Interesting comments by Fed Chair Powell in hearing yesterday.
"The outcomes are perfectly average for a first-world nation, but we spend 6 to 7% of GDP more than other countries. So it's about the delivery. That's a lot of money that you are effectively spending and getting nothing ... It's not that these benefits are fabulously generous, they're just what people get in Western economies"
Again - I'm totally open to a different way to dramatically improve the system. But we are overspending by 6% of GDP for average outcomes. MFA doesn't magically fix that, by itself, but it establishes a framework to help control costs going forward based on things proven to work elsewhere.
I'm open to other ideas. "Repeal Obamacare" is not a health care policy idea, which is all the GOP has offered for the last 10 years or so. So if not MFA, then what is structural change that addresses this?
Finally, something we can agree on, and I can
'meet you half-way.'
The Republicans stated they were going to remove ACA and replace it with a market-based system that was better. They didn't. They utterly punted it. Heck, even Trump was criticizing his own party over this. The only thing that the Republicans have done that is good is Rand Paul's AHAs, but that's only for self-employed.
But stepping back, the problem in the US is 3-fold ...
- Employer-based - the US Gov't penalizes you in taxes if you don't get your health insurance from your employer, because premiums of all other plans are taxes. So not only do most people get their insurance from their employer, but that makes everyone who does a victim of their employer's choices, their employer's views and ... worst of all ... their employment. If this didn't exist, we wouldn't need COBRA or pre-existing condition clauses. People wouldn't have to switch.
- Utter-waste - the level of waste, from non-standard fees and negotiated rates to the endless paperwork to the point we have to hire 10 people for every doctor, is out-of-control. Even I, a Libertarian, is for the US Federal government mandating disclosure of all costs and passing laws to utterly simplify the process via a 'minimum plan.' Unfortunately the US and State governments keep creating more layers instead.
- Not self-funded - until Americans seriously look at the real costs -- $2.3T/year -- we'll never address the issue. Countries like Switzerland have market-based insurance that, while costly compared to the rest of Europe, is the #1 medical benefits and -- most of all -- it's self-funded. In the Swiss system, employers pay into market-based options, instead of controlling it.
Being a Libertarian, I'm a huge fan of market-based solutions, so I'm biased towards the Swiss system, which is the best system in Europe, and completely self-funded -- 92% benefit paid from 100% of the premiums, 8% overhead total. The US system runs on a massive deficit, with unreal overhead. But Americans need to recognize it costs money, and we need to fund it. The ACA did not, jokingly so (don't get me started). That was my #1 problem with it.
I've often used the analogy that health insurance is like whole life insurance, not the best investment ... unless you die, or in this case, get sick. And that's the point. It is funding other people who need it ... until you need it. It needs to be
actually funded, and that means
everyone paying ... from age 16 or 18 or 21 ... on-ward, when healthy. This
'rich' or
'corporations' argument is getting old. At least Sanders understands that.
I have the same argument on the environment (which the Swiss also excel at, consumers pay for their impact) and other things. We need to stop just
'blaming' the
'corporations' and
'politicians' -- let alone the politicians are destroying it with '
green economy' BS (California is a joke to us EEs) -- and look at the actual costs. Sanders, to his credit, is pushing Medicare for All, which will cost $2.5T/year, and cover everyone. The base plan will suck compared to those of us with good PPO plans, and there will be gaps in coverage, but it should get everyone basic coverage.
I just hope Sanders and the left doesn't outlaw
'Supplementary Plans.' Right now, the current options for the latter don't allow for much, which means it will become the
'lowest common denominator.' I.e., forget keeping your doctor. E.g., as even Democratic polls show, and articles from Liberal magazines like
The Atlantic point out, 3/4ths of Democratic voters don't understands what Medicare-for-All actually implements. The employed middle and, especially, upper-middle class will have horrendous coverage.
But that's what it costs, when everyone gets equal benefit. UK NHS ... here we come!
