We're a long way from ICE bans at this point, but what the heck.

I'm all for universal healthcare but having seen the finances behind hospitals with a large Medicare payer mix I can tell you the healthcare system will not survive on a strict M4A plan. The nonprofit hospital I work for is one of the few that manages to run in the black, but it's not because of Medicare reimbursements. That is strictly a red proposition with commercial and self-pay moving it slightly into the black area each year.

I can only speak from my family's personal experience, but I have 3 sons that have worked low end jobs in high school at grocers and other retail jobs. At no point were they paid minimum wage even as 16 year olds. In fact, the Bureau of Labor Statistics says that in 2017 less than 2.3% of all hourly workers made minimum wage or less.

My sons all made, starting out, a minimum of $10 per hour (38% higher than minimum wage) as far back as 12 years ago.

I've also not seen anything that convinces me that $31,200 a year ($15x2080) is a "living wage". Maybe if you're single, and you don't live in NYC or Los Angeles.

According to MIT, the living wage in the county where I live in Georgia (which is a relatively affluent county) is $13.66 but that changes to $35.79 ($74,443) if you have 3 kids and a single parent. So, then, does the Federal minimum wage need to float based on your family circumstances?

Also, their estimate for LA County in California is $14.83 for a single person. Based on what I know about price differences in Georgia and CA I find it hard to believe that $46.80 difference per week ($2,434 per year) is enough to give you the same lifestyle between the two areas.

I don't know what the real "answer" is, but I don't think it's one that can be legislated.

This.

There are many potential 'solutions'. We can try to learn from the examples of the 192 other countries on Earth and see what works and what doesn't. If you look at cost and quality as the most important factors in assessing healthcare (seems reasonable, how good is it and how much does it cost?), so many measures show that the U.S. has, by far, the most expensive healthcare in the world, but far from the best. In cost we're always #1 by a wide margin, but in quality, depending in the metrics, we're usually somewhere between 20th and 40th. The World Population Review rates us 37, down there with Cuba and Slovenia -

https://worldpopulationreview.com/co...e-in-the-world

For most countries around the world, and certainly for all the countries in the top 20, healthcare is a legislated solution. It was a conscious decision by the elected leaders that healthcare is a right that should be given to all people, not just to those who can afford it. The U.S. is the only major country on Earth that takes the position that healthcare is not a right for all its people.

It's not that top-quality healthcare isn't available in the U.S. It certainly is. This country has some of the best physicians, some of the best facilities, and some of the best treatments available anywhere on Earth. It's just that they're far from universally available to everyone. If you want the best, it's only available to those who can afford to pay for it. Even though the ACA reduced the number of people without health coverage by about 20 million, there are still almost 30 million people today who don't have any health insurance because they can't afford it (or don't have jobs that provide it). That brings the average quality of healthcare in this country way down.

France often is considered to have the highest quality healthcare in the world (compared to our 37th). Yet the cost of healthcare in France is less than half of what it is in the U.S. Likewise Italy, with the second best care has a cost about 1/3 that of the U.S.

https://www.healthsystemtracker.org/...untries___2018

All those countries with better quality healthcare than we have legislated it into being. They took profit out of the picture and instead used the money for salaries for physicians and nurses, hospital equipment and staff, and medicines.

Our costs are so high because of how much must go to pay for the profits of all the for-profit companies involved in delivering our healthcare. Every dollar that goes to corporate profits is a dollar that doesn't go for physicians, nurses, or anything else that actually provides healthcare to people.

For any public company in the U.S. (and most of the insurance and other companies involved in healthcare are publicly held), it has been codified into law that the highest priority of any corporation is to maximize shareholder value. Always. At all times. Above any and all other obligations or activities. That means squeezing every last possible penny possible in profits (plus 30%), and doing anything and everything to pump (hype) up the stock price right now, immediately, today, short term.

Any CEO that dares incur the wrath of hedge funds and other institutional shareholders by not charging usurious prices for drugs, by not paying employees the bare minimum you can get away with, by not borrowing money and leveraging the company to the hilt, or by being so foolish as to actually try to invest in R&D for new drugs, invariably gets quickly and viciously sued and then has to defend himself before a judge and rapacious plaintiff's attorneys asking 'why didn't you do this to increase profits and share price?'. Ask me how I know.

The goals are mutually exclusive: as a society, is our priority to maximize corporate profits, or to maximize the quality of healthcare and how many people have it?

Pick one.

My last statement you quoted was more about minimum wage and wage equity than healthcare.

I agree that healthcare needs to be affordable, portable and universal. I just don't think M4A or single payer of any sort is the answer.

Open up insurance across state lines, and lets see what the free market with a government backup does first. Provide subsidies like AHA does for those that can't afford it outright based on income and mandate all insurance companies accept it against their policies. Maybe that's a start.

Real answer is to outlaw bribery and reform campaign financing. Absolutely *is* legislatable, but our legislators are bought and paid for by corporate $$$$$$$

I pick 2nd one, extended such that we *all* have healthcare.

One in the same to me since its unlikely either will happen.

I'm sorry but personnel costs are a big part of the issue with healthcare in the US. Have you seen what physicians make? It's so high that the Bureau of Labor Statistics I quoted earlier doesn't even list an average, only that it's "over $208,000 per year". Along with everything else, that will have to be reigned in to make healthcare "affordable".

Here's a comparison from a UK website, notice the differences:
https://img.medscapestatic.com/pi/fe...eport/fig7.png

Of course! This opens up a whole 'nother can of worms about why personnel costs are so high in the U.S. A part of the reason is malpractice. Malpractice insurance isn't cheap. If you had tort reform so that anyone couldn't easily sue anyone else for anything and everything under the sun, with the possibility of 8- and 9-figure settlements, and brought litigation costs down to a level comparable with other countries, physicians wouldn't have to make as much money because they wouldn't be paying out so much for malpractice insurance.

It's also partly a function of the top end of the market driving demand. Wealthy consumers who can afford to pay for their own healthcare demand, and can pay for, the best cardiologists, neurologists, cosmetic surgeons, etc., especially in major cities like New York, Boston, etc. I imagine primary care physicians or pediatricians in poor rural areas aren't raking in 7-figure salaries (but their malpractice insurance still needs to be paid for).

Then there's yet another can of worms with costs of schooling. Medical school in the U.S. isn't cheap. In France, if you get in, medical training is virtually free. Having a national healthcare system, combined with nationally-paid medical training, seems to make costs a lot more reasonable than in the U.S.

We have some nurses making more than doctors, TBH.

Doctors in this country also need to pay $200k for med school on top of their undergraduate. They are saddled with debt and don't start making money until their early thirties. A nurse finishing college at 22 is better off than a doctor finishing residency at 30-33 until age 54 or something, when the higher salary of the doctor finally crosses his net worth over the nurse's net worth. Why? The nurse had a head start on income with less school debt. In other countries, college is free. Getting in is a matter of going to college prep schools and merit. That is why the comparison doesn't make sense.

France and Germany have free college. England use to have free college, but they went away with that, and it is yet to be seen if there will be long term consequences for short term gains. Pretty sure Spain is free or tuition is about as bad as community college here.

https://www.investopedia.com/article...ge-tuition.asp

I should add, if you think $200k is bad then you should see the salaries of the top execs. My hospital's execs are making half a mill, and they aren't even CEOs for big, big companies.

Doctors deserve $208k/year way way WAY more than health insurance CEOs deserve $20M/year. Their jobs are non-essential. So let's start with eliminating the need for people to buy insurance from profit-driven corporations who by god are going to charge the MAXIMUM and give you the MINIMUM in return. And of course drop you if you get sick enough to lose your job and are unable to afford the jacked-up rates to keep them...

It isn't about minimum wage for me or determining what a living wage means. It is about corporations and CEOs making millions and billions and not sharing the profit with their employees to the tune that their employees struggle to live to such an extent that I have to pay via my tax dollars, so these employees can have food stamps or whatever. Walmart and the Waltons are one of the richest companies and families in the world, but they can't afford to pay their employees enough, so their employees don't qualify for government assistance and can make ends meet. That is insane to me that I am supplementing the income of one of the richest families in the world.

With healthcare, there is no need to hold onto a system that is broken. As long as people can't be turned away from ERs private insurance will forever be paying for non-payers and non-payers will gamble going into bankruptcy if a large event happens. There is no other fix for this except universal healthcare where everyone has to contribute something. Universal healthcare removes profits and high executive salaries from insurance, and it simplifies the billing department for hospitals and doctor's offices. We don't have to wonder. It has been overwhelming demonstrated to be the case in other countries and with bipartisan studies. Cheaper with better outcomes. There would be losers. No doubt.

I've already said it's broke and it needs to be fixed but we already have an example of Uncle Sam lead healthcare (VA anyone?) and having personally had relatives with experience in that system, no thanks.

A private company can pay its employees (at both end of the spectrum) what the market will bear, and that's what happens. People underestimate the impact the members of the c-suite have on how a company runs and survives. Are there abuses, sure, just like with everything else. Folks are just smoking some good stuff though if they think letting the Feds run healthcare is somehow going to magically make it better.

Remember this is the same people that just passed as "COVID recovery bill" that was over 5,000 pages long and were able to completely understand it with just 2 hours before they voted on it.

Yea, my system likely does as well, particularly nurse practitioners.

Millions of Americans being able to just go to the damn doctor, get their insulin, etc., will be worth the *effort* it will take us to make M4A work.

Profit-driven healthcare is not working. Only reason these CEOs are "worth" millions is because of how well they are screwing us over.
We are paying far more than other countries for less desirable outcomes. We can do a lot better. We must do a lot better..

The health insurance fund I pay money to is not-for-profit. Weird huh?

This is the essence of the problem, and why it's insane to leave health insurance up to the for-profit private sector: companies maximize their profits by minimizing how much healthcare they provide.

It's that simple. The more a company spends on providing, you know, actual healthcare to a person, the less money they make. Because a company and its executives are legally bound (in the U.S.) to always maximize shareholder value they have to spend as little as possible (or they'll get sued and the executives replaced with amoral ones with no hesitation to do it).

Some insurance companies talk about 'investing' on 'prevention', 'wellness care', etc. Of course those are sound and needed approaches - preventing illness is usually more effective, less expensive, and better for you than treating disease once it's occurred.

Unfortunately, it's also mostly bu!!sh!t. Some worker-level employees believe in this necessary mission and try to carry it out. But the senior executives know it's just propaganda.

Company share prices are driven by short-term profits. Public companies literally live and die by their quarterly earnings. Their executives (and their hallowed bonuses) also live and die by that. 'Investing' might pay off years down the road. Or it might not. But cutting costs to the absolute bare minimum you can possibly get away with, investors LOVE that because it pays off TODAY. Investors don't care about what a company does that might improve the fundamentals of the business years down the road. They severely punish you if you try to do that. Shareholders want a company spend money on stock repurchases, not to invest for the future, and often sue if you don't. They only care about pumping the stock price in the shortest time possible. I worked with venture capitalists and Wall Streeters for over 35 years, and would be hard pressed to think of a single institutional investor I ever dealt with who actually cared about anything other than the short term (because that's how their performance is judged, and how their bonuses are determined).

Every other developed (and not-so-developed) country in the world has realized this. You don't want to put healthcare in the hands of people whose mission is to deliver as little healthcare as they possibly can.

Why do we put up with it? Money. The people in charge are making so much money with the current system, they are highly incentivized to keep it. The companies raking in the money certainly have no incentive to put themselves out of business, and their shareholders are also profiting from the ride. They spend unimaginable amounts of money lobbying members of Congress and lining their pockets to keep things just the way they are. So we end up with false messaging equating national healthcare with 'socialism' and ridiculous untruths and scare tactics about 'government death squads' deciding who lives and dies, and how awful 'socialized medicine' is in other countries. Enough people believe the lies, don't educate themselves on the realities, and the system continues.

Regardless of what a person believes, we all pay the price by spending a lot more than we should, and getting a lot less. In the case of the roughly 30 million uninsured people in this country, getting nothing at all.

Yea, if given the option. I’m choosing private. Until I’m told I don’t have a choice, that’s my right.

How many of you M4A supporters signed up for ACA? Or even (as a stretch) experienced public insurance whether it be in the military, VA, or Medicare? I’m interested to hear some real life, first hand, experiences instead of paper ideas.

I already posted this. There is a difference between VA insurance and VA hospitals, but this:

https://content.gallup.com/origin/ga...4jxswxqvjg.png

https://news.gallup.com/poll/186527/...satisfied.aspx

Even with non-profits we have this:

https://www.google.com/amp/s/www.ibt...863585%3famp=1

I don’t have first had experience of government insurance. I work for a hospital and am on private insurance that is an EPO (half way between a HMO and PPO). I have been under-insured and uninsured in my life. I’ve had bad experiences with private insurance and not being insured.

I obviously see the benefits from healthcare expansion through the ACA first hand from patients. I deal with the VA hospital and clinics, as well as, medical and medicare and medicaid insurance. I have family using different types of insurance from government, medicare and private. I know of bad experiences, but I don’t know their overall opinion.

I see waste from restrictions like VA patients need to be transferred to the VA for admition, so they get two bills now. I see the same for HMO/capitated patients that have to be transferred and double charged.

These types of anecdotal stories really aren’t guaranteed to be representative. I’d like to think my experiences aren’t bias and would reflect most experiences, but I can’t guarantee that, which is why we rely on other metrics. I probably have thousands of stories from patients, so there is a lot to share. In general, I see that coverage is an obstacle for receiving the best care, and insurance causes a lot of waste, while passing the buck to patients with higher premiums or refusing to pay for something.

Because I work for a Catholic hospital system, my insurance reflects their values, so even though most insurance companies would jump at the opportunity to pay for an abortion or pay for a vasectomy, they don’t allow it. In fact, if it wasn’t for the ACA mandating they pay for birth control, we would have to pay that out of pocket. That wouldn’t be the end of the world, but it highlights the issues. Per diem employees get 15% extra pay to offset the lack of healthcare and lack of other benefits, but full time employees either accept the healthcare plan, or they get nothing, so if I wanted to get on my wife’s insurance then I wouldn’t get 15% and the hospital gets to pocket the premiums they don’t have to pay for me. Odd because I would rather have the cash or have taxes taken than feel like I’m getting less contributions than my coworkers just because I chose her plan. Because of that, we have a problem maintaining full time staff and maintaining staffing levels. I’m regressing and ranting.

The system needs improvements.

This is skewed. The VA is relentless with their surveys, I get two letters and a follow call for a survey after every interaction. I spend on average ab 45 minutes on hold just to get simple questions answered. I don’t believe that number to be accurate at all. It’s quite laughable. For the record, I’ve never filled out a survey because the last thing I want to do is be on the phone with them longer.

I prefer BCBS over my VA insurance everyday of the week and twice on Tuesday. As a recipient of a VA insurance, I avoid it like the plague until they require me to be there.

Gallup did the survey. This information was in the article:

https://content.gallup.com/origin/ga...pg3y0ybdxq.png

Frankly I don't trust the surveys to mean much. I'm a good example. I've been on some form of health insurance for 40 years. During that time, my use of the system has been only for routine care as I've never had a major health event. So, for the most part I am satisfied with the insurance I have because it has always covered my needs.

The problem is, my opinion shouldn't matter because why would I have a bad opinion of the system?

Lol another thread gone off topic

I’m sure medicare, medical, medicaid and VA insurance patients use the system more than private insurance members, so the fact that they report back satisfied reflects that much better, as whatever they say is likely more accurate. I’m sure the biggest problem people have with private insurance is the premiums that continue to rise and employers jumping plans all the time. The other things are the limitations some plans have like the ones I mentioned in mine or network limitations. While problems can be found in all insurance providers, and there is some overlap, I see more people underinsured or limited with private insurance, even though it can offer the opposite. The reality is many don’t have premium private insurance.

The elephant in the room is that satisfaction is inversely correlated to outcomes *for hospitals*. Meaning, someone could be upset that they didn’t get that MRI for their hangnail, or didn’t get antibiotics or retrovirals for their cold, or didn't get a prescription for two bottles of oxytocin, but they are better without those things when they don’t need them. This could be the case for insurance too, but I don’t know if it applies the same. I only know it is true for hospitals, but it is worth mentioning. FYI, patients of female physicians have better outcomes like mortality is lower.

It’s not that I don’t trust Gallup it’s that I don’t believe it is an accurate representation of the truth. Go visit of a VA hospital and tell me that 78% of that lobby is happy with their service.

I’m aware of you feel about, I just want to know how someone who has actually enrolled in ACA feels ab their service.

Exactly. My experience with the public option has been nothing but the typical military rigamarole - just another head of cattle in the chute. It’s to the point that I’m willing to pay the copay and deductible for better service rather than get it free from the VA. Even while I was active duty, I paid extra so my wife and kids didn’t have to go to the same doctors I did.

Another thing to consider: you may be thrilled with your employer-provided insurance, but if you get sick enough to lose your job, guess what...

They will gladly take your money for years and decades, but if something really serious happens you are selectively removed, as most employers will just let people go if they are too sick to produce for them.

To recap, California mandating EVs => statements about California having too many regulations => conversation about the benefits of more regulations versus less regulations => focusing on one category—healthcare.

Healthcare is one of those subjects that radiates with everyone. It affects everyone. It is a subject that is harder to apply normal economic/capitalistic principles. If I say I have a pill that can save your life then what is that worth to you? It is harder than quantifying a car or phone or TV. It is harder to quantify than the price for a hair cut, for an Uber ride or to have someone install a turbo kit on your car. If radiation could save your wife from cancer then what is that worth to you? If your child needs an emergency appendectomy for a ruptured appendix then what is that worth to you? If you have a hard time pricing out these items then congratulations you or whoever reading this is human. That is why healthcare is different. People will pay anything to have more time alive and with their loved ones and for their health, when it matters like this. This is why everyone has a vested interest in this conversation, and why we can’t treat it like any other industry. Healthcare at the hospital level and all the way to the pharmaceutical level requires a different approach.

FWIW, the EV mandate is likely not necessary or going to happen, but it may encourage more development, investment and planning, which may accelerate us getting there even faster. I think we might get there through public interest that fast without the mandate, assuming there are the already planned investments in green utilities to support such a transition. In another 5-10 years, EVs will be cheaper and just be a better vehicle for the masses. The enthusiasts aside of course, but even some of them will change their tune.

A lot of big companies have medical leave buckets that are employee donation oriented which require a certain number of hours of leave to be donated to be a member in case something like this happens. Kind of like insurance for leave. It’s a cool new thing.

Do you mean do people like their version of Kaiser or Blue Cross insurance through the ACA market in terms of coverage, deductibles and premiums?

Some states didn't set up their own exchanges. Some insurance providers wanted the ACA to fail. Some state’s governors didn’t support the ACA. California set up their exchanges:

https://www.healthinsurance.org/cali...ance-exchange/

The ACA was suppose to be the start—not some final solution. Single-payer is likely the final solution, but even if that is a state decision like California might do, states were suppose to adapt the programs to their specific markets. We see the difference in states that went all in. More have coverage. Outcomes are better. Costs are more controlled.

Cool story. Two thumbs up.

You are confusing VA insurance with VA medical services.

Honestly, I’m just looking for anyone that enrolled, at all. I’m not picky. I’m hesitant to listen to rationales until after I hear from someone who had it and heard their opinions.

That most people don't have access to...

Well I’ve never used VA insurance without the VA medical. I’m not sure you can unless you have specialty care that the VA can’t handle - a rarity.

I don’t even think I’ve interacted with them. All of your insurance info is on file because it’s all taken care of in house.

. . . Social security disability . . .

. . . Unemployment . . .

There are options.