[Anonymouse]

Originally Posted by DW

This is a correction to misstatements

“... Also CRITICAL to note is that when you join a Medicare Advantage plan, you are WITHDRAWN from actual Medicare and are then covered by an entirely "for-profit" PRIVATE healthcare underwriter - though you can go back to straight Medicare without a penalty any time you wish.
This probably explains the higher co-pays and stuff - they ARE out to make a profit off your misery, afterall.
They get paid on multiple ends - by you, by Medicare for handling your claims, and they cut side deals with big pharma on meds & get discounts from providers for everything else.
Whatever they can chisel out from all sources is theirs to keep, and pad their profits...”

Originally Posted by DW

Last I checked the health insurance industry earn an average slim 4% margin which is unfair to portray as greedy. I suspect that is a bargain when the same service is provided directly by the Feds.

As many are, you are mistaken as to what is covered in the term "profit" for private insurers & how that affects how much you pay for that private insurance.
Premiums are divided up into 2 pools;
• Expenses - that is to say how much the insurer pays out for goods and services to providers.
If the insurer is honest, any rebates on those goods and services will be shown as deductions from the expenses ledger.
Saying the words "honest insurer" somehow doesn't strike an easily accepted chord, but to each his own opinions on that.
The ACA obliges insurers to spend no less than 80% of premiums on delivery of services - 85% in the case of large pool insurers.
In the first six years of the MLR (Medical Loss Ratio) rule implementation, insurers rebated $3.24 billion in excessive premium charges to consumers.
So much for "honest insurers".

• Administrative costs & profits must both come from the remaining 20%/15% of premiums taken in.
Here's where your 4% figure becomes absurd (trust Anonymouse, it's closer to triple that, when all is said & counted on the P&L sheets).
Administrative overhead for Medicare is <2%.
Yes, that's right, as hard as it is for right-leaning individuals who worship the invisible hand of the free market as being the best path to the lowest costs, the gummint actually operates a HALF TRILLION DOLLAR enterprise for 10% to 16% LESS than even the most efficient private health insurance companies - who are busy paying their officers 8 figure salaries - salaries that do NOT show up as "profits".
Indeed, they are not profits for the shareholders (who are being robbed blind by these interlocking BoD 1%ers on multiple fronts), but they sure LOOK like profits for the corporate officers who also hold YUGE chunks of company stock - to this observer anyway.
The point is, even at 4%, taxpayers are paying DOUBLE what gummint employees would cost us to run Medicare if Obama hadn't caved on the ACA and let the foxes into the hen house in the first place.
It's not all that complicated when you figure out a CEO making $20M/year is the same "administrative expense" as 400 gummint employees making $50,000/year in salary and benefits (standard package cost of a Clerk II gummint worker).
Nor is it that complicated to figure out that 20% in administrative costs+profit is still many times the 1.4% Medicare spent to administer the program in 2017.
https://www.politifact.com/truth-o-m...e-insurance-a/

Originally Posted by DW

It is true that Medicare Adavantage insurance companies assume Medicare responsibility from the Feds, as was intended.
Congress created the Advantage plans to lower Federal costs and risk while improving patient service.
Not only do Advantage plans reduce the Fed costs, but generally reduce patient costs, and in my case by a LOT!
Most Medicare doctor deductibles are 20%. My copays are $10 to $50 depending.

Advantage plans do NOT "reduce" the Fed's costs.
They allow the conservatives in gummint to reduce the size of gummint employee rolls through privatization and cost shifting (at a profit) to "For-Profit" corporations who generally pay substantially less in wages and benefits than gummint employeees receive.
It's a case of personal opinion as to whether we are better served by gummint sending our tax dollars back into the private sector and allowing the 1% to enrich themselves at the expense of those they employ, vs directly paying tax dollars to employees at a somewhat higher rate of remuneration that doesn't have to have "profits" shaved off their income to support the "Leech"...er "Money-ed" class.
On the other hand, large gummint payrolls support the political class, so either way the taxpayer is getting screwed.
It's a choice between whether you want to get screwed by political appointees and elected officials - or Old Man Scrooge, who already owns the entire town.
We THINK we already know which way better supports the actual workers getting stuff done, however, and it ain't by begging Scrooge for a decent-paying job and being told to go suck it up or die.
At least you can vote to rotate the political class and let someone else slurp from the public trough once in a while.

Originally Posted by DW

If you think the Feds do it better, count the number of Doctors who will accept Medicare only covered patients. Not many!

Since 2006, we have not been refused services by any physician, hospital, or pharmacy.
They ALL accept Medicare - and in fact, it is as much as 60% of their annual income, even at the reduced compensation rates.
Medicaid, you might have a slight possbility of a point, though personally we have never heard of anyone on Medicaid being turned away either.
Anonymouse suspects that propaganda is as big a canard as the whole "rationing of service" lie told about Canadian Universal Healthcare.

"However, profits in the health insurance industry have been growing in recent years, fueled in large part by growth in the Medicare Advantage and Medicaid managed care markets.
The ACA's medical loss ratio rules don't apply to the private plans that participate in the Medicare and Medicaid markets, although those plans have to win contracts with the governments (state governments for Medicaid managed care contracts, and the federal government for Medicare Advantage plans).
So they have to provide a net value to the government in order to win those contracts....
{snippty}...Currently, health insurers are the only segment of the health care industry in which profits are directly curtailed.
In the rest of the industry (ie, hospitals, device manufacturers, pharmaceuticals, etc.), a more free-market approach is taken.
There is certainly an argument to be made for eliminating or further curtailing the profits generated in the health insurance industry, but there is a similar argument for reducing or eliminating profits in health care in general."
https://www.verywellhealth.com/health-insurance-companies-unreasonable-profits-1738941

The point in bringing this to your attention is that administrative costs and amounts spent on paying out for covered services are ONLY as low as they are because the ACA prevents them from totally gouging the consumers - which is WHY Anonymouse specifically spelled out HOW they get around those ACA restrictions on "war profiteering".
It's the side deals that generate all the Benjamins & quite often vertical ownership by healthcare insurers, (of medical device suppliers and pharma intermediary companies - prescription benefits management companies or PBMs), who's profits are NOT restructed by the ACA, generate a boatload of cash for insurance companies operating in the Medicare arena.

Not to disparage in any way your attempt to bring this discussion forward, but if you want to go around correcting the statements of someone, its probably better to look elsewhere for an easy victory than to someone who has spent the better part of the past 2 decades studying the disparities between the U.S. "For-Profit" style of delivering healthcare and the costs and improved benefits of using a Universal Healthcare model operating in every developed and most UNDER-developed nations on Earth.
It's ridiculously easy to demolish ANY defense of the American "For-Profit" system, once you dispense with all the right-wing propaganda presented by those who profit handsomely from it - big pharma, big insurance, & the AMA system of restricting healthcare providers to sustain and even boost their members' wealth.
Do you honestly believe greedy corrupt dictators would be using the universal healthcare model in 3rd world countries if there was a cheaper way to provide at least minimal revolution-preventing levels of healthcare to their peeps?
Heck no, because for all it's vaunted "best in the world" BS, "For-Profit" healthcare in America is delivering worse results than 3rd world countries, to a 1st world population.

Anonymouse congratulates you on being open to discussing this at all, and not locking your mind up and "knowing" only YOUR side has all the answers.
As always, Anonymouse welcomes vigorous debate on healthcare or any other subject in which he is adequately researched and informed enough to now have a supportable opinion.