Why not let people above the Medicaid income threshold buy Medicaid?

[Yavin4]

They can just select to have additional money taken out of their check or they can just pay into it through their income taxes.

Doesn't that solve the problem?

[scheming daemons]

1. That's basically Medicare-for-All and it is what 90% of Democrats want.

We have to sell it.

[marylandblue]

2. They probably wouldn't be able to afford it

[exboyfil]

3. Single payer income based withholding

like the Germans. Aggressive negotiation with the providers (hospitals, physicians, and drug companies).

Single federal plan bringing all federal entities into it. Also anyone not provided health insurance by employer must be in this plan. Carrot and stick to move employers into as well.

Germans do it with 7.5%/7.5% of withholdings.

Some consideration for copays to dissuade frequent flyers and not using the lowest cost alternative (clinic vs. ER for example).

[MichMary]

4. Many docs don't accept Medicaid

because the reimbursement is so low.

[Wounded Bear]

6. Yeah, well rates are set by Congress...

so who's fault is that?

Fix that, and perhaps index it to inflation and Medicaid would be fine.

[Yavin4]

8. Okay, you can negotiate higher rates or reimbursement with the additional money that people are

paying into the system.

[stopbush]

5. No one buys Medicaid. They buy Medicare.

Medicaid costs nothing for those who qualify for it, at least while they are living. One of the quirks of Medicaid that never gets talked about is the fact that the government can come after the estate of a deceased Medicaid patient and seek reimbursement for services rendered.

So, the solution would be to alow people to buy into Medicare. That would cost an average of $110 per person per month.

[democrattotheend]

7. I'd rather let them buy into Medicare

I think most people who make too much to be eligible for Medicaid would prefer to buy into Medicare. The advantage of Medicaid is that it has lower out of pocket costs for patients, but the downside is that a lot of doctors don't accept it because the reimbursement rates are too low, and the doctors who do take it may be good doctors, but it can be difficult to get an appointment and there are often long waiting times to be seen because they either overbook or tell everyone to come at the same time and wait all day. And in some areas it is difficult to find any doctors in certain specialties who take Medicaid.

I also think a Medicare buy in is easier to sell because Medicare is popular and doesn't have the same stigma associated with it as programs that subsidize the poor do. Letting younger people buy into Medicare might also help resolve the projected funding deficit with Medicare as more boomers retire.

In an ideal world, we would eventually do away with Medicaid and let everyone buy into Medicare for a percentage of their income, and make it free or almost free for the very poor. That way we wouldn't have a two-tiered system like we do now.

IMO, Democrats in 2009 and 2010 made a mistake by pushing a "public option" instead of a Medicare buy-in. Unfortunately, Republicans have made the word "public" a dirty word to a lot of people, whereas Medicare is a popular brand. It would have also drawn on the existing infrastructure of a program that works instead of creating a whole new system.

[Yavin4]

9. Tomato - Tomahto n/t

Okay fine. Let folks buy into Medicare.

[Lee-Lee]

10. Looks like in NC the average spending per Medicare patient is just over $10,000 per year

If we assume that your typical person buying in optionally will have the same burden to the system then they will need to pay a premium of that much to have the idea break even.

And on top of that they will need their supplemental plans to go with it.

So your looking at a person paying around $12,000 a year in premiums for the math to work out extending Medicaid optionally and covering the cost with premiums. Now it could be argued that it would be younger people with fewer expenses buying in than your average recipient now, but it could also be that the people with the most difficult cases who can't find coverage anywhere else will be the ones buying in and things would be more expensive. You won't know until it's down.

That's why an optional buy-in won't work. It would require either crazy high premiums or increased taxes to pay for subsidies for those buying in, and people are too greedy to go for subsidies for other people. You have to force everyone in at once or by groups by gradually lowering the age to make it the same across the board for it to be politically viable here.

[Nevernose]

11. Because the governor of NV will veto it

Hey Gov Sandoval: fuck you.