The way forward is *Medicare Extra*. Neera Tanden's "Social Contract for the 21st Century"

[ehrnst]

26. I know four people who are on all three.

One in South Carolina only uses TriCare for glasses because she's not near a facility, so she relies more on Medicare and Medicaid, and my Grandfather juggles some health care locally with Medicare and Medicaid, and has some procedures at the VA hospital an hour's drive away.

One basis for the funding mechanism for Medicare is that the vast majority of those funding it are not eligible to use the services. That would change if everyone was put on it.

So your claim, "We can afford" to move everyone, based on this 40% number, to it isn't quite accurate or based in an understanding of how Medicare and Medicaid are funded. You state that you aren't an economist, and you make declarations on complex economic issues based on "it seems..." and "a personal belief." It's important to understand what you don't understand.

Medicaid is primarily administered at the state level, much like Canada, so the affordability and access to care of it varies widely. The vast majority of countries with universal health coverage do not use single payer, but a hybrid of payers and administrators, usually involving some involvement by private non-governmental entities.

Much of the savings involves cost controls, and it's much easier to hold down costs over a period of 75 years than it is to cut them to get to that rate in 4 years despite the promises of politicians running for office. One cost is the negotiation process for insurance companies to determine their discount.

One example of cost cutting is Maryland's "one price for everyone" las that requires hospitals and providers to charge one price to everyone - large pools, Medicare, small pools and individuals, eliminating the expense of negotiating. That has brought down prices without harming health care delivery.

"I am not an economist but it seems that much of the savings comes from cutting out the middleman, insurance companies." "It is my personal belief that it can be done without raising taxes on the lower or middle class and not a large increase on the upper class."

Every country with universal health care coverage utilizes private entities to provide some health care cost administration. They are heavily regulated, however, they are government contractors used when the government does not think they can perform that function efficiently. Canada relies on private companies, as does Medicare does to administer dental and other insurance coverage. Canada also didn't go single payer federally until all the provinces had done so independently, which took decades. Then in the 60's, a very liberal government added a federal layer to make it portable, but they were still tweaking and updating it in the 80's. That's not going to happen here, as the failures of Vermont, Colorado and California to implement their own single payer has shown. It's still run primarily at the province level, and not at the federal level like Medicare, or the proposed Medicare for All - and doesn't cover nearly the services that M4A promises to, and they still pay around 10% of their income on out of pocket health expenses. Promises and opinions always work perfectly until they are put into action.

Health care reform is far more complicated than some politicians would have you believe, especially when they are running for office. This explains it better:

https://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/