How much would 'medicare extra for all' cost

[Wesley_Clark]

@Caldazar

I doubt there’s an easy way to estimate how much it would cost to insure the currently-uninsured. Uninsured people are uninsured for a reason (relatively poor, have health issues, etc…). Sure, demographics of the uninsured population would tend to skew younger than the typical Medicare recipients, but you figure the uninsured would also cost more than equivalent persons who had coverage, on average. In the absence of granular demographics on the uninsured, my guess is you’d have to use a ballpark estimate of $7000-$8000 to be on the safe side.

My understanding is the uninsured are healthier on average, not less healthy. That is why they are uninsured, because a lot of them don’t think they need insurance.

America’s medical spending follows a power law distribution. 5% of people use up 50-60% of all medical spending, 20% of people use up 80% of medical spending. I would assume most of those people are already insured under medicare or medicaid.

So the uninsured should in theory be cheaper to cover.

[Caldazar]

@Wesley_Clark

My understanding is the uninsured are healthier on average, not less healthy. That is why they are uninsured, because a lot of them don’t think they need insurance.

The numbers vary depending on which data you use, but in general, the uninsured do not have health insurance primarily due to cost, not because they could theoretically afford the insurance but choose not to buy. (one sample dataset: Key Facts about the Uninsured Population | KFF). Unsurprisingly, the uninsured rate among the poor is much higher than of the “not poor” population (https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201802.pdf), and folks that live at-or-below 200% of the poverty line make up about half of all uninsured persons. This doesn’t necessarily mean that coverage costs would be higher for such persons, but lower incomes do tend to be correlated with poorer health statuses.

[Anny_Middon]

@jasg

$260 billion in 2017 according to this paper from the Tax Policy Center. It is the largest single tax expenditure for the federal government.
I would do it the other way around - charge/tax employers to cover the cost of employees who sign up for Medicare Extra. Employers still keep paying premiums for those who stick with corporate policies. I would also make it an 80/20 like regular Medicare, then let people sign up for Advantage or MediGap if they want more coverage.

That $260 billion is an interesting number. It appears that’s enough to pay for almost all of the costs projected here to provide Medicare Extra to those who are currently uninsured.

[md2000]

@jasg

$260 billion in 2017 according to this paper from the Tax Policy Center. It is the largest single tax expenditure for the federal government.
I would do it the other way around - charge/tax employers to cover the cost of employees who sign up for Medicare Extra. Employers still keep paying premiums for those who stick with corporate policies. I would also make it an 80/20 like regular Medicare, then let people sign up for Advantage or MediGap if they want more coverage.

This is the problem with these “half-assed” solutions. If an employer has to pay for an employee signed up on Medicare, then either (a) it’s less than the plan, stop offering a private plan, or b) it’s more than the plan, fire anyone who quits the plan.
… or (c) it’s set the same as whatever private plan is offered, so sign up for the cheapest, most useless plan and pay low dollars for all you employees to migrate to Medicare. By getting convoluted and trying to counter those gaming the system, it just makes for results that simply don’t work… like the incentive in ACA for employers to make personal coverage cheap but raise the cost of insuring additional family members, because the single coverage rate is the one that counts.

There are two types of uninsured - those who can’t afford coverage, and those who can but don’t bother. the former would have about the same costs as the general population, possibly more since their minor issues become aggravated through non-treatment. The latter are usually younger and healthier, pretty cheap to cover and bring down average costs. They are a reason why many group plans require everyone to participate.

[PatrickLondon]

@md2000

There are two types of uninsured - those who can’t afford coverage, and those who can but don’t bother. the former would have about the same costs as the general population, possibly more since their minor issues become aggravated through non-treatment. The latter are usually younger and healthier, pretty cheap to cover and bring down average costs. They are a reason why many group plans require everyone to participate.

Or a reason for funding the system, or the bulk of it, from taxes.

[md2000]

@PatrickLondon

Or a reason for funding the system, or the bulk of it, from taxes.

Yes, which is the ultimate “the whole group enrolls” concept.