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We might want to remember that health care is a limited resource exceeded by the demand for. So does price become the means of allocating it.
If Medicaid becomes a block grant to states and they have less money per person:
Will they pay for fewer people to get nursing home care or reimburse less per person with the obvious reaction from private facilities.
Another hypothetical outcome is states supplement the block grant with some of their own funds. I can imagine a healthy discussion of the form of "should out state be using scarce tax revenue to fund nursing care for the elderly, or should we use the scarce tax revenue instead to fund licensing and investigation of beauticians & barber shops? Or should we use it to subsidize school lunches?"
Back in the 1990s (I assume everyone reading this in the retirement forum is old enough to remember the 90s), under President Clinton, welfare was transitioned to block grants to the states. There were many talking heads back then who forecasted dire outcomes (say, Robert Reich). Many are the same talking heads who forecast dire outcomes for a hypothetical block grant to states for Medicaid. Those talking heads were wrong in the 90s, and they are wrong today.
Respectfully, the "equitable distribution of healthcare" is not the topic of this thread. The costs of healthcare and how to pay for them is the problem.
Equitable distribution is absolutely the topic before Congress, and the topic of this thread. This thread was prompted by the fact that older people are going to be faced with a huge jump in their premiums, and hence the OP posted that fact as a warning to potential early retirees (before Medicare eligible), which is inequitable (older pays more than younger person).
ACA had/has a similar problem except it was young people, not old, who were faced with unaffordable premiums. ACA was founded on the notion that there are two big problems in health insurance: Access and cost. Both ACA and AHCA are trying to solve the access problem but both have done it in an inequitable way - some segment of the population is getting screwed. There is another segment of the population getting screwed by AHCA - the poor, since Medicaid will be rolled back under AHCA. Prior to ACA another segment getting screwed were people with pre-existing conditions. All of these things constitute the equitable access problem - how to make sure all income levels, all ages, and all levels of health have the same (i,e, equitable) access to health care.
The above is a distinct problem from one of cost. We can lower the cost of healthcare by 40% so it matches the average across OECD countries but that doesn't help the equitable access problem. If you are poor and have near 0 income, 40% cheaper is not going to do anything for you. And if you are denied access due to a pre-existing condition, 40% cheaper won't do anything either. Hence the need to solve both problems.
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I disagree. Single payer does not solve the root cause of an escalation in healthcare costs. Single payer would do nothing to roll back the costs of healthcare.
As I said, single payer is necessary but not sufficient for a rational national health care strategy.
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I don't understand what you mean by "unify". Can you explain?
We have a hodge-podge of insurance companies that each negotiate rates with providers. That creates lists of "preferred" providers which takes choice away from the individual. People need choices or it is not a free market.
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* A personal anecdote. My personal prescription medicine plan says I can use either (1) ExpressScripts or (2) Costco. I went to Costco yesterday and I asked them,
"Hi. You have my insurance on file. Can you please tell me what my price would be for these two medicines? I want to compare your price to the price of ExpressScripts so I know if I want to fill them here, there, or not at all."
"I'm sorry. We are legally prevented from telling you the price of what a prescription would be under your insurance plan unless you actually submit the prescription to us to fill it."
One of the ideas of Obamacare was that pricing would be more transparent so individuals can make decisions based on price. I can call up any LASIK center and ask for their price & they will give it to me over the telephone, as LASIK isn't covered by insurance. Contrast that with a knee replacement. I called a local hospital just for fun & asked "How much for a knee replacement" and got absolutely nowhere.
And I cannot even find out the price of a common statin at Costco -- because it is currently illegal for them to tell me the price unless I submit the Rx for fulfillment.
Single payer isn't the answer.
You are confusing single payer with the totally out-of-whack regulations and laws we have in the US for health care. Those regulations have more to do with both Dems and Repubs being way too influenced by powerful lobbies and nothing to do with single payer. I completely agree with transparency in all parts of health services pricing. Personally I think that any provider (pharmacy, doctor, hospital, etc.) can choose the price they want to charge, but once they choose it, that is the price everybody pays, regardless of whether you have insurance or not. So no more behind your back bargaining of prices. And all prices must be published so you can make a choice whether to go to Costco or Walmart.
I'm well aware of this problem. My sister have health issues, would love to have Medicare but not old enough and she got laid off multiple times since the Great Recession. What she did was milking the Cobra and ACA. She has contract jobs for a few months, but what comes with it is 18 months COBRA. She finally landed a permanent job, so even if she gets layoff again, she only has a few months to Medicare. But the American Health Act is not removing any of the ACA features, or existing conditions are still covered, as well as child under 26. The only difference is more tax credit vs subsidy. Yes poor American between 50-64 don't do as well but these people I would NOT think can afford to retire early either.
Just so you know, everybody, I mean everybody in my immediate circle has to stay working until 65 or 70. They are not considered poor, NOT according to CD, but they have to stay working for one reason or another. No free lunch.
Removing the universal mandate will cause a major bump in premiums, as younger and healthier people decide to forego health insurance. It will also move the cap on older insured from 3x the youth rate to 5x the youth rate, so you can expect health insurance premiums for the 50-60 age group to at least double and possibly triple. Instead of putting money into a retirement account, they will be paying it to the insurance companies. In exchange, you get a $4,000 tax credit, which will pay your premiums for about 2 months. The rest of the year you are on your own.
If you are otherwise ready to retire and the only thing holding you back is health care, I say, RETIRE.
Head down to Mexico and wait out all this nonsense. If you are under 65, private health care is affordable. Or you can opt for a public plan (almost free), but you need to qualify for residency to get the public insurance.
We lived there from age 55/56 until 61/62. Came back to US reluctantly to care for an elderly parent. He has since passed on and we are once again back to Mexico, age 64/65.
As my Latin teacher taught me: Tempus Fugit.
We retired at ages 50/51 and never looked back. In a certain way, you just MAKE it happen if you want it bad enough. Same with careers, marriages, families.
Out of pocket, treatment will save you 50% to 75% off US costs, plus a similar savings in prescription drug costs. Many insurance companies are also offering Mexico-only health insurance, which will cost 2/3 of the premium for US health insurance. I couldn't find any info on whether you will qualify for the tax credit for Mexico-only health insurance, but judging from the stark ignorance of most congresscritters, probably.
Another hypothetical outcome is states supplement the block grant with some of their own funds. I can imagine a healthy discussion of the form of "should out state be using scarce tax revenue to fund nursing care for the elderly, or should we use the scarce tax revenue instead to fund licensing and investigation of beauticians & barber shops? Or should we use it to subsidize school lunches?"
Back in the 1990s (I assume everyone reading this in the retirement forum is old enough to remember the 90s), under President Clinton, welfare was transitioned to block grants to the states. There were many talking heads back then who forecasted dire outcomes (say, Robert Reich). Many are the same talking heads who forecast dire outcomes for a hypothetical block grant to states for Medicaid. Those talking heads were wrong in the 90s, and they are wrong today.
Wouldn't bet on that in states that didn't expand Medicaid when the government was giving them money to. This will probably become part of the best states to retire to discussion as folks down the road may want to weigh Medicaid benefits in possible retirement locations. On the other hand it may for future retirees drive up the percentage buying LTCi.
If this reform is implemented I want to see how future LTCi threads go.
The vast majority of health care dollars are spent on labor. The US labor costs in the medical cartel are roughly 2x more than anywhere else in the first world (other than Canada where they need to pay more to stop workers from crossing the border into the US for more money). If you're willing to pay nurses, radiology techs, physicians, janitors, .... 50 cents on the dollar, our health costs line up with the rest of the first world. Sure, we could trim some administrative fat and pay world prices for Rx drugs to Big Pharma but that doesn't fix the problem. Only trimming labor costs fixes the problem.
How do you do that? First, you break up the AMA cartel. Quadruple the number of seats in medical schools. Government-paid education in exchange for service in the under served parts of the country. Do the same with all the community college medical career paths. Make it free to get a nurse-practitioner master's degree.
Are you suggesting increasing the number of folks working in the field by expanding training and cutting salaries and benefits?
Remember there is no such thing as a free lunch and somebody is going to pay somehow for the training.
ACA had/has a similar problem except it was young people, not old, who were faced with unaffordable premiums.
What?! I'm in my early 50s and my health insurance as been unaffordable since ACA was enacted. (keep in mind my state already had a pre-existing conditions clause and other clauses the ACA made mandatory).
Am I young then?
The people I know that are doing great on it and love it are either very young (under 30) or way underemployed.
Maybe you meant the other way around? Or is this another thing that varies by state?
Wouldn't bet on that in states that didn't expand Medicaid when the government was giving them money to. This will probably become part of the best states to retire to discussion as folks down the road may want to weigh Medicaid benefits in possible retirement locations. On the other hand it may for future retirees drive up the percentage buying LTCi.
If this reform is implemented I want to see how future LTCi threads go.
I certainly agree with you on this (I think you and I live in the same state).
I actually laughed out loud at the idea that our current legislature would actually put any "extra" money in the pot. They have been busy cutting benefits any place they can, including making a run at Medicaid as it stands now even with no expansion.
I think LTC issues are going to be catastrophic in the next decade or two in many, many states if the bill passes with block payments to the states.
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