r/FluentInFinance • u/The-Lucky-Investor • 13d 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 13d 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/thicckar 13d 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 13d 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 13d 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 13d 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 13d 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 13d ago edited 13d 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 13d 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 12d 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 13d 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 13d ago

And she’s likely worth every cent!

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u/sketch24 12d 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 12d 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 11d 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 13d 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 13d 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 13d 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 12d 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 13d 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 13d 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 13d 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 13d 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 13d 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 13d 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 13d 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.