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Single payer will likely happen regardless of hiliary because the ACA is designed to fail.
People will get fed up with the ACA. It not cheap. Millions will still end up without insurance.
The only real issue with single payer and it's a huge issue is how to pay for it. Germany is facing huge pressures trying to control its own health care cost. It recently had to raise individual taxes for health care to I believe 8.5%? And employers still need to kick in 7%. That's a total of 15.5% of taxes from employer and employee to pay for single payer.
Health care eats 16% of GDP in the US. It really is going to take a LOT of money to have single payer, insurance or whatever. Germany has admin costs that are a fraction of what they are in the US and most people are in non-profits lowering the cost more. But anyone who thinks there is going to be a free lunch, now in the exchanges, or later if we go true universal is in for a shock.
And what exactly do you think will happen in 2020 when the regular matching formula for state contributions kick in.
You see, this is like the equivalent of a interest only home loan. It's an good deal for states for 3 years. Than states will be required to chip in a bit for 3 years. But what happens in 2020 when they gotta support all those new people on medicaid?
What's California going to do in 2020? What's New York going to do in 2020. To pay for all these new medicaid enrollees with the regular federal/state formula. Raise taxes again? Isn't California already at 13% state income taxes for the wealthy already thanks to prop 30?
We have got to think long term. State governors don't want their states to be on be hook for billions of unfunded medicaid enrollees.
Both NY and CA are participating, so they must see a long-term benefit to doing so.
Looking at the cost of treating the uninsured here in SC, I see long-term benefit in expanding Medicaid. It will provide oversight and control that isn't currently happening, and by increasing access to routine care and regular clinics, it will help curb costly ER visits and preventable hospitalizations. These currently cost about as much as the expansion would in a given year.
As far as I know, in my state anyway - which didn't expand medicaid, if a person falls in that gap then they aren't required to get insurance under the ACA, and they won't be fined for not having insurance.
Those that fall in the gap will continue to do what they're doing now - either not seek medical treatment, or, receive medical treatment but default on what they owe, and probably end up filing bankruptcy on it.
They won't qualify for ACA without the expansion that is the issue, and many will continue to use emergency rooms increasing healthcare premiums.
Health care eats 16% of GDP in the US. It really is going to take a LOT of money to have single payer, insurance or whatever. Germany has admin costs that are a fraction of what they are in the US and most people are in non-profits lowering the cost more. But anyone who thinks there is going to be a free lunch, now in the exchanges, or later if we go true universal is in for a shock.
I agree with your entire statement. I am a fiscal conservative Republican and also a health care provider. Not opposed to single payer.
It's just that the public has to get all these ducks lined up if they want to go single payer. We in the USA (those who have private insurance or Medicare). That's about 80% of the population have a vast array of doctors and hospitals to choose from.
There are going to be a lot of sacrifices and costs associated with single payer. The problem is most Americans want to keep their current system and want reduced costs. There's gotta be give and take.
Thanks for the insights. It seems, though, that most states who rejected expansion have had strict requirements, and the result has been an uninsured populace that doesn't seek care until they are very ill...which ends up costing a great deal. When people don't utilize healthcare, it's no bargain in the long run. Expansion of Medicaid would give the poorest people access to routine care that would help avoid hospitalization costs, and would give them access to places other than emergency rooms when they have an illness or injury that could be treated at a regular clinic/doctor's office. That's where the savings comes in. The write-offs in SC, where I live, are astronomical. But of course, we rejected the expansion.
Re the rollback issue...I wonder if states wouldn't be so keen on a rollback once they saw the benefits of the expansion. Since they do have the rollback option, it seems counterintuitive not to try the plan.
Except it IS a bargain in the long term. The argument that people not utilizing costs in the long run is repeated ad nauseum, and of course there are individual cases and anecdotes, and in some limited scenarios (i.e. follow-ups after discharge to ensure compliance with medications, annual wellness visits for people with high-risk conditions, etc.) it's true, but beyond some very specific cases like that it just doesn't pan out in practice when you hit the macro level of insuring or not insuring large populations. Great logical argument, not so much in terms of being supported by data. Coverage costs more, even in the long term, even looking at emergency care, even with uncovered care under EMTALA.
That doesn't make the expansion bad per se, it's a trade-off between economic and social good that there is no "right" or "wrong" answer to in the absolute, but it definitively does not save money, and there 100% is that trade-off to be made - expanding Medicaid does cause economic harm, no question, and it does do social/human good, no question. The politicians in your area (SC) may not have made the choice that you prefer, but they were making a choice with real pros and cons not shooting themselves in the foot for no good reason.
Hey I wonder if there has been academic research done that looked at a group of people who suddenly gained or lost insurance and sees if the same person will have more Hospital emergency room visits if insured or unisured?
Result from the first page when you google "uninsured medical utilization:"
"Abstract
Substantial uncertainty exists regarding the causal effect of health insurance on the utilization
of care. Most studies cannot determine whether the large differences in healthcare utilization
between the insured and the uninsured are due to insurance status or to other unobserved
differences between the two groups. In this paper, we exploit a sharp change in insurance
coverage rates that results from young adults “aging out” of their parents’ insurance plans to
estimate the effect of insurance coverage on the utilization of emergency department (ED)
and inpatient services. Using a census of emergency department records and hospital
discharge records from seven states, we find that aging out results in an abrupt 5 to 8
percentage point reduction in the probability of having health insurance. We find that not
having insurance leads to a 40 percent reduction in ED visits and a 61 percent reduction in
inpatient hospital admissions. The drop in ED visits and inpatient admissions is due entirely
to reductions in the care provided by privately owned hospitals, with particularly large
reductions at for profit hospitals. The results indicate that recently enacted health insurance
coverage expansions may result in a substantial increase in ED visits and hospital inpatient
visits for currently uninsured young adults. "
This study only pertains to young adults who have aged out of parental coverage. These are generally healthy people. Data on other populations that tend to be uninsured would tell a different story.
15 million of them have household incomes above 75k.
Another 15-20 million are young adults ages 18-25. Most of them are young and healthy who choose not to carry insurance.
So that 50 million number looks good on paper. But in reality the true number of uninsured not by choice is closer to 20 million.
The ACA still going to leave 20-30 million people uninsured. It becomes a zero sum game that's going to cost trillions.
The key to any health plan is participation by the healthy, if that participation isn't there any plan will fail. I have to wonder where those people in the $75K category end up because they most certainly are getting health care at some point in their lives, how do they cover an emergency room visit for a broken leg or something more serious.
If they don't come around when things start rolling along smoothly within The ACA, they are going to pay a price at the polls.
I wonder how many families will leave the states that don't get on board down the road.
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