Would the public healthcare insurance proposed by Biden be akin to medicaid?

He is proposing a public option similar to Medicare, with coverage for a wide range of issues and conditions.

At least he has a proposed plan ready for the legislative process.

@crazyguy “If the public option controls its costs like most medicaid plans throughout the country, it will not make significant inroads into the healthcare insurance market. If it does not, its costs will be astronomical.”

There are several things wrong with this sentence. First, Medicare does control cost. Second, Medicare is cheaper than private plans in terms of waste. In other words, Medicare healthcare dollars are spent more efficiently than with private insurance, which makes sense since they don’t have to pay shareholder dividends, executive bonuses, marketing costs, or employ the “how do we squeeze more revenue by denying care” squad.

Finally you don’t have to worry about Biden or Harris doing any of it. They take too much money from the private insurance and pharma to fight for this. So you can rest safely knowing you can continue to pay more for worse care for many more years. Maybe you’ll get really lucky and the Supreme Court will strike down your protections from being denied coverage for preexisting conditions! Just think you and your loved ones can be even more susceptible to medical bankruptcy too, despite paying your premiums every month, because fuck Socialism! Am I right?!

“If everybody’s watching, you know, all of the backroom discussions and the deals, you know, then people get a little nervous, to say the least. So you need both a public and a private position,”’

Those are HRC’s words in 2013 to a private group of bankers. I think this is pretty much universal for politicians taking corporate money like Biden and Harris. Don’t expect their private positions to include fighting for healthcare.

No. The comparison I hear most often about socialized healthcare is with the VA. None of us want that.

@KNOWITALL There’s an important distinction between the VA and Medicare. The VA has socialized CARE (and it’s actually ranked highly by participants—with notable horror stories like in all systems). Medicare has socialized PAYMENTS. There’s a BIG difference. The public option is referencing socializing the payments, not the delivery of care.

First off, let’s realize there’s a difference between Medicaid and Medicare. I see both being used above, and the question references Medicaid.

@jca2 There are no proposals for a public option that reimburses at Medicaid levels, that is why I was referencing Medicare, because that’s what the actual proposals are modeled after.

I had heard Biden was looking to change Medicare age to 60? Has that changed and now instead just offering a public option?

As far as I know it will be comprehensive and cover everything. ACA has subsidies, but if you didn’t qualify the insurance was a fortune. I don’t know if Biden’s plan still has the subsidy component? I assume it does.

I don’t really see how it will bring down costs well unless everyone is paying into the system. I guess if enough people join, and since it will be nonprofit, it should be cheaper premiums premiums, unless he is still coordinating it with private insurers. Then I have serious doubts about the plan. I need to read more.

Regarding VA, I know a lot of people who use the VA and the vast majority are very happy with their care. Where I live the vets per capita in my city I’d one of the highest if not the highest in the country, and everyone I know here has overall a good experience, of course there are exceptions like any healthcare facility or system. I know people who use VA care up and down the east coast and in TN, all are happy.

I grew up in DOD healthcare and it was great, but still you can find problems to cite believe me, but I felt well cared for.

@gorillapaws Thanks for your multiple inputs on the thread.

You answered my question in your first post. Biden/Harris are proposing a Medicare-tip option, not the cheaper Medicaid plan.

Your first post also says: “Medicare does control cost.” I never said they do not. However, they are permitted by law to provide more generous coverage than Medicaid. You also say they are cheaper than private insurance in terms of waste (which you define as admin cost). The only admin cost incurred by Medicare is matching of treatment codes by lowly paid clerical people. As per my medical friends, all they have to do to get reimbursed is use the right codes! There is little or no checking by Medicare of whether the patient received the right treatment or not. Private insurance assumes (often rightly) that doctors can and do make mistakes in diagnosis and treatments. Medicare does not. Because Medicare is not constrained to make a profit, or to even hit a budget (if they go over, the deep pockets of the Federal Government will be ready to rescue them), admin costs are of course lower.

I do believe in “FUCK SOCIALISM!” However, I am willing to take a more nuanced approach with healthcare. I do not know how old you are, or whether you have personal experience of medicare. If you have been shopping for Medicare, I think you will admit that there are far better deals available this year than last. I have been with Kaiser Permanente for many years, and do not shop for alternative plans. However, I have noticed that the Kaiser Permanente coverage requires lower co-pays and provides additional benefits. I think that is because, the costs of providing medical care have dropped. Because of its connection to Federal bureaucracy, Medicare will take years to adjust, if it ever does.

As for Biden and Harris accomplishing anything, I think you are perfectly right. The two are establishment people, and once the noise dies down, they will settle into governmental ways of committees and studies, and not accomplish anything.

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@JLeslie The latest healthcare plan pushed by Biden is Obamacare with a public option. As @gorillapaws has explained, the public option is supposed to be a Medicare-type plan. @gorillapaws, I guess the distinction you are making between socialized care and socialized payments is that in the former case, all care is provided at designated (government) facilities, while the latter allows private care. By the way, VA will allow the use of private facilities if the nearest VA facility is more than 40 miles away.

The cost of the public option will be whatever the government wants it to be, since neither profit nor the budget is much consideration. The VA is better now from all I hear. However, I think competition from private facilities would improve it.

The thing that is missed about our healthcare mess is that the effect of our jumbled up for profit tangle is hugely inefficient and throws a monkey wrench in our economic viability. It is a nightmare for everyone concerned. The huge advantage other nations have in government mandated universal care is in the simplification of care. Employers are relieved of the burden of sorting through healthplans and financing of their employees insurance. Doctors are spared the hours devoted to blizzards of paperwork, and those who find themselves unemployed do not face financial ruin at the delivery of a medical diagnosis. As I have said here before, those terrified of the incursion of socialism should recognize that it is inevitable, and particularly here, where the failings of capitalism compel it.

Having dealt with VA up close and personally, I would would avoid anything that is based on that model. As @crazyguy said, there are options now out there for using non-VA outlets is there are no VA outlets nearby.
I have to say, though, with Medicare…the program is paid for by a tax that any working person gets to pay into. Gets to = has to. You pay into it throughout your working life and then should be able to tap into it when you need it. But Medicare does not pay for everything. In fact, they pay for really just basics. That’s why supplement plans are a must if you want any real coverage for things you will likely need as you get older. So I guess the questions then become, if Biden is modeling his program after Medicare, does that mean that the overall quality of healthcare for all will go down, unless the individuals can pay for the “supplements”? And if it is going to be Medicare for all, so to speak, does that mean that for those of us that have paid into Medicare for decades are now going to have to pay even more for all those people that are just going to be able to tap right in without waiting until age of retirement? And how much is all that going to cost?
Biden has campaigned on not raising taxes on people making less than $400k/yr. But his plans are going to cost more than he can get from just those people. So is this healthcare plan of his just a hidden tax waiting to slam us?

Just further examples of the wiggling required to avoid what in the end is proven to work. Not perfectly, but without dispute better than anything we’ve yet to come up with. If nothing else, the ravages of the current pandemic will serve to emphasize the advantages the rest of the world has over us regarding healthcare.

@seawulf575 Even in the bastion of national health (the UK), private insurance is required for such things as:

1. no-wait elective surgery. Hernia is classed as elective surgery. If the hernia develops complications its is considered required emergency surgery. For some patients, that is too late.
2. esoteric treatments like new-fangled chemo drugs.

Of course, in a litigious society like ours, you can bet your bottom dollar that any time a wealthy individual’s life is saved by a self-paid esoteric treatment not covered by the ‘free’ plan, and that results in the death of some poor person, the expensive treatment will be added to the ‘free’ plan!

@crazyguy “Even in the bastion of national health (the UK)...”

The UK has underspent on healthcare for years. Their system is no longer exemplary.

@longgone You are soooo right! The UK spent more per covered citizen in 2018 than in 2017; which, in turn, was more than in 2016. Of course, the listed expenditures do not include private spending. Here is the link:
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2018

The 2018 spending constituted only 10% of the GDP. In the US our total healthcare spending (government + private) amounted to 18% of the GDP. in the same year.

However, I always thought that Obama and Biden have promised cost savings by switching to a system with a public option. Do you think we’ll get any savings?

If you would rather use some other country as “the bastion of national health”, be my guest.

So the British spend 10% of their GDP while we spend 18% of ours, and they manage to cover everyone with better outcomes than our own. What should that tell you?

@crazyguy Well, you made the claim. I’m just here to disagree most helpfully :)

Personally, I don’t think there’s any country universally accepted as “the bastion of national health”. There’s just different priorities. It’s like asking “which country is the best?” The only sensible answer is “depends on what you’re looking for.” Colourful wildlife, banana bread, sun, and hammocks? Try Costa Rica. Stellar education, snow, and saunas? I’d recommend Finland.

Now, back to healthcare. What are you looking for? Personally, I’m interested in affordable premiums and little to no “surprises” (I don’t ever want to get a bill exceeding 10$ or so). Healthcare plans around here don’t operate with deductibles and copays are limited to some medicine for adults (as well as capped at 10$). As a student, I paid 90$ per month for premiums. Now it’s about twice that, but it would cover any kids I might have as well (until they age out at 25). And it covers everything. No parent ever pays for a child’s medicine. We walk into the hospital and get MRIs without ever thinking or talking about money. I just scan my card, and my provider is billed. I can call a hospital for a friend or a stranger, and know that they’ll be taken care of without then being ruined by medical costs. If you’re unemployed, premiums are waived until you get back on your feet.

Morally, I believe premiums should be staggered so the wealthy cover the poor and the healthy cover the sick. Noone should be excluded from affordable health insurance because of preexisting conditions. People who need insulin or other drugs to stay alive deserve society’s help. And of course, insurance companies should not be allowed to make money off sick people.

Here’s a short article on why one of the few things I think actually work in my county happens to be health insurance.

@longgone Germany has a good healthcare system. According to the Allianz website linked below:

“All salaried employees in Germany must have health insurance which is equivalent to the cover of the statutory health insurance. If you fall within a specific income band, joining a state health care scheme is usually compulsory. However, if your income is above or below these limits you can opt to take out private health insurance which can offer benefits, both financial and in treatment, over state insurance.”

The same site also states:

“Once your income is below the annual income limit of €59,400 you are automatically insured on the statutory health insurance scheme. If your income is above this limit you can choose to be insured on statutory health insurance, however it often works out more expensive than opting for a private option.”

The last two quotes were taken from

https://www.allianzcare.com/en/support/health-and-wellness/national-healthcare-systems/healthcare-in-germany.html

I was curious as to why a person may need supplemental insurance. Here are two quotes, taken from

https://www.allianzcare.com/en/support/health-and-wellness/national-healthcare-systems/healthcare-in-germany.html

that shed some light on it. Perhaps you can add your experience as a resident of Germany.
“You can also purchase additional insurance coverage from a private company.”

“Patients who require overnight care are charged an additional fee, including for meals. This is typically not covered by many insurance companies.”

https://www.internations.org/go/moving-to-germany/healthcare

One of the problems I’ve seen with Germany’s healthcare is what I perceive as a fundamental philosophy of believing the body can heal on its own, and a resistance to doing diagnostic tests when someone has a chronic problem and it seems warranted to investigate more.

I do believe the body can heal, but sometimes reluctance to treat or assess further is almost abusive. America is sometimes too far the other direction, which isn’t good either. Both countries often leave chronic patients without helpful care, partly because medical science doesn’t know everything, and partly because in medicine in general, medical doctors have no patience for chronically ill patients with what the medical professionals feel are only minor problems.

Doctors are more likely to be healthy, especially young doctors. It’s difficult to get through medical school if you’re unhealthy, it’s too mentally and physically taxing, so the profession attracts healthy people.

@JLeslie Your post is essentially reflecting an opinion based just on personal observation. My opinion is that the US does indeed go too far in the direction of intervention. I am a huge believer in the body’s ability to heal itself. Indeed, my selected doctor at Kaiser usually asks me if I will take a medicine before prescribing it for me. Because she knows that nine times out of 10, I won’t even fill the prescription. I have been prescribed cholesterol reduction medicine on many occasions – I am yet to take even 1 pill.

So if the Germans believe in “nature cure” more power to them.

@KNOWITALL “socialized healthcare is with the VA. None of us want that.” Simply incorrect. I’d take VA-style health care.

The VA is the best portion of our “system” in the US, in terms of both patient outcomes and cost per patient. The VA is followed closely by the Mayo Clinic and The non-profit portion of Kaiser-Permanente. The clear takeaway from this information is that for-profit medicine makes different decisions that do not benefit the patients.

The problems with the VA at this time are due to underfunding/flat-funding while the U.S. started two wars in the Middle East and thousands of wounded vets came back from them. Funding was not increased to handle their care and the VA system does the best it can.

@crazyguy My observation is from Americans in Germany who get some medical care taken care of in the US when they visit, because they are frustrated with German doctors. Granted that’s only a few people I know in that situation, but I’m just giving their perspective.

No healthcare system is perfect. The problems I’m talking about have less to do with access, but more to do with cultural attitude, but they are intertwined.

@JLeslie – I’ve always been intrigued by German ideas of health. Last time I was there I noticed a lot of homeopathy in the mainstream. My understanding is that a lot of this garbage is covered by the government too. Actually, I shouldn’t judge too harshly, considering I use placebos for the placebo effect too.

My Austrian aunt died of cancer some years back while my uncle kept adjusting her healing stones and rubbing oils into her as she slipped away. It was frankly pathetic to see a man so clinging to his stories he couldn’t even say goodbye to his sister.

@dabbler As a veteran, I can tell you that military healthcare is NOT what you want. And that is what the VA is based on.

@seawulf575 How long were you in the service and where was your healthcare when you were getting it through DOD? I know very few people unhappy with DOD or VA healthcare. Sure there are complaints here and there, but nothing like out in the private sector. Not from the people I know.

@dabbler The VA annual budget includes healthcare. The annual budget covers, in addition to healthcare, compensation and pensions, cemeteries, housing and insurance. For 2021 the requested budget for healthcare, benefits and national cemeteries is less than half the total requested amount of $243 billion – see
https://www.va.gov/budget/products.asp

So, unlike Medicare, the VA has a way of hiding overruns in healthcare. The VA has requested an increase of 14% in their 2021 healthcare budget compared to the 2020 allocation. In medicine, as in most other areas, the adage that “you get what you pay for” is very applicable. The VA is essentially an HMO where you hope that the long-term cost saving idea is to prevent all disease; when you cannot, you try to prevent serious disease; and when you fail in that effort, you try to avoid prolonged end-of-life situations, where most of your budget will eventually go.

I have been with Kaiser Permanente for over 20 years now. Many doctor friends of mine praise the Kaiser system for healthy individuals; however, they would rather go with a PPO if you happen to need a lot of specialist attention. I did not know that Kaiser has a for-profit section. I will research it.

@JLeslie You are absolutely correct. Medical care is judged through a prism of cultural attitude. I believe most native-born Americans expect answers from their doctors and usually get them, along with a prescription and/or surgical intervention. I was not born in the US, and have always had the attitude that doctors cannot, and do not know, everything; I am used to judging the confidence level of a doctor in the diagnosis and recommended treatment. If I ever sense the doctor is not really sure of a recommended treatment, I will not take it.

I’ll end this answer with my favorite anecdote. Cholesterol reduction medication reduces LDL; does it actually prolong life? The answer may surprise you.

@Smashley As you said: “I use placebos for the placebo effect too.” While I have not consciously used a placebo, I often use so-called natural remedies whose benefits are proven only in old wives’ tales. I guess those could be considered placebos.

@crazyguy I agree with you that Americans and American doctors often over prescribe “western medicine.” I also believe the body has great ability to heal itself, depending on the type of injury or illness. But, it can be taken too far in either direction.

Your cholesterol example is the same that I would say for a lot of herbal remedies. No real proof, and sometimes even tested and shown not to work. At the same time, I completely accept that natural remedies of course can be effective. Wasn’t aspirin made from tree bark? Something like that. Just to backtrack to statins, it’s controversial, but studies do seem to show they extend life, although on average minimally. I think maybe they work better for some groups than others.

Seems the answer to health lies in the middle and is still an imperfect science.

@JLeslie I found an article which seems to substantiate both of our viewpoints;
https://www.statnews.com/2019/04/03/statin-heart-disease-prevention-more-than-medicine/

The article says that perhaps statins can prolong life expectancy by a year or so. It also says that the formula for estimating the risk of a heart attack in the next decade over-estimates the risk substantially. I wonder if the calculator is designed by big Pharma?

@crazyguy My doctor wants me to take some test that’s supposed to estimate if statins will help prolong my life. Some genetic test. I’ve put it off, but I’ll try to dig it up in the next few days to get your opinion on it.

Some countries focus more on calcium building up in the artistries. The Japanese have much less heart disease and they consume more K2 and D and it’s thought that’s very heart healthy. They’re also much thinner and overall healthier diets.

My dad had heart bypass at age 46. I think he would be dead by now without the statins. He’s 76. I think statins are over prescribed though.

@crazyguy – that’s kinda where I’m coming from. I believe in some herbal remedies, as far as they go, but the placebo effect is real, and at least one study has shown it doesn’t even matter if you know it is a placebo. I find that the ritual of a supplement, combined with whatever bracing bitter qualities it has, tends to get me out of a funk. Ginger and garlic are cheap go tos, but sometimes I get a bottle of some weird expiring elixir from the folks at the health food store I sell to, and whatever it is does the trick.

@JLeslie I was in for 6 years. I got medical treatment from the base hospitals, every time. I had to deal with long lines, inept doctors and technicians, and had no recourse to any of it. Example: I had a sinus infection one time. I knew it was a sinus infection because of the color of the snot and the pressure in my head. I talked to the corpsman on my sub and he agreed it was a sinus infection. However, since he was just a corpsman, he wasn’t allowed to dispense antibiotics. So he sent me to the base hospital. It took me two hours to get into see the doctor. When I did, I told him why I was there and that the corpsman agreed with it being a sinus infection. His response was “I’m the doctor here!”. He sent me for x-rays. I had to wait for x-rays of my head. When I finally got them, the technician took 5 shots of my head, screwed up 3 of them, retook those three, screwed up 1 of those, and retook it again. Back to waiting for the doctor. When I finally got into see the doctor, he looked at the x-rays and said “Here’s your problem. You have congested sinuses here and here!” Amazing. It was just what I told him hours before, when I first saw him. But did he give me antibiotics? Nope. He gave me something called Fiorinal. More waiting to get the pills from the dispensary. I got back to the sub and the corpsman asked me how it went and I debriefed him. He asked if I got the antibiotics and I said I didn’t think so and showed him what I did get. He looked shocked and got out his reference book and showed me what it was. Fiorinal was a pain killer made of aspirin, codeine, and phenobarbital. The directions I was given was to take one pill when I felt pain. It was right on the bottle that way. I spent the next week in a haze, but still had my sinus infection for most of it.
So I ask…would you consider that good medical care? And I was not the only one that I knew that had dealings like that. Most people I worked with recognized that going to the base medical facilities was pretty useless.

@JLeslie: When I worked in Children’s Services, one of my “clients” used to get Xanax prescriptions from a local doctor. Long story short, he was prescribing similar prescriptions to addicts and the state took his medical license. I remember reading it in the paper and was amazed because it’s not too often that someone loses their license. Who hired him after that? The VA Hospital.

A friend’s husband had a sore throat and was going to the VA Hospital for a few months. They were treating him for a sore throat. Long story short, it turned out to be tongue cancer, and after getting 90% of his tongue removed, and a fake tongue made out of leg skin, he ended up dying of the tongue cancer. The surgery and cancer treatment was not at the VA Hospital as he also had my friend’s health insurance. If he had gotten the right diagnosis from the beginning, he might be alive today. When I told the story to a friend who’s a doctor, she said the VA should have looked closely at his tongue and checked it, which, apparently they didn’t do.

I know these are two anecdotal examples but they wouldn’t make me too confident in the VA services.

@JLeslie I was intrigued by your post. Because, I am convinced that eventually we’ll use genetics for a lot of our diagnosis and treatment recommendations.

I found one article that talks specifically about cardiovascular genetic risk score (cGRS). See
https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.117.004171

Hope this helps.

@Smashley My wife who is really into old Indian (from India) remedies, swears by ginger and garlic. Another natural substance she is very fond of is turmeric.

Whenever I have a problem for which the prescribed medicine causes side effects or feels like a hammer to kill an ant, she does some research and gives me something. Usually it is a solution or suspension (always neutral-to-bitter in taste). But she will not give me just a placebo. She always finds “proven science” for it.

@seawulf575 Here is what Google shows:

“Antibiotics are not needed for many sinus infections. Most sinus infections usually get better on their own without antibiotics. When antibiotics aren’t needed, they won’t help you, and their side effects could still cause harm.”

Antibiotics are one class of medication that is over-prescribed in the US. That is the reason for bacteria developing resistance to most antibiotics.

@jca2 I know many non-VA doctors who would never suspect throat cancer on the first couple of visits. However, after a few weeks, I would hope just two, suspicions would be raised and tests run. I am amazed that any doctor would continue to believe it is just a sore throat in the second month!

@crazyguy: I know. In hindsight, it’s unbelievable. For him, totally tragic.

I have scary examples both private care and DOD care with myself, my parents, people close to me. I don’t see more problems in DOD or VA than private care from where I sit.

As far as tongue and throat cancers and anus, rectal, I’ve been annoyed for 20 years that doctors don’t check for HPV. They wait until you have cancer.

Think about your GBS story @jca2.

I know!

Also, about 20 years ago I had a thyroid biopsy and the doctor called me on a Friday and told me I had thyroid cancer. Long story short, to spare you the details (and spare me the typing), I don’t have thyroid cancer. I found a new, better doctor and thankfully, I didn’t have my thyroid removed on the advice of the first idiot.

I should add that the second doctor was a “boutique doctor” who didn’t take insurance, you pay him out of pocket and get reimbursed on your own. He was $350 a visit. Well worth it, I might add.

I had forgotten your thyroid story! You have told it before. Healthcare is terrifying in so many ways.

@JLeslie @jca2 I believe buyer beware applies in healthcare as well as other fields where we used to rely on professionals. Let’s face it – nobody can spend as much time on your problems as you; be it finance-related, health-related or even law-related. I agree we are not professionals; but the Internet gives us some ability to at least check the “experts”. If an expert is relying upon a ‘fact’ and you can prove it to yourself that the ‘fact’ is incorrect, that gives you a basis for further action.

@crazyguy That is usually true, unless it is acute and either recurrent or progressive. Mayo clinic says:
“Antibiotics usually aren’t needed to treat acute sinusitis. Even if your acute sinusitis is bacterial, it may clear up without treatment. Your doctor might wait and watch to see if your acute sinusitis worsens before prescribing antibiotics.

However, severe, progressive or persistent symptoms might require antibiotics. If your doctor prescribes an antibiotic, be sure to take the whole course, even after your symptoms get better. If you stop taking them early, your symptoms may recur.”

That is pretty much where mine was. Persistent and progressive. Yes, your body will eventually fight off even this sort of infection, but sometimes antibiotics are a good thing. And I’m the one that doesn’t like ANY medication if I don’t see a benefit or a real need. I’d rather let my body take care of itself.

@seawulf575 My best friend is a pulmonologist. Lately, in order to make ends meet, he has been seeing a lot of patients with the common cold or flu. I asked him: “Do you prescribe an antibiotic for most of your patients?” His answer was illustrative of the problem we have in this country. He said: “Since they felt sick enough to come and see me, I generally do”. He continued: “I may look at the color of the phlegm, but I know that even yellow phlegm is not a definitive indication of a bacterial infection.”

@crazyguy I’m in agreement that antibiotics are overprescribed in this country. I believe most drugs are overprescribed. I’m not sure if it is because it is easier for the doctor, if the doctor gets some monetary benefit for prescribing specific drugs, or if the patients would rather get a pill than to be told they should just muscle through until they heal themselves. Drugs have a use in our lives, that is a fact. But I feel they are used far more than they should be. That being said, I want to emphasize that there are times they are necessary or extremely helpful.

@seawulf575 My buddy has this to say: “If I don’t write a prescription, they will find another doctor who will!”

@crazyguy You live in the United States, and your “best friend is a pulmonologist” who sees flu and cold patients “to make ends meet”???? Your specialist in a VERY rarified field has to moonlight to get by in AMERICA???