[hellotomyrars]

Based on what? Why even leave this comment if you’re just going to say “would likely be worse off” without giving literally any evidence or even suggestion of why.

Insurance is a pool. The bigger your pool the more you spread the risk/load. It’s brain dead simple. Medical care is a human right, beyond that.

Nothing about our system makes any sense and it is built to pad so many pockets in entirely opaque ways between you and the care you actually receive. Cut out several layers of middlemen and the costs go down. God forbid you have an accident and you end up at the wrong hospital when the one down the road is in-network but the one they took you to is out-of-network and you wake up owing thousands of dollars.

I had pretty good marketplace insurance this year but the plan I’m on now isn’t even offered anymore and if I got the next closest offered plan I’d be paying 6X as much for the premiums with higher copays on top. I’ll be switching to my union offered plan instead which is much better than the new marketplace plan but still worse than the marketplace insurance I had before.

[aleksejs]

> God forbid you have an accident and you end up at the wrong hospital when the one down the road is in-network but the one they took you to is out-of-network and you wake up owing thousands of dollars.

If you examine the statement of benefits for your plan, you will find that it says something similar to this:

> Emergency Services are covered at the in-network cost-sharing level as required by applicable state or federal law if services are received from a non participating (out-of-network) provider.

> The member is responsible for applicable in-network cost-sharing amounts (any deductible, copay or coinsurance). The member is not responsible for any charges that may be made in excess of the allowable amount.

[hellotomyrars]

You’re right. The No Surprises Act did make this a lot better. However it still doesn’t cover ground transport (and specific state laws do in some cases.)

Additionally for post-stabilization care the hospital is going to shove a lot of papers in your face and they’re probably not going to tell you that one of them is the one that says you agree to pay to whatever those services and waive your protection against balance billing. Yes they’re supposed to present it on its own and with your full consent and yes you can dispute that but people sign the forms and then still get screwed.

[tptacek]

I think it's telling that people are shocked at the assertion I just made, which is not complicated or outlandish or hard to understand and is in fact backed up by referendum and attempted implementation results for state-level programs. I think two big things are happening that fog people's understanding of this issue:

First, there's a widespread belief that M4A is popular, based on public opinion polling. The problem is that you can make almost anything popular in public opinion polling, and a lot of public opinion polling is deliberately run by interest groups to generate narratives about popularity. It's true: the "M4A" that poll respondents support would be enormously popular: it's proposed as abstraction with no clear tradeoffs. When you confront voters with the prospect of increased taxes and the loss of their current insurance policies, the wheels come off the wagon.

The second big factor is that the demographics of people with employer-provided coverage --- the majority of all non-Medicare covered people in the US --- are not what you'd expect. As soon as you stipulate employer coverage, the cohort you're describing excludes basically all fixed-income and Medicaid-eligible households. The median household income of a family with employer-provided health insurance is closer to $120k than it is to $50k.

For those households, M4A is not a very compelling deal:

* There is a very clear trend in the data for them to already be satisfied with their existing health care.

* The visible component of their insurance spending (their out-of-pocket, excluding employer side payments) is usually quite small compared to total spending.

* M4A would mechanically eliminate the availability of existing plans (unless you came up with a truly weird and distortionate system of tax incentives to keep Anthem and United and Aetna policies going).

Best case: costs that are hidden from those households today become visible, and you hope people are chill about that (in sort of the same way we hoped that people would be chill about inflation given wage increases outpacing it --- see how that went). Worst case, a lot of these households would lose their existing, favored insurance plans and pay more.

Useful here to note that broad taxes on the middle and especially upper-middle class are how Europe funds generous social service packages; you can't get there by taxing the bejeezus out of billionaires. You should do that anyways, just because it's a good idea, but there aren't enough of them to pay the absolutely gobsmacking cost of a single-payer health system in one of the wealthiest large countries in the world.

I'll cop to this: what I wrote last night, about "currently insured" people, was way too vague. I should have said "households with employer-provided health coverage" (again: that's most non-Medicare households). I plead strep throat; you're going to have to give me a break on clarity today.

[hellotomyrars]

Sorry but I reject this thinking. You’re essentially saying that Medicare for all is bad because it’ll seem to cost more because the way the money works isn’t obscured so people will be mad and that it has to be worse than their existing policies.

I’m still not seeing how or why it has to be worse. This just seems like an assumption you’re making. Also sure the exact existing policy you have won’t be available by definition because the system has entirely changed but once again if you want private insurance you will still be able to get it, as is the case in other countries with socialized medicine.

Also really don’t see why you would say that the polls that say people want socialized medicine are rigged and not-representative but the polls that you’re saying show that most people with private insurance are happy with it are accurate. Not really sure how that stands to reason.

I really feel like the argument you’re making here boils down to M4A is bad because it has to be worse and people who have private insurance now are happy with their plans and could only have them replaced with something that would be worse. Or even more simply: Change is scary so I guess we’re stuck with the current system and actually people like it so don’t rock the boat.

Also the median income for someone with employer provided healthcare is 120K? I’m going to need some data on that. Also you’re then cutting out everyone with marketplace insurance which is 24 million people.

More people are poised to lose Medicaid and my marketplace insurance plan, if I chose to accept it for next year was going to cost me 6X for the monthly premiums and require co-pays I don’t have before as well as much larger copays for ones I did.

I’m going to be completely honest. I don’t care if people making 120K/year are upset if their visible cost for healthcare is more obvious or not. From 2024 census data 41.2% of households made above 100K annually. That number becomes roughly 33% when you step it up to $150K/year and drops to something like 12% when you get to $200K/year. By the time you get to $400K/year you’re at like 3%.

Also households as a unit isn’t necessarily representative of the distribution of people within them.

I reject the idea that government system are inherently bad and so we can’t have them. I reject the premise that the wealthy will be forced to have worse healthcare to subsidize the majority of Americans. I absolutely reject any notion that our private healthcare as it exists is efficient, affordable and the superior system.