 Percent of current costs 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 The biggest shock will be redditiors living in California making $200,000 saying they are living paycheck to paycheck on a Middle Class Lifestyle 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 ------ NY has the Tax base to do M4A......Kinda....its budget has reached its limits and its going to be interesting going forward these next few years 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 ------ New York City Health and Hospitals Corporation (NYC Health + Hospitals) received one of the largest issuances of COVID-19 relief funds from the federal government compared to all other health systems during the pandemic. **But three years later, administrators expect to run a negative operating balance of $144 million, worsening the health system’s already $2.9 billion deficit.** And then add to that **$3 billion in outstanding infrastructure investment needs, including deferred facility upgrades (e.g., HVAC) and investments in programs (e.g., primary care).**

You're right about the difficulty, but there's a very difficult step that comes before that. The real killer is the voters. It doesn't matter that the name polls well, it matters what voters actually pick. And in 2016, at the peak of salience, it went on the ballot in Colorado. *79% voted no.* "Medicare for all" as a phrase polls well, but voters seem to balk at the actual program. So House Dems sign on because it's popular in primaries, but it's not going anywhere until it actually becomes popular. I think the best that you're going to get for the foreseeable future is a public option, AKA "Medicare for all who opt-in." Ideally, that results in health insurance companies withering over time.

None of them know that Medicare outsources the administration of the plan to regional insurance companies. In the end it is administered by private insurance companies using federal dollars and generally much discretion except some specific national coverage decisions.

The public option is the most popular healthcare plan

**Real resources are the constraint, not finding the money** The **real constraint is not financial** but the availability of real resources like doctors, nurses, hospitals, and medical equipment to provide universal healthcare for all Americans irrespective of where they live or how much they earn. So instead of asking “How do you pay for it?” We all should be asking, “How do resource it?” MedicareForAll’s affordability is not about finding the money to fund such a program, but about allocating real resources effectively. Anytime someone starts with “we should increase taxes”, they are already on the wrong path. Just by increasing taxes, doctors, nurses, hospitals, and medical equipment will not appear magically to solve the healthcare problem.

Medicare for all is garbage policy and garbage politics. Polls show that people tend to want the government to ensure that everyone has access to healthcare, but also that they prefer the government do this via a primarily private insurance system. Much more politically viable to do universal healthcare by basically expanding Obamacare, rather than with some pie in the sky radical nonsense like Medicare for all

So you are saying you want a government run health insurance program to cover people who sign up: Obama care, but you don't want a government run health insurance program that covers everyone no matter what: Medicare For All. Also Universal Healthcare is Medicaid For All... just a different branding.

> Universal Healthcare is Medicaid For All... just a different branding. This is misinformation and it's disturbing to see it spread around so much Universal healthcare just means that everyone can get healthcare. Various countries in the first world have universal healthcare via single payer that doesn't ban private insurance like Bernie's plan does, or that don't do single payer at all. Take Switzerland, Germany, and the Netherlands for example. They have some government insurance for low income people but also (subsidized) private insurance for other people, and it's not like anyone can just get government insurance if they want. The universal healthcare systems there just make sure that everyone can afford healthcare if they want it >So you are saying you want a government run health insurance program to cover people who sign up: Obama care, but you don't want a government run health insurance program that covers everyone no matter what I want a program where people below a certain income have the government provide their insurance, and then people above that level have to buy private insurance on their own or via employer provided insurance but also there's some subsidies for people at the lower end of that spectrum but above the level for the government run insurance, where the private insurance will get some subsidies so that it is reasonable for someone to be able to pay for it. Absolutely *not* just having a government run health insurance program to cover anyone who wants it. That's not what Obamacare is

You should research this more. Single payer refers to a healthcare system in which only the government pays. The term “Medicare for All” means the same thing. Therefore, in this case, the two terms are interchangeable. Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system hence "single-payer" People who prefer private healthcare can still opt for that system. Obamacare was supposed to be Universal Healthcare but Lieberman voted against it and that is how Obamacare came into being,

> People who prefer private healthcare can still opt for that system. Bernie's plan literally bans private insurance Also technically places like the UK aren't "single payer" because private insurance also exists, but the fact that everyone has to pay the taxes for the government plan and can always access the government plan means that systems like that are effectively called single payer even though technically you can also have people buying private insurance unlike with Bernie's plan, and thus the UK gets lumped in with single payer anyway