Medicaid and Medicare

[futurepres]

Would health care costs decrease without Medicaid and Medicare?

[President Marokai]

Perhaps by virtue of a lot more people dying, yes.

[DC Al Fine]

Perhaps by virtue of a lot more people dying, yes.

Plus a lot of the bloat in the programs would be gone. Doctors would order fewer tests etc, if the patients were footing the bill.

[Marston]

Perhaps by virtue of a lot more people dying, yes.

Plus a lot of the bloat in the programs would be gone. Doctors would order fewer tests etc, if the patients were footing the bill.

Uh, no. Doctor's do the same thing with private insurance plans (actually some HMO-managed Medicaid plans are actually less likely to reimburse medical professionals for unwarranted tests and procedures then private insurance plans are...) What you're describing isn't a symptom of public insurance. It's spawned from something else entirely.

[DC Al Fine]

Perhaps by virtue of a lot more people dying, yes.

Plus a lot of the bloat in the programs would be gone. Doctors would order fewer tests etc, if the patients were footing the bill.

Uh, no. Doctor's do the same thing with private insurance plans (actually some HMO-managed Medicaid plans are actually less likely to reimburse medical professionals for unwarranted tests and procedures then private insurance plans are...) What you're describing isn't a symptom of public insurance. It's spawned from something else entirely.

I was thinking more of people who would otherwise pay out of pocket if the safety net were eliminated, but I suppose that they are a pretty small portion of the population. Fair point.

[Lіef]

Medicaid and Medicare are actually currently keeping the price of healthcare down.

[greenforest32]

The cost problem is from the private providers, not the public insurance.

[shua]

The cost problem is from the private providers, not the public insurance.

It's from third-party payment, which applies to both.

[DC Al Fine]

The cost problem is from the private providers, not the public insurance.

It's from third-party payment, which applies to both.

True that. There is bloat everywhere, even in single payer systems like Canada's.

[greenforest32]

The cost problem is from the private providers, not the public insurance.

It's from third-party payment, which applies to both.

Things like the price of pharmaceutical drugs here and their associated patent status are more of an originating source problem than a distribution problem if you ask me though there are some ridiculous distribution giveaways as well (ban on importing drugs, ban on Medicare negotiating Rx prices, etc). Leaving the methods of healthcare delivery with private providers, even with public funding, gives those providers the real leverage when the government isn't willing to compete directly. Allowing for-profit hospitals to receive public funding is just as bad as allowing student aid like Pell grants to be made accessible to for-profit colleges. They're going to look at Medicare/aid as a business opportunity.

I think public funding should be restricted to public facilities for things like this so there is no underlying price increase incentive for private owners. Like the difference between public housing subsidies for privately owned residences (Section 8 vouchers) vs a Red Vienna-style public housing system or private for-profit hospitals&payments+public insurance for the poor/old vs the NHS. A lot of what is being subsidized in the private provider/public finance system is profit. The price of these services could be lower if we decided that not everything has to be for-profit, that housing shouldn't have to include thousands of dollars a year in profit through the rent because the land is privately owned and the owner wants a return on their investment at least equivalent to the other market opportunities his/her land could make them, that medical care shouldn't have to be delivered as a commodity at publicly-traded market rates but instead at-cost, that money shouldn't be made like this when it comes at the expense of people's standard of living, etc.

I don't think the progressive position should be to say let's ignore the past price increases and focus on limiting the rate of future increases to at or slightly below inflation or increased tax revenues/personal income. The progressive position should be to cut down those past increases to get to the lowest possible price for those essentials so people can have a higher standard of living and more economic security. Given the way things have gone in the recent decades with the upper consolidation of influence among the rich, those price decreases would probably lead to massive layoffs and drops in profit in the real estate and healthcare industries so they obviously lobby and buy-out government(s) with their power and wealth to stop new directly-government-run services and work to takeover the existing ones (see the steady privatization of the NHS in the UK).

Private service costs don't seem to be scrutinized the same as public service costs, even when they are the only provider. I hear a lot about reducing public costs, but not much about reducing private costs. When is the last time you've heard of a rent cut on the scale of these huge tax cuts? Price decreases don't benefit everybody the same, especially not the people who make money at our expense and I see restrictions on the government's ability to provide services like health insurance/healthcare or housing as signals for upcoming private cost increases in those services, embedded and normalized as annual 'cost of living' increases. Those transfers of income and wealth upwards is what I believe is the mission of neoliberal deregulation and privatization of public services.

[shua]

The mission of deregulation and privatization is to allow for more choice and innovation. But sometimes it's implemented carelessly and you end up with monopolies and crony capitalism.  I hear what you're saying about public financing for private providers driving up costs - I think that's right.  On the other hand, I wouldn't want to be in a position where a government run program is the only provider I have to choose from.

[greenforest32]

The mission of deregulation and privatization is to allow for more choice and innovation. But sometimes it's implemented carelessly and you end up with monopolies and crony capitalism.  I hear what you're saying about public financing for private providers driving up costs - I think that's right.  On the other hand, I wouldn't want to be in a position where a government run program is the only provider I have to choose from.

I don't buy the idea that every service is better off delivered through private providers. I think public services like utilities should never be privatized. What is the public benefit of allowing investors to turn a public utility into a publicly traded company that profits off ratepayers and pays out dividends to shareholders? When the public option is more efficient, I think it should be expanded instead of reduced and choice and innovation are often what these privatizations are sold under until the public provider no longer exists despite the fact that private monopolies/crony capitalism are the real goal with things like privatizing water infrastructure/access rights or passing state laws banning local governments from providing municipal internet access.

On the topic of health insurance, I think it would be more efficient to end public subsidies for private health insurance (something the ACA expanded) and the tax deduction for employer-provided health insurance to merge Medicare/aid into a national single-payer system accessible to everyone (not just 65+ or the very poor) at public hospitals. The tax financing it and the charges levied could be progressively scaled and this doesn't stop anyone from purchasing additional services (from public or private providers) with their own money but it does take out a lot of profit and raise the floor of basic coverage beyond what we have today or what we'd see in a purely personal out-of-pocket system.

[DC Al Fine]

The problem with single payer is that there's no incentive for people to ration their consumption of health care. You'd be amazed at what qualifies for a trip to the ER or doctor's office when you don't have a co-pay. The state either has to drastically raise taxes (well beyond Canadian levels) or rations healthcare via wait times.

[greenforest32]

You could always make such an incentive with co-pays/reduced subsidies for frequent use (probably need an appeals process) if it was that much of a problem. A system completely rationed by price is going to be underutilized in terms of things like need and prevention.

[opebo]

The mission of deregulation and privatization is to allow for more choice and innovation.

No, the mission is to 1) provide huge profits to 'private' entities controlled by a privileged few, and 2) to reduce public expenditure and taxation of the parasitic rich, and finally, 3) to incentivize the poor to obey by threatening them with death by illness and injury without access to even the most basic care.