r/FluentInFinance • u/The-Lucky-Investor • 11d ago

“Medicare for All” would save the U.S $5.1 Trillion over 10 years Discussion/ Debate

https://www.commondreams.org/news/2018/11/30/easy-pay-something-costs-less-new-study-shows-medicare-all-would-save-us-51-trillion
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u/effdubbs 11d ago

I don’t know if this claim or its math are accurate. What I do know is this: US healthcare is in crisis. I’m a nurse practitioner and I have never seen turnover like this before, especially of physicians. The workload and environment are untenable. Systems are crumbling, yet money continues to be extracted. Patients and workers are not getting what they need.

Another thing I know, patients wait here too, sometimes for over a year, depending on the complaint and specialty. The argument to keep our system as is because patients wait in single payor systems is simply not a good one.

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u/IbegTWOdiffer 11d ago

Do you believe paying nurses less would somehow ease the staffing issues? The argument against a single payer system like in Canada, is valid, has always been valid, and always will be valid. Healthcare sucks in Canada. Wait times are terrible for anything other than acute care. Pay for providers is low which is why you get a lot of immigrant providers from places like India, where as in the US you get immigrant providers from places like Canada...

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u/erydayimredditing 11d ago

Show me something supporting your claim like everyother idiots claim that Canada has longer wait times than the US. Not just that there is wait times. YOU HAVE TO SHOW THEY ARE LONGER THAN THE US. And you can't, because wait times for the non elite or wealthy are just as bad here.

This claim is tiring

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u/Iron_Chip 10d ago

I work in US healthcare, and rural health facilitate in dire need right now. Half the doctors in our area either left or retired, and there aren’t any new physicians taking up the slack. Current new patient wait times span anywhere from 5 months to a year depending on location.

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u/pieboytrooper 10d ago

This is only one data point but I live in Texas and everytime I need to see my GP I have to wait at least 6 weeks, if not longer. Any idea what the wait time is in Canada or Europe?

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u/helluvabullshitter 10d ago

Sometimes there is simply no data on a subject but that does not make it false. If nearly everyone [minus redditors that use all caps sentences to “yell”] has experience with extended Canadian wait times for medical care, then it starts to no longer be anecdotal.

You are the one refuting these claim so the burden of proof is on you, if you are so confident then why not show evidence to the contrary? Seems like the easiest way to win the argument once and for all.

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u/akmalhot 10d ago

No they are not lol

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u/leafscitypackersfan 10d ago

Just want to chime in here real quick. I live in Canada and qas diagnosed with cancer a couple years ago and it progressed to stage 4 about 6 months ago. My Healthcare has been A+. Literally no complaints. I haven't had to pay a dime either.

I'm in multiple forums for the type of cancer that I have and probably every 4 out of 5 posts are people from the states looking for advice on how to afford drugs or pay hospital bills. It's awful. Meanwhile the only bill I ever get is for parking. I'm incredibly Thankful that I don't have to worry about finances during all this.

Healthcare Def has its issues here, very short staffed but overall it's nowhere near as bad as people make it out to be.

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u/IbegTWOdiffer 10d ago edited 10d ago

I lived in Canada for a couple decades, my family suffered with Canadian healthcare for serious things like strokes, cancer, heart attacks, etc... If it had been in the US, we would have filed a malpractice suit, but in Canada, just smile and wave.

EDIT: I'm glad you had a good experience and it went well for you! It went terribly for my family.

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u/effdubbs 11d ago

I’m not sure how paying nurses LESS would ease staffing issues. Sure, there are places that cut staffing too much, but I was speaking of the issue of healthcare workers electing to leave because the working conditions suck so bad.

Nurses are paid well in some areas, but not all. The work is absolutely back breaking and soul crushing. Between admin and patients abusing nurses, the problem will only get worse. Benefits are being taken away piece by piece.

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u/pls_bsingle 11d ago

Why is public approval higher for the Canadian healthcare system than the US healthcare system? Health outcomes are also superior in Canada.

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u/IbegTWOdiffer 11d ago

Canadians less satisfied in their access to health care than Americans: poll

https://www.cbc.ca/news/health/canada-health-care-access-1.6574184

"there is a perception that access to health care in Canada is better than in the U.S., but that gets "turned on its ear" when you actually speak to Americans. 

U.S. citizens have a much more favourable opinion of their own health care system, with almost double the number of Americans surveyed (29 per cent) saying they are comfortable with the access they have. 

There were also far fewer U.S. respondents (13 per cent) who said they have chronic difficulty seeking medical care.  

Faced with the possibility of needing emergency care, 70 per cent of Americans felt confident they would get it in a timely fashion compared to just 37 per cent of Canadians. "

You may also want to look at cancer outcomes...

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u/pls_bsingle 11d ago

Canadians Largely Satisfied with Healthcare System, But Eager for Increased Access

Two-Thirds (66%) Satisfied with Provincial Healthcare System, But Seven in Ten (71%) Agree System is Too Bureaucratic

https://www.ipsos.com/en-ca/news-polls/canadians-largely-satisfied-healthcare-system-eager-increased-access

^ from an actual polling company, not an online survey of 2,000+ people

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u/IbegTWOdiffer 11d ago

Should I point out the hilarity in you citing a company that was previously owned by the market research company I cited?

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u/pls_bsingle 11d ago

How about the proposition that 85% of Canadians are dissatisfied with access to healthcare (in a country with universal access)? Lol

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u/Petricorde1 11d ago

You can be dissatisfied with healthcare in a universal access country you realize?

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u/Dumeck 11d ago

Still doesn’t matter, 1,200 Americans in an online poll with vague questions isn’t a good survey. Hell we could get a bigger more accurate survey on Reddit here with an equal amount of bias. They are “satisfied with their access to care” with the article seeming to lead towards speciality care being what’s referred to. Is the survey for people who specifically have had medical care recently? What was the exact question asked? They are very vague with that. Of course the results would be skewed if you are targeting the small % of Americans who can actually comfortably go to the hospital when they have an medical issue and sweep all the people under the rug who “just deal with” medical issues until they can’t any longer. Seeing as how ALL Canadians can do this without going into crippling medical debt I’d be very skeptical that we are comparing apples to oranges with that survey.

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u/GWsublime 10d ago

And yet Canadians have better health outcomes, live linger and pay less for healthcare. It takes longer to get your hip replaced but otherwise wait times are pretty comparable between canada and the US

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u/IbegTWOdiffer 10d ago

"Pay less for healthcare"... Come on, can we not understand that when you pay $25,000 more in taxes and save $1,200 on Healthcare (numbers for illustration only), you aren't spending less?

I don't know why this is so hard for people to understand.

Canadians are not Americans. We are different, I am not sure why it is such a mic drop for some people to point out that completely different demographics will have different life expectancies.

Wait times are absolutely not comparable, they just aren't. Urgent care is similar, everything that requires diagnostic imagining is a fucking joke in Canada.

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u/GWsublime 10d ago edited 10d ago

Because we (canada) notably do pay less for healthcare? https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#GDP%20per%20capita%20and%20health%20consumption%20spending%20per%20capita,%202022%20(U.S.%20dollars,%20PPP%20adjusted)

Wait times are very comparable unless you only look at studies conducted by right-wing think tanks https://en.m.wikipedia.org/wiki/Comparison_of_the_healthcare_systems_in_Canada_and_the_United_States#:~:text=Studies%20by%20the%20Commonwealth%20Fund,to%20see%20a%20specialist%2C%20vs.

Which, of course, result in better life expectancy, lower rates of infant mortality, similar health outcomes across procedures and better physical quality of life.

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u/IbegTWOdiffer 9d ago

Ok…. If you pay $25k including healthcare and I pay $15k including healthcare, does it matter how that breaks down? Or does it just matter that I pay less? This is the most frustrating conversation… your eggs cost $5 and your milk cost $7. My eggs cost $6 and my milk costs $3. You are happy that you are paying less for eggs… 

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u/GWsublime 9d ago

But that's not what happens? Like, yes, I pay more in tax but still less than the sum of tax and healthcare you pay? For which, I also get more than just healthcare.

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u/IbegTWOdiffer 9d ago

The hell you do. I pay way less than I would (did) in Canada. It isn’t even close. I also get more than just healthcare…

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u/GWsublime 8d ago

Alright, pick a tax bracket and let's do the math

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u/IbegTWOdiffer 8d ago

Sure, let's pick the median household income in the US. Married, two kids.

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u/ajh1717 10d ago edited 10d ago

Yeah that nurse in Florida being paid 29/hr is the problem, not United Health, which made 23 billion last year in net profit.

We totally save money by paying middle men a shit ton of money for them to try and deny every claim a person makes while providers have to hire staff to sit on hold with them to argue over whether or not a treatment is really needed.

This one insurance company made enough money doing everything possible to not pay for treatment that you could give every nurse in the US a $5,000 raise.

That's one company's net profit. The top 3 companies have a combined revenue of almost half a trillion dollars. But sure, lets keep pretending that we would have to cut wages across the board to go to single payer

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u/MainSailFreedom 8d ago

Having lived outside the US for extended periods of time I can assure you the US system is not great. Both Canada and France do an equal or better job.

The issue in the US is we think of Healthcare as a patient’s relationship with a hospital. The reality is that healthcare needs to be thought of in every part of society. Infrastructure, education, nutrition, labor laws, financial systems all impact health. To think about healthcare as just hospitals is a losing proposition.

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u/16semesters 11d ago

It's saying that it would cut costs by roughly 11%, which is rather audacious.

Medicare admin costs would be the same, or higher, which is around 2-5% under M4A.

Private insurance admin+profit is ~17%.

However only about 65% of people are on private insurance.

So even if you dropped all private insurance and profit to admin rates of Medicare, it wouldn't cut over all costs by 11%. They are claiming some downstream economic benefits which may or may not be actualized.

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u/effdubbs 11d ago

I agree. I’d like to see the data behind this claim.

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u/limukala 8d ago

They're probably assuming we could cut hospital and physician reimbursement rates to Medicare rates without impacting care or outcomes.

That's quite an assumption, considering we are already experiencing a provider shortage, and Medicare reimbursement rates are so shit that plenty of practices refuse to see Medicare patients (though nowhere near as shitty as Medicaid).

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u/KeptinGL6 10d ago

Nobody wants to keep the current system as it is. The question is whether we fix it by going back to policies that worked, or with more of the same poison that's been destroying it since 1965.

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u/thicckar 11d ago

Wow. Do you have any insight into how medicare is viewed by the medical side? Like nurses, doctors and admins?

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u/soggybonesyndrome 11d ago

I have no problem taking care of adult Medicaid patients despite the disaster problems they often show up to my doorstep with.

However, after I pay my expenses in private practice, I lose money on that patient’s surgery. Therefore, I only reserve one Medicaid patient slot in clinic a month. I literally cannot afford to do more than that.

Medicare is approaching the same territory.

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u/bellj1210 11d ago

that is depressing.... but single payer hopefully solves that- since if it all comes from the same place- why would the hospital feel the need to charge as much for the facilities to do the surgery.

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u/soggybonesyndrome 11d ago

Relying on the govt to pay me enough to pay my expenses and make a profit is not something I’m optimistic about considering govt insurances are becoming a losing game as stated above. I am seriously considering going cash pay only. I know what my skills are worth and it for damn sure isn’t what the government thinks my skills are worth.

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u/thicckar 11d ago

Yeah I can understand the desire of medical professionals to not support this system as they get paid so much higher than pretty much every other country. Thank you for sharing your insight

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u/soggybonesyndrome 11d ago edited 11d ago

Our schooling can incur 250k-500k of debt, followed by less than minimum wage (not an exaggeration) for 3-7 years of on the job training to the tune of 60-100hr weeks. Not an apples to apples comparison my friend.

Let me also add, the increased US MD salaries you see quoted are for proceduralists who bust their ass to practice at a high volume. No one does that in socialized medicine, hence the long wait times etc. And why would they? It’s not incentived to work harder in that system.

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u/thicckar 11d ago

That training and debt sounds similar to equivalent prices back home in India. I don’t think you shouldn’t get compensated well. Wait times aren’t too much better here in the USA though, even though I know Canada and Britain do have longer wait times for specialists.

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u/bellj1210 10d ago

if you have the customers that will follow you if you go cash only- then have at it. Like every industry- if there is a large customer, someone will figure out a way to do it cheap enough and make up for it in volume.

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u/tiger32kw 11d ago

My friend’s wife is a primary care physician at a corporate owned clinic. She has been out of school for 6 years. Last year she made ~$380,000 for the year not working overtime. Her company made > $5 billion in profits.

Your story might not be the same, I know there are plenty of other models and situations in healthcare, but I have a hard time sympathizing with her and her company making less money from their patients.

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u/soggybonesyndrome 11d ago

And she’s likely worth every cent!

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u/sketch24 10d ago

If she works in primary care, she deserved every penny if not more. She probably has hundreds of thousands in loans also and didn't make that much until after her residency.

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u/tiger32kw 10d ago

Definitely worth the money as she is pulling in more money for her company than she costs. That’s how people get paid in skilled positions.

She did have $200,000 in loans but her very high salary allowed her to pay off the loans off in 1.5 years. So the loans aren’t really much of a burden relative to the salary.

Her residency was 3 years. So with the loans + residency + late start she did start in a hole but is now way out of that hole already. Her lifetime earnings will dwarf pretty much any professional career.

I’m all for people getting that bag if they can but I’m also not going to feel too bad if they make less, especially when it comes to HCA’s profits.

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u/limukala 8d ago

You can "not care" all you want, but if physician pay goes down, then you will get nowhere near the quality of providers, as many talented people will choose to pursue other careers. The already existing provider shortage will be exacerbated.

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u/effdubbs 11d ago

Like most things, Medicare is a mixed bag. I’m not involved with the budget side, so I can’t rightfully comment on reimbursement rates. From a prior auth perspective, it’s great. Medicare “Advantage” is actually not government sponsored Medicare. It is private insurance and it is trash. It is very restrictive and low paying. Yes, you will have people tell you it’s great, right up until they can’t get their procedure where they want or the have to change doctors year after year because their not in network.

Also, Medicare is not free. My husband pays about $450-500/month for Medicare A, B, D, and a supplement. Be prepared. The premium will be taken out of your Social Security check.

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u/bellj1210 11d ago

so many people fail to realize that.... i work in housing, and see a ton of elderly on SSI that pull in 1700 a month, 400 to medical off the top, and then rent is still 1700 (that is the average cost of a 1 bedroom in my area)- so the math fails to math- and there are not enough slots at LIHTC properties or spots on voucher programs (and honestly when i see someone on SSI with a HCV and SNAP is sort of hate that they need all those other progams- since they were never designed for that- being on every benefit possible was never how we intended people to retire- but you need everything for a chance to retire without savings)

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u/thicckar 11d ago

Hmm yeah. Why do you think we ended up in a position where people are reliant on so many programs? Thank you for your work

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u/bellj1210 10d ago

The race towards a seperatation up the upper and lower classes (destorying the middle class) has been going on for a long time. Many of these programs have not really kept pace with the added costs.

The biggest thing i am seeing is the boomers that never really thought about retirement simply not having a job anymore. Either getting fired or something that just ends their working time (the odd ones are the times where they retire into nothing). They immediately need to rely on those progams- and even decades ago those programs were not designed to provide 100% support.

So person lived life without saving for the future. They hit 70 and simply can no longer work. They go on SSI, the cap is 1991 per month. That is literally on the line for poverty (works out to about 23k per year).

Average rent in the US is over 2k. So you cannot afford to live alone on SSI alone- but often 60-80 year olds do not want to live with roommates- so they go broke living alone- normally wasting what little savings they have so they can live alone as long as possible.

Then they hit any medical issue- and any savings let is just gone.

SO if your entire SSI check is rent- you need SNAP to eat. TANF has lifetime limits that are rather low. So they need to find another way to free up money to pay for anything else.

The HCV program was not designed to allow people to retire. It was to give people a shot to live where the jobs are on a subsidy (large projects are a bad idea- LIHTC make sense for that sort of model. If you dump several thousand people in a large area where none of them have money- there are no jobs for them without making a horrible commute- if you put a building here or there- then you now have the workforce for the lower paying jobs that can actually get to said low paying jobs without a 3 hour bus ride- which in my area 2 hours gets you to the next town over i could drive to in 15 minutes- but i digress)

So you have retirees that are taking up what limited supply we have of these- so instead of supporting lowing income people- we are just further subsidizing peoples retirement. There needs to be a level of heartlessness in these programs so they do not fall apart- imo we should not prioritize the elderly for HCV or any other subsidized program. That is not what they were designed for- so stop taking them from the younger generation that needs them.

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u/thicckar 11d ago

Wow. It seems awfully deceptive for a private insurance to be called Medicare + anything.

Thank you for sharing your insight. I didn’t know that

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u/tiger32kw 11d ago

Medicare Advantage is the name of it and it’s just a scheme to funnel public money into the private sector. People on Medicare Advantage cost the government more, pay more themselves, and are less satisfied than those on Medicare. It’s a big scam.

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u/effdubbs 11d ago

I agree with you. It is extremely deceptive. I’ve seen many patients hurt by it. I honestly think we need PSAs regarding healthcare. Another very important thing to note, computer systems can vary from office to office and system to system. They don’t necessarily talk to each other. It’s very important to keep your own records.

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u/16semesters 11d ago

Medicare pays okay, better than medicaid.

It's paperwork isn't awful, but it's not great either and still can be tedious and cumbersome.

Biggest places that'd be fucked are places like the bay area of California. No way that under M4A you can pay the 150-200k+ salaries of RNs that get paid there now.

They are buoyed by private insurance in those areas. Under M4A they'd have to drastically cut RN salaries.

In other places it wouldn't be as big of a problem.

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u/jawknee530i 11d ago

My wife is a PA. She prefers dealing with Medicaid and Medicare over private insurance. She's never wished she could burn down a Medicaid office but I can't say the same for private insurance.

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u/thicckar 11d ago

Interesting. Someone earlier up said the pay is less with Medicare which makes the private practitioner lose money. Does your wife see that happen if she works at a private practice?

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u/jawknee530i 11d ago

Yes the pay is lower but the headache of the insurers is generally not worth the difference in her opinion. In her private practice around 2/3 of the patients are very low income. She also rounds at hospitals and constantly complains about private insurance pressuring admins to free up beds by getting patients out the door before she thinks is medically proper.

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u/rraak 11d ago

I see it as a patient. Not only is the medical care egregiously expensive, but it also sucks. Bad. When I was hospitalized after emergency surgery a year ago I don't think I saw a single provider more than twice the entire time and nobody seemed to know what the hell to do with me. I ended up having to explain what antibiotics I needed in the IV drip and that my drains needed to be looked at, etc. The only thing they got right was knowing when to wheel me around for CT scans and so on.

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u/effdubbs 11d ago

Sadly, this is not an uncommon tale. It used to be that your primary doctor rounded in the hospital and cared for you. Now, most hospitals have a “hospitalist” service, which I made up of physicians, but they don’t know you like your family doc. It’s also more of a shift work situation now.

Hospitals are generally now run my non-clinical admin. As a nation, our need to worship at the altar of capitalism and irrational fear of “socialism” has led to these.

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u/bellj1210 11d ago

and it solves a lot of weird logjams.

ERs are overused by the uninsured, Urgent cares (if you strip out the corporate aspect of it) will do what they should be doing- and handling those cases.

The money will forever be the issue. The health care industry has too much money and too much at stake to not go down without a fight- and we keep electing weak politicians that are clearly for sale.

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u/effdubbs 11d ago

Agree. There’s a lot at stake and the money is going to the wrong places. It shouldn’t be for profit. It should be a public service, like utilities.

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u/bellj1210 10d ago

yes- and i am 100% ok with co-pays being a thing. At that point it is more like the postal service- everyone pays for part of it in their taxes, and then you pay another portion for actual use (but that is a small amount) in order to avoid abuse. A $20 co-pay to see any doctor (and then treatment is all covered) would accomplish that (just like a stamp stops spam mailers to some degree)

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u/throwaway23345566654 11d ago

All this and the system consumes half of global healthcare spending.

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u/effdubbs 11d ago

I find the problems overwhelming. I could leave this world satisfied if I could move the ball a few yards in the right direction. I don’t know where to begin.

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u/LegDayDE 11d ago

You could come up with your own number. Average how much per capita UK, Germany, Japan, France, Italy, Canada spend on healthcare and compare that to the US.

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u/desperado67 10d ago

I’m from the UK. If you think a Medicare For All system would help healthcare staff, just look at the NHS.

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u/effdubbs 10d ago

I wasn’t implying it would be better. I was merely saying that what we have isn’t working.

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u/0WatcherintheWater0 11d ago

There should be some significant changes to the healthcare system, but adopting a single-payer system would help no one and provide no efficiency benefits.

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u/countdonn 11d ago

Scales of economy don't provide costs and efficiency benefits? They don't lower costs due to negotiation power? My free market believing economics professors must have lied to me.

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u/[deleted] 11d ago

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u/0WatcherintheWater0 11d ago

You don’t know what you’re talking about, you’re referring to administrative costs, which are not a good proxy for waste.

In fact, a number of studies suggest the amount medicare spends on administration is in fact far too low, driving inefficient provision of care.

Private insurance has less waste overall.

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u/[deleted] 11d ago

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u/0WatcherintheWater0 11d ago

Providing the right amount of care to those who need it.

Theoretically we could spend $1 billion each on every single 100 year old to keep them alive indefinitely, but you would agree, that’s not a very efficient use of resources, is it?

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u/countdonn 11d ago

So death panels that decide who lives and dies? Another boogieman brought up when discussing the horrors of universal healthcare. Both systems obviously engage in triage of resources.

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u/0WatcherintheWater0 11d ago

Death panels are actually the one thing that makes single payer healthcare systems even halfway work.

But care does need to be rationed one way or another, either by individual’s finances and willingness to take on debt, or by a central authority. I prefer the former.

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u/effdubbs 11d ago

I don’t disagree that single payor may not be the solution. My point was that the wait time argument isn’t a great one, as the US also has wait times.

Regarding rationing of care, that is happening in the US in real time. It is rationed by insurance, indirectly through a Byzantine system, and by individual finances. Anyone who tells you otherwise either does not know or is lying.

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u/[deleted] 11d ago

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u/0WatcherintheWater0 11d ago

And at too low a price, yes.

That is possible, believe it or not.

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u/lazercheesecake 11d ago

Private insurance reported hundreds of billions of dollars in profits NOT including funds used for stock buybacks and the billions in executive pay. ALL of that is waste that should have gone to treating patients and paying doctors.

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u/0WatcherintheWater0 11d ago

hundreds of billions of dollars in profits

Literally only 18 billion, otherwise known as around 0.4% of all healthcare expenditures in the US.

Why lie so blatantly?

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u/Joshfumanchu 11d ago

you comment like you have a smart observation while entirely dismissing the fact that the issue with cost of insurance will literally provide trillions of dollars of relief to individuals that can be spent elsewhere.
It also raises the entire nations health standards.
I feel like you are trying to try by using someone's AI or something, your comments never make your point any more valid. It's like watching someone argue with a bowl of fridge magnet letters.

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u/erydayimredditing 11d ago

This entire post is about the benefits it would provide and the cost it would save. Also under single payer gov healthcare, its in the governments interest to reduce healthcare costs as much as possible. This would mean more nationalization of different drugs, which is a buge positive.

Private healthcare helps only the rich, and it strokes the "muh freedom" claims of the uneducated right wingers almost suredly to benefit from singlepayer anyways.