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> The only reason you say that is that you haven't actually experienced Medicare. I have experienced Medicare (along with pre- and post-ACA Gold level individu

> The only reason you say that is that you haven't actually experienced Medicare. I have experienced Medicare (along with pre- and post-ACA Gold level individual marketplace plans, small group plans, premium employer-sponsored plans, and Medicaid). The only system I’ve experienced which is better than Medicare was my state’s Medicaid system. Every private insurance plan I’ve had has been significantly worse in every metric—more expensive, less coverage, super stressful (imaging having a kidney stone and having to decide whether to spend $300 + coinsurance to go to the emergency room on a Sunday night or wait in excruciating pain until you can get an appointment for a $10 office visit instead the next day). On Original Medicare with a Medigap plan I pay $377/mo in premiums and have 100% coverage for hospitals, doctors, surgeries, ambulances. There are no provider restrictions. The “coverage area” is the whole country. Outpatient services in hospitals is fine. There’s no arguing over billing, no copays, no coinsurances, no hassle. Drug coverage is a whole different thing, but it sucks about as much as it did with private insurance—which it would, since Part D is just a marketplace of private insurers! Notably, though, any drugs I get in a clinic, like super expensive biologics, are covered under Original Medicare for that $377 premium. What is your experience that makes you think so differently?

ars 7y ago
I completely agree that Medicaid is the best one of all. But I need to point out that (at least in my state) Medicaid is simply contracted out to local insurers, it is not run by the government. It's the fact that you need to buy a medigap plan that is exactly the problem. Those plans are not available to everyone. And you have to buy private insurance to fix what the government doesn't do right. Medicare Advantage is the same exact thing: you have to buy private insurance and the one the government offers is terrible. So basically your experience exactly confirms what I said. Medicare for all is not a good plan. Medicare Advantage for all however is a good plan. And Medicare Advantage is simply private insurance companies that are paid by the government. And personally I think that's the best option. Leave it as private insurers, but let the government give every family an allowance to help pay for it or even pay for it entirely.
- csnover 7y ago
  Thank you for sharing your thoughts with me. > It's the fact that you need to buy a medigap plan that is exactly the problem. Those plans are not available to everyone. I’m not sure I understand this comment. There is a guaranteed issuance period after you become eligible for Medicare. Several states also either have permanent guaranteed issuance periods, or annual guaranteed issuance enrolment periods. What do you mean when you say the plans are not available to everyone? > And you have to buy private insurance to fix what the government doesn't do right. Sure, but supplemental insurance exists in Canada and the UK too, even though those care systems are quite good. Most people don’t need it because the basic services are comprehensive and reasonable. A Medicare for All plan just needs to offer the same level of service that you see in other universal health care systems. > Medicare for all is not a good plan. There are multiple plans that are described as “Medicare for All”. Which specific version of this concept do you think is bad? Why? > Leave it as private insurers, but let the government give every family an allowance to help pay for it or even pay for it entirely. The main thing I don’t understand about this approach is where cost savings and improved patient experience are supposed to come from. Having multiple insurers means that all the billing and administrative overhead costs continue to exist. Insurers will demand a profit margin on top of the actual cost of providing services. We’ll still have the restricted networks and copays and coinsurances and denials and appeals and prior authorisations and formulary exceptions and annual enrolments that make navigating care in the U.S. a nightmare. Can you explain how you think these problems would be mitigated under a “Medicare Advantage for All” type system?

ars 7y ago

I completely agree that Medicaid is the best one of all. But I need to point out that (at least in my state) Medicaid is simply contracted out to local insurers, it is not run by the government. It's the fact that you need to buy a medigap plan that is exactly the problem. Those plans are not available to everyone. And you have to buy private insurance to fix what the government doesn't do right. Medicare Advantage is the same exact thing: you have to buy private insurance and the one the government offers is terrible. So basically your experience exactly confirms what I said. Medicare for all is not a good plan. Medicare Advantage for all however is a good plan. And Medicare Advantage is simply private insurance companies that are paid by the government. And personally I think that's the best option. Leave it as private insurers, but let the government give every family an allowance to help pay for it or even pay for it entirely.

csnover 7y ago
Thank you for sharing your thoughts with me. > It's the fact that you need to buy a medigap plan that is exactly the problem. Those plans are not available to everyone. I’m not sure I understand this comment. There is a guaranteed issuance period after you become eligible for Medicare. Several states also either have permanent guaranteed issuance periods, or annual guaranteed issuance enrolment periods. What do you mean when you say the plans are not available to everyone? > And you have to buy private insurance to fix what the government doesn't do right. Sure, but supplemental insurance exists in Canada and the UK too, even though those care systems are quite good. Most people don’t need it because the basic services are comprehensive and reasonable. A Medicare for All plan just needs to offer the same level of service that you see in other universal health care systems. > Medicare for all is not a good plan. There are multiple plans that are described as “Medicare for All”. Which specific version of this concept do you think is bad? Why? > Leave it as private insurers, but let the government give every family an allowance to help pay for it or even pay for it entirely. The main thing I don’t understand about this approach is where cost savings and improved patient experience are supposed to come from. Having multiple insurers means that all the billing and administrative overhead costs continue to exist. Insurers will demand a profit margin on top of the actual cost of providing services. We’ll still have the restricted networks and copays and coinsurances and denials and appeals and prior authorisations and formulary exceptions and annual enrolments that make navigating care in the U.S. a nightmare. Can you explain how you think these problems would be mitigated under a “Medicare Advantage for All” type system?