Reply to How would you feel about losing your company-provided health insurance for "medicare for all"?

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[quote=Anonymous]As a fed with decent insurance, I'm nervous.  But, as someone who has had to worry about getting coverage several times in my life, I think Medicare-for-All could do a lot of good.

The devil is in the details.  I don't think Medicare-for-All will be cheaper or better for me- at least, not initially.  But we're not on a sustainable path right now, and I've (hopefully) got a lot of years ahead of me.  Moving to a single payer system looks inevitable, or at least almost certainly better than any other plausible outcome.  So, I'd be OK ripping off the bandaid now, even if that means moving to something that's initially worse than what I have.  But, there's a limit to how much worse I'd tolerate...

The thing is, I can't really tell how any proposals on health care would work.  Bernie's Medicare for All plan seems like the most clear.  It would certainly result in higher taxes for me, although not by that much when you offset them with insurance premiums.  But, I really wonder how employers would deal with the huge cost shift into taxes, and I suspect a lot of them would end up taking advantage of this change to shift more of the cost burden on employees.  I'm also skeptical that even his long list of proposed tax changes would be enough to pay for it.  And then there's the obvious problem: that's it has zero chance of passing.

A public option, like Buttigieg has proposed, seems more politically tractable, but it's a lot less clear how that would work.  It would almost certainly suffer from severe adverse selection compared to employer-sponsored group plans, so it would need to be subsidized in some way to keep the costs reasonable.  If the subsidies are only based on income, then it's not going to work well for higher-income people.  If the subsidies are across-the-board, then there will be never-ending debates over whether the public option if competing fairly with private insurance.

I used to think a public option was the way to go, but I just don't see how you design it fairly.  And if it's not fair, it's not stable.  I've never been able to figure out how other countries with universal healthcare based on private insurance handle this.  I also don't think it would create a good situation to have most well-off people on private group insurance, with mainly the poor on the public option.  That's how you end up with something crappy like Medicaid.[/quote]

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