Saturday, September 29, 2007

RomneyHillaryCare vs. Medicare For All: A comparison

(Note: Bumped to top of blog for the rest of this month).

RomneyHillaryCareMedicare For All
Enrollment method Requires individuals to purchase health insurance either from current insurance programs or from a new government-run insurance program Automatic -- all individuals residing in America are automatically covered by Medicare For All.
Method of Funding Billing of individuals by insurance companies, combined the existing Medicaid tax for subsidizing lower-income insurance purchasers Already-existing Medicare payroll deduction, increased to cover full cost of program and with employer matching of the employee portion, combined with a deduction from Social Security recipients' Social Security checks
Enforcement costs Requires significant enforcement costs, up to and including imprisonment, in order to obtain compliance with the mandatory insurance purchase requirement. Enforcement is against 120,000,000 households, rather than 10,000,000 businesses. No additional enforcement costs -- current already-existing Medicare tax enforcement against the 10,000,000 businesses in America suffices, which is much less expensive than enforcing a new mandate against 120,000,000 individual households.
Additional government bureaucracies created 5 - a new government-provided health plan distinct from Medicare with its own bureaucracies for enrollments, billing, and payments, a new government bureaucracy to handle computing and distributing health insurance subsidies to lower-income Americans, and a new enforcement bureaucracy to enforce the purchase of insurance -2 - eliminates current Medicare enrollment and billing bureaucracies (everybody is automatically enrolled thus no need for a new enrollment bureaucracy, and the funding method eliminates the need to bill anybody unlike Medicare which is required to bill people who are receiving Medicare but not Social Security because they're still working)
Savings in insurance marketing costs Increases marketing costs, since now marketing must be directed at 120,000,000 households rather than 10,000,000 businesses 100 percent savings. No marketing costs -- everybody is automatically enrolled
Savings in billing costs Increases billing costs, since now 120,000,000 individuals must be billed rather than 10,000,000 businesses. Over 100% savings -- total cost of plan piggy-backs on already-existing Medicare payroll tax already taken out of your paycheck and eliminates the current Medicare billing bureaucracy (for working Medicare recipients not yet receiving Social Security)
Savings in insurance claims processing costs slight increase, due to new government bureaucracy Drastic decrease -- dealing with only one program (Medicare For All) rather than with thousands of plans provided by hundreds of insurance companies will result in at least 15% average reduction in costs for the typical physician practice, and probably more.
Savings to businesses 100 percent -- now individuals, not businesses, pay for health insurance. Increases costs for businesses that currently do not provide health insurance because the amount taken out of paycheck as Medicare tax is matched by the employer in the same way as the current Social Security tax. Decreases by at least 50% costs for employers who currently provide health insurance.
Savings in individual insurance premiums Most people will see higher premiums than under their old employer-provided plans, due to higher billing and marketing costs. Inability to enforce the insurance mandate means little savings due to no longer having to bear cost of care for uninsured. Dependent on income, if you count the Medicare payroll tax as a premium. Lower income people will see a drastic savings, upper income people will see a drastic increase, most will pay less than today because total cost of the program is less.
Coverage for pre-existing conditions Mandated Everybody in America is automatically covered
Percentage of individuals uninsured Roughly 10%, consisting of people who do not file income tax statements (and thus are not tracked by RomneyHillaryCare), are here illegally and thus do not qualify for subsidies for low-income households, or simply cannot afford health insurance even with the subsidies provided under RomneyHillaryCare for low-income households. None -- everybody in America will be automatically covered, regardless of income status or immigration status.
Overall savings Increases overall costs of health care in America, due to the cost of the additional federal bureaucracies and cost of billing and enforcement Decreases overall costs of health care in America by at least 25% due to elimination of all billing, marketing, and sales costs and drastic reduction of claims processing costs due to economies of scale.
Consumer choice of physician Limited As is currently the case, you will be required to "choose" a physician who is part of your particular PPO or HMO. Drastically improved. With Medicare for All, you can go to any physician, anywhere, and receive care.
Consumer choice of health care coverage Moderate increase in consumer choice. Right now you are limited to what your employer provides. You will be able to choose any plan you can afford under RomneyHillaryCare. Moderate increase in consumer choice. While everybody's base level of health care coverage will be the same, you can choose to purchase MediGap insurance from private providers at extra cost to provide additional coverages beyond those provided by Medicare under Medicare For All.
Ability of states to create their own health plans different and distinct from the national plan Eliminated. Eliminated


  1. One problem with medicare is that everyone will want to be cured of everything no matter how old they are.

    I think that after 80 a person should just accept that they are going to die and not to be draining the system of funds expecting it to fix them.

    Some of these issues will be hard to resolve, but I'm not keen on the insurance industry being in charge of it all. To much capitalistic greed in it.

    They build fancy offices and pay themselves big wages instead of building new and better hospitals.

  2. Check todays Prickly City comic.

    Prickly City

  3. **BBC said...I think that after 80 a person should just accept that they are going to die and not to be draining the system of funds expecting it to fix them.**

    A tad cold-hearted, bbc? Will you still feel the same way when you hit 80 after all your years of paying into the system? Are you so totally altruistic?

  4. That said, BBC, extending Medicare to all Americans will not affect the cost of covering the prunes in any way. The costs of end-life care are indeed an issue but one that is hard to address while at the same time you have children dying due to lack of health care (over 10,000 people in America die per year of easily curable ailments such as infections and appendicitis due to lack of health care caused by lack of health insurance, and a significant percentage of them are children).

  5. Two points.

    1. Since this isn't socialized medicine doctors don't have to accept Medicare patients, or any other insurance program, so some doctors will be outside the system. A very minor point, but important in the case that this is not a commie plot.

    2. There will be huge savings to states as this will eliminate Medicaid, a big burden for many state budgets.

    To BBC's point - there are limits to what medicine can do and after 80 many of the cures will kill you. This isn't a major concern until medicine advances a lot more than it has, and at that point 80 may be the new 50. With the current system not enough people make it 80 to be a problem, it only seems like a problem because all of those who have reached 80 tend to want to drive their Caddie at 45mph on the freeway in front of you.

  6. Wow, Evil Spock feels smarter, and a little bit healthier too.

    Thanks for being so thorough!

  7. This was great. I quit my job at the hospital 12 years ago...was the "financial counselor" which is a glorified collector...I had to bleed people dry...including the elderly who couldn't afford care and deserve not to worry at their age and stage of health and income (sorry bbc...cannot agree with you). I HATED my job. I had no plans, two kids, was a single parent and I never looked back. I went to school. Here I am. Self employed and paying way too much for insurance that covers nearly nada.

    Great post!

  8. i was wondering if you could expand the choices in your poll. i'm torn between medicare for all [canadian style] and france's system.

    lovely, lovely table. muchas gracias, viel dank, mange takk, and thanks for all the fish.

  9. "and drastic reduction of claims processing costs due to economies of scale."

    No not really, it still all has to be documented and processed correctly. All insurance companies use the CPT-IV code book from Medicare (this is the procedure codes, IIRC). Most of the coding for insurance has been pretty well standardized through out. It's the appeals process and the loopholes insurance companies have that cost in processing claims. While quite a bit of appeals will go down.... the claims still have to be correct. Medicare does not cover *everything*, so.....

    One problem with going over to having medicare be the 'insurer' is that their reimbursement rate isn't all that good. While they're really fast paying out (3 week turn around time generally for this institution), the pay out doesn't come close to reflecting the true cost to the provider.

  10. I'm so glad you took the time & trouble to do this. I'd do it, but I'm too busy trying to find 'affordable' insurance.

    Of course Medicare doesn't cover everything, nor would Medicare For All. Show me the insurance policy that DOES cover everything, 100%.

    That's what supplemental insurance is for. Even after single payer, there would still be plenty of profit for the private insurers in that market.

  11. Anonymous, I'm going by what I was told by someone who actually has worked in the medical claims processing field (on the software end of things). But now that I think about it, the various "Medi-Gap" insurers that would arise in a Medicare For All plan would be an issue mitigating some of the claims processing savings, so I'm not sure in the end just how big of a savings it will be.

    And reimbursement rates are noted. But Medicare's reimbursement rates aren't much different from private insurers' reimbursement rates nowdays. Something has to give here, doctors are starting to go on strike (i.e., refuse to accept new patients and generally winding down their medical practices) because it isn't worth their time anymore to practice medicine. But one thing is clear, the current system isn't going to resolve that problem either, so at least Medicare for All doesn't make it worse.

  12. Medicare/Medicaid's administrative costs run roughly three percent of budgeted revenues.

    No HMO is within a factor of five of that.

  13. "someone who actually has worked in the medical claims processing field (on the software end of things)."

    I worked on the software side of claims processing for a major midwestern facility for 3.5 years. You have got to get all the 'codes' right, no matter the payor. Clerks entering can only do so much without errors. Programmers can only do so much to weed out things that are obviously wrong (eg a pap smear on a male patient, etc). The savings will be in not having to deal with other insurers if you don't want to.

    I'm not knocking Medicare 'type' coverage for all. Just that currently there are many doctors that are not taking new patients that have Medicare as primary payor because the reimbursement rates are becoming insufficent to the providers costs of operating. IIRC, the reimbursement rate is around 45% of cost. There's nothing wrong with reasonable co-pays and deductables either.

  14. There are many doctors who aren't taking new patients period, regardless of insurance provider. Low reimbursement rates are a concern, period, Medicare or not. When I lived in Phoenix, I called every single primary care doctor in my PPO's provider book looking for an appointment to deal with a chronic cough. There were three (3) doctors in the entire metropolitan area accepting new patients for this PPO, and the closest appointment I could get was three weeks out. When I objected that this seemed a rather long time given that I could possibly be suffering some life-threatening ailment such as throat cancer, the lady at the other end snapped "then go to the emergency room." Yeah right.

    But you can't address the reimbursement rate without addressing costs. Without eliminating the gigantic costs imposed by the private health insurance industry, which is making record profits off the deaths of tens of thousands of Americans who lack health insurance or whose insurance refuses to pay for necessary treatments, there just isn't the money in the American economy to address the reimbursement rate issue. We are spending over 15% of GDP on health care, roughly twice the OECD median. There is no way to raise reimbursement rates without lowering OTHER expenses. And the easiest way to lower other expenses is to eliminate the private health insurance industry as the primary care insurance for Americans, which immediately makes available all of those billions currently going for health care administration and expenses and profits on the part of health insurance companies.

  15. The penguin dont really care about human health care. I know his plan. Check it out:

  16. maybe we should just criminalize healthcare and see what happened. Doctors would no longer have to pay malpractice insurance, but any contractual waiver you were asked to signed by the doc would be null and void because it involved an illegal activity.

    Obviously, sending the healthcare industry underground would mainly benefit the strong and wealthy and disadvantage the weaker and poorer-- but I wonder if it would be much worse than Hillary/Romneycare.

  17. Good morning, Tux. Have you seen the statistics at She writes about how many military bases the US has. What's your take on this?


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