No. Just make “Medicare for All” a “public option” offered alongside the existing private system and let doctors, hospitals, and patients vote with their feet. You’re already seeing this with Medicare Advantage with many doctors and hospitals realizing that traditional Medicare is a better bargain for them because of the lower admin cost, less hassle, and Medicare pays quicker. They’re now refusing to accept Medicare Advantage.
It’s particularly bad in rural areas with a culture of racism, ignorance and innumeracy, Texas especially. Traditional Medicare pays a premium of about 50% to rural hospitals vs. urban hospitals to reflect the higher cost of serving a lower volume of patients in a remote area. Medicare Advantage doesn’t pay the 50% premium. So if a lot of the local, elderly population have bought into the Medicare Advantage scam, reimbursement revenue to the hospital declines and the hospital eventually closes. Obamacare and “immigrants” are typically blamed by the locals when the hospital closes rather than the Private Equity oligarchs who have “bought & paid” for their Congressional delegation.
Ah - sorry, I most often ran into Medicare for All proposals in connection with progressive efforts to adopt universal single-payer (the “all” in M4A). Like Sanders’ plan to replace private health insurance. I didn’t think you were suggesting a public option.
But a voluntary public option is unlikely to actually do very much, for all the reasons it had problems during the original ACA. It has to set a premium high enough to cover expenses (unlike Medicare), which means that it isn’t as insanely attractive as Medicare is. Because it can’t be assured massive and almost universal enrollment (and doesn’t have the mandatory and automatic opt-ins of pre-paying premiums through FICA), it won’t have the volume advantage that Medicare has. And because enrollment isn’t mandatory, it will have many of the administrative costs that Medicare can avoid - the costs that come with obtaining and losing enrollees (churn) as people move on and off the plans, and the costs that come from monitoring claims more closely (because you have to keep your premiums competitive). And it can’t force the reduced provider reimbursement rates that Medicare can, since they’re unlikely to have any greater pricing power over providers than any other private market participant. All of those things run the risk of adverse selection and narrower provider pools which limit the importance of any public option. The Brookings analysis at the bottom of this post has a good discussion of all those issues in section 6.4.
That’s why most public option proposals are robust public options - ones where participation is mandatory, either as a condition of licensing or as a condition of remaining in the Medicare or Medicaid programs.
You’ll have to mandate insurance coverage, whether you buy it from Medicare-for-All, or a private plan. And I’d force large employers to offer the Medicare-for-all plan alongside their private, for-profit insurance choices, and let the employee decide. In my example above in the thread, I’m pretty sure there will be few employees that will choose the $21,000/yr private plan that covers 94% of your costs, versus the $12,000 Medicare plan that only covers 84%.
Oh well, this is only an academic exercise. With a “bought & paid” for Congress and an innumerate public, it will never happen. And we’ll continue to “circle the drain”.
Medicare/Medicaid is superior coverage to the ACA. When a poor worker at 138% of the Federal Poverty Line gets a pay raise and moves from Medicaid to a heavily subsidized ACA plan, it costs the Gov’t a lot more because of the 20% skim rate to the insurer. And the worker gets a crappier health plan than Medicaid with higher deductibles and co-pays. Poor people know Obamacare is crap, precisely because of the for-profit insurance company involvement.
They pointed this out in the 2010 Congressional Budget Office score for the ACA legislation. A person moving from Medicaid to an ACA plan cost the Gov’t about $1,600/yr more in tax subsidies to the insurer vs. letting them stay on Medicaid. And they got a health plan with higher deductibles and copays.
Somewhere or other, if we are to have a far healthier and less impoverished and risk terrified population, we need to
Have a REAL PUBLIC HEALTH system that far more effectively handles health education, disease tracing, epidemiology, pre-natal, what to eat and what to avoid, drug addiction treatment, and more… all like falling out of bed, just around the corner, basically free;
Education that You Will Freakin DIE so take the steps you need to cope with that reality rather than suffering endlessly as your family flails around like idiots for weeks and useless weeks.
The buyers owe out of pocket regardless of years of claiming otherwise in the marketing.
I disappear for a few hours and we have an endless thread.
I see you posted the out-of-pocket costs. That does not make MA a good solution. For years in CT the ads said nothing out of pocket. Regardless of the law.
Trying to round this out all the way to an all-in cost, this is what I get.
For the 12k option getting 84% of total medical costs, using numbers upthread, add another 2k to get the other 16% of total medical costs (assuming Medicare reimbursement rate), for all-in cost of 14k for 100% coverage (vs 21k to get 94% of coverage).
Undoubtedly - but those numbers are a fantasy in the context of a public option. There’s no reason why providers would be willing to accept that insurance, if it pays a third less than a private policy.
They do it for Medicare, because Medicare enrollees consume nearly as much health care as all of private insurance - most providers, and all major and regional hospitals, can’t afford to cut off that large a segment of the population. But paying into Medicare is mandatory, and current premiums are a fraction of costs - so nearly everyone eligible for Medicare joins. The same won’t be true of a public option. So you can’t expect their reimbursement rates to providers to be significantly different than any other competing private health plan.^
Nor will their administrative costs be as low as Medicare - because, again, they don’t have the enrollment lock provided by mandatory pre-payment and subsidies. Like any other health insurance program, they’ll have to invest money in customer acquisition, experience enrollee churn as people move on and off their policies, and have to control costs through serious claims examination in order to keep competitive.
Again, that’s why public option proposals are almost always “robust” - mandatory or near-mandatory for providers. If you can’t force them to accept the lower reimbursement rates, they won’t sign up - because unlike Medicare, they won’t have a third of insurance spending locked up in their enrollees.
^ Public options without mandatory provider participation can come in with a narrow-network plan, much like many private plans under the ACA did. If you have a very small network, you can limit yourself to the providers that will accept below-market rates in exchange for a decent source of patient referrals. But such a public option is unlikely to have a tremendous amount of uptake, or put a lot of pressure on private plan pricing.
We’re talking about a theoretical public option based on Medicare - not the current situation.
The idea is that since Medicare has both a low administrative load and lower-than-market provider reimbursement rates, the government could similarly offer a “public option” that also had those features. My point is that those features stem from the fact that Medicare is something that is all-but-mandatory for most enrollees and providers, not from the fact that it’s government run. Which, again, is why most public option proposals typically involve more than the government just offering a competing plan, but usually contain some provision that requires (or all-but-requires) most providers to accept the public option even if it has lower-than-competing payment rates.
Correct. 1st cut military spending, it’s at an all time high, more than when the United States was involved in two bloody wars.
2nd tax. Like every country in the industrialized world, 8% tax on all income including cap gains, dividends, property tax, sales tax.
That ouuta cover it
The military currently has about 1.4 million active personnel. There are about 10 million 19-21 year olds. You still have to pay these people…and pay more experienced and senior people to train and supervise them. What on earth would they do all day? We don’t need a 10 million-person armed forces.
This doesn’t make sense. You would delay university education by years. the workforce of working-age Americans is already insufficient to replace the large number of baby boomers that are retiring . While kids in the United States are wasting their time in a government program, foreign nationals would fill universities in the United States and be employable while your children are just starting college, or bring their degrees from outside the US and take over the job market.
It sounds more like punishment. I’m not sure, what’s the purpose?