Gov. Tim Walz of Minnesota suggested at fund-raisers that he backed switching to a national popular vote. His spokesman clarified that this was not the position of Kamala Harris’s campaign.
Kamala already did? She outlined her plan. It’s better than what we have, which is a low fucking bar, but she’s still terrified to cross commercial insurers. No backbone. As a result she proposes a tiered system where you can buy fancier private plans from Aetna, Cigna, etc for more “premium” service while every American would be guaranteed Medicare
As a provider this system fixes a few issues but leaves a lot of the rot in place. On the plus side making insurance compulsory has many great advantages: better access means healthier populace (assuming copays and deductibles aren’t obscene), more younger healthier people paying into the system via taxes means that the increased cost burden isn’t solely spread across people who use their insurance (an issue since trump repealed the individual mandate. Sorry young folks but you’ll be happy when it’s your turn, I guess).
On the negative side this tiered system, without serious regulation, creates an environment where those who have “basic Medicare” might struggle immensely to find providers. I work with many providers now that don’t take certain insurances because they pay less and take more effort to bill and stay in network with. Where I live very few take Medicaid outside of large hospital networks and many of the super cheap commercial insurers struggle to get providers paneled as well. In both cases because they pay shit rates, in the former because on top of the bad pay they demand an insane amount of paperwork to both enroll and bill.
The other issue here is that I waste about 20-30% of my working hours dealing with the complexity of insurance. Today alone I had to call 3 different insurers about claims issues, I had to use three different websites to verify said claims, and the rules change slightly between all of them. That complexity eats tons of money in “administrative overhead”, of which we pay significantly more than other any nation. It either means I pay someone to deal with it (and usually pass that cost on to you somehow) or like my small practice I waste tons of hours I could be spending on seeing more patients, which is desperately needed. This complexity will almost certainly remain with dozens/hundreds of companies selling their own variants of Medicare.
Further this goes beyond m4a but she’s silent on corporate and profit led ownership of hospitals, emergency rooms, rehabs, nursing homes, and psychiatric inpatient which is one of the biggest detriments to patient care at the moment
There is more but those are the big points. It’s very frustrating to see that she took something that was initially proposed as a single payer system, co-opted the name, and turned it into a mess to appease the insurance lobby. To her credit I and my colleagues were saying years ago there was 0 chance of m4a getting off the ground unless something like this happened.
There is far too much lobbying power behind the gigantic insurers (specifically Aetna and Cigna after their mergers that have basically made them monopolies) and it would be political suicide to suggest that their healthcare divisions will be essentially redundant overnight. You’re talking hundreds of thousands of jobs going poof. A portion of those jobs would need to be recreated in the government under a single payer system of course but the anxiety of not having a guaranteed position would be enough to get many voting against it. Additionally a lot of those jobs would be exposed as the redundant administrative roles that are just burning through our health care dollars, by some estimates as much as 25% of healthcare spending.
Say M4A. Please just say M4A.
Kamala already did? She outlined her plan. It’s better than what we have, which is a low fucking bar, but she’s still terrified to cross commercial insurers. No backbone. As a result she proposes a tiered system where you can buy fancier private plans from Aetna, Cigna, etc for more “premium” service while every American would be guaranteed Medicare
As a provider this system fixes a few issues but leaves a lot of the rot in place. On the plus side making insurance compulsory has many great advantages: better access means healthier populace (assuming copays and deductibles aren’t obscene), more younger healthier people paying into the system via taxes means that the increased cost burden isn’t solely spread across people who use their insurance (an issue since trump repealed the individual mandate. Sorry young folks but you’ll be happy when it’s your turn, I guess).
On the negative side this tiered system, without serious regulation, creates an environment where those who have “basic Medicare” might struggle immensely to find providers. I work with many providers now that don’t take certain insurances because they pay less and take more effort to bill and stay in network with. Where I live very few take Medicaid outside of large hospital networks and many of the super cheap commercial insurers struggle to get providers paneled as well. In both cases because they pay shit rates, in the former because on top of the bad pay they demand an insane amount of paperwork to both enroll and bill.
The other issue here is that I waste about 20-30% of my working hours dealing with the complexity of insurance. Today alone I had to call 3 different insurers about claims issues, I had to use three different websites to verify said claims, and the rules change slightly between all of them. That complexity eats tons of money in “administrative overhead”, of which we pay significantly more than other any nation. It either means I pay someone to deal with it (and usually pass that cost on to you somehow) or like my small practice I waste tons of hours I could be spending on seeing more patients, which is desperately needed. This complexity will almost certainly remain with dozens/hundreds of companies selling their own variants of Medicare.
Further this goes beyond m4a but she’s silent on corporate and profit led ownership of hospitals, emergency rooms, rehabs, nursing homes, and psychiatric inpatient which is one of the biggest detriments to patient care at the moment
There is more but those are the big points. It’s very frustrating to see that she took something that was initially proposed as a single payer system, co-opted the name, and turned it into a mess to appease the insurance lobby. To her credit I and my colleagues were saying years ago there was 0 chance of m4a getting off the ground unless something like this happened.
There is far too much lobbying power behind the gigantic insurers (specifically Aetna and Cigna after their mergers that have basically made them monopolies) and it would be political suicide to suggest that their healthcare divisions will be essentially redundant overnight. You’re talking hundreds of thousands of jobs going poof. A portion of those jobs would need to be recreated in the government under a single payer system of course but the anxiety of not having a guaranteed position would be enough to get many voting against it. Additionally a lot of those jobs would be exposed as the redundant administrative roles that are just burning through our health care dollars, by some estimates as much as 25% of healthcare spending.
https://kamalaharris.medium.com/my-plan-for-medicare-for-all-7730370dd421