The US has had "Medicare for some" since 1965.

[guillaumeb]

So can someone explain to me how this program, which is well established and well liked, cannot possibly be modified to become Medicare for All?

Even if it is done incrementally, such as by initially lowering the qualifying age down to 50.

By lowering the qualifying age, younger, presumably healthier people would broaden the pool of Medicare recipients.

We are told, mainly by health insurance lobbyists, that Americans love their private insurance. Put that claim to the test.

[Eliot Rosewater]

1. Just need GOP to support it, is all.

There is no reason for democrats not to once it becomes clear it is what people want.

Until we control the House and Senate, it will not matter who is prez.

But you know that, I know that...I hope others do.

I do think people are afraid, some people, of change. But that is normal...

I remember every change in our computer lives at work was met with resistance. So this is normal.

However, people will just have to get over it, change is necessary.

Oh and I dont want Medicare for all, I want UHC with NO premiums and NO RX copays. Increase taxes accordingly.

[guillaumeb]

2. Well noted.

We agree, again.

And if there is a blue tsunami in 2020, we must press for this. We both know that the industries affected will spend billions in bribes in an attempt to control the scope of the debate, but we as citizen activists must demand it.

[Eliot Rosewater]

3. Hundreds of thousands of people would lose their jobs if health insurers disappeared

tomorrow.

But, you would need hundreds of thousands of new people to run the new system, make sure THEY get those jobs first.

(just preparing for the insurers arguments)

[guillaumeb]

4. True. And as blue collar workers are always told,

workers must retrain themselves, and educate themselves for the new market.

And some of those insurance company workers are working from overseas centers.

[Yavin4]

65. The GOP needs to be defeated 100%

The Democratic party should be dedicated to this goal esp. after these impeachment hearings. That party needs to be eradicated from American life.

[MH1]

5. I think doing it incrementally increases potential for successful adoption

BUT the huge problem with doing it incrementally - and it is a HUGE problem - is that approach delays making it accessible to all the people who really need it.

But I think if you lowered the age to 60, and made it an alternative for people still employed, you would see slow adoption at first and then rapid adoption in that group. That result would provide justification for further expansion - down to age 55, then 50, and so forth.

The argument against it, delaying access to the larger population, is valid. But if the country is not ready for M4A, why not at least start the incremental approach, and help SOME people?

[guillaumeb]

6. True, and making it a choice

removes the lie that anyone would be forced into it.

[MH1]

7. Exactly.

I have no idea why this simple idea is not being pushed by more politicians.

[guillaumeb]

8. Big money does not want this change.

Unless they can weaken Medicare even further and create a space for more "Medicare advantage" plans.

[MH1]

9. True, sadly. nt

[Blue_true]

15. Because they would be called Dinos. There is a side that wants nothing but all

or nothing now, and at this time, they are the loudest voices.

[NewJeffCT]

36. Medicare expansion to 50 or 55 and over

was part of the supposedly too conservative Democratic platform in 2000, where Nader criticized Democrats as no different than Republicans.

[MH1]

44. We could be well on the way to actual M4A - or even there

If we had started that national conversation and incremental progress in the early 00's.

Instead of, for example, invading Iraq.

[NewJeffCT]

45. and, back in the late 70s

disagreeements between Jimmy Carter (wanting a public option type expansion of healthcare) and Ted Kennedy (wanting a medicare for all type plan) at least partially led to Kennedy challenging Carter from the left in 1980. Dems had big majorities in both houses under Carter due to Watergate, but the liberal and moderate wings could never agree.

[JustABozoOnThisBus]

54. Current Medicare is a choice.

At 65, my company expected me to sign up for Part A (hospitalization) of Medicare. Or, it was just automatic, I don't remember. But, the stuff that's covered by Parts B and D (medical and drugs) I could defer, continuing to use the company group plans.

I got Medicare part b and d when I retired at age 68. There was no penalty for the delay because I was covered under a company plan.

So, in a way, current medicare is optional.

Also, I suppose I could opt for no insurance, no Medicare, no nothing. That would be a bit reckless, but probably legal.

[Blue_true]

14. I like your idea. Allow people that currently have insurance to buy Medicare instead. nt

[csziggy]

24. I agree with doing it incrementally, but I think it needs to be from both ends

Cover children and young adults while lowering the eligible age.

It is getting more and more difficult for young working adults to get a job that includes coverage - that is why the ACA allowed parents to keep their children on their policies to age 26. So as young people get jobs, cover them so they start out knowing they will have health coverage. Covering children reduces the costs to parents in marginal jobs without any coverage and will tend to push those parents to wanting coverage of their own.

Reducing the eligible age allows companies to keep experienced workers without increasing their costs - and same as covering children and young adults will increase those who have problems getting coverage and those who will add to the support for a national health service - no matter what it is called.

No matter who is covered, allow supplemental policies so those who can afford it (or the companies that employ them) can get better coverage without taxes paying for "cadillac" policies.

Those who like their policies (and doctors) can keep them - of course, the insurance company may decide to change their accepted practitioners or the company they work for may change their insurance company and which providers are in network - same as now and before the ACA.

[NewJeffCT]

37. wasn't part of Obamacare

including coverage of children up to age 26?

[Mariana]

39. It included coverage up to age 26 on their parents' policies.

If they don't have living parents, or if their parents don't have policies, they aren't covered by that.

[MichMan]

10. People now pay in for 45 years before they are eligible

They draw benefits for 10-20 years.

To cover people at 50, that means they paid in for 30 years and collect benefits for 30 years.

Payroll taxes would have to be increased significantly I would think. Also under the current system, everyone must cover themselves; there is no dependent or spousal coverage.

[csziggy]

25. Also under the current system, ...; there is no dependent or spousal cove

Uh, I never paid into Medicare but I am covered by my husband's Medicare (and by his Social Security). We each pay for supplemental policies that not only cover the copay but also get us faster approval for tests and procedures.

For working people, Now they pay a significant amount for their current health insurance plus a good amount into their supposed future insurance.

If we change the system, people will be paying for their own insurance. Since everyone will be covered, general health quality should improve, and since everyone will be covered the insured pool of patients will not be skewed toward the old and infirm. They will also not be paying for services to the uninsured since everyone will be covered.

[MichMan]

26. I stand corrected. Spouses can be covered, but not children

Very few adults of the age of 65 have never ever been employed outside the home for their entire lives.

[MichMan]

35. Spouses are only covered if age eligible

If I am currently covered by Medicare, my 40 year old spouse and 2 minor children are not covered as my dependents

[csziggy]

40. Yes - I am six months younger than my husband

So he started his Medicare coverage in January while mine started in July.

[NewJeffCT]

38. Not necessarily

the people in the 50-65 year old range are generally healthier than the persons over 65, where many experience the most expensive health issues - heart disease, smokers with lung cancer, alzheimer's, dementia, diabetes, cancer, etc.

and, people under 50 are healthier still.

[stopbush]

11. Taxes would need to be raised substantially.

Currently, you and close to 100% of employees pay a tax of 1.45% of your yearly salary to support Medicare. Your employer also pays a tax of 1.45% on your salary and the salaries of all your coworkers to support Medicare. That’s a total tax of 2.9% being paid into the fund on your behalf as an employee.

That tax currently raises enough money to support Medicare for the 19% of Americans currently in the program. 19%.

It is logical to assume that if the program is now asked to cover 100% of employees rather than only 19%, current taxes would need to be raised five-fold to cover the number of people being added to the program. That’s 7.25% for you and all your coworkers, and 7.25% paid by your employer for you and each of your coworkers. That’s a total of 14.5% in taxes being paid on your behalf to fund the program.

In addition, every person currently on Medicare pays an average monthly premium of $135 for coverage. Those patients also have co-pays for check-ups, services, prescriptions etc. Those monthly premiums are a big source of funding for Medicare, and they are paid on a per-person basis. One can safely assume that a family of four would pay a monthly MFA premium of $540.

So, let’s do the math, using the median base salary of $75,000 a year to calculate the cost of MFA for a family of four:

Payroll tax paid by employee @ 7.25%= $5,437
Premiums for 4 @ $135 each per month = $6,480

Employee cost per year = $11,917

Employer contribution for employee = $5,437

TOTAL in taxes and premiums to support MFA for a family of 4 making $75000= $17,354

[Blue_true]

16. Health insurance for a family of four runs $20,000 and up.

So a family of four would come out ahead on MFA. Single people would be closer to a wash.

The problem is that most Americans don't know how much it costs to insure them because employers pick up most of the tab. Until that changes, there won't be a groundswell for MFA.

What can be done easily is to allow people younger that 65 who are now having to pay in full for their health insurance buy into Medicare. Such people would pay a larger premium than $135, but considerably less than what they pay today. Between such a system, Medicaid and employer sponsored health insurance, 100% of Americans would have health insurance.

[stopbush]

27. Back when I got my health insurance thru my employer

I saw all kinds of plans.

I’ve had a number of employers who picked up the entire tab for me and my family of four. People currently enjoying such a plan would see their cost go from $0 to over $11,000. Not good candidates to support MFA.

I’ve had plans where I was covered 100% but adding a family member cost me anywhere from $100 - $1000 a month per. I’ve had plans where I had a monthly premium of $400 whether I was on the plan by myself or if the whole family was on the plan.

So it’s different for each person. MFA is a hard sell for anyone who is getting decent healthcare thru their employer at a reasonable cost.

[Blue_true]

31. You touched on the problem.

For most people that work for decent sized companies, the economics of MFA don't work. So why not leave people that are ok with their private insurance alone and look at the low hanging fruit, people that work and are paying big bucks for health insurance, giving those people a Medicare buyin option that gives them sound coverage and saves them money will increase support for the concept of MFA at some point in the future. Shoving MFA down the throats of Americans that are comfortable with the insurance that they have now will backfire in our faces bigtime.

[TheRealNorth]

53. How is that different from The ACA?

I think part of the problem with the ACA is that people who need to use the ACA for insurance have a higher then average risk for illness, which causes the costs for people using those plans to rise. This is further complicated by the geographical distribution of the people at highest risk and that plan costs are adjusted by geography.

[Blue_true]

56. The ACA leaves out tens of millions of Americans that make too much to qualify for subsidies.

So those people have to go into the insurance market to buy at the full rate, which is significant for both individuals and families that don't qualify.

An alternative to the plan that I mentioned is to eliminate the earnings cap for entry into the ACA, with everyone getting a subsidy that keeps the cost of their policies to a percentage of their income, with lower income people getting bigger dollar value subsidies. The tradeoff for removing the earnings cap for entry is that people pay an income tax for entry, with the total of the tax they pay and their insurance premium being less than what they pay now. Insurance companies must be regulated to insure that they don't game that system. People with no earnings or very low earnings can get Medicaid, which most likely do already.

You make some good points. The first being sicker people likely being in the ACA on average. That is likely because them buying insurance on their own likely is a crushing financial burden. I don't know whether the ACA adds illnesses that people report when signing up into the premium subsidy calculation, but that would make sense if people have to provide proof of their illness (Doctor's records, ect). But a higher density of sick people would certainly result in higher premiums, BUT allowing more healthy people who are currently barred to joins lowers the risk of the ACA pool, so premium rates should drop pretty sharply. The second point that you made is the quality of people's health by region of the country. There is a considerable amount of empirical evidence that people in richer areas are healthier than people in poorer areas, with obesity being a very large contributor to that difference, along with smoking because I believe that I read that better educated people are statistically less likely to be smokers. So on the second point, NO health insurance system will not have long term problems if culturally people at an early age are educated on avoiding health risks that are preventable with personal choices.

[SoCalNative]

58. It shouldn't be a problem for anyone

I have very good insurance through my employer that costs me very little comparatively.

I would much rather pay more and not have it tied to an employer, so I don't have to worry that if I lose my job, or that I have to stay with this employer instead of looking for another job, I'm screwed because I can no longer afford all of my medications.

[stopbush]

32. Actually, the average cost overall for employer-provided insurance for a family of four

is $28,000. But that number includes the cost to the employer.

The important number is what the cost is to the employee. That number for a family of four is around $1100 a month, or $13,200 a year. And those families are also paying Medicare taxes for decades on top of their costs, taxes that won’t benefit them until retirement.

[Blue_true]

34. I am single so I don't know what a family policy cost. I have

seen numbers in the $20,009-$24,000 range, but your number is much larger.

I don't oppose MFA, but so far no one other than Warren has taken a swipe at costing it out and figuring out implementation details, and she got resolutely hammered afterwards.

If your synopsis is accurate, then a family of four that has a $100,000 income and face a 7% MFA tax would come out ahead under MFA as long as the employer contribution stayed there.

[WyattKansas]

41. That is the bait and switch...

As long as people keep thinking that what they pay for their private health insurance is the only cost that they are really paying. When they do not even see the cash contribution for their health care plan that they would otherwise see on their paychecks, which their employer picks up.

People can whine about it all they want, but it is illogical to think a middle man collecting a big salary that does nothing for medical care, is going to be cheaper in the end. Only if that middle man cuts what the insurance company will actually pay for with a patient's total medical expenses. As for the Medical Industry, they can give up all their opulent perks and mood enhanced spa health care facilities and get back to medical care. Sorry for the rant... But the whole system is set up on Vulture Capitalism now.

[guillaumeb]

19. Canadians are covered for 1/2 the cost of US citizens.

And that fact refutes all of the "taxes would need to be tremendously raised" arguments.

And any increased taxes would be offset by the elimination of premiums to the insurance companies.

[stopbush]

28. Speculation on your part.

And the USA is not Canada.

[guillaumeb]

42. It is not speculative to report a fact.

And most other developed countries spend far less per person than does the US. The reason is that in the US, healthcare has been monetized.

[former9thward]

60. People who have serious diseases and can afford it

come to the U.S. for treatment. They don't go to Canada. The U.S. has the best treatment facilities in the world for serious diseases. That is why the cost is more here than the rest of the world. The cancer mortality rate is 20% higher in the UK than the U.S.; in Canada it is 10% higher. The medical journal Lancet reported in 2019 that individuals with pancreatic cancer are twice as likely to survive 5 years in the U.S. as compared with the UK. Five year survival rates for brain cancer are 37% in the U.S., 27% in France and 21% in the UK. This is all good news for people in the U.S. but it costs money. Money which countries like Canada, UK, and France are unwilling to spend.

[guillaumeb]

61. Have you ever heard of many peple traveling to India, Meico, and other countries

for treatment?

The key words in your statement are "and can afford it". You are confusing what care is available in the US with the issue that, for many, that treatment is unaffordable.

What good is a cure, or a medicine, that only the 1% can afford?

[former9thward]

62. The cancer survival rates in the U.S. apply to everyone.

Not just the 1%. The facts are clear. If you have a serious life threatening disease your chance of survival is better in the U.S. than in other western countries. I doubt Lancet made up their numbers.

The systems that exist in UK, Canada and France may be better and cheaper than the U.S. for routine medical care. But not for serious issues.

[guillaumeb]

63. Lack of access to routine care can often lead to many conditions beng undiagnosed.

And those undiagnosed conditions do not go away, they often become serious conditions.

[Autumn]

12. It can easily become Medicare for All. All we need is a party and a president to decide to do it.

[Blue_true]

17. That is not totally correct.

The cost of MFA is pretty large and many Americans have company or Union health insurance (or both) and don't see utility in MFA. Until those dynamics change, we won't see MFA.

[Autumn]

22. The cost of the ACA with it's subsidies are large also and Biden seems to think that the republicans

will work with him to increase those subsidies. ( )

https://www.cnn.com/2019/07/15/politics/joe-biden-health-care-plan-obamacare-public-option/index.html

[Blue_true]

23. Not nearly as large as MFA.

Plus, many Americans who could not afford coverage now have it through the ACA, so building on that is more doable that an entire system rework.

I want to see everyone with good health insurance (that does not destroy them financially) just like you do, I just happen to disagree on the best approach for doing that.

[Hoyt]

13. Medicare for All -- without 100% coverage, dental, etc., as Sanders/Warren propose -- might

have a chance. But first dollar coverage and dental will make it cost prohibitive for years, unless we manufacture a lot more billionaires to tax or be honest about how much middle class will have to pay and give people a chance to try it out through Public Option.

[Blue_true]

18. Most Americans have employer paid health insurance and don't realize

how much their coverage cost per month. So, in their ignorance, there is no appetite for change. Until that changes there won't be a groundswell for MFA.

[Recursion]

52. That's why the ACA required that line on the W2 showing health insurance costs

That's not big or obvious enough, though. It should be printed on every pay stub. Empoyers will really, really resist that, though, because they want to be able to pocket those savings if we get universal health care.

[Blue_true]

57. All universal healthcare plans presented so far require an employer contribution.

Well, MFA as it is currently configured MAY left employers who can due to economics, but don't, offer health insurance off the hook, so that loophole will need to be slammed shut. In theory, a massive in scale over-arcing insurance plan should result in all participants paying less than they pay now, because of the group size, so insurers should welcome universal coverage. A case in point to the last observation that I made was Berkshire Hathaway, Chase and a third company joining together to insure their employees under one over-arcing plan. It is informative that one of those companies IS in the insurance business, though not health insurance. The three recognized that grouping employees into a massive healthcare insurance buying group gave the more power over negotiating lower rates.

[Recursion]

59. That's not necessarily true

It only ends up with everybody paying less than now if we assume the same amount of healthcare keeps being provided. But hopefully we'll be providing a lot more healthcare. But that means it may not end up being cheaper.

[Blue_true]

64. I have to admit, at some point heroic measures to save some people's lives seem to be ill spent.

A case in point is myself. I have lived a little over half my life, if I live to be 100. I am childless. So if I go into a deep coma and need life support, my instructions to my family members is to quickly say goodbye and have the life support turned off. Now a much younger person should be given more time before life suport is turned off.

One of the reasons (there are several others such as smoking and obesity) that healthcare is so expensive is today people stay in the hospital being treated for illnesses that were an immediate death sentence 40-60 years ago, that add to cost throughout the system, because some of the equipment and skills that are required are not inexpensive.

Maybe I am insensitive, but part of the reducing of healthcare costs will require that people give up some things that they have held as sacred.

[SMC22307]

20. Medicare at 55 is a winner.

People my age would FLOCK to the polls, especially since Fat Nixon is threatening cuts to SS and Medicare later in the year.

[guillaumeb]

21. And as that age to enroll was lowered,

the market for private insurance would become smaller. Not as quickly as if Medicare for All were to be immediately available, but it would happen.

But another component would be to rewrite the laws that weakened Medicare and allowed for "Medicare advantage" supplements.

[stopbush]

33. My Medicare Advantage plan (Kaiser) costs me $0. I pay an extra $20 a month

for dental/vision/hearing.

So my total Medicare premium is $155 a month.

[Recursion]

30. It requires pretty hefty payroll levies from the entire population

just to pay for the retired portion of the population. Furthermore, most providers that accept Medicare lose money on it, which has to be made up from patients on private insurance.

[guillaumeb]

47. Canada has a single payer system.

It is 1/2 the per capita price of the US system, with better outcomes.

That reality proves many of the insurance industry memes to be false, and attempts to frighten US citizens.

[Recursion]

48. And it's important to acknowledge why Canada's system can't work here

The Canadian Federal government tells the provinces to provide a Medicare system for their residents, and has no means to actually force the provinces to do so.

If we did that, the red states would simply do nothing.

Canada can trust its provinces not to kill their own citizens. We absolutely cannot trust the states in that way.

[guillaumeb]

49. Incorrect, but allow me to explain.

Per the Constitution, each province is required to set a budget for care. There is no option to not participate.

Even the conservative provinces know that their single payer system is far better than the US system. Single payer first started in Canada in a conservative province.

[Recursion]

50. Incorrect, but allow me to explain

We could make a Constitutional amendment requiring that, and the red states would simply ignore it. And ignore the Federal court orders trying to enforce it.

You really, really need to understand that a majority of state governments actively want to kill their citizens. You will never understand US healthcare politics until you accept that fact.

[guillaumeb]

51. You made a point about what Canada does.

And you were incorrect.

And if we take your assertion as fact, nothing can ever be done that the most conservative US citizens do not want. And US history disproves that assertion.

[TheRealNorth]

55. Medicare pays out normal costs

Medicaid is where they lose money. This is why hospitals in poor areas have trouble staying in business- if they have too many Medicaid patients and uninsured patients that can't pay, there are not enough people with regular insurance to offset those losses.

[Caliman73]

43. Healthcare is complicated. On purpose. People make a lot of money from it.

Others of us are afraid of change and afraid of loss. Those who stand to gain profit, understand that and play to those fears.

Here is a video that I think explains well, though it may be somewhat simple.

[guillaumeb]

46. Agreed.

Follow the money, and the money trail.

Many industries profit from the current, dysfunctional system.

The insurance companies profit by denying care.

The pharmaceutical companies profit by overpricing medications.

Doctors profit by restricting access to training.

[yellowdogintexas]

66. I have been saying this since the 1970s

I was a claims analyst for the State Part B Medicare carrier and it was clear to me that everybody should at least be able to get it if they wanted it.

This of course was way before gigantic deductibles and premiums. Back then medical insurance was not the high profit enterprise it is now and deductibles were very reasonable

I totally agree that it should be phased in. Let's not overwhelm SSA which determines eligibility and tracks the deductible for part B etc.

Medicare has the lowest cost per claim, fastest turnaround time, lowest error ratio and highest satisfaction. No money is spent on advertising or obscenely high CEO and upper management salaries and perks. Medicare does not make a huge profit; the budget has enough overhead to allow for rent, raises for employees, office supplies etc.

You are quite right that including younger and healthier people in the plan will definitely expand the pool. If only very ill people are covered, then costs will escalate and the Republicans will get what they want: a plan that is underwater and a failure so they can get rid of it.

I'd like to see the plan modified some if this happens, with things like a maximum out of pocket per year, which most commercial employer plans have. It would be nice if dental and vision could be added. As it stands now a vision claim is only covered for medical causes; injury, infections, glaucoma, cataracts etc. SOme dental is covered if due to an injury, or having to have one's teeth extracted before radiation therapy to the head. (that's a real thing, if you have metal fillings or crowns)

Big Insurance and Big Pharma are the spawn of the devil.

[guillaumeb]

67. Very well argued, and from an inside perspective.

Any time profit is the first consideration, either the cost of the service will be raised, or what is covered will be narrowed. And all of these raised costs and lower services will be at the expense of the patients and doctors.