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> 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 d

> 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 8y 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 8y 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 8y 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.
- Hozzle 8y ago
  The NHS is what is called a Beveridge style system. I think that is what you mean by single managed. Similar systems are used in Spain, the Nordics, etc. They are often managed at local levels though and may include private hospitals and treatment that gets reimbursed by the payer at the same level as public ones. The VA is an example of this type of system although other nations have far more oversight and performance control than the VA does. A competing setup is the Bismarck style of insurance company administered management, either for-profit or non-profit. Germany, the Nederland's, Switzerland, etc runs this sort of system. Always with a lot of legislation and safeguards to ensure that people do not fall outside the system. It is similar to the US employer-provided insurance setups. Other systems are National Insurance, as used in Canada and Japan. Similar to Medicare. Canada is fairly unique in its hostility to private provision. And then there is out of pocket, like rural Africa does it. That's basically like being uninsured and not qualifying for Medicaid. Thing is, the US accumulated massive bureaucracy and costs by h\trying to run every system at the same time with little attempt at standardization and lots of billing and gatekeeping. Everyone else picked one system and stuck with it, letting private providers fill in the gaps. (Except Canada for the last)
- chimeracoder 8y ago
  > 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. I don't think you understand how Medicare Advantage works. There's really nothing about it that suggests a single-payer system would work. The premiums are not subsidized. (Reimbursements are, but that's a separate matter.) Medicare is the fullest extent to which people can legally opt out of Medicare, short of claiming religious exemptions (rare), working for a foreign government while in the US (rarer and legally questionable for citizens), or surrendering US citizenship altogether (drastic). Medicare Advantage outperforms Original Medicare on the top performance indicators (medical outcomes, cost, patient satisfaction), though underperforms the same exact private insurers on those same metrics, despite the latttermost also being saddled with the burden of subsidizing Original Medicare reimbursements. If you still want to advocate for single-payer healthcare on philosophical grounds, okay. But from an empirical standpoint, Medicare is not the place to look for data to support that stance.

sykh 8y 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 8y 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 8y 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.

Hozzle 8y ago
The NHS is what is called a Beveridge style system. I think that is what you mean by single managed. Similar systems are used in Spain, the Nordics, etc. They are often managed at local levels though and may include private hospitals and treatment that gets reimbursed by the payer at the same level as public ones. The VA is an example of this type of system although other nations have far more oversight and performance control than the VA does. A competing setup is the Bismarck style of insurance company administered management, either for-profit or non-profit. Germany, the Nederland's, Switzerland, etc runs this sort of system. Always with a lot of legislation and safeguards to ensure that people do not fall outside the system. It is similar to the US employer-provided insurance setups. Other systems are National Insurance, as used in Canada and Japan. Similar to Medicare. Canada is fairly unique in its hostility to private provision. And then there is out of pocket, like rural Africa does it. That's basically like being uninsured and not qualifying for Medicaid. Thing is, the US accumulated massive bureaucracy and costs by h\trying to run every system at the same time with little attempt at standardization and lots of billing and gatekeeping. Everyone else picked one system and stuck with it, letting private providers fill in the gaps. (Except Canada for the last)
chimeracoder 8y ago
> 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. I don't think you understand how Medicare Advantage works. There's really nothing about it that suggests a single-payer system would work. The premiums are not subsidized. (Reimbursements are, but that's a separate matter.) Medicare is the fullest extent to which people can legally opt out of Medicare, short of claiming religious exemptions (rare), working for a foreign government while in the US (rarer and legally questionable for citizens), or surrendering US citizenship altogether (drastic). Medicare Advantage outperforms Original Medicare on the top performance indicators (medical outcomes, cost, patient satisfaction), though underperforms the same exact private insurers on those same metrics, despite the latttermost also being saddled with the burden of subsidizing Original Medicare reimbursements. If you still want to advocate for single-payer healthcare on philosophical grounds, okay. But from an empirical standpoint, Medicare is not the place to look for data to support that stance.