buffalo Loc: Texas

Why not put the final "health CARE/INSURANCE bill" on the ballot in 2018 and let the American voters approve or reject it? Or would that be in the interest of the taxpayers and not in the best interest of the greedy health INSURANCE and PHARMA corporate organ grinders and their monkeys in Congress?

straightUp Loc: California

Best news I've heard all week... Trump, in his first decent move since taking office pulled the replacement plan, leaving the ACA in tact. I'm sure it's not what he really wanted to do, but there is apparently some decency among the Republicans that haven't forgotten they represent the people and the people are demanding that the ACA be replaced with a BETTER plan or not at all. So it was becoming apparent the idiot crap Paul Ryan was pushing wasn't going to fly. It's also pretty obvious at this point that the American people don't want to be stripped of healthcare either, so repealing without a replacement isn't looking like an option either.

As for the die-hards that opposed the AHCA because it doesn't cut enough from the budget, the hard lesson for them seems to be that the American people really aren't as stupid as they were hoping.

In any case... I'll be celebrating tonight! :)

straightUp Loc: California

It's kind of rare for a federal bill to be put to the people like that but I wouldn't have a problem with it. Of course now they know the people are getting smarter about the issue so they probably won't be able to rely on a Paul Ryan style snow-job; so the bill will have to hold water at least. But why not? That gives them about 2 years to come up with something decent then yeah, let the people decide.

buffalo Loc: Texas

That would be too honest and as you have surely learned on OPP, you can't argue with dishonest people....

CounterRevolutionary

Doc, if we don't get rid of this Obamacare this year, we will lose the House and Senate the next year. Let's reverse Donald Trump's 3 steps by this:

1) Open up Interstate Commerce by overturning the 1945 McCarran-Fergusson Act. Michele Bachmann proposed this, our Tea Party founder is smart!

2) Expand HSAs for all in the Reconciliation Act.

3) Allow Sec. HHS Tom Price to gut 3000 more pages of regulations in Obamacare, and put the 1% of truly handicapped and chronically ill on Medicaid under HHS block grants to the states.

I think we have to move fast on this; anything to avoid the full collapse of Obamacare and its replacement with the Public Option. That would be the death of the human race as we know it.

CounterRevolutionary

Buffalo, you write: "Hey, doc, if health CARE is not a right, what are you going to do with the homeless man that shows up to the ER having a massive heart attack? Let him lay in the lobby and die or kick him out to the parking lot? How about the teenage pregnant girl in active labor? Let her shit the kid out in the parking lot?"

Cut the drama. Hospitals may not turn anyone away because of poverty. It is like this today, it will always be like this. How do you think the 20 million illegal aliens get medical care? The 1% of chronically ill that consume 25% of health insurance expenses need to be placed on Medicaid with that $10 billion dollar block grant from HHS to the States. You don't put the entire nation on welfare. That bureaucratic nightmare will banerupt the nation.

Stop complaining about the big, bad corporations. Enough is enough. The problem is the big, bad government!
If you want the Public Option:

Go to Cuba where they quarantine homosexuals in prisons as a national security threat.

Go to China where they harvest organs from live political protestors, strapped to an operating table, then and sell their steaming hot organs for waiting customers. Welcome to the communist world of hi-tech cannibals.

Go to the Soviet Union where they experimented with new drugs and surgeries on their cancer patients and locked political dissidents up in insane asylums.

Move to Nazi Germany where they practiced race purification on their own German citizens, sterilizing the undesirables and insane, euthanizing the MS patients, the alcoholics, the blind, the feebleminded, the elderly, and other "useless eaters."

Look at Obamacare creating medical triage, the Gang of 15, legal euthanasia by government proxy, "just give grandma the pain pill."

You write: "The government (taxpayers) is already paying for 64.7% of health CARE expenses in the US and that % is rising. Health INSURANCE corporations can't extract their $500 BILLION by insuring the Elderly and Poor without the huge subsidies from taxpayers."

The cost of healthcare is not medicine, nor the doctors; it is the cost is RED TAPE, the myriad of millions of paper-shuffling bureaucrats determining the cost of a band aid, every hiccup, every sniffle, every skinned knee on the tennis court. We don't need the nanny state running around behind us with a roll of toilet paper. Grow up and take care of yourself. Buy catastrophic health coverage for $50/month from Wells Fargo Bank or join a medical co-op, and be done with it. Pay your own way because I am not paying for this crap.

First, we kill all the bureaucrats, forget the lawyers.

buffalo Loc: Texas

Then tell me why those that hospitals cannot turn away because of inability to pay (for whatever reason) get to treat medical CARE as a right paid for by those(taxpayers) that have to treat their health CARE as a bankrupting privilege? Is that fair?

Or, I could stay in the good ole US of A. Are you foolish enough to think the US government innocent of evil medical experimentation, often without the knowledge or consent of the subject?

http://www.ranker.com/list/the-13-most-evil-u-s-government-experiments-on-humans/robert-wabash

There are studies comparing Canada and the United States that show a single payer vastly reduces administrative spending.

http://www.nejm.org/doi/full/10.1056/NEJMsa022033

You need to quit believing the propaganda, myths and LIES put out by the health INSURANCE corporations deathly afraid of losing their $500 BILLION and growing annual profits they extract from the US health CARE system with not one cent going toward health care.

padremike Loc: Phenix City, Al

Republicans dodged the Obamacare like plan that failed. That is a good thing. The ACA will indeed stay until conservatives come up with a good plan. The ACA is going to fail most likely before the Conservatives can work up an affordable plan. The Democrats own that plan 100%. It took them eight months to create the ACA and in the end they had to give away free stuff and use bribes to pass it. I believe we can allow time for conservatives to work out an affordable plan. But it still remains that health care is not a right. You Marxist are trying to create an America where the government is in the business of redistributing wealth. If not stopped, America will fail.

CounterRevolutionary

You are so overwhelmed with envy that you have missed the point. These commie countries that treat their citizens like cattle have set the example for our socialist medical experimentation. You want more socialized medicine? That's plain nuts!

The illegal aliens that abuse our generosity and compassion need to be come LEGAL or get out.

We have welfare, aka Medicaid, for the destitute poor and handicapped. Trump has asked that Congress allot an additional $10 billion block grant to the States to help with coverage of that 1% of truly handicapped citizens.

But you don't put the able-bodied entire nation on welfare. Most of the working poor should purchase cheap catastrophic health insurance by shopping across all state lines. The 1945 McCarran-Fergusson Act prohibits that because it placed the insurance industry under the Interstate Commerce Clause by redefining a "non-profit" health insurance industry as a "for-profit industry," quarantining us consumers state by state, by health, wealth and zip code, a very sublime form of economic containment and racism.

And by the way, as I have posted over and over and over on this board, the health insurance industry makes a mere 4% profit in the market, (not much to sneeze at,) and it is now going down compared to the pharmaceutical industry that makes a 26% profit. (See the Morningstar stock exchange and Wall Street Journal for the facts.) I am not going to post these statistics again. You have to get off this labor union propaganda and greed against all corporations. These are the guys that provide the jobs! You gotta a problem with work?

The problem is GOVERNMENT regulation, impeding us consumers under the pretense of protecting us. Overturn the McCarran-Fergusson Act, enforce the anti-trust laws, and open up interstate commerce. So simple!
You want affordable healthcare? I'll say it again.
First we kill all the bureaucrats, forget the lawyers!

CounterRevolutionary

Buffalo writes:
"In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada."

These statistics show the Canadian "marginal tax rates," combined federal and provincial tax rate changes between 2016 and 2017 which have doubled.
http://www.taxtips.ca/taxrates/canada.htm

Canadian Federal Personal Income Tax Brackets and Tax Rates

2017 Taxable Income...................2017 Marginal Tax Rates.......2016 Marginal Tax Rates

first $45,916.................................15.0%......................................7.50%
over $45,916 up to $91,831..........20.5%...................................10.25%
over $91,831 up to $142,353........26.0%...................................13.00%

Honestly, I don't think the Canadian healthcare system is any more sustainable than Obamacare.
The cost is in the bureaucratic paperwork, the OVERHEAD of administration, not the doctors or the medicine.
The government is not efficient! The insurance companies offer policies much too broad, also regulated by the government and hence, are also ridiculously inefficient.
Health Savings Accounts will reduce the administrators by at least 50% or more, lowering of the cost of healthcare and forcing these megalithic insurance companies to downsize.

The Canadian population is also 1/10 the size of the United States which already is a real bureaucratic nightmare.!

CounterRevolutionary

How is it that The American Health Care Reform Act, HR 3121, already passed the House in 2014 but could not be used now to Repeal and Replace Obamacare? The House Republican Study Group put this together, and all it needed was to pass on to the Senate and have President Trump sign it into law:
https://en.wikipedia.org/wiki/American_Health_Care_Reform_Act_of_2013

Provisions of the bill

American Health Care Reform Act of 2013 - Repeals the Patient Protection and Affordable Care Act and the health care provisions of the Health Care and Education and Reconciliation Act of 2010, effective as of their enactment. Restores or revives provisions amended or repealed by such Act or such health care provisions.[2]

Amends the Internal Revenue Code (IRC) to allow an income tax standard deduction for a specified percentage of an individual's health insurance costs, regardless of whether or not the taxpayer itemizes other deductions. Excludes the amount of such a deduction from employment taxes.[2]

Allows a taxpayer, for earned income credit purposes, to exclude from earned income any employer contributions to a qualified accident or health plan.[2]

Allows double additional contributions to a health savings account (HSA) if both spouses are age 55 or older and one spouse is not an account beneficiary.[2]

Prescribes special rules for HSA coverage eligibility for certain individuals: (1) participating in a Medicare Advantage Medical Savings Account (MSA), (2) receiving periodic hospital care or medical services for a service-connected disability, (3) eligible for Indian Health Service assistance, or (4) eligible for TRICARE coverage.[2]

Prescribes requirements for interaction of health flexible spending arrangements (FSAs) and health reimbursement arrangements with HSAs.[2]

Prohibits the payment of health insurance premiums from HSAs, with certain exceptions.[2]

Prescribes circumstances in which certain medical expenses incurred before establishment of an HSA may still be qualified expenses.[2]

Prescribes requirements for protection of any HSA in a bankruptcy proceeding.[2]

Amends title XIX (Medicaid) of the Social Security Act (SSA) to authorize additional health opportunity account demonstration programs.[2]

Treats membership in a health care sharing ministry as coverage under a high deductible health plan.[2]

Renames high deductible health plans as HSA qualified plans.[2]

Allows payments from an HSA for: (1) direct primary care service arrangements, (2) certain exercise equipment and physical fitness programs, (3) certain nutritional and dietary supplements, and (4) periodic fees paid to a primary care physician for the right to receive medical services on an as-needed basis.[2]

Increases the maximum limit on contributions to an HSA to match deductible and out-of-pocket expenses limitations.[2]

Prescribes requirements for establishment of child health savings accounts, for which an income tax deduction shall be allowed a taxpayer equal to the aggregate cash amount paid into the account during the taxable year.[2]

Amends the IRC to include in gross income any distributions from an HSA for an abortion.[2]

Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PHSA), and the IRC to authorize premium and cost-sharing variances in group health plans based on certain financial incentives for participation (or lack of it) in a standards-based wellness program.[2]

Amends the PHSA to direct the Secretary to provide a grant of up to $5 million to each state for the costs of creation and initial operation of a qualified high risk pool if it has not created such a pool as of September 1, 2013. Limits participation in such a pool to U.S. citizens and nationals.[2]

Declares that the laws of the state designated by a health insurance issuer (primary state) shall apply to individual health insurance coverage offered by that issuer in the primary state and in any other state (secondary state), but only if the coverage and issuer comply with conditions of this Act.[2]

Prohibits a health insurance issuer from offering, selling, or issuing individual health insurance coverage in a secondary state if its insurance commissioner does not use a risk-based capital formula for determining capital and surplus requirements for all health insurance issuers.[2]

Amends the McCarran-Ferguson Act to declare that nothing in it shall modify, impair, or supersede the operation of any of the antitrust laws with respect to the business of health insurance (including the business of dental insurance).[2]

Amends SSA title XI (General Provisions) to require the Secretary to make available to the public Medicare claims and payment data, including data on payments made to any provider of services or supplier.[2]

Authorizes a state to establish a Health Plan and Provider Portal website to standardize information on: (1) health insurance plans available in the state, and (2) price and quality information on health care providers (including physicians, hospitals, and other health care institutions).[2]

Declares that nothing in this Act shall be construed to interfere with the doctor-patient relationship or the practice of medicine.[2]

Amends the American Recovery and Reinvestment Act of 2009 to eliminate the Federal Coordinating Council for Comparative Effectiveness Research.[2]

Amends ERISA to prescribe requirements for establishment and governance of association health plans, which are group health plans meeting certain ERISA certification criteria whose sponsors are trade, industry, professional, chamber of commerce, or similar business associations.[2]

Limits the commencement of a health care lawsuit, except in certain cases including fraud or intentional concealment, to three years after the date of manifestation of injury or one year after the claimant discovers, or through the use of reasonable diligence should have discovered, the injury, whichever occurs first.[2]

Limits to $250,000 the amount of noneconomic damages in such a lawsuit, but allows a claim for the full amount of any economic damages.[2]

Requires the court, in any health care lawsuit, to supervise the arrangements for payment of damages to protect against conflicts of interest that may have the effect of reducing the amount of damages awarded that are actually paid to claimants.[2]

Specifies criteria for the award of punitive damages, limited to the greater of $250,000 or double the amount of economic damages.[2]

Preempts state law with respect to health care lawsuits.[2]

Declares that nothing in this Act shall be construed to: (1) require any health plan to provide coverage of or access to abortion services; or (2) allow the Secretary, the Secretary of the Treasury, the Secretary of Labor, or any other federal or non-federal person or entity in implementing this Act to require coverage of, or access to, abortion services.[2]

Prohibits the use of funds authorized or appropriated by this Act to pay for any abortion or to cover any part of the costs of any health plan that includes abortion coverage, except: (1) if the pregnancy is the result of an act of rape or incest; or (2) in the case where a pregnant female suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the female in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself.[2]

Tax Effects[edit]

Eliminate a 3.8 percent tax on investment income for high-income individuals and families. Eliminating the tax would save these taxpayers $158 billion over the next decade, according to the nonpartisan Committee on Taxation, the official scorekeeper for Congress. About 90 percent of the benefit from repealing the tax would go to the top 1 percent of earners, who make $700,000 or more, according to the nonpartisan Tax Policy Center.

Repeal an extra 0.9 percent Medicare tax on wages above $200,000 for individuals and $250,000 for married couples. Repealing the tax would save higher income families $117 billion over the next decade.

Repeal an annual fee on health providers based on market share. Repealing the tax would save health insurers $145 billion over the next decade.

Repeal an annual fee on prescription drugmakers and importers. Repealing it would save pharmaceutical companies $25 billion over the next decade.

Allow taxpayers to deduct out-of-pocket health expenses if they exceed 7.5 percent of their income. The ACA limit is 10%. Taxpayers would save $35 billion over the next decade.

Repeal a 2.3% excise tax on medical device makers and importers. Repealing it would save them $20 billion over the next decade.

straightUp Loc: California

So then... don't even try?

straightUp Loc: California

Gotta stop ya there cowboy... Records have repeatedly shown that overhead costs for Medicare have consistently been lower than the average for the private industry. For example, the Annual Report of the Boards of Trustees for the Medicare trust funds figures the overhead cost for Medicare at about 1.5%. Meanwhile, the Congressional Budget Office, estimates administrative costs for private insurers at about 12%.

http://www.politifact.com/truth-o-meter/statements/2011/may/30/barbara-boxer/barbara-boxer-says-medicare-overhead-far-lower-pri/

It always amazes me how such a simple lesson in grade-school economics about "competition" can become such a banner for privatization. It's as if the innocence of childhood is preserved in political rhetoric.


OK... you're probably going to roll your eyes and tune out but I'm just going to say it anyway because its the truth. There is no cost incurred by regulation that comes close to the demand for private investment returns. In the private market healthcare becomes a managed investment competing on the finance market. Only the highest performers survive, so it's cut down costs, cut down coverage and sell high as possible. On a fundamental level... the profit margin gives private industry a built-in disadvantage against any single-payer solution.


How do you figure? A Health Savings Account does the same damned thing an insurance policy does. The only difference is that contributions are taken out before taxes. How the heck do you figure that's going to bring costs down?


All the more reason why the United States should break up... At least the stronger states that can stand on their own like California, New York and Texas should break free. The people of these states would have a much better chance at a responsive government and sensible health care.

PeterS

You saw it coming in 09? God doc you really make me laugh. Costs for EVERYONE were skyrocketing in 09. That's the principle reason that Obamacare was pushed through--because costs were so high that they were forcing more and more people off the insurance rolls--now, heaven forbid, costs are rising for those on Obamacare. That isn't good and it needs to to be fixed but it's not as bad when prices were out of control for everyone. So fix the problem and stop throwing the baby out with the bath water simply because you don't, in this case, like the baby.

You guys are such fuking morons--you carry your ideological bias through with everything you touch. Here's the thing--you were promising to repeal and replace to a people, many of whom were on Obamacare and were only terrified of it because of the fear parade that you had placed on it for 7 fuking years. For those who were on it, Obamacare met the promises that were made--they finally had insurance!!! Yes, Obamacare has problems, so address the problems, and stop trying to destroy the whole thing simply because it somehow offends your incredibly fuked up political ideology.

You wouldn't be hanging your heads in defeat if you had just taken the time, reached across the isle, and worked on the problems Obamacare had and fixed them. Christ, of all the countries in the entire world we have the highest prices and ours is the most screw up healthcare system employed by anyone. The fact that everyone else has lower prices, and health care, tells us that there are systems that work to bring healthcare to others. So follow the example they have for us and implement a system that works to insure everyone.

And doc, it's not like we haven't tried a single payer system--we've had it for decades for our elderly and it's worked just fine.

buffalo Loc: Texas

On this, I have to agree with Petersucker....

Health care. Go public or go broke.
By Mark Krasnoff, M.D.
PNHP Missouri, February 5, 2016

Dr. Mark Krasnoff I’ve practiced general internal medicine for over 20 years, and I’ve personally witnessed the average American’s health care burdens descend into a national financial crisis. Yes, crisis.

On January 5, 2016, the Kaiser Family Foundation and The New York Times revealed their joint survey indicating 20 percent of insured Americans have serious problems paying their medical bills. Some 63 percent must sacrifice most or all of their savings; 75 percent are forced to cut back on food, clothing or other essentials. Medical bills financially cripple 44 to 45 percent of those who have a significant illness, whether they got sick while insured or not. For far too many, health care insurance is actually bankruptcy insurance, and for many others, it merely slows the fall to bankruptcy. This is not what being insured is supposed to mean. Why are we accepting this?

Hidden costs of uncontrolled insurance

Think of all the ways health care insurance separates us from our money: we are financially hammered at every turn by copays, deductibles, coinsurance, soaring drug costs, limited and ever-changing physician panels, hospitals covered and drug formularies. In addition to direct costs, the wage increases we Americans used to be able to expect are now being replaced with inadequate employer-provided “coverage.”

“Great news this year, everybody, you only have to pay 6 percent more for health insurance. Of course, there’s no pay raise, but, hey, we’re all still lucky just to be privately insured!” Why are we accepting this?

Unaffordable care

I’ve witnessed the steady decline in the average American’s ability to pay for the basic health care they need to stay alive. In just one example, albuterol, a drug that gives quick relief from asthma when you can’t breathe, was once generic and inexpensive until a new way to deliver the drug was needed (for environmental reasons). The HFA delivery system was patented and priced so high that many asthma patients could no longer afford the medication that enabled them to breathe and stay out of the emergency room. To this day, all three brands of albuterol HFA inhalers are still not generic.

In another example, new studies established a set dosing pattern for colchicine, an inexpensive generic drug used for decades to treat painful gout. You guessed it; it suddenly became an expensive patented medication again, and now those patients who can no longer afford the drug miss three or more days of work when they get an attack of gout. Why are we accepting this?

The best forms of prescription insulin, the hormone replacement drug that controls diabetes and prevents amputations, blindness and kidney failure, are so expensive, many patients cannot adequately control their diabetes. They develop premature kidney failure and must go on dialysis, or they have an amputation which could have been delayed or prevented. At that point, they are prematurely disabled. They can no longer work and must either pay for their own expensive health insurance or go uninsured for two years, then transition to Medicare. Does this sound like the best health care system in the world to you?

A young patient of mine told me she doesn’t know which type of a rare disease she has because, in the United States, the genetic test that would identify it is too expensive. If she were in Europe, she would know.

Someone’s making money

Drug companies charge Americans the world’s highest out-of-pocket prices for medication, consequently making those same drugs cheaper for Europeans and others whose governments negotiate a lower price for their citizens. So we Americans, in effect, subsidize cheaper drugs for Canada, Europe, Japan, Taiwan and other countries.

The drug companies also orchestrate inversions to lower their American tax bills. They go abroad, pay low taxes to the countries that demand lower prices, but don’t pay taxes on their corporate profits in America, where they charge the highest prices. So not only do we subsidize the cost of drugs in other countries, those countries also get to tax the corporate profits the drug companies make in America – the taxes America should be able to collect. Why are we accepting this?

It affects everybody

I recently spoke with a retired corporate attorney who had one of the best retirement arrangements one can have in America. I consider him to be at the “top of the food chain,” so to speak, able to afford the best health care America has to offer. Nonetheless, the night before he was due to have lithotripsy for his painful kidney stone, his urologist’s office called to say that they could not perform the procedure at the facility the attorney chose because it wasn’t a participating provider in his insurance plan. In this instance, one of the wealthiest Americans was in a worse position than the average Frenchman or Canadian.

Why are we getting shafted?

What do other countries in the developed world have in common that we don’t? They have public health insurance (or some close approximation of it) that provides health care for all. They have health insurance that negotiates on behalf of consumers for lower drug prices yet still allows the drug companies to make a profit. They have health insurance that lets you see almost any doctor in the country with no restrictive panels. They have health insurance with about half the per capita cost of care, even as they cover every citizen.

Why are we accepting this?

The truth is we do not accept this, but we feel helpless to bring about change. The majority of Americans want national health insurance, like that envisioned by Teddy Roosevelt and Harry Truman, but they see it as a political impossibility. The truth is that it is actually an inevitability. An unsustainable system, which we have now, cannot be sustained. The only question is how much will we sacrifice before we come around to the only viable solution to the problem?

For-profit private health insurance is not working for the great majority of Americans

It defies logic to think that private health insurance could ever play a productive role in health care. It is a defective product that adds to the cost of care and divides the pie without adding any value to the system. Yet, any single-payer-based-alternative proposal gets branded a fantasy by the opposition and servile media. But the real health care fantasy is that a gigantic industry that siphons 30 percent of each health care dollar can somehow cover its costs, make a profit and reduce the cost of care just by denying payments for unnecessary tests and medical care.

Think how untenable their business model is. They collect their money up front from employers, employees and now, the U.S. taxpayers through Medicare Part C (which came before Part D and Obamacare). They then pay for care by cutting deals from a relatively weak position, with providers, hospitals, drug companies and device manufacturers. They impose claim restrictions and charge their customers for a portion of the very costs against which those customers supposedly are insured.

Their profits depend on the difference between the premiums they collect and their costs of delivering care and doing business. Their mission, as a private, for-profit health insurance company, is not to provide the best care for the lowest price, but to make health care insurance more expensive than the actual cost of health care. That difference is the profit for their shareholders.

I’m not saying the industry’s motives are nefarious or that the industry should be maligned; we all agreed to this system, and we have continued to endorse it in the name of free enterprise. But the reality is that it’s a rigged system, and the deck is stacked against the American consumer.

Compare private insurance with Traditional Medicare

For proof that private for-profit health insurance is less efficient in providing care, consider the history of Medicare. In the old days under Medicare Part A and B, it was against the law for any private health insurance company to duplicate Medicare services. Everyone got the same benefits and could see any doctor in the entire country who accepted Medicare payment. Everyone paid Medicare taxes and Medicare premiums, and when you became disabled or reached age 65, you were insured by Medicare A for hospital care, Medicare B for 80 percent of outpatient care, and you paid a private supplement for the other 20 percent of outpatient-care costs.

Medicare’s not all Traditional anymore

But now, Privatized Medicare Part C gives some of our tax money to insurance companies that sign up the healthiest pool of Medicare patients they can find. These companies offer perks like gym memberships, but do their best to avoid insuring the older, sicker, more-expensive patients. (So, all men are created equal, but now some are more equal than others.) The idea behind this privatization of Medicare is that the private companies will reduce the overall cost to Medicare. If that’s true, and cost reduction is the goal, you’d expect that this privatized Medicare would receive fewer Medicare tax dollars per enrollee than traditional Medicare, thus saving the taxpayers money. But that’s not the case. Medicare Part C (which they call “Medicare Advantage,” and I call “Taking Advantage of Medicare”) actually gets more money per enrollee, and costs all of us more money. Why are we accepting this?

Traditional Medicare (A & B) has an incredibly efficient 3 to 4 percent overhead, way below the 15 to 30 percent costs of private health insurance companies. Traditional Medicare makes no profit; if it did, that money would go to the U.S. Treasury.

The Affordable Care Act (Obamacare) limits health care insurance companies to a 15 percent profit, but that profit is considerably higher than Medicare’s zero profit. The 15 to 30 percent overhead is 5-10 times traditional Medicare’s 3 to 4 percent overhead. Medicare Parts A & B also have had lower health care inflation – lower than Part C, even lower than non-Medicare private insurance that benefits from covering a selected younger, healthier population.

No chance for affordability today

Today, there is hardly a single patient encounter that does not involve some accommodation to meet the demands of insurance companies or drug companies, whether it’s choosing a medication, a test, a consultant, a laboratory, a radiology facility, a skilled-care facility or a rehabilitation plan. And despite all their bureaucratic mandates – and, in part, because of them, the cost of health care keeps going up rather than down.

So, there is no chance for affordability while insurance companies are calling the shots. There is no chance to rein in drug prices without being able to negotiate with suppliers en masse as other countries do. Our entire health care system is out of control.

The answer is Improved and Expanded Medicare for All

Traditional Medicare A & B has a phenomenally efficient 3 to 4 percent overhead and a proven, 50-year track record that affirms that Medicare, in its traditional (A & B) configuration, is, so far, the most cost-effective, cost-controlling way of delivering health care in America. If we improve that construct and offer it to all Americans, we’ll have Medicare for All – improved, expanded Medicare for everyone.

Medicare for All will mean almost all doctors and hospitals will compete for your business, creating a real free market between patients and caregivers. Don’t like your doctor or hospital? Switch whenever you feel the need. In addition, your employer will no longer be burdened by the risk of hiring a 50- or 60-year-old, and older employees will be free to change jobs without risking loss of health insurance. Now that’s a free market – for everyone.

Medicare for All is simple, efficient, fair and logical, and that’s why politicians who are beholden to special interests will try to obstruct it every step of the way. Don’t let them win. We – the collective we – have to wake up and support those true leaders who are informed, immune from industry influence and courageous enough to make it happen. Improved Medicare for All is the answer.

Dr. Mark Krasnoff is a board member of the Missouri chapter of Physicians for a National Health Program.