Americans Don't Really Want Medicare for All -- They Want Japanese Health Care

[Recursion]

https://gen.medium.com/americans-dont-really-want-medicare-for-all-they-want-japanese-health-care-e82dcf38b898

I really like this piece because it gets to the fact that the things Americans want from our health care system are contradictory. But Japan's system probably comes the close to threading the needle.

In practice, the Japanese system doesn’t seem much different than single-payer systems: In Japan, large companies set money aside in special accounts, and the government then tells them how to pay hospitals. In single-payer systems, large companies have to give money to a special government account, which then gives it to hospitals. However, the difference has real political implications.

Rhetorically, American politics is weirdly obsessed with people “losing their employer health insurance,” but we rarely ever talk about how insurance changes almost every year, usually for the worse: higher deductibles, new narrower networks, more co-pays, and so on. Only 44% of Americans say they would prefer a system mostly run by the government and 68% have a favorable view of employer coverage. Yet, at the same time, insurance regulations the government puts on employer coverage are very popular.

This employer coverage also solves the funding problem which plagues reform efforts. Americans don’t seem to understand or simply don’t care just how much they indirectly pay for employer insurance. The type of broad new taxes needed to pay for Medicare for All tend to be very unpopular. Even with very favorable wording, polling by YouGov found just 32% supported paying for Medicare for All with a tax on income over $29,000. (Proponents of M4A claim the net savings from no premiums or coinsurance would outweigh the cost of new taxes.) Even in deep blue Vermont, once local Democrats saw the size of the taxes needed to replace employer premiums — an 11.5% payroll tax and a new income tax of up to 9.5% — they declared their single-payer plan politically infeasible.

The same poll found a per-employee fee proposed by Sen. Elizabeth Warren to get around this anti-tax problem polls better, with 50% yes and 31% no. Yet what is consistently even more popular is just mandating all employers provide quality insurance, like Japan does. That polls at 69% support.

[guillaumeb]

1. So this system would allow private companies to skim billions in "expenses"

and restrict access to healthcare?

Sorry, this one fails.

[Recursion]

2. No, it doesn't fail: it works really well. Read the piece (nt)

[guillaumeb]

3. The page will not load.

And how do we convince employers to do this?

[Recursion]

4. That's the whole basis of the New Deal: hide government benefits behind corporations

Social Security and Unemployment Insurance only work politically because they are mediated by a company. You don't see most of your FICA or UI or Medicare levies so you don't even know they exist. People with insurance through their employers, even if they pay some of the premiums, don't see the generally much larger amounts their employers are paying for the premiums.

Just like with the rest of the New Deal, we don't "convince" the companies of anything. We pass a law saying they have to do it.

[guillaumeb]

6. And that brings us to how we generate the political will to do this.

Medicare for All is a known quantity. Expanding it would be the best way to solve the real problem, which is that much that we pay for health care goes into insurance company coffers.

[Recursion]

9. No, Medicare For All is in absolutely no sense a "known quantity"

You're joking, right?

We don't even have Medicare For All for actual Medicare recipients now (they still have premiums and deductibles and copays -- actually pretty high ones). Expanding a much broader program to the entire population is absolutely not a "known quantity".

[bluedye33139]

14. I agree with the goal of single-payer but

I hate hearing people describe Medicare as if it would be good insurance coverage. Virtually every element of it would have to be rewritten and changed. The copays alone would bankrupt and destroy poor families.

My joke about this goes: If Medicare is going to be transformed into Medicaid, then why don't we talk about Medicaid for all?

[Recursion]

15. That was O'Malley's plan back in 2016, and obviously it didn't catch fire

"Medicaid for most; capitation budgeting for the rest" just isn't a very good bumper sticker, which is unfortunate because it's the most workable idea anybody has come up with.

[bluedye33139]

18. Worst bumper sticker of all time

[Perseus]

22. Correct!

You are right and so are Warren and Sanders.

Can't understand why there are people who don't get this. I have family living in Europe and they love their Universal Healthcare.

[guillaumeb]

25. Most of my family still lives in Canada.

They laugh when I talk to them about the US system.

I could as well, if my wife had agreed to move back to Canada when I retired.

[Perseus]

21. How does it work well when USA families already pay about 10.1% in insurance costs

and that doesn't account for what they pay in co-payments, payments after the insurance coverage limit is exceeded.

By the way, it is 10.1% of their salary.

At the end of the day, with all the ancillary costs we pay more for insurance than a mere 11.6%.

A banker friend of mine from Montreal put the numbers for me many years ago and showed my how much more we pay in the USA for health insurance.

Ask yourselves a question, do you really believe the USA system of health has been designed to benefit the citizens? The numbers have been split so much to create confusion but when we put all the numbers together of what we pay we end up paying more than we think we do, and it definitely exceeds that 11.6% of the "Japanese System".

[Recursion]

23. I'm not following you. You're agreeing with me and the article that the Japanese system is better

than ours. But you sound like you're disagreeing.

[Perseus]

29. I am disagreeing with you because that system doesn't help the employee when

he/she looses their job. Once again, we want to leave healthcare to the corporations by setting money aside. Do we trust any of the corporations?

Medicare for All solves all those issues without the complication. Just tax companies and people accordingly to pay for healthcare. No one but the Japanese, as afar as I know, have that method, Europe, Canada and all other countries that have "Universal Healthcare" use what we would call "Medicare for All".

[Recursion]

32. Most of Europe does it through employers

The UK and Canada are kind of unusual in that they don't

[Blue_true]

43. How do you tax someone that doesn't have a job?

You bought up people losing their jobs under the Japanese system, not me. You went on to say that MFA taxes companies and people, but if a person lose their job, how do they get money to pay a tax to keep health insurance?

[Recursion]

44. In Japan they make it part of the unemployment system

We have COBRA, which would be a good program if we would actually fund it.

[rampartc]

37. might work well in japan

American corporations can not be trusted with this money any more than they can be trusted with employee pensions.

[TreasonousBastard]

5. Someone has to manage the money, and Medicare already contracts some out...

and, of course, there's all that Medigap stuff.

Forget all that evil insurance company silliness-- they can have a positive function if we design it that way.

[guillaumeb]

7. Silliness is pretending that the US being ranked 37th

can be fixed without getting at the actual root of the problem.

And that is greed on the part of these companies.

[Recursion]

8. No, read the article. Companies are greedy everywhere. That's not the problem.

Companies are greedy in Japan too, but they made this work.

[guillaumeb]

10. When people speak of all the obstacles to passing Medicare for All,

those exact same obstacles exist regarding forcing companies to offer health care.

And allowing private companies to extract 18% of healthcare premiums for expenses enables the same system that we have now.

[Recursion]

11. You're missing the political reality: we have to hide the benefit. That's why the New Deal worked.

The New Deal worked because Social Security was handled by people's employers so they didn't see it as government spending. They saw it as money being put by their employer in a retirement account somewhere. Which is absolutely not how it works, but it's the only way to keep white voters from burning the country down.

[Midnightwalk]

17. Our costs are 2x out of wack

We need a lot of reform. The 18% might be under counting but it isn’t enough to get our costs in line.

Don’t get me wrong. 20% over a few years would be fantastic and would ease the pain of job losses.

Repeat that for the next decade and get to universal coverage we might have a functioning system.

We are gouged and screwed by virtually every aspect of the system. I don’t say this to be discouraging. I’ll take most rational improvements but don’t believe theres a single silver bullet

[guillaumeb]

20. Agreed. There is no perfect system.

But allowing insurance companies to decide how much everyone pays builds in an unneeded layer of profit for these companies.

[Perseus]

30. How many countries have adopted the Japanese Method?

I know Europe and Canada use essentially what would be "medicare for All" to us.

[TreasonousBastard]

39. And billing practices have nothing to do with it?

[guillaumeb]

41. And the way that they determine prices?

Yes, all of these tings work together, to the detriment of US residents.

[The Polack MSgt]

27. My wife is Japanese and I lived in Japan for 11 years

Your dismissive one line summary is inaccurate.

[guillaumeb]

31. It is a summary of one aspect of the US system. eom

[redqueen]

12. K&R!

Thanks for posting this!

[bluedye33139]

13. I like the Japanese model

One of the basic issues with private insurance is the ability of the insurance companies to deny coverage. In the Japanese system, hospitals get paid and doctors get paid and clinics get paid and health care providers get paid for services performed.

I think that many Americans are comfortable with the idea of private insurance companies. It's just something that millions of us have gotten used to. I don't view my private insurance companies as my enemy.

I think that single payer would be wiser and more rational, but I also recognize that I don't have the power to make 300 million people agree with me.

[Recursion]

16. Now, here's what's *really* crazy: Canadians have more anxiety about health care than US citizens

https://www.axios.com/nervous-angry-rich-countries-90036353-9758-42f4-95a9-7340cebfdc10.html

It is absolutely insane, but it is consistent: people in countries with stronger safety nets are more anxious about them than people in less socially-developed countries. As we saw in 2010, when you deliver something that actually helps voters they will probably punish you for it.

[guillaumeb]

19. And only 87% of Canadians prefer their system to the US model.

And how many Canadians declare bankruptcy due to uncovered medical expenses? Versus the US, where medical expenses are the number 1 cause of bankruptcy.

[Recursion]

24. Voters are not rational

If the past 4 years haven't taught us that I'm not sure what will.

[guillaumeb]

26. Some are not, but my view is that many are uninformed.

I do not, of course, include us in either category.

What Americans really want is to be able to receive the care that they need.

And to receive that care without any worry that the care will be so costly as to bankrupt them.

[Perseus]

34. trump did not win the presidency, not even with EC

They cheated, just like they cheated in Georgia last year, they cheated and are going to do it again.

[Perseus]

35. I know a lot of people in Canada, doctors as well

And I have never talked to one who has anxiety about their health insurance. Who wrote the article?

[Perseus]

33. You don't have 300 million agreeing with you about Medicare for All, but if the polls are correct

you have about 250 million people (that is exaggerating because kids are not part of the poll, but so is 300 million), maybe more agreeing with you about "Medicare for All". this meme that insurance companies and republicans have thrown at us and now we have some of our candidates repeating it that "people love their insurances", its not true. I am sure people who have never had to deal with their insurance love their insurance, but the moment something major happens and they have to deal with the denials and the bureaucracy insurance companies have created just to make it difficult for people, then suddenly the love is gone.

Anyway, according to some polls, 70% of USA citizens support "Medicare for All".

[Recursion]

36. Medicare for all polls at about 25%

I know it's frustrating, but people with insurance want to keep it.

[bluedye33139]

38. There is data on this. There is not 70% stable support

https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-november-2019/

When you explain to people that Medicare for all will mean the end of private insurance, support drops to 48%.

[Scurrilous]

40. "Medicare for All" Is Getting Less Popular

"According to the Kaiser Family Foundation’s latest Health Care Tracking poll, a small majority of adults still say they would favor putting all Americans on a single national health plan, with 51 percent in favor and 47 percent opposed. But the margin of support has shrunk significantly from the beginning of this year, when as many as 57 percent backed such a proposal, and only 37 percent were opposed.

Recent polling by other organizations has shown even lower levels of support for a single-payer system. An NBC/Wall Street Journal survey last month found just 41 percent said they backed one, with 56 percent against, while a Fox News poll found 46 percent in favor and 48 percent against. But polling results on health care can be extremely sensitive to how the question is phrased. What makes the Kaiser Family Foundation survey interesting is that it’s been asking the public the same version of its question for more than two years now—“Do you favor or oppose having a national health plan, sometimes called Medicare-for-all, in which all Americans would get their insurance from a single government plan?”—giving us a picture of how public opinion has evolved. And it suggests that as single payer has become a more contentious political topic during the presidential campaign, it has lost a bit of its shine."

https://slate.com/business/2019/10/medicare-for-all-is-getting-less-popular.html

[guillaumeb]

42. Speaking of polling, and what we should read into the results,

polling regularly showed that the public preferred the ACA to Obamacare.

[blm]

28. UMass CEO backs Med4All - likes Warren's plan

https://www.telegram.com/news/20191207/umass-ceo-eric-dickson-backs-medicare-for-all-calls-plan-bold-courageous?