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Comment by redis_mlc | Hacker News Reader

> This isn’t quite Medicare for all

Why not have "Medicare for all"?

Like every other Western country.

My impression is that medicare for all covers people, and reinsurance covers insurance companies. A huge danger would be that the premiums would be insufficient, and it would become a taxpayer bailout program. Spreading a cost over the population doesn't necessarily mean it's a reasonable cost.

Perhaps a middle ground is to have it like the FDIC, which covers depositors not banks. As I understand it, if a bank goes under, the FDIC takes it over and runs it until a suitable buyer can be found.

That isn’t true though. Switzerland has a much better predecessor version of the ACA: everyone is required to buy insurance (with subsidies for those that can’t). They got rid of the group market so everyone is in the same risk pool, which is an improvement over our system. However, Switzerland has the second highest healthcare costs when comparing developed countries in a per capita basis.

AFAIK every other rich country regulates some or all medical costs per procedure or what have you (that is, they have price controls). Some do it directly and others by establishing a monopsony on buying healthcare, but that and a good fall-back insurance provider (or a system set up such that one isn’t needed as everyone’s basically already on it) seem to be the common necessary ingredients in keeping costs sane and everyone covered, as far as I can tell.

Sure, I can agree with that. But many countries have hybrid systems that mix public and private insurance (Netherlands?) and then add it in a bunch of regulation and control to keep things sane.

I’m not really sure what health insurer roles are in Switzerland, since the cantons heavily regulate premiums and care. Maybe a Swiss could make light of the situation.

When you actually look at any of these systems, you find there is such great government control of these nominally "private" insurers that it's effectively Medicare-for-All.

All insurance offered at a standard price, subsidized by government, that covers the exact same things by law for every single person and can't be cancelled... who cares whether you're nominally dealing with the government or a private entity?

"Quality Federal Health Insurance for all" = yes "Medicare for all" = Terrible idea

Medicare is insufficient coverage. Almost all folks on Medicare need supplemental insurance, or a state plan to actually get the care they need. Medicare under pays on claims, typically under the costs of providing care. Every industry group, union, medical association, who has looked at all the various plans has said it would lead to more hospital bankruptcies, particularly in rural areas.

Now, if you want to break the current system and force a government take over of the whole system it's not a bad idea, but selling it as something that would give folks the care they need is very disingenuous.

Medicare for All isn’t an extension of existing Medicare benefits to everyone, it’s an expansion of those benefits, for everyone, under a single-payer system.

https://www.vox.com/2019/4/10/18304448/bernie-sanders-medica...

You didn't understand what the person you replied to said, and he's right.

Medicare is NOT good insurance. Its reimbursement rates for hospitals is lower than their costs, and it doesn't fully cover people, it only covers 80%.

Like the person you replied to said: Most people on Medicare need to buy supplemental private insurance - it's called Medicare Advantage, and it may be government funded.

We need good insurance, and Medicare is NOT good insurance.

They clearly did understand what they said. The "Medicare for All" proposals do not simply extend existing Medicare benefits to everyone, they also expand what Medicare covers for the people it covers.

I understood perfectly and they and you are both incorrect. Medicare for All is not Medicare, it expands and closes the gaps in coverage under the current regime using a single payer system (which is not even really a form of “insurance” to begin with).

Because such a system would require years of refinement and I don't want to sacrifice my health while the government figures it out.

Public option is a fine transition.

Because the problem isn't on the payment side of health insurance, it's on the cost side.

So Medicare for all will solve nothing.

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