A Path to Medicare for All

Here's the way it works. When most people pay their own medical bills, the doctor sits down with the patient and they discuss options and costs and decide what to do. When most people have insurance, that discussion does not take place. Tests and second opinions that would otherwise have been optional are automatic. The doctor hires more staff to fill out the insurance forms and keep extensive records. The doctor has to have the latest equipment to be sure his diagnoses are legally defensible. Everybody knows the bills are covered, and services are assumed to be competent. All of this, the extra tests, the second opinions, the documentation, the equipment, has to be paid for, and the cost goes on the patient's bill. The insurance company's only concern is that charges are necessary and reasonable.

Please notice that I have not suggested any form of deception. All of this is normal, honest, and unavoidable. Increased medical costs are automatic when most people have insurance.

But normal market forces are still at work. Demand is limitless, but services are scarce. In a normal market, demand is controlled by costs. When that restraint is removed some other method must be found to keep demand equal to supply. One way to limit demand is to make patients wait. When there aren't enough doctors to treat people as fast as they come in, patients must wait. Those that can't or won't wait go away. Travel to a treatment center has the same effect. When the market is controlled by costs, people who really need treatment can get it by paying the cost. When the market is controlled by some other method, individuals are prevented from making their own decisions about what they really need. They can only get treatment by waiting, or by obtaining some sort of official approval or professional reference, that is to say, by political influence.

The bottom line is that you need more people working for less income per capita to make health care affordable so more people can be covered.

In general this is the problem of expanding US society to accommodate more individuals with less resources, because if people are going to have better access to health care at a lower cost, there are going to be more people who make less money but nevertheless enjoy higher quality of life.

This has nothing to do with socialism (social capitalism) vs. free market capitalism because you can have more people enjoying better healthcare and higher quality of life in either system. If people voluntarily work harder to learn and practice medicine for less income, that is a free market path to more affordable healthcare for more people, while forcing/coercing people to do so by means of taxation and regulatory manipulation the socialist way of going about it.

The problem obstructing expansion of health care, either through free market or through socialism, is greed. People see health care as a lucrative market to use to their advantage financially. They don't want to lower the costs of education, costs of drugs, facilities, bureaucracy, etc. because all the people who work in those businesses and jobs want to make a lot of money because they are connected with the health care industry. That is why they went into that field.

It is also the case for all the global pharmaceutical companies and other medical suppliers that want to make money exporting to the US. They will all be elated if the government puts more money into insuring everyone at current rates, because that will just increase their revenues while burdening US taxpayers (and co-payers) more.

To lower health care costs, these businesses and people have to make less money. To do that, their cost of living must decrease and they must make sacrifices, e.g. less boats, vacation houses, etc. Many everyday lifestyle patterns that have been normalized in the US are wasteful and thus bad for environmental sustainability, in addition to boosting the costs of everything including health care.

Everyone doesn't need to drive a car. Transit can be better. Urban planning and infrastructure can be more efficient and cost less. Housing can cost less. Few want these costs to go down, however, because the expenditures all funnel money into various businesses and industries.

Inefficiency and waste is bad for an economy overall, but it is good for individual businesses that sell more because more is getting built and wasted than necessary.

Your example of how healthcare works when insurance is involved is yet another example of waste and inefficiency where there are alternative methods of doing things that are not lower quality, but which are more efficient and thus use less resources, including time.

Generally, if more people could save more time by doing less of other things/work, they could spend more time learning to carry some of the burden of health services so more people could be served at a lower cost. I just recently heard about someone who got out of his job as surgical assistant because he hated it and wanted to do something else. It is a problem when certain people get stuck doing really important jobs that cause a lot of stress, and then they make so much money that they can afford to just quit and someone else has to be trained and forced by means of debt to do that job until they make enough money to escape. That is basically the way indentured servitude worked, and it would be far better to change things so that people can spend less time on stressful-yet-critical jobs, so they can have more time to do other things, such as doing some other job that they like better but which isn't as relevant and thus makes less money.

Overall these things are easier said than done because there is enormous cultural resistance to change. When change is suggested/promoted, it has to be done like a marketing campaign, convincing businesses/investors that it will be better for the bottom line or for the economy in general, and otherwise the assumption is that it can't/won't happen.

Instead of always thinking in terms of what is financially feasible or not, we should just start thinking in terms of what is practically achievable and then realize that we will go on making money, even if the ways we do so change. If someone can get training to assist surgeons for a lower cost and then works only 10 or 20 hours a week in surgery so that they can do something else with the rest of their time, surgery may become more affordable and more people will work part-time in surgery, but everyone will still be making money because patients need operations, regardless of how much or little they cost.

The problem is that people don't want to risk making less money, so economic politics involves blocking/obstructing changes that will indeed lower costs. More people could get health care, and Medicare could be expanded in that it would be affordable to taxpayers due to low costs; but more expensive insurers and health care providers will obstruct it to maintain a system where people are terrorized into paying such high rates and costs- and then the politicians will keep arguing over whether or not to boost the markets even more with government subsidies/insurance; and the result will be that many people will just continue to not get health care because they don't fall into the privileged classes of those who are covered and can afford out-of-pocket costs because of their jobs, social-welfare entitlements, etc.

What should happen, though, is to work at lowering all the costs involved by working more efficiently and lowering the wages/income/prices of everyone involved. Then, when the costs are low enough, it will not be a burden to taxpayers to fund Medicare-for-All to lend money and/or subsidize those who can't afford to pay the otherwise-low costs.

To get those costs down, however, people are going to have to take a lot of liberties to allow more educational access for less, allow people to work in health care part-time for lower hourly wages, and hold people who can't afford to pay accountable for their utilization by keeping track of their debts and only forgiving/subsidizing certain utilization costs while creating new ways of holding them accountable for others, such as work-programs and/or debtors' prisons. It sounds harsh and cruel, but it is just a question of what it takes to deter people with no financial accountability from wasting resources and shirking responsibility to prevent utilization by taking better care of themselves, their diets, etc.

IOW you run out of other people's money.

Not really. (Hyper)inflation would make it possible to continually tax and spend money so that it just keeps circulating and doesn't run out; but the social-economic and environmental/sustainability consequences of that would be bad.

People want to make more money, but they don't realize that when their income grows, that is a form of inflation just as when other prices/expenses/costs get higher.

To have real economic value growth, you would need to have deflation; i.e. prices/incomes/costs going down instead of up. That works best when people are also spending less time working for the decreasing wages.

People don't want to make less money by working less hours, but doing so is the ultimate achievement of economic efficiency and value. It's like building a house in a day from materials that cost you $100. It would be a fantastic bargain and if you get it done in a day's work, you get lots of free time; and because you did it yourself and only spent $100, you save the rest of your money AND you have no mortgage to pay off.

That would be the ultimate economic efficiency, but such a model is loathed and feared by those who want to keep people in debt so they have to keep working all the time.