General Discussion
In reply to the discussion: Incredible: Single Payer way more popular than ObamaRomneyCare. [View all]Yo_Mama
(8,303 posts)The reason it can't work is that then you would have adverse selection - the group of people for whom insurance is relatively cheap would not buy Medicare, and the people who badly need insurance and can only get it a very high price would buy into Medicare. That would inevitably either drive Medicare premiums up or bankrupt the system.
The reason Congress passed the individual mandate is not because they were stupid - it's because any non-universal system has to charge significantly higher premiums.
If you wanted to buy into Medicare, this year it would cost $451 for hospital insurance each month, plus $99.90 for outpatient. That's an 80/20 coverage. It would cost extra for any prescription coverage, and it doesn't include dental, eye etc. There are deductibles. The cost was actually higher last year, but in part that was due to non-processing of payments, so next year the premiums will go up.
So most people would pay at least $600 a month for the basics - physician/outpatient/basic prescription coverage. There is no cap really on out-of-pocket expenses, and some items, such as most orthopedics, aren't covered at all. For many this would be unaffordable - try paying that if you earn $300-$400 a week, gross. If you earn 20K a year, after FICA/SECA (old style) plus federal tax, your monthly after tax income is about $1,440 a month, without figuring state tax. It would be very hard to pay $600 a month out of that, or even the $550 without prescription benefits. So a very substantial pool of pretty healthy people couldn't buy in.
That would be a really good deal for some people and not a good deal for groups of younger people, so it is likely that mostly the really sick would buy into Medicare, and that would drive premiums up.
If you actually had Medicare for all, of course pulling in significantly healthier groups of people would tend to control overall costs in relation to overall revenues.