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>Do Medicare recipients seek to leave it? No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typ

>Do Medicare recipients seek to leave it? No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typically add on additional coverage, an indicator that Medicare alone is not enough for a large segment of the population, or that they prefer a private insurer even with government subsidization. https://www.kff.org/medicare/fact-sheet/medicare-advantage/ https://www.kff.org/medicare/fact-sheet/medicare-advantage/

sykh 9y ago
Excellent. We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it. Perhaps the idea that everyone be covered in such a system is not so far fetched.
- chimeracoder 9y ago
  > We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it. People literally are leaving it, to the fullest extent that they legally can. It's not a small number, either. About 40% of Medicare patients aren't on the government-run system at all, and that number has consistently grown over the years.
  - Clubber 9y ago
    They supplement it, I don't believe they are leaving it, unless they are wealthy and can afford to pay out of pocket because they want to use a doctor that is not participating in the medicare program. Do you have a cite?
    - chimeracoder 9y ago
      > They supplement it, I don't believe they are leaving it, unless they are wealthy and can afford to pay out of pocket because they want to use a doctor that is not participating in the medicare program. Do you have a cite? No, this is wrong. Private Medicare plans fully replace Original Medicare. If you are on a privately-managed Medicare plan, you receive none of your benefits from Original Medicare (the government-run program). Unfortunately, you're still subject to some of the care delivery restrictions that Medicare sets, which means people moving from privately-managed plans (without Medicare) to Medicare Advantage (privately-managed Medicare plans) will typically experience a drop in coverage, because private insurers tend to be more forgiving with these limits. > they want to use a doctor that is not participating in the medicare program I'm not sure what you're referring to here. Though yes, one of the big advantages of Medicare Advantage is that it's dramatically easier to find in-network providers, even for Medicare Advantage plans that don't cost anything out-of-pocket above what Original Medicare does.
      - Clubber 9y ago
        My mother is supplementing her medicare with insurance. GAP insurance is I think what she calls it. I mean I'm sure what you are describing exists, but it's not universal.
        chimeracoder 9y ago
        > My mother is supplementing her medicare with insurance. GAP insurance is I think what she calls it. I mean I'm sure what you are describing exists, but it's not universal. I am talking about Medicare Advantage. Medigap is different. What I am talking about isn't "universal", but it's what about 40% of Medicare patients use in 2018. It's not universal because people have to choose to opt into Medicare Advantage, but it's an option for everyone: everyone[0] who's eligible for Original Medicare is eligible for Medicare Advantage. [0] well, there are a couple of small exceptions, but I'm 100% sure your mom doesn't fall into those categories, based on what you've already said
      - ScottBurson 9y ago
        > No, this is wrong. Private Medicare plans fully replace Original Medicare. Uh, no. "Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans." [0] So although the Advantage plans are privately managed, the premiums are subsidized. I don't think this counts as "leaving" Medicare. [0] https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html https://www.medicare.gov/sign-up-change-plans/medicare-healt...
        chimeracoder 9y ago
        > Uh, no. "Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans." [0] So although the Advantage plans are privately managed, the premiums are subsidized. I don't think this counts as "leaving" Medicare. By that logic, there's no way to leave Medicare, because you can't stop paying taxes for it or "disable" your eligibility for it (and all of the restrictions that Medicare eligibility brings for people on private insurance). People leave Medicare to the full extent allowed by law. Unless you want to claim that people using school vouchers for private schools is a demonstration of their satisfaction with the public school system in their area, you can't view their use of Medicare Advantage as a demonstration of their satisfaction with Original Medicare either.
- Andre_Wanglin 9y ago
  Why would anyone refuse free money? Are you sure you understand the parent's point? They are taking the money but using private networks, which indicates they prefer private providers.
  - sykh 9y ago
    In the absence of Medicare/Medicaid there would not be universal coverage for the elderly. The elderly do not advocate dismantling this coverage. The coverage is a government program. We are in agreement that a U.S. government program can cover lots of people and maintain the property that those people don’t want to the program to be dismantled. It’s not, then, hard to imagine everyone being covered by such a program.
    - Andre_Wanglin 9y ago
      I did not support the ACA but I use the healthcare exchange because it is in my best interest to do so. I get free money from others to pay for my family's health insurance. In fact, I get a 100% subsidy. But the reason I get a 100% subsidy is because I am affluent enough to live comfortably on only a small portion of my income and funnel the rest into tax-advantaged accounts that reduce my AGI to a fraction of my actual income. It would thus not be in my interest to advocate the ending of the ACA. This is the same reason the elderly (who are the wealthiest cohort) do not wish to see Medicare/Medicaid dismantled. But is this what's best for society? Everyone gaming the system to benefit at the expense of everyone else?
      - sykh 9y ago
        I feel sorry for you that you think this way. There’s a reason Medicare came into being. It simply isn’t profitable to treat people near the end of their lives. One illness, calamity is enough to wipe out a lifetime of savings and leave one penniless. The absence of a government program for providing healthcare to the elderly would be horrific and immoral. Some things ought not be profit driven. You wish to make our already horrible system into something worse. I’m glad your view does not prevail. I would hate to live in a country in which the majority shared this opinion.
chimeracoder 9y ago
> No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typically add on additional coverage They don't simply add on coverage; they replace it. Most people on Medicare Advantage don't opt for coverage above what Medicare itself can provide - they simply receive their benefits from a private entity instead of Medicare, because Medicare provides such a bad experience for patients.
- sykh 9y ago
  Private entities contract with Medicare to provide insurance that covers what Medicare covers (and perhaps more). Would said insurers cover everyone that Medicare covers in the absence of Medicare? The answer is no. How many of these people on private Medicare plans pay for Medigap? Everyone who get kicked off a private plan can go back to the original Medicare. Your point is disingenuous. Medicare is the universal insurer of last resort for elderly. Their lives would be much worse without this last resort insurer.
  - chimeracoder 9y ago
    > Medicare is the universal insurer of last resort for elderly. Their lives would be much worse without this last resort insurer That's a far cry from "people don't seek to leave Medicare", which is literally the original claim. By and large, people do seek to leave it, to the extent that they can, both legally and financially. Yes, for people who can't access anything better, having Medicare is better than literally nothing, but nobody's arguing that. That doesn't mean that Medicare provides a good model of what would best suit everyone else, and that's the relevant question when talking about a single-payer system. If you want to talk about a single-payer system and use Medicare as an example in support of it, you have to address the fact that privately managed plans consistently outperform Medicare on the top three performance indicators, and that patients themselves prefer all the alternatives to Medicare except "no coverage at all".
- ScottBurson 9y ago
  You've repeated this claim in several places so I'll just link to my rebuttal: https://news.ycombinator.com/item?id=16979565 https://news.ycombinator.com/item?id=16979565 While you may have a good argument against a "single-manager" health care system, this doesn't seem like an argument against a single-payer system. In fairness, I guess a lot of existing universal-coverage systems, such as the UK's NHS, are also single-manager (someone will correct me if I'm mistaken), but the very existence of Medicare Advantage shows an alternative possibility. I think that, far from being an argument against single-payer, it shows how single-payer can be made to work even better, through premium subsidies (and, I would guess, reinsurance for catastrophic losses) to private insurance companies, for those who are willing and able to pay additional premiums for better care.

sykh 9y ago

Excellent. We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it. Perhaps the idea that everyone be covered in such a system is not so far fetched.

chimeracoder 9y ago
> We are in agreement that the American government can and does provide a health insurance program that covers lots of people and has the property that people don’t seek to leave it. People literally are leaving it, to the fullest extent that they legally can. It's not a small number, either. About 40% of Medicare patients aren't on the government-run system at all, and that number has consistently grown over the years.
- Clubber 9y ago
  They supplement it, I don't believe they are leaving it, unless they are wealthy and can afford to pay out of pocket because they want to use a doctor that is not participating in the medicare program. Do you have a cite?
  - chimeracoder 9y ago
    > They supplement it, I don't believe they are leaving it, unless they are wealthy and can afford to pay out of pocket because they want to use a doctor that is not participating in the medicare program. Do you have a cite? No, this is wrong. Private Medicare plans fully replace Original Medicare. If you are on a privately-managed Medicare plan, you receive none of your benefits from Original Medicare (the government-run program). Unfortunately, you're still subject to some of the care delivery restrictions that Medicare sets, which means people moving from privately-managed plans (without Medicare) to Medicare Advantage (privately-managed Medicare plans) will typically experience a drop in coverage, because private insurers tend to be more forgiving with these limits. > they want to use a doctor that is not participating in the medicare program I'm not sure what you're referring to here. Though yes, one of the big advantages of Medicare Advantage is that it's dramatically easier to find in-network providers, even for Medicare Advantage plans that don't cost anything out-of-pocket above what Original Medicare does.
    - Clubber 9y ago
      My mother is supplementing her medicare with insurance. GAP insurance is I think what she calls it. I mean I'm sure what you are describing exists, but it's not universal.
      - chimeracoder 9y ago
        > My mother is supplementing her medicare with insurance. GAP insurance is I think what she calls it. I mean I'm sure what you are describing exists, but it's not universal. I am talking about Medicare Advantage. Medigap is different. What I am talking about isn't "universal", but it's what about 40% of Medicare patients use in 2018. It's not universal because people have to choose to opt into Medicare Advantage, but it's an option for everyone: everyone[0] who's eligible for Original Medicare is eligible for Medicare Advantage. [0] well, there are a couple of small exceptions, but I'm 100% sure your mom doesn't fall into those categories, based on what you've already said
    - ScottBurson 9y ago
      > No, this is wrong. Private Medicare plans fully replace Original Medicare. Uh, no. "Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans." [0] So although the Advantage plans are privately managed, the premiums are subsidized. I don't think this counts as "leaving" Medicare. [0] https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html https://www.medicare.gov/sign-up-change-plans/medicare-healt...
      - chimeracoder 9y ago
        > Uh, no. "Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans." [0] So although the Advantage plans are privately managed, the premiums are subsidized. I don't think this counts as "leaving" Medicare. By that logic, there's no way to leave Medicare, because you can't stop paying taxes for it or "disable" your eligibility for it (and all of the restrictions that Medicare eligibility brings for people on private insurance). People leave Medicare to the full extent allowed by law. Unless you want to claim that people using school vouchers for private schools is a demonstration of their satisfaction with the public school system in their area, you can't view their use of Medicare Advantage as a demonstration of their satisfaction with Original Medicare either.
Andre_Wanglin 9y ago
Why would anyone refuse free money? Are you sure you understand the parent's point? They are taking the money but using private networks, which indicates they prefer private providers.
- sykh 9y ago
  In the absence of Medicare/Medicaid there would not be universal coverage for the elderly. The elderly do not advocate dismantling this coverage. The coverage is a government program. We are in agreement that a U.S. government program can cover lots of people and maintain the property that those people don’t want to the program to be dismantled. It’s not, then, hard to imagine everyone being covered by such a program.
  - Andre_Wanglin 9y ago
    I did not support the ACA but I use the healthcare exchange because it is in my best interest to do so. I get free money from others to pay for my family's health insurance. In fact, I get a 100% subsidy. But the reason I get a 100% subsidy is because I am affluent enough to live comfortably on only a small portion of my income and funnel the rest into tax-advantaged accounts that reduce my AGI to a fraction of my actual income. It would thus not be in my interest to advocate the ending of the ACA. This is the same reason the elderly (who are the wealthiest cohort) do not wish to see Medicare/Medicaid dismantled. But is this what's best for society? Everyone gaming the system to benefit at the expense of everyone else?
    - sykh 9y ago
      I feel sorry for you that you think this way. There’s a reason Medicare came into being. It simply isn’t profitable to treat people near the end of their lives. One illness, calamity is enough to wipe out a lifetime of savings and leave one penniless. The absence of a government program for providing healthcare to the elderly would be horrific and immoral. Some things ought not be profit driven. You wish to make our already horrible system into something worse. I’m glad your view does not prevail. I would hate to live in a country in which the majority shared this opinion.

chimeracoder 9y ago

> No, because it's free, but 1/3 of Medicare recipients opt to receive their coverage through private insurers that typically add on additional coverage They don't simply add on coverage; they replace it. Most people on Medicare Advantage don't opt for coverage above what Medicare itself can provide - they simply receive their benefits from a private entity instead of Medicare, because Medicare provides such a bad experience for patients.

sykh 9y ago
Private entities contract with Medicare to provide insurance that covers what Medicare covers (and perhaps more). Would said insurers cover everyone that Medicare covers in the absence of Medicare? The answer is no. How many of these people on private Medicare plans pay for Medigap? Everyone who get kicked off a private plan can go back to the original Medicare. Your point is disingenuous. Medicare is the universal insurer of last resort for elderly. Their lives would be much worse without this last resort insurer.
- chimeracoder 9y ago
  > Medicare is the universal insurer of last resort for elderly. Their lives would be much worse without this last resort insurer That's a far cry from "people don't seek to leave Medicare", which is literally the original claim. By and large, people do seek to leave it, to the extent that they can, both legally and financially. Yes, for people who can't access anything better, having Medicare is better than literally nothing, but nobody's arguing that. That doesn't mean that Medicare provides a good model of what would best suit everyone else, and that's the relevant question when talking about a single-payer system. If you want to talk about a single-payer system and use Medicare as an example in support of it, you have to address the fact that privately managed plans consistently outperform Medicare on the top three performance indicators, and that patients themselves prefer all the alternatives to Medicare except "no coverage at all".
ScottBurson 9y ago
You've repeated this claim in several places so I'll just link to my rebuttal: https://news.ycombinator.com/item?id=16979565 https://news.ycombinator.com/item?id=16979565 While you may have a good argument against a "single-manager" health care system, this doesn't seem like an argument against a single-payer system. In fairness, I guess a lot of existing universal-coverage systems, such as the UK's NHS, are also single-manager (someone will correct me if I'm mistaken), but the very existence of Medicare Advantage shows an alternative possibility. I think that, far from being an argument against single-payer, it shows how single-payer can be made to work even better, through premium subsidies (and, I would guess, reinsurance for catastrophic losses) to private insurance companies, for those who are willing and able to pay additional premiums for better care.