If costs for medical care were not so high, there would not be much of a problem.
Of course, back then, costs were lower partly because far fewer medical services were possible – it was not a question of medical care being rationed or the patient not being able to afford medical care, but that there may have been nothing possible to do. Lots more things are now possible, but very expensive, forcing people to confront the question (both personally and politically) of “how should medical care be rationed?”.
" Back in the olden days when I was born, my parents just paid for my birth in cash. No insurance and this on small salaries. They never indicated the cost was a burden on them."
Well we are headed back to the Fifies so I’m sure any day now we too will be able to pay in cash, on small salaries for medical care.
Anyone remember that the original plan was to have a single payer system like Medicare but that got killed by politics. Then most of the premium and other cost containment provisions in the early versions of the ACA got stripped out due to the politics of special interest groups in the health care industry.
The original Hillarycare envisioned a single payer system, and we know what happened to that. Interestingly, the GOP countered with a private insurance based plan developed by the Heritage Foundation which is basically what became ACA, and of course the GOP hated it because it was Obama’s plan.
Back when I was in health care consulting (late 80’s), one of our urban hospital clients served a certain population, and most paid for their ‘stay’ with cash upon checkout. As a result, the hospital had three armored truck cash pickups per day.
I don’t, in fact, remember that the original plan for the ACA was for it to be single payer, because that was never the original plan.
You are wrong. This was an issue that I followed very closely for professional reasons and the original idea for health care reform was in fact to have a single payer system. It got killed early on for exactly the reasons I stated.
I’m not sure what you’re referring to by “the original plan,” MichaelNKat. Neither Hillary Clinton nor Barack Obama campaigned on a platform of a single payer health plan. Recall that the individual mandate was an issue in the 2008 campaign-- Clinton favored it, but during the campaign Obama did not. The individual mandate is only relevant in the context of buying insurance. So both candidates were already envisioning that people would be buying insurance in the private market, before the legislation began being drafted. There was talk during the drafting of the legislation of a “public option,” but that is not the same as a single payer plan.
Here’s a 2007 article discussing the campaign promises of the three Democrats then running for President. Already, a year before the 2008 election, none of the candidates was promising single payer.
http://www.politifact.com/truth-o-meter/article/2007/dec/03/clinton-and-obamas-dueling-health-plans/
The article @NoVADad99 posted in #251 is worth a read. From the article:
"Since then, the price of individual-market plans has climbed higher. Health-care prices go up all the time, no matter what. We all wish they didn’t; they do anyway. But in the years since the ACA was implemented, individual-market premiums haven’t been rising as fast as they were before, according to Jonathan Gruber, an economist at the Massachusetts Institute of Technology.
They went up by “35 to 40 percent in the three years before ACA,” Gruber told me. “If you look at the three years since ACA, it’s still below that, including this year.”"
CF – I believe that MichaelNKat is referring to the plan that Hillary implemented in 1993 with the reference to “original” plan. Hence NoVADad99’s reference to the Heritage Foundation plan, also put forth in 1993.
I’d note that no matter how a plan is structured, if it involves private insurance then there always has to be a layer of costs to allow for reasonable profit for the health insurance companies. Additionally, health insurance companies have to build their own administrative costs into their premiums, whereas there is nothing that inherently requires a government-administered system to sustain itself based on premiums-- as opposed to a combination of premiums and tax revenues. (Same basic logic as to why state universities can operate while charging significantly lower tuitions than private universities).So reliance on private insurance is always going to result in higher premiums than any plan run by the government. That doesn’t mean that it’s necessarily terrible… just that it is going to cost more by definition. (In some cases the government comes out ahead by hiring the insurance companies to handle the administration – such as the Molina’s role for Medicaid – but in that case the government is paying the bulk of premiums rather than consumers).
cardinalfang- the Obama administration, AFTER the election and in the midst of the beginnings of the recovery from the financial crisis, TRIED to get a single payer health insurance program passed, but ran into a buzzsaw of opposition from both the insurance companies[ after all, a single payer system would put them out of business] and pharmaceutical companies, who fought the administrations plan to allow patients to be charged no more for drugs than Medicare paid] so there were compromises made in order to get SOME sort of additional health insurance plan passed to cover the millions that had no insurance and those who could not get insurance because of per-existing conditions…
What came to pass was a compromise, which is now in danger of being gutted.
BUT ,what does it MATTER what the candidates were advocating 1 year before Obama was elected?? It all changed in light of the financial crisis that developed and the billions of $$ that had to be pumped into the economy to save the banking system from completely crashing the economy.
It is, however, possible to have a hybrid system, with a mostly single-payer system but the option to take a voucher instead to apply to a private plan. That exists today for people age 65 or older as Medicare (the voucher for private plan option is called Medicare Advantage, which is chosen by about 31%). Of course, the insurance companies would lose the customers who do not choose the voucher for private plan option.
Of course, paying for such a thing would have been another political battle. An employer-paid payroll tax would come closest to substituting for existing costs (of employer-provided insurance), but it would have the disadvantage of being a tax on jobs and a similar American worker competitive disadvantage (versus workers in Canada or other rich countries) that employer-provided insurance has been and still is. Paying for it out of general revenue would avoid that, but then anyone whose taxes go up would complain (or those concerned about deficit spending would complain if there were no compensating increases in tax revenue).
There are no easy answers, since any reform (of any ideology) will cause substantial complaining from various directions.
When I was consulting and DH was self employed I couldn’t find coverage for pre-existing at any cost. Even though I didn’t use the marketplace, I was grateful for ACA because Kaiser was forced to comply this, they immediately reinstated.
I’m happy to pay for office visits and the occasional ER visit for bumps and bruises but a catastrophic injury or illness would have bankrupted us.
In reply to a question upthread, My OOS college kid has to come home for treatment as Kaiser is only in the west. Although she’s covered for ER visits OOS.
Just a comment about the provision to allow children to stay on their parents’ insurance. This provision turned out to be revenue positive for the insurance companies. Most parents were glad to insure their kids regardless of their health, and the age group has few medical claims. So it’s a case of a rule that turned out to be good for everyone with no losers.
Lower premiums from single payer do not automatically mean lower total costs. Low premiums often just means a higher burden on taxpayers.
Single payer has the possibility of lower costs due to not having to earn a profit, and the possibility of lower administrative costs. That is where the savings can come from.
I think fundamentally the U.S.has to move into this century by agreeing that healthcare is a basic human right.
This could be done in a single payer system, or with a real mandate with financial teeth.
But otherwise we get the healthy (for now), young (for now), man who has read Atlas Shrugged and decides that he is a rational actor who shouldn’t have to pay for those people who had the nerve to have bad luck.
Not everyone agrees that it is a human right, but I think most everyone agrees that it should be made affordable for all people.
I actually agree, however the risk would be that lack of competition could cause quality to suffer across the board.
Is there really ‘competition’ in our current system? Seems the medical provider costs are the same across the board no matter what insurance you have. Only difference is in the premiums the policyholders pay and the services that come with it. You pay more, you get more. You pay less, you get less. We can have a system like that of the UK’s NHS that provides a basic level of care for everyone, and if you need more and better treatment that what’s provided by the single payer system, you buy supplemental insurance for it, like they do in the UK and Canada.
“that lack of competition would cause quality to suffer across the board.”
How does lack of competition among insurance companies lower quality? Insurance companies don’t have anything to do with healthcare advancement. Only doctors, hospitals, pharmaceutical companies, high tech companies do.