Can Expanding Access to Medicare Really Solve the US Healthcare Crisis?

[turbo]

Then that's Medicare + a whole new rate structure, not just more "US citizens" who "opt into Medicare"

The idea has been floating around for years, not just during the Obama administration. Accept younger members, who would pay higher premiums, and who would incur lower health-care costs. Private insurers are dead-set against it, of course.

 

[talk2glenn]

The idea has been floating around for years, not just during the Obama administration. Accept younger members, who would pay higher premiums, and who would incur lower health-care costs. Private insurers are dead-set against it, of course.

Ok, so now you want to charge younger members higher rates. To be viable, these rates would need to be comparable to equivalent private sector rates for the same coverage with a like risk pool, plus the subsidy, effectively making a Medicare program more expensive than a like private program.

Given that Medicare also restricts provider and treatment access relative to private plans, why would any rational individual "opt in" to paying more for less, unless he was uninsurable in the private sector (and therefore will be consuming more than he pays in, at any conceivable rate premium)?

This kind of structure is only viable as single-payer. Any suggestion that it could work on an opt-in basis is a clear red herring.

 

[turbo]

You propose to increase the number of individuals eligible to receive benefits, presumably at existing subsidized rates, without any corresponding change in the payroll tax structure. How would this maintain program viability?

Are you deliberately mis-stating my position for a reason? Putting words in my mouth doesn't elevate your argument any more than the ad-hom attacks. If you have a cogent, defensible point of view, you shouldn't have to resort to dishonesty.

 

[mheslep]

The idea has been floating around for years, not just during the Obama administration. Accept younger members, who would pay higher premiums,

Yes, higher premiums

and who would incur lower health-care costs.

Unlikely. Either we'd get rationing or higher costs, as we do with every government run program

Private insurers are dead-set against it, of course.

As are at least 42% of the public, since you are essentially describing a single player plan AKA the public option.
http://www.realclearpolitics.com/horseraceblog/2009/10/the_public_option_in_the_nbc_n.html
http://www.rasmussenreports.com/pub...9/32_favor_single_payer_health_care_57_oppose

 

[turbo]

As are at least 42% of the public, since you are essentially describing a single player plan AKA the public option.

It would be a public program existing alongside the private programs. The reason that so many people are against a public option (option!) is that the right-wing media has been railing against it with end-of-the-world scares, and too many people are gullible enough to buy the scares without being able to think through the consequences of the option. The US public is not very well-informed regarding economics, health-care costs, or insurance plans. As a result, they are easily duped into thinking that health-care reform is a simple good/bad dichotomy, when it is clearly far more complex than that.

 

[airborne18]

It would be a public program existing alongside the private programs. The reason that so many people are against a public option (option!) is that the right-wing media has been railing against it with end-of-the-world scares, and too many people are gullible enough to buy the scares without being able to think through the consequences of the option. The US public is not very well-informed regarding economics, health-care costs, or insurance plans. As a result, they are easily duped into thinking that health-care reform is a simple good/bad dichotomy, when it is clearly far more complex than that.

But we already have two public options, and it is a contrast of the good and the bad with the healthcare profession. But it does illustrate the fundamental issue in our healthcare system: that doctors treat insurance cards and not patients.

I agree it is not a simple issue, but the blame falls directly on the healthcare industry. They over treat one segment of the population, the aging, and they abandon treatment for the young.

The fact that hospitals can have non-profit status is laughable. They set rates, which nobody pays, and then write off what medicare does not pay as donated services. And then they hold health fairs and write that off as donated services. ( at the inflated rates ). Yet they over treat every old person who rolls in an out of the facility on a daily basis and keep racking up write-offs.

We ration care already. But we don't ration care for the oldest, we do it to those on the other public option: medicaid.

Do you know a person is cured and can leave the hospital? When the visit hits the medicare limit.

 

[Proton Soup]

I didn't realize I constituted everyone, but okay. The missed opportunity is that they had a chance to pass what they proposed, and still didn't. Is our system that corruptable that a party with a majority can persuade themselves out of passing their own agenda?

That is what they ran on, and Obama had enough good will and popularity that he could have passed any law he wanted, in his own fashion. The missed opportunity is that his inaction and lack of leadership doomed his own agenda.

And the status quo of healthcare in this country is seriously flawed, and it does not take a phd to realize that fact.

I have no pet ideas, just many examples of how flawed our healthcare system actually is.

The problem is that there is no happy middle ground in our system. Everything is driven by profit. Even something as simple as medical records privacy is compromised by lobbyist, so drug companies know how many scrits each doctor is writing so they can give kickbacks. Read the HIPPA laws, the receptionist in your HR department has better access to your spouse's medical records that you do. And better access to your own medical records.

There is not one aspect of the healthcare system that is not tainted by profit.

And I am actually not for Medicare, because that is golden cash cow of the medical industry.

So don't make assumptions.

yeah, i don't think Obama et al. really ever got much further than slogans, like "change" and "status quo". whatever opportunity they might have had to have a real public debate on the issue was squandered, because in the end, there really is no change. it's government as usual with most deals made in back rooms. talking change is easy, but actually doing it is like herding cats.

i agree with you about the profit motive. the people who come out on top with nationalization are insurance companies. because they will be the ones administering the plan, with a more or less guaranteed percentage.

 

[mheslep]

Some context for predicting whether or not Medicare would reduce costs with everyone under its roof:

Year: Medicare cost ($billions)
1980: 34
1990: 107

2000: 216
2002: 254
2004: 297
2006: 374

2007: 432

2008: 461
2009: 501

2010: 521

www.kff.org/medicare/upload/7731.pdf
www.cbo.gov/budget/factsheets/2009b/medicare.pdf[/URL]

In those latter figures, add another $50-100B/year or so in eventual interest payments as ~half or more of that money is borrowed.

 

[talk2glenn]

Are you deliberately mis-stating my position for a reason? Putting words in my mouth doesn't elevate your argument any more than the ad-hom attacks. If you have a cogent, defensible point of view, you shouldn't have to resort to dishonesty.

You could not charge rates sufficiently high for Medicare to both be competitive relative to private options and simultaneously solvent, as I already said in my response to your later post which linked an article suggesting higher rates could somehow make this idea less insane. There is no mechanism for making this work in fiscal reality. It is a subsidy program. By definition, benefits payments exceed premium collections.

Expanding access to the program would not help anyone except, in the short-run, the individuals given access to the subsidized rates (and they're only helped if the rates they pay are lower than the rates they would have to pay on the open market, obviously). It certainly would not give any conceivable benefit to the healthcare system in the United States, which is already plagued by excessive institutional benefits that offset consumer cost and discourage responsible use of a scarce resource, pushing up prices for everyone.

It would bankrupt Medicare absent a dramatic increase in payroll taxes, increase medical costs, and seriously damage the viability of the private system (moreso than the government already has through ongoing rounds of increasingly onerous and nonsensical regulations). And the individuals who "opt in" to Medicare (love that - you'd have a lot of choice when Aetna goes broke because government deliberately undercuts market rates and covers the losses with public money) would end up with an inferior product that was desgined to cater to the needs of the old and the dieing, not the healthy, the young, and the profitably insurable.

Insane. I never thought I'd see the day.

If single payer, monopolized health care is what you want, at least be intellectually honest and say so. Don't pretend that you can "expand access" to Medicare on an "opt in" basis. This is nonsense, and would never seriously be considered by Dennis Kucinich, let alone the broader Congress, which is why it never gets further than the editorial pages of some obscure Dallas newspaper.