TGIF

September 1, 2017 Batch It Takes a Village, Uncategorized 15

Morning Meese…

With all this talk about healthcare I thought I’d delve into it a little..

Single payer..

There are a few ways that single-payer can work, but at its core it is the government paying for healthcare services through revenue generated via taxation.

Put another way, people who live in a country pay into a pot of money through their taxes. The government then takes this pot of money and pays drugmakers, healthcare facilities, and doctors.

One of the hallmarks of a single-payer system is the ability for the government to have more control over prices.

For instance, in many single-payer systems, the government can negotiate prices for prescriptions drugs since it controls the purse for much of the spending. This makes sense because in the case of the UK, nearly 80% of the healthcare spending comes from the government. So if a drug is not bought by the government, it almost totally closes off the market to a pharmaceutical company. This gives the government a lot of bargaining power.

Payments to healthcare providers, prescription drugs, and other aspects of the system are all subject to price negotiation with the government in single-payer systems.

Across different countries, however, it can take different forms.

 

Canada’s single-payer system is mostly run by provincial and territorial governments, but is funded heavily by the federal government. The federal government also sets baselines of standards for care at the provincial level.

Healthcare spending per capita (2014): $4,728

Out-of-pocket spending per capita (2014): $644

Percent of GDP spent on healthcare (2015): 10.1% (11th-highest among OECD)

Percent of healthcare costs from the government: 69.8%

 

The UK technically has four different national healthcare systems, one for each country that makes up the union, but the general construct is known as the National Health System.

Within the NHS, there is a system of smaller community health boards that help ensure that national standards for care, cost, and efficiency are maintained.

For patients, the NHS is generally “free at the point of use,” meaning that when you go to a hospital or doctor’s office there are no bills or co-pays.

The UK pays for all this using both a specific national insurance tax on people making more than £157 per week and general tax funds to provide 98.8% of the funding for the NHS. The other 1.2% is paid for by out-of-pocket costs for things like prescriptions and dental care. The cost of co-payments for the out of pocket procedures are set by the NHS.

Healthcare spending per capita (2014): $4,094

Out-of-pocket spending per capita (2014): $586

Percent of GDP spent on healthcare (2015): 9.8% (13th-highest among OECD)

Percent of healthcare costs from the government: 79.5%

 

Taiwan’s healthcare system is run through the National Health Insurance Administration and features a premium-based system different from Canada and the UK.

Instead of money taken out of annual taxes, Taiwanese make monthly premium payments based on their payroll income and nonpayroll income. There are also taxes on tobacco and lottery winnings that add money to the system. Premium payments are split between employers, the government, and individuals with adjusted rates based on income levels.

Put another way, instead of taking a chunk of money from overall taxes into the system, the Taiwanese pay a monthly fee from their paychecks that goes directly into the pot.

There is some co-payment and co-insurance that fall on citizens, but these levels are capped based on criteria like the type of sickness or the length of stay in a hospital.

 

There are two types of coverage in Germany: statutory health insurance (SHI), aka sickness funds, and private health insurance (PHI).

As a way to think of it, the SHIs are more like the single-payer government-funded plans like the UK and Canada, while the PHIs operate like the US system. Since there are two groups, this means the country does not qualify as single payer.

SHIs are made up of nonprofit firms that compete to sign up Germans, funded through a premium-based payroll tax split between the worker and their employer and taxes in the German Health Care Fund. SHI insurers are then reimbursed by the government on a risk-adjusted basis (meaning those that have sicker customers get more, while those with a healthier pool get less). There are some co-payments for care under an SHI, but these are fairly low. For instance, co-pays for prescriptions range from five to 10 euros.

Healthcare spending per capita (2014): $5,119

Out-of-pocket spending per capita (2014): $664

Percent of GDP spent on healthcare (2015): 11.1% (4th-highest among OECD)

Percent of healthcare costs from the government: 74%

 

On cost, here’s an article I found. Most of the articles I have found read a lot like this though some seem to think that single payer will drive down the overall quality of care. Some seem to think it will never happen because of the pressure doctors,for profit hospitals, drug companies and insurance companies that have a vested interest will fight to keep it the same as it is now.

Thanks to a landmark study in 2013 by Gerald Friedman, Professor and Chairman of the Department of Economics at the University of Massachusetts, we have a solid financial analysis of the costs and benefits of a single-payer national health plan. With NHI, $592 billion would be saved annually by cutting the administrative waste of some 1,300 private health insurers ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). These savings would be enough to cover all of the 44 million uninsured (at the time of his study) and upgrade benefits for all other Americans, even including dental and long-term care. A single-payer public financing system would be established, similar to traditional (not privatized) Medicare, coupled with a private delivery system. Instead of having to pay the increasing costs of private health insurance, so often with unaffordable deductibles and other cost-sharing, patients would present their NHI cards at the point of service without cost-sharing or other out-of-pocket costs. Care would be based on medical need, not ability to pay.

 

They’re kidding right…What qualifies Nikki Haley as Sec State…Of course I could ask what qualifies anyone in the WH circus.

 

Good thread..

 

https://twitter.com/jonlovett/status/903356595169443840

 

This is your Friday open thread…Fire away!

 

 

 

 

 

About Batch 76 Articles
64, Life long Democrat...Kossack ex-pat...fed up with the puritanical leftists wanting to destroy our Party.

15 Comments

  2. Good morning Pond Dwellers and thanks for all the information, Batch. It’s way too much info and too deep to dive into first thing this morning.

    For those who don’t know, Michael Holmans had a heart attack sometime within the last two weeks. My money is on last week when he was nauseous and couldn’t do his diary (since one of the symptoms is intestinal problems). I understand from what I read last night that he’s doing better but won’t be doing his diary Sunday. How’d I do with providing the info, Batch? Feel free to add/edit my statement.

    I, however, am having only hpg problems. I notice if it’s slow (like the last two nights) he’s not as active so I’ve been staying out a lot. I have had conversations with other villagers and I know it’s not just me. I have quit doing a rec of every comment. If it’s a new article, and I read/like it? Rec. Duplicates from previous diaries or tweets rather than thoughtful original replies? Nope. Back and forth kitteh pictures for no reason? Nope. I won’t ask others to join my “boycott” but I wonder if he’s acting like this to get his 5 bars of mojo?

    111 today. I hope I don’t melt. Stay cool, y’all, and enjoy your three day weekend.

    • Re: hpg, what you are going is what I have been doing – no auto-recs, only reccing something that I specifically like or think is useful and no auto-recs for cat pics. Or dog pics. Recs for meaningful communication.

      I have no idea how aware hpg is of recs anyway.

      I kind of need to spend less time in the daily threads anyway, though I miss the company.

    • Good morning dear..Don’t need me to do anything…You did perfect relaying Michael’s info…

      I hope you don’t melt either…Stay cool yourself!

  3. {{{Batch}}} – Thanks for the write up. My take? single payer may or may not be universal healthcare – either in what or in who it covers. What it is no matter who or what it covers is at the mercy of Congress for funding. As long as that is true, I don’t want single payer. As for the Medicare for All=single payer meme, you guys do know that Medicare does not cover vision or dental, right? And costs more than most proponents think it does.

    {{{WYgalinCali}}} – thanks for the info on Michael. If you are actually in touch with him, tell him i’m holding the Good Thought and sending Healing Energy. I will put up a draft when I get a minute for the Sunday not-a-British-Breakfast diary at DK. Wish I had an answer for hpg. From my view he’s too excitable and that makes him irritating but he’s also sweet. I know you don’t find him to be the last. sigh. So do whatever you need to do for your own health and sanity.

    Gotta get back to work. moar {{{HUGS}}}

    • {{{fitz}}} You remember the convo we had at squirrel about the Medicare-Plus I got from Humana that costs me $40 out of pocket/month. Well it covers vision and dental.

      1 routine eye exam per year…cost -$0
      Frames and lens package/yr…cost- any amount over $50
      1 periodic dental and 1 comprehensive dental eval per year…cost -$0
      2 bitewing x/rays, per year…cost- $0
      1 cleaning/yr…cost-$0
      1 restoration(filling)/yr…cost-$0

      You really need to look into getting one of the supplemental plans…
      moar{{{Hugs}}}

      • That’s not a supplemental in the sense you’re talking about. Supplemental plans are insurance plans that pay the “gap” of part B. What you have is you selected which company to handle your part B. The govt pays them a certain amount and you pay, based on your income, a set amount. Kaiser will do that for me. I will pay my part B to Medicare and Kaiser will be my hmo.

        But, I agree, she needs to look into it. I think if you don’t select one, Medicare does it for you. There’s lots of companies besides Humana. They all want that insurance money from the government.

        • What I have is definitely a supplemental plan…Humana Gold Plus is a Medicare Advantage HMO plan with a Medicare contract. It offers things that a standard Medicare plan doesn’t. The gov’t will deduct the $134 part B from my SSI regardless, which they stated to me they would without going with what I did. In that case the gov’t would eat the cost of my Medicare. In my case with the Gold Plus the gov’t pays Humana to handle my Medicare and they pay $92 of my $134 for that right, which leaves me to pay $42 to Medicare. When I signed up for the supplemental plan I was given options as to which to go with…Some were more generous, some offered more but I chose the one best suited for me.

          • I’ve got the book from Medicare with all the information – but until MaureenMower told me where to look for the private stuff offered I wasn’t sure what I was looking at. Now all I need is an uninterrupted hour to actually read it! Then I can see what AR has to offer. I’m covered through work until the end of the year so I have a little time yet. Thanks and moar {{{HUGS}}}

  4. Thanks Batch for the TGIF edition!

    I’m currently self-employed, have ACA, and can barely afford it. Also, I am so out of the habit of using health coverage that I don’t use it. No idea what next year will bring but I may have to reduce my plan to something with a stupid high deductible just to afford anything next year. Assuming we still have ACA.

  5. I have long favored a hybrid similar to Germany’s system, if for no other reason than it is the logical progression from the ACA. Do we need the government to step in and negotiate drug prices? Absolutely. Do we need a system that covers ALL of women’s healthcare, including BC and abortions? Hell yeah…and that’s why I think single-payer is a huge reach. As long as there is the Hyde amendment, we don’t have true universal healthcare; tell me just how we’re going to get rid of Hyde AND achieve single-payer?

    Batch, please pass on my best wishes to Michael if you can.

    Re hgp, I’ve noticed that he responds to redirection…if it is suggested by bfitz or Gracie. I think it’s the warm, fuzziness of their personalities that makes it [sort of] work; that’s not my online persona at all, so I doubt anything positive would happen if I tried it. (And let’s be real…my RL persona isn’t exactly warm and fuzzy either. ) My personal strategy has been to try to engage in actual conversation a bit more with other Villagers. If modeling the desired outcome doesn’t work, at least it helps to keep the community engaged.

  6. I’m super busy at work today, and yet, my wandering mind still has time for things like this:

    I need to remember to get cat litter on the way home from work.

    Must figure out a way to help folks with end-of-month bills + Harvey funds; why do I take this so personally?

    I wonder how the uber-Lefties would like it if our government actually shifted back to a true balance between the executive and the legislative branches, rather than the last 60 years or so of stronger-than-intended executive. Would their Savior mythology hold up?

    I should bake some bread tonight.

    If 45* does a Friday news dump and undoes DACA, should I go to Detroit, Flint, or Lansing to protest? Will I still be able to sleep in at all this weekend?

    I am wearing a sweater on September 1st. What’s wrong with this picture?

    Anyway, I only share this, not to scare you with the rambling nature of my thoughts, but to let you know that I’m thinking of you all (however obliquely) even when I’m swamped at work.

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