Democrats Continue to Prop Up High Cost Medical System by Buying Health Insurance

Yves here. It’s encouraging to see Kaiser Health News, admittedly in its typically measured way, call out the Democrats for reinforcing high priced medical care by running more subsidies through private insurers. You can’t say you weren’t warned. Biden did vow that nothing fundamental would change on his watch.

By Noam N. Levey, Kaiser Health News Senior Correspondent, spent 17 years at the Los Angeles Times, the last 12 as the paper’s national health care reporter based in Washington, D.C. and has also been published in Health Affairs, JAMA and the Milbank Quarterly. Originally published at Kaiser Health News

When Democrats pushed through a two-year expansion of the Affordable Care Act in the covid-relief bill this month, many people celebrated the part that will make health insurance more affordable for more Americans.

But health care researchers consider this move a short-term fix for a long-term crisis, one that avoids confronting an uncomfortable truth: The only clear path to expanding health insurance remains yet more government subsidies for commercial health plans, which are the most costly form of coverage.

The reliance on private plans — a hard-fought compromise in the 2010 health law that was designed to win over industry — already costs taxpayers tens of billions of dollars each year, as the federal government picks up a share of the insurance premiums for about 9 million Americans.

The ACA’s price tag will now rise higher because of the recently enacted $1.9 trillion covid relief bill. The legislation will direct some $20 billion more to insurance companies by making larger premium subsidies available to consumers who buy qualified plans.

And if Democrats want to continue the aid beyond 2022, when the relief bill’s added assistance runs out, the tab is sure to balloon further.

“The expansion of coverage is the path of least resistance,” said Paul Starr, a Princeton University sociologist and leading authority on the history of U.S. health care who has termed this dynamic a “health policy trap.”

“Insurers don’t have much to lose. Hospitals don’t have much to lose. Pharmaceutical companies don’t have much to lose,” Starr observed. “But the result is you end up adding on to an incredibly expensive system.”

By next year, taxpayers will shell out more than $8,500 for every American who gets a subsidized health plan through insurance marketplaces created by the ACA, often called Obamacare. That’s up an estimated 40% from the cost of the marketplace subsidies in 2020, due to the augmented aid, data from the nonpartisan Congressional Budget Office indicates.

Supporters of the aid package, known as the American Rescue Plan, argue the federal government had to move quickly to help people struggling during the pandemic.

“This is exactly why we pay taxes. We want the federal government to be there when we need it most,” said Mila Kofman, who runs the District of Columbia’s insurance marketplace. Kofman said the middle of a pandemic was not a time to “wait for the perfect solution.”

But the large new government commitment underscores the disparity between the high price of private health insurance and lower-cost government plans such as Medicare and Medicaid.

Acutely aware of this disparity, the crafters of the ACA laid out a second path to provide health insurance for uninsured Americans beside the marketplaces: Medicaid.

The half-century-old government safety net insures about 13 million low-income, working-age adults who gained eligibility for the program through the health law and make too little to qualify for subsidized commercial insurance.

Medicaid coverage is still costly: about $7,000 per person every year, federal data indicates.

But that’s about 18% less than what the government will pay to cover people through commercial health plans.

“We knew it would be less expensive than subsidizing people to go to private plans,” said former Rep. Henry Waxman, a California Democrat who as chairman of the House Energy and Commerce Committee helped write the Affordable Care Act and has long championed Medicaid.

For patients, Medicaid offered another advantage. Unlike most commercial health insurance, which requires enrollees to pay large deductibles before their coverage kicks in, Medicaid sharply limits how much people must pay for a doctor’s visit or a trip to the hospital.

That can have a huge impact on a patient’s finances.

Take, for example, a 50-year-old woman living outside Phoenix with a part-time job paying $1,000 a month. With an income that low, the woman could enroll in Arizona’s Medicaid program.

If, one day, she slipped on her steps and broke an arm, her medical bills would likely be fully covered, leaving her with no out-of-pocket expenses.

If the same woman were to find a full-time job that pays $4,000 a month but doesn’t offer health benefits, she would still be able to get coverage, this time through a commercial health plan on Arizona’s insurance marketplace.

Taxpayers would still pick up a portion of the cost of her health plan, in this case about $300 a month, or half the $606 monthly premium for a basic silver-level plan from health insurer Oscar, according to a subsidy calculator from KFF, a health policy nonprofit. The woman would have to pay the rest of the monthly premium.

Unlike Medicaid, however, her Oscar “Silver Saver” plan comes with a $6,200 deductible.

That means that the same broken arm from her fall would likely leave her with medical bills topping $4,700, according to cost estimates from the federal marketplace.

The main reason commercial health plans cost more and saddle patients with higher medical bills is because they typically pay hospitals, doctors and other medical providers more than public programs such as Medicaid.

Often the price differences are dramatic.

For example, health insurers in the Atlanta area pay primary care physicians $93 on average for a basic patient visit, according to an analysis of 2017 commercial insurance data by the Health Care Cost Institute, a research nonprofit.

By contrast, Georgia’s Medicaid program would pay the same physician seeing a patient covered by the government health plan just $41, according to the state’s fee schedule.

“It’s much cheaper to deliver health coverage to people through public programs like Medicaid than through private insurance because the prices paid to doctors, hospitals and drug companies are so much less,” said Larry Levitt, executive vice president for health policy at KFF.

The price disparity also explains why the health care industry, including insurers and providers, for years has fought proposals to create a new government plan, or “public option,” that might pay less.

Industry officials frequently argue that hospitals and physicians couldn’t stay in business unless they charge higher prices to commercial insurers to offset the low prices paid by government programs.

The Biden administration and congressional Democrats for now skirted a battle over this issue by simply upping subsidies for private health insurers.

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  1. Tom Doak

    It is interesting to see any coverage of this issue in Kaiser Health News, so kudos to them, but calling the ACA’s reliance on private plans “a hard-fought compromise in the 2010 health law that was designed to win over industry” is a funny way to describe Obama’s capture by the industry. There wasn’t much compromise.

    1. Louis Fyne

      IIRC Kaiser Health News is part of the Kaiser Foundation, which is legally not related to Kaiser, the health insurer.

      But the Kaiser Foundation and Kaiser Perm. Health both can trace their origins to the Henry Kaiser/Kaiser Companies.

      the origins of Kaiser, the insurer, started when Kaiser Co. wanted to reduce the health care costs of its employees

  2. Mark Gisleson

    I honestly do not understand why an aggressive state attorney general can’t charge these companies with RICO violations. At every step of the healthcare process they choose to make things more expensive, they NEVER look for more affordable/cost-effective options.

    Apparently their way of doing business is only illegal when the Mafia does it.

  3. MP

    Whenever I take my cat to the vet, they don’t tell me what it’s going to cost, charge my neighbor about half what they charge me and always give me surprise bills. Then they file the insurance for this, and the insurance company refuses to pay while swamping them with paper work.

    No, that’s not how the vet works, that bs is reserved for when I need health care. My cat gets much better health care.

  4. LowellHighlander

    Is it too cynical to ask whether, in fact, the primary purpose of Obambacare was to safeguard the health insurance industry’s revenues and profits? After all, if the primary purpose had been to make sure that everyone who needed health care could have it, millions (27 million? 30 million?) would not have been left to fend for themselves.

    1. tegnost

      Obama couldn’t save wall st without bailing out the huge pile of money taken in by the insurance industry. Violence to the social order and all…

      1. John Wright

        I remember one of the few Senate Democrats who supported Medicare Part D, which helped George W. Bush with elderly voters.

        This was CA senator Dianne Feinstein.

        She commented that Medicare Part D was flawed, but they would fix it later.

        This kind of “fix” is never in.

          1. John Wright

            One would have thought the free market Republicans would have pushed to allow the US government to negotiate drug prices under Medicare Part D.

            But this was PROHIBITED.

            The Repubs want the Post Office to be run as a business, but justified, somehow, prohibiting the US government (in Medicare Part D) from negotiating lower prices from a set of vendors, the drug companies.

            If hypocrisy were a fatal disease, Wash D.C. would be decimated.

    2. Peter in Seattle

      It’s not cynical, it’s 100% accurate. But it’s also incomplete. The ACA had two other “primary” purposes, as well as one secondary (but still very important) one:

      • To preserve providers’ ability to price-discriminate and price-gouge (a primary objective).

      • To ensure that the wealthiest and most influential Americans continue to be first in line to see the best providers with the latest treatments at the best clinics with the most cutting-edge equipment (a primary objective).

      • To maintain or increase the ca. $14 billion a year in advertising revenue US commercial media take in from the for-profit health sector (a secondary but critical objective, since news outlets will take a hatchet to any politicians who threaten to take away the hand that feeds).

      The only sense in which “providing healthcare to everyone who needs it” ever entered into the picture was as a thin cover story to con voters into swallowing what was in fact the institutionalization and further subsidization of healthcare-as-an-extortion-racket. And now they’re doing it again.

  5. flora

    Between DeJoy at the USPS and this, I’m starting to see Congress as essentially employees of a US “PE consortium” sort of setup and thinking. Congress is the ‘limited partners’ in the setup. They get into office and work in concert and in bipartisan agreement to break down and sell off US public assets and public safety net financial resources to private Wall St companies, costing tax payers thousands of dollars in lost assets. I hear that pays well. What was once said about the missionaries to Hawaii in the 19th century? ‘They went to do good and ended up doing very very well.’ Maybe Marcie Frost will run for Congress.

    1. juno mas

      …nah! Someone would expose the veracity of her thin educational accomplishment and that would be the end of that. Oh, wait?!

  6. MDA

    Have we ever considered doing public healthcare the same way we do public schools, where the state directly employs salaried doctors and nurses to staff full service community clinics? Why does the conversation always assume private providers, and limit debate to payment amount and mechanism? I have to believe there are a lot of healthcare professionals who would love the freedom to practice medicine unencumbered by the headaches of insurance and billing. Every issue we’ve had with Covid testing and vaccine delivery would have been mitigated with this type of infrastructure in place. Not to mention the data collection opportunities, beyond Covid, if billing codes didn’t exist and medical record keeping could be limited to symptoms, treatment and outcomes.

    1. Jeff N

      Single payer healthcare is best done at the federal level, where they have the power of the [money] printing press. State budgets are finite and always under assault.

      1. juno mas

        Yes. But California (40 million pop.) is working on something akin to single payer (with the ability to control pricing). Of course, they intend to use federal dollars to assist implementation.

        1. Jeff

          CA passed a bond initiative for high speed rail by lying to voters about the cost. The HSR bond said that the project cost would be $40billion. It’s now over $105 billion.

          The graft in CA is breathtaking.

          1. juno mas

            Agree that the CA HSR project is a fiscal disaster. This is what happens when the government attempts construction projects in “partner” with private design/engineering firms. When private firm personnel have more expertise than the government overseers fantastical projection of both viability and cost get too much traction. (Gov. Jerry Brown’s rah-rah for HSR simply accelerated the folly.)

  7. juno mas

    My cardiologist regularly complained that medical insurance companies reduced his group practice gross income by 30%. Personnel overhead, mostly. While Medicare takes it sweet time paying out to physicians (typically 90 days) it nonetheless is dependable. Private insurance not so much (“We don’t cover that…”).

    He eventually dislodged from the medical group, started a sole practice, and accepts ONLY Medicare patients. Go figure. He commented that his patient care/experience has improved and life is better now. Who wooda’ thunk it?

    1. juno mas

      Addendum: The article at the top compares a private insurance payout ($91) to a Medicaid payout ($41). MEDICARE payouts are usually somewhere in between; depending on the medical procedure.

      1. fjallstrom

        In Sweden we have a medallion system for private primary care physicians in addition to public primary care physicians. The single payer system pays about 100-125USD to private primary care physicians per visit. And Sweden has lower costs and a lower median wage then the US so PPP weighted it would be even more. Not only is your system bad for patients who end up without care or in bankrupcy, it even pays poorly for primary care physicians.

        Yet the US pays a significantly larger proportion of GDP for health care.

    2. Peter in Seattle

      In France (which has what functionally operates as a single-payer insurance system), physicians typically swipe the patient’s insurance card and electronically submit the bill at the conclusion of the visit, and get paid within 7 days.

  8. Jeff

    Just had an epidural for c4-c6. The doc charged $600, anesthesia was $200 and the surgical center fee was $400. I’m a cash payer that uses a health sharing ministry. I will argue that this should be a reimbursed expense and not something applied to my deductible, but we’ll see.

    My point in sharing this info is that it’s up to us as patients to share this type of info. We can’t rely on political leaders to do their jobs because they don’t give a rip about us. They’re mostly sociopaths who only care about themselves.

    1. Glen

      I’ll contribute:

      My wife and I were charged $22,000 for rabies shots. Each of us, $44,000 total.

      But you know, we had a choice, get the shots or die, so yeah…

      1. ian

        I have similar stories from my family. I don’t know how it is possible to have an intelligent discussion about health insurance without knowing what procedures actually cost. Full transparency would seem to be the starting point for any effort to reform health care.

    1. Peter in Seattle

      Private health insurance should not exist. Period. Full stop.

      Fixed that for you. I have no problem with _public_ national single-payer insurance, which, while generally more expensive than a national health service, fixes some of the incentive/motivation hazards inherent in any civil-service operation.

  9. Hayek's Heelbiter

    I was the first non-campaign worker in the gymnasium for In the January 9th Rally for Change at St. Peter’s College, Jersey City.
    Pre-nomination Barack Obama told the story of sitting with his mother on her death bed, surrounded by insurance papers. She had Stage IV breast cancer and had recently changed jobs and insurers, Her previous insurer said, “You left. We’re not covering you.” Her new insurer said, “Stage IV breast cancer is obviously a pre-existing condition, and we’re not going to cover you.”
    And she died.
    There was not a dry eye in the gymnasium.
    “When I am president, I will fight tooth and nail for single payer health care for all Americans.”
    It took five minutes for the applause and stamping of feet to quiet down.
    I left the auditorium a fervent convert to Obamacy and worked tirelessly to help him get elected.
    Be careful what you wish for…

      1. Anonapet


        “… and all liars–the place for them is the lake burning with fire and sulfur, which is the second death.” Revelation 21:8

        There’s a lot to be said for the fear of God…

    1. Peter in Seattle

      Not be careful what you wish for; be careful whom you believe and trust. Vet the hell out of any politician who claims to support something the little people want, especially if they’re not being blackballed or savaged in the mainstream press. Odds are, they’re lying in their teeth and have no intention of ever trying to deliver.

  10. Felix_47

    To answer MDA above we do have many programs with doctors on salary to include the VA, the military, Kaiser to a large degree. We have a good comparative experiment in England where everyone is covered for about a quarter of what is spent in the US. When we really need a doctor and we call 911 paramedics come and provide the most critical care on salary. There is no reason the payment structure should change at the swinging doors of the ER. As a doctor I have tried private practice, Kaiser, the military and the VA. Morally and medically doctors need to be on salary is my conclusion. This was not so important years ago when doctors treated everyone without regard to pay but made the rich pay heavily. In other words a broken hip in the wife of a Goldman Sachs partner was a pretty expensive thing. The others got ward care with the same surgeon perhaps but different accomodations. Medicare eliminated that and made doctors rich because all of a sudden they were being paid for things they used to do for free on the ward services and every hospital required that doctors on staff take ward service patients before medicare. After Medicare those patients were paying and getting a semiprivate room. Those days are long gone with Medicare and a much higher number of doctors especially after immigration rules were relaxed in the Johnson administration. The problem now with fee for service is that we get what we pay for and if we pay more we get more of it. When there was a limited number of surgeons, for example, they would operate only on the best candidates but now it is if they can justify it legally. It is estimated that half of surgeries in the US are unnecessary and my experience would support that. Literature supporting this sort of thing does not come out of the US but it comes out of countries with national health care and doctors on salary….like England. Fee for service has polluted our medical literature. Studies that show something does not work do not get published as easily. Our lack of a national system makes it almost impossible to do decent clinical research. Most is done overseas.

    Lastly I grant that there is an elephant in the room. That is the tort system. The costs of the system are not the most expensive part. The expensive part is that so much care is given now just to cover the bases in case something might happen. Kind of like my 90 year old mother. She had minimal high blood pressure and the lady doc gave her blood pressure medication. She even admitted it was kind of pointlless but she said what if she had a stroke? Then a case review would find her at fault for not prescribing blood pressure medication which the mother rarely took and which made her more demented. The multitude of tests often done as a substitute for the doctor knowing the patient are an effect of tort law. Things like CTs and MRIs in the ER in cases where it really offers a marginal utility. And often surgeries undertaken because if it is not done and there is a bad outcome the surgeon will get blamed and on an on.

    And then there is the argument that if doctors are on salary good students wont go into it. Already many good students no longer see medicine as a good career, including my children. In the old days medicine was a preferred career choice for the top students at Harvard, Yale and Columbia and Princeton, for example. Now it is finance followed by law. Medicine is way down on the list. My view is that a big problem is that students see medicine as a way to get rich. I dont want to be treated by doctors like that. If students want to get rich let them go to the law school or the business school. These are the students who eventually we read about who bill millions to Medicare per year and do unnecessary and even criminal things. So the counterargument is that the students that if the students that want to get rich dont want to go into medicine that is a good think They are going to be crappy doctors anyway.

    And then there is patient satisfaction. If doctors are on a federal salary, for example, they will do less google medicine and do less testing and treatment demanded by the patient or the patients lawyer. That will reduce costs and a lot more. But patients will be upset. Often patients use surgery and treatment to justify disability demands and they are driven to that by our neoliberal economy. Lawyers who depend on excess surgery and high medical for their personal injury cases will be upset. But we need to let doctors speak the truth and not have to worry about the consequences if we want good and efficient medical care. That is why in England we get better literature. It does not cost the doctors to tell the truth.

    The tuition costs argument is ridiculous. The government is already subsidizing most of the tuition. The government needs to subsidize the whole thing.

    We need to just put providers on salary with a pension structure. We can afford it simply by paying for it with the surgeries and testing not done. Firemen paramedics make a very good living with good pensions. Doctors can do the same thing. We need to have no incentives at all for production and then let the doctors do the job that they are best prepared to do……arguably better than lawyers, politicians etc. That is to determine who should and who should not get treated for what based on their best estimate of potential outcome in an uncertain environment. Medical school should be a better preparation for knowing about medicine that law or and MBA or a nursing degree. And if med school is not there is no reason any other training would be any better.

    What Biden is doing with healthcare is kicking the can down the road and paving the road with taxpayer gold. He promised his campaign contributors he would take care of them and he is and so is Jim Clyburn. Biden is exactly the same candidate we had in 1988 with no improvement with age. But I understand that the democrat poobahs heard from the drug companies and hospital corporations and Wall Street that if Sanders was nominated that they would vote for Trump, according to the recent book, Lucky.

    1. m

      Not sure tort has anything to do with that. Doctors have to give meds to lower cholesterol, medications to treat high blood pressure and follow many other core measures. If not they will get reduced reimbursement from CMS. Naughty doctors that treat individuals and don’t blindly follow algorithms get punished.

  11. Keith Newman

    @Arizona Slim
    Indeed. Every developed country has some form of publicly provided universal healthcare – except the US. The US also devotes almost 18% of GDP on its system of largely private healthcare, far more than any other country, and yet it doesn’t cover everyone. At least 7% of GDP (about $1.5 trillion) is wasted compared to other countries – yet the system continues on, decade after decade, exploiting the sick, enriching a few (which is why it continues), and making the lives of many very uncomfortable and stressful, or killing them.

    1. jefemt

      Words matter. Care versus insurance.

      It is irrational to insure the health of a mortal being that will inevitably die, have accidents , disease, and maintenance on the way out.

      To capitalize on the fears and love for that being by family and friends is immoral.

      Universal care, cradle to grave. Acknowledge it is socialization of costs, cost shifting, into the collective ‘we’ .
      Manage costs, fees, services, expectations. By, of, and for The People. We all will be asking for each other to pay for the services we all receive. Dental and optical included… its part of the imperfect vessel our souls occupy. Ditto mental health for coping with life in the 21st century.

      No more United Health care Billion-dollar executive ‘packages’. Open markets with price controls and price discovery. No more fifth-wheel parasitic no-value-added ‘Insurance’ Industry.


  12. Bob Hertz

    This article leaves the impression that the government could just impose the Medicaid fee schedule, and thereby save many billions of dollars a year versus private insurance.

    Doctors everywhere would refuse to work with Medicaid if it was imposed on them. The same is true for the Mayo Clinic and many other large hospitals.

    You would then have the untenable combination of many persons paying higher taxes to support Medicaid, but simultaneously needing to keep private insurance so they could go places like the Mayo Clinic.

    Obama had many flaws, but he was operating in the real world when the Affordable Care Act was hammered out.

    1. run75441


      Where would you go and what would you do if healthcare insurance and its 15% and 20% take on groups and individuals no longer existed?. Other countries have better healthcare and dictate what will be paid to providers in the Netherlands, Germany, etc. and what insurance companies will be paid. It sure isn’t 15 and 20% and neither are physicians and hospitals employing multiples of personnel to handles the different payment schemes for commercial insurance.

      A person in the Netherlands chooses what their deductible will be which is typically too conservative and which dictates what their costs will be. Far too many error on the conservative side and pay more than what their needs are.

      Hospital prices accounted for over 60 percent of the total price of hospital-based care 2007 – 2014 (Health Affairs’) .Between 1996 – 2013 changes in service price and intensity (hospitals) were associated with a 50.0% increase or $583.5 billion. Humira and Rituxan are #1 and 2 for drug costs (WHO). Most recently the ICER did an analysis of those cost increase of 15 and 20-somthing percent for Rituxan and found the increase was not justifiable for the value added. Similar was determined for Humira.

      To your point we are not just talking about doctors which appears to be a popular point amongst politicians and insurance companies. We are talking about the entire picture which includes hospitals lack competition, pharmaceuticals, hospitals supplies, insurance companies margin of 15 and 20%, etc.Same Commonwealth funded Health Affairs report the increase was 6 percent for physician-prices 2007 -2014.

      The government could control costs and margins like they do in other countries. If the US did it, it would succeed as the US is the gorilla in the room.

      1. Bob Hertz

        I do not disagree with your vision of stronger government controls on health care spending. In fact for 15 years I have written numerous articles on the needed controls. Some of them are compiled on my website

        But my post was about the practical difficulties in getting from our current system to a better system. If a medical clinic has a business plan that depends on $300 office visits, and if the doctors and nurses in the clinic have car and house payments that depend on $300 office visits, then they will not go quietly into a Medicare or Medicaid for all system that pays them $75 for an office visit. (not to mention Hospitals that rely on $50,000 reimbursements for bypass operations.)

        The USA has precious little collective bargaining in any area of life, and we sure don’t have it in medicine. I would like to be wrong about this, so do not hesitate to give me examples of effective cost controls.

        1. freebird

          Geez, that would be awful if their incomes went down. Ask the tens of millions of manufacturing workers what they did when massive factories closed, or farmers who had to quit farming, or fishermen whose industry undergoes random strangling, all caused by changing times or regulation changes.

          Screw the special snowflake designation the medical profession has granted itself.

          1. Bob Hertz

            You are totally correct that millions of workers have suffered……..but the sad fact is that we did not rely on those workers the way that we rely on doctors.

            To put the question less melodramatically:

            How do you have a single payer system if some doctors and hospitals do not participate?

            The actual designers of Medicare in 1965 concluded that they would have to pay the doctors whatever the doctors wanted. It took 20 years to pull this back and get even a little cost control.

            1. Anthony G Stegman

              What if private insurance were abolished? If the Mayo Clinic wishes to be paid anything they would need to work with the “system” and accept what is offered, or else close because they would have no other source of revenue. Medical providers look upon themselves as business persons for the most part. Just as defense contractors rely on government to pay for expensive planes and other weaponry medical providers will have to rely on government to pay for various medical services. Medical providers that refuse will go out of business, or shrink to become “boutique” providers to those willing to pay directly out of their own pockets. That business opportunity is likely to be quite small by comparison.

          2. Peter in Seattle

            Yes, given that American physicians earn almost twice as much as the developed-country average for physicians and are the highest-paid major profession in the United States, it would break my heart if their incomes went down in the slightest. If it were up to me, I’d break up their state-based cartels by moving to national licensing, train more physicians (especially primary-care), and pay for their education on the government dime so they can graduate debt-free. And while I wouldn’t want to screw other countries with a “brain drain,” if necessary I’d throw open the door to “scabs” like Tommy Douglas did when Saskatchewan physicians went on strike to protest Canada’s first provincial single-payer system.* Physicians aren’t the biggest villains in our healthcare system. That distinction goes to insurance companies, pharmaceutical companies, medical device and equipment manufacturers, hospitals, imaging clinics, and diagnostic labs. But they are, at the very least, passive, second-tier villains.

            *Canadian physicians are doing just fine, by the way. They run their profession in provincially based cartels, earn almost as much as American physicians, and never have to deal with no-pays and slow-pays. Also, their support-staff payroll is around fourth of their American counterparts’. It would almost certainly be lower than that if they had national single-payer, but unfortunately they started out with provincial/territorial 15-payer — 10 provincial systems + 3 territorial systems + 1 Canadian-military system + 1 federal-prisoner system — and have stayed stuck there. (Also, no dental, no vision, no out-patient pharma, and no long-term care. But if you need to see a doctor or go to the hospital, it’s crackerjack.)

            1. R W Millard

              Congratulations, finally pulling Tommy Douglas into this stream. He’s one of the most popular Canadians of all time. He stood up to the physicians, and as you note, they are doing fine. Tracking how he did this is useful to know about (see biography by Vincent Lam).

              This seems like a particularly USAmerican dilemma. The healthcare bind resembles how so much cash is siphoned off for the military and the defense contractors. I can’t see how the military or medical parasites will ever be dislodged.

        2. run75441


          Where would doctors go? Germany, England, Canada, Mexico, etc. The game is in the US for Uncontrolled Healthcare pricing based on a much lower cost basis. There are ~11 million taxpayers (6% of the total) making $200,000 – $500,000 annually (TPC) of which the average is ~$301,000. The $301,000 is the average between PC Docs and Specialists. Are you saying doctors can not live on an average $400,000 annually or $200,000 annually?

          Does an infusion of Rituxan (came to market in 1997) really cost $30,000. ($28000 for the drug and a couple of thou for a chair and a needle? I am not sure where you got $50,000 for a bypass, last time I looked it was $90,000 for a triple and a weeks stay in the fishbowl intensive care unit in mid-Ohio.

          The only and I will emphasize it again, the Only reason they can be demanding is the consolidation of healthcare industry which has become even worst with the ACOs. The healthcare insurance industry absorbs 15 to 20% of those costs solely on administrative function due to the difference in each. The hospital pricing increase I pointed out was solely pricing increases as reported by Health Affairs and JAMA.

          Doctors do accept Medicare which is fee for service.and they can charge more for service, hence fee for service. . The current scam amongst healthcare insurance is Medicare Advantage which is promulgating additional rent taking. With Medicare your payment for that insurance may increase; but you will not pay more for the procedure, With Medicare Advantage the prices paid are on the procedure or hospital stay and can be increased far higher than what is paid for traditional Medicare. The insured is eventually caught in a trap. If they come back to traditional Medicare they may not be accepted by MediGap due to pre-existing conditions.

          What do you believe Single Payor does? It eliminates the 15 -20% paid today for healthcare insurance administration. There is only one-payor to doctors and hospitals. It sets budgets for hospitals, clinics, etc. It sets fees for doctors, surgeons and specialists. It sets a celing for pharma pricing.

          The out-of-control prices of healthcare is driven by Overhead (much of which is insurance administration), decreasing competition due to consolidation of hospitals and services (ACOs) in regions, inflated pricing for drugs like Rituxan, Humira Kymriah, Vimovo, Humalog, EpiPens, etc. and healthcare supplies.

          You did not present any of this and Obama wanted a lot more than what he got in the ACA.

    2. Jeff

      Your comment ignores reality in that our current healthcare ecosystem isn’t working unless you are either wealthy enough for very expensive insurance, can self fund or are healthy and don’t need it.

      ACA “succeeded” by not solving the foundational problem of affordability of healthcare and instead focused on access to insurance.

      A recent example of this graft came from the cfo of Pfizer talking about monetizing Covid vaccines in booster shots and not allowing other countries to mfg it, limiting supply and inflation the price.

      No response from sleepy joe on that note a peep out of Kamala. Not surprising either.

  13. DTK

    “…costs taxpayers tens of billions”, “…taxpayers will shell out”, “This is exactly why we pay taxes.” No, no, and no. The sun should not rise on another day before the good people at Kaiser understand basic Fed monetary operations;
    Thank You

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