Yes, and even more aware now that I’m retirement age and on medicare.
The premiums charged to enrollees cover about 13%, or 1/8th of the program’s costs, with another 38% covered by the medicare payroll tax. But 42% of the costs come from general revenue, meaning income taxes, which probably no one realizes.
https://kaiserfamilyfoundation.files.■■■■■■■■■■■■■/2013/01/7731-03.pdf
I was a hospital pharmacist and am certainly aware of the cost of meds. As to billing…I know my director years ago shrugged when we were building the rules for charging in our app and said it doesn’t matter what we bill, the insurance companies are going to pay what they are going to pay …or not. It just is so screwed up, it really is. And drug companies keep cranking out new drugs and charging an arm and a leg for them. We paid $25,000 COST for one chemo med for a woman who got it once a month; we billed $63,000; I was not privvy to how much we were actually paid but I highly doubt it was $63K. Now, some insurance companies are going to pay and some are going to deny, right? That, I guess, is where “do you have good insurance”? question comes into play. I never looked to see what insurance this woman has but given her history, I am pretty sure she was on disability probably as she had been chronically ill with multiple conditions for years. She is around 63 years old.
We had many, many repeat patients. Some were indigents, yes. When they present in the ER, they cannot be turned away. Taxpayers ultimately pay for some of that, yes, but hospitals are going broke these days trying to stay afloat, or closing down if not rescued by a corporation.
I believe it’s time for universal insurance but man oh man, what a project THAT will be. Just the logistics of providing for 340 million people efficiently. Would the best approach be to expand Medicare gradually? Insurance companies will downsize to entities providing just supplemental insurance.
Which brings me to the subject that someone upthread spouted that those who are well off enough always have the best health care. Others familiar with the Canadian and British models both had pointed out that people who can afford private insurance or who can pay privately can use it to circumvent the wait times that are mandated for some conditions. So, I don’t think any of us should assume that we all will have the same great coverage. Rich folks are still and always going to have better care simply because they can afford it. But at least, at last everyone would have insurance. Now…who is going to pay for it? I do hope that anyone who works MUST contribute something, even if it’s only a pittance so we can at least have the concept that it is indeed universal.
I think a two tier system would be the way to go too. People seriously need to adjust their expectations though. the NHS and medicareAU in Australia are terrific if you are in ICU, not so much when your meniscus is an issue or you live rurally or you need a drs appointment tomorrow. Americans who are decently insured really have no idea what that adjustment would look like. Most UHC countrymen are so defensive about their UHC, because they have never had US health care care with good insurance. I have had a couple of serous god bless america moments when accessing health care (minimally) because stuff like valet parking and carpeting are not what you get in your average NHS experience LOL. IME most US health care is consumer orientated, UHC is not consumer oriented and nor should it be.