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> Social Security and Medicare seem notable counterexamples, neither is local, and neither is laissez-faire. Medicare and Medicaid are both a lot more laissez-

> Social Security and Medicare seem notable counterexamples, neither is local, and neither is laissez-faire. Medicare and Medicaid are both a lot more laissez-faire than people realize. 40% of all Medicare patients are on Medicare Advantage plans - ie, plans that are privately managed by brand-name health insurers that sell private insurance. And this understates the number of Medicare patients who utilize private insurance in one way or another, because (a) Medicare Advantage patients represent a disproportionate amount of utilization of care by Medicare patients, and (b) some Medicare patients are eligible for dual-coverage (so they "have" Medicare, but they use a privately-purchased health plan for all of their actual medical needs). Incidentally, to address the original argument, Medicare Advantage patients are the ones who report higher satisfaction with their health care.

deleted 11y ago
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dragonwriter 11y ago
> Medicare and Medicaid are both a lot more laissez-faire than people realize. You seem to be using "laissez-faire" to mean "private businesses are involved, regardless of the degree of government regulation". This is an unusual use of the term. > 40% of all Medicare patients are on Medicare Advantage plans - ie, plans that are privately managed by brand-name health insurers that sell private insurance. And very significantly regulated -- in who they are sold to, what they must cover, and various other things -- by the government, as well as the premiums being subsidized by the government. This is not "laissez-faire" by any normal definition. > And this understates the number of Medicare patients who utilize private insurance in one way or another, because (a) Medicare Advantage patients represent a disproportionate amount of utilization of care by Medicare patients, and (b) some Medicare patients are eligible for dual-coverage (so they "have" Medicare, but they use a privately-purchased health plan for all of their actual medical needs). And it overstates the degree to which any of this is "laissez-faire", because not only is Medicare Advantage in general not "laissez-faire" as discussed above, but some Medicare Advantage plans are even more regulated as Medicaid/Medicare managed care plans (Dual-Eligible Special Needs Plans) into which beneficiaries eligible for both Medicaid and Medicare are either made eligible or outright assigned into by state Medicaid rules. Also, dual coverage does not mean they use a privately-purchased health plan for all their actual medical needs. Ignoring Medicaid/Medicare dual eligibility (where Medicare is primary and Medicaid potentially pays for costs not covered by Medicare), dual coverage with Medicare results in either Medicare being the primary payer and the other payer being secondary and potentially paying costs not covered by Medicare or Medicare being secondary to the other payer. [0] It doesn't mean either Medicare or the other plan is used exclusively. [0] https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Medicare-Secondary-Payer/Medicare-Secondary-Payer.html https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Re...

deleted 11y ago

[deleted]

dragonwriter 11y ago

> Medicare and Medicaid are both a lot more laissez-faire than people realize. You seem to be using "laissez-faire" to mean "private businesses are involved, regardless of the degree of government regulation". This is an unusual use of the term. > 40% of all Medicare patients are on Medicare Advantage plans - ie, plans that are privately managed by brand-name health insurers that sell private insurance. And very significantly regulated -- in who they are sold to, what they must cover, and various other things -- by the government, as well as the premiums being subsidized by the government. This is not "laissez-faire" by any normal definition. > And this understates the number of Medicare patients who utilize private insurance in one way or another, because (a) Medicare Advantage patients represent a disproportionate amount of utilization of care by Medicare patients, and (b) some Medicare patients are eligible for dual-coverage (so they "have" Medicare, but they use a privately-purchased health plan for all of their actual medical needs). And it overstates the degree to which any of this is "laissez-faire", because not only is Medicare Advantage in general not "laissez-faire" as discussed above, but some Medicare Advantage plans are even more regulated as Medicaid/Medicare managed care plans (Dual-Eligible Special Needs Plans) into which beneficiaries eligible for both Medicaid and Medicare are either made eligible or outright assigned into by state Medicaid rules. Also, dual coverage does not mean they use a privately-purchased health plan for all their actual medical needs. Ignoring Medicaid/Medicare dual eligibility (where Medicare is primary and Medicaid potentially pays for costs not covered by Medicare), dual coverage with Medicare results in either Medicare being the primary payer and the other payer being secondary and potentially paying costs not covered by Medicare or Medicare being secondary to the other payer. [0] It doesn't mean either Medicare or the other plan is used exclusively. [0] https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Medicare-Secondary-Payer/Medicare-Secondary-Payer.html https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Re...