We can’t cancel everybody’s private insurance and then promise that we’ll get the government system up and running “real soon now”. Instead, we have to preserve the existing payments system and then start replacing people’s private insurance the public system.
The federal government currently pays a bit short of half of all medical billing dollars in the US and well over half if one includes state contributions to Medicaid. I hate to break it to you so abruptly, but it’s already “up and running” and is far more efficient than private insurance administration.
To make it work financially, we’d have to transfer the money that people were paying to insurance companies into the treasury, and start them on the new system.
This displays a total lack of understanding of finance at the federal level. Congress “pays for” things with votes, not money. The money is allocated according to its decree by the Fed via simple keystrokes to mark up accounts. Money is not a “thing” that we have to truck around from bank to bank and it is not necessary, or even advisable, for government to “get” money prior to spending to fund programs for the public purpose.
I suspect that the federal system will need to be fully funded independently before it can start shutting down insurers.
All government spending at the federal level injects new money into the private sector and all federal taxation removes money and cancels it against the debt that created it. This dual entry spreadsheet logic has mostly been lost in the political rhetoric surrounding the deficit and debt, but it is the only way the government can provision itself and provide dollars to the private sector economy. It can always afford anything that is for sale priced in US dollars without needing revenue.
Sans a gold reserve to defend, Treasury bonds are no longer a funding mechanism to enable federal spending, so any cost of M4A can be easily forwarded without incurring Treasury debt as we now do with much of our military spending via war power authorization. The one concern Bernie’s econ advisor has with M4A is a large number of people that will be made involuntarily unemployed as the insurance industry is dismantled.
She feels it is best to leave dollars in the economy to mitigate any damage done to them before attempting to “pay for” the program with fees or taxes on the middle-class workers. She views the program, even with greatly reduced costs to patients and providers, as potentially deflationary and the only thing that can reverse deflationary pressure is money creation.
It could easily take years to get everybody transferred into the system; how do we decide who goes first and who goes last? By geography? Alphabetical order? Age? Some people will die during the transition due to not getting coverage in time; what do we do about that?
Bernie’s bill (you should read it) does phase in the program over four years. It starts with those most at risk, the 55–65 age group and adds another age group each year to the Medicare rolls. Any uninsured patients receiving treatment prior to being covered are automatically enrolled and all copays and deductibles are assumed by the system so there is no reason for anyone to die from lack of coverage. We can’t forget that 30,000 currently die each year from not seeking care because of fear of bankruptcy from medical billing.
A much simpler solution is to expand Medicare to cover more people. We already have the entire Medicare system in place; all we have to do is lower the minimum age every year. This runs into the same problem of transferring to the government the revenue that’s currently going to the insurers. But we can handle this by charging people a fee just as we now do.
Yep, what I said above. That’s what I get for responding as I read. Any problems will be in available resources, not funding. The insurers will have to be tightly regulated in the transition as the most expensive and risky patients are taken off their rolls first, or they will benefit from an enormous windfall while their required expenses are reduced. As much as Republicans want to eliminate Medicare and Medicaid none of them is addressing what the cost of insurance will be without the government footing those extreme expenses. It would put coverage well beyond the reach of any but the wealthiest.
Again, the litigation will be the killer problem. What happens when our system starts to cover young women and we tell them that we don’t cover contraception or abortions?
And we aren’t already moving that direction with private coverage? Insurance companies know who butters their bread and are likely to exclude both from coverage as soon as the issue rises in public awareness again to cuddle up to conservatives. I wouldn’t be surprised if there aren’t already test cases working their way up to a heavily stacked SCOTUS to do just that.
