# I get the argument for Medicare for all, but what is the argument for abolishing private insurance? **URL:** \ **Category:** Politics & Elections\ **Created:** [August 2, 2019, 1:17pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057 "2019-08-02T13:17:39Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![JohnT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnt/32/15048_2.png) [@JohnT](https://boards.straightdope.com/u/JohnT)\ **Post date:** [August 2, 2019, 3:43pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/21 "2019-08-02T15:43:24Z")
Lastly, since Kid doesn’t seem to know this, in Texas, group insurance for businesses with 49 and fewer employees are table-rated based upon age, gender, and zip code. These rates are filed by each of the insurance companies (in this market we have four: UHC, Aetna, Humana, BCBS), reviewed by the Department of Insurance, and approved. When a firm decides they want to offer benefits, including health insurance, they have a choice: 1. To be community-rated (above) 2. To be self-insured (meaning the premium is based upon the individual health of the members of the group, ala how it was done pre-ACA. But what usually happens is one of the group has type-2 diabetes, or had cancer in the past 5 years, or something, and their rates are even higher than poor Delores, above.) Regardless, the health insurance business, even in Tejas, _already has a vast level of government involvement in the financing and pricing of insurance plans_. The argument that the government can’t budget for a national insurance program is silly. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [August 2, 2019, 3:44pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/22 "2019-08-02T15:44:20Z")
The way that insurance is supposed to work is, you pay a fixed, predictable amount, so that if you suffer some calamity, you’ll be able to afford it. If that were the way that it actually worked, then there would be no problem in letting it continue to exist. The way it usually actually works, though, is that you pay a fixed, predicable amount, and then if you suffer some calamity, the insurance company comes up with some damned fool excuse for why they don’t have to pay out (the janitor who sweeps up the doctor’s office is out-of-network or something), and now you’re stuck with the cost of the calamity, _and_ whatever you’ve already paid to the insurance company. People want to ban insurance for the same reason they want to ban those e-mails from Nigerian princes. ---
**Author:** ![JohnT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnt/32/15048_2.png) [@JohnT](https://boards.straightdope.com/u/JohnT)\ **Post date:** [August 2, 2019, 3:46pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/23 "2019-08-02T15:46:37Z")
To Chonos’s point, I would like to note that the abolishment of private health insurance carriers means the abolition of private insurance health networks: If there is only one network, then the only way your doctor is out of network is if they decide to go pure capitalist and take no insurance at all. ---
**Author:** ![Kevbo](https://avatars.discourse-cdn.com/v4/letter/k/e47774/32.png) [@Kevbo](https://boards.straightdope.com/u/Kevbo)\ **Post date:** [August 2, 2019, 3:48pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/24 "2019-08-02T15:48:14Z")
If everyone has the same insurance, then there is strong incentive for those in power to make sure it works. If the people who are part of “the powers that be” mostly have Cadillac plans, then the have-nots end up with the leftovers…because they are “those people.” ---
**Author:** ![KidCharlemagne](https://avatars.discourse-cdn.com/v4/letter/k/ed8c4c/32.png) [@KidCharlemagne](https://boards.straightdope.com/u/KidCharlemagne)\ **Post date:** [August 2, 2019, 3:51pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/25 "2019-08-02T15:51:04Z")
> [@JohnT](#): > > I am still not hearing any arguments for keeping Humana alive. I am quite interested in them, especially ones that aren’t based on faith-based systems like “capitalism is always good” 'n stuff. Ummmmm, wtf makes you think I want to keep private healthcare alive or that I subscribe to the notion that “capitalism is always good?” Where in my op is there even a scintilla of evidence to suspect im questioning MFA by asking what the reasoning is for abolishing private insurance? In fact I considered putting this question in GQ but had a feeling it would be sent here so I reconsidered. Honestly, your suppositions are just plain weird. ---
**Author:** ![KidCharlemagne](https://avatars.discourse-cdn.com/v4/letter/k/ed8c4c/32.png) [@KidCharlemagne](https://boards.straightdope.com/u/KidCharlemagne)\ **Post date:** [August 2, 2019, 3:54pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/26 "2019-08-02T15:54:29Z")
> [@JohnT](#): > > To Chonos’s point, I would like to note that the abolishment of private health insurance carriers means the abolition of private insurance health networks: If there is only one network, then the only way your doctor is out of network is if they decide to go pure capitalist and take no insurance at all. Finally you say something reasonable. Doctors should already have to take Medicare now. This loophole would have to be remedied. ---
**Author:** ![KidCharlemagne](https://avatars.discourse-cdn.com/v4/letter/k/ed8c4c/32.png) [@KidCharlemagne](https://boards.straightdope.com/u/KidCharlemagne)\ **Post date:** [August 2, 2019, 3:59pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/27 "2019-08-02T15:59:55Z")
> [@Chronos](#): > > The way that insurance is supposed to work is, you pay a fixed, predictable amount, so that if you suffer some calamity, you’ll be able to afford it. > > If that were the way that it actually worked, then there would be no problem in letting it continue to exist. > > The way it usually actually works, though, is that you pay a fixed, predicable amount, and then if you suffer some calamity, the insurance company comes up with some damned fool excuse for why they don’t have to pay out (the janitor who sweeps up the doctor’s office is out-of-network or something), and now you’re stuck with the cost of the calamity, _and_ whatever you’ve already paid to the insurance company. > > People want to ban insurance for the same reason they want to ban those e-mails from Nigerian princes. But again, a public option covers this. I’m with you on why a private healthcare only system is bad - what I don’t understand is the need to proactively abolish it. If the free option is remotely decent, then sure as hell no one is gonna pay for it. ---
**Author:** ![KidCharlemagne](https://avatars.discourse-cdn.com/v4/letter/k/ed8c4c/32.png) [@KidCharlemagne](https://boards.straightdope.com/u/KidCharlemagne)\ **Post date:** [August 2, 2019, 4:01pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/28 "2019-08-02T16:01:42Z")
> [@Kevbo](#): > > If everyone has the same insurance, then there is strong incentive for those in power to make sure it works. If the people who are part of “the powers that be” mostly have Cadillac plans, then the have-nots end up with the leftovers…because they are “those people.” This is certainly a reasonable argument. If Republicans want to sink the ship then at least they go down with it. ---
**Author:** ![naita](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/naita/32/5862_2.png) [@naita](https://boards.straightdope.com/u/naita)\ **Post date:** [August 2, 2019, 4:09pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/29 "2019-08-02T16:09:23Z")
> [@KidCharlemagne](#): > > How exactly is this a thread that starts with a misunderstanding of Warren’s and Sander’s policy position? When Lester Holt asks in the debate “Who here wants to abolish private health insurance?” and they both raise their hand, I shouldn’t interpret that to mean they don’t want to abolish private health insurance? To quote myself: “As far as I can tell there is no plan to directly abolish private insurance, but I can be wrong since I’m just going from the statements I can find on the presidential campaign websites.” I was wrong, as I admitted ahead of time I might be, and as you could have figured out from reading my whole post. ---
**Author:** ![JohnT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnt/32/15048_2.png) [@JohnT](https://boards.straightdope.com/u/JohnT)\ **Post date:** [August 2, 2019, 4:16pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/30 "2019-08-02T16:16:32Z")
> [@KidCharlemagne](#): > > Ummmmm, wtf makes you think I want to keep private healthcare alive or that I subscribe to the notion that “capitalism is always good?” Where in my op is there even a scintilla of evidence to suspect im questioning MFA by asking what the reasoning is for abolishing private insurance? In fact I considered putting this question in GQ but had a feeling it would be sent here so I reconsidered. Honestly, your suppositions are just plain weird. I’m not asking you to make this argument, I’m asking _anyone_ to make this argument. Apologies for being unclear. Current conversation on this topic tends to focus on the hypotheticals of “what if’s”. They are framed from a Right perspective - even your title to this thread has a Right-tilted framing - “abolish private insurance”. Perhaps instead of asking why we want to “abolish private health insurance”, perhaps we ought to frame the question as to why we want to “keep the current system”? Anyway, I’m pretty sure I answered your question: the above responses are my reasons for abolishing this shit, and I make a nice living selling it. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [August 2, 2019, 4:19pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/31 "2019-08-02T16:19:46Z")
Because if there is private insurance, it would likely carve out the most profitable group of people, and exclude those that aren’t profitable. What is left in the M4A program would be high cost individuals, making the overall program more expensive. By eliminating private insurance, the government would force those that have lower expected costs to subsidize others with higher expected costs. Risk pools in insurance are more predictable if the risk is roughly equivalent among members of the pool. If my insurance company only insured low risk, low cost individuals, then their costs would be lower, and I’d be able to pay a lower premium. Once higher risk people are introduced in the pool, then the overall cost will rise. If you are a person who is in the lower risk categories, like, age 24-40, non smoking, no previous health issues, you really don’t cost much to insure. Why would you want to be pooled with 70 year old smokers with a history of heart disease and cancer? Eliminating private insurance forces you to throw in your lot with everyone else. ---
**Author:** ![steronz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steronz/32/11765_2.png) [@steronz](https://boards.straightdope.com/u/steronz)\ **Post date:** [August 2, 2019, 4:24pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/32 "2019-08-02T16:24:09Z")
> [@Bone](#): > > Because if there is private insurance, it would likely carve out the most profitable group of people, and exclude those that aren’t profitable. What is left in the M4A program would be high cost individuals, making the overall program more expensive. By eliminating private insurance, the government would force those that have lower expected costs to subsidize others with higher expected costs. > > Risk pools in insurance are more predictable if the risk is roughly equivalent among members of the pool. If my insurance company only insured low risk, low cost individuals, then their costs would be lower, and I’d be able to pay a lower premium. Once higher risk people are introduced in the pool, then the overall cost will rise. > > If you are a person who is in the lower risk categories, like, age 24-40, non smoking, no previous health issues, you really don’t cost much to insure. Why would you want to be pooled with 70 year old smokers with a history of heart disease and cancer? Eliminating private insurance forces you to throw in your lot with everyone else. But making participation in M4A mandatory solves this problem without necessarily requiring private insurance (to go above and beyond what M4A covers) to be banned. ---
**Author:** ![Snowboarder\_Bo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/snowboarder_bo/32/229_2.png) [@Snowboarder\_Bo](https://boards.straightdope.com/u/Snowboarder_Bo)\ **Post date:** [August 2, 2019, 4:27pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/33 "2019-08-02T16:27:04Z")
> [@Bone](#): > > Eliminating private insurance forces you to throw in your lot with everyone else. Is having to “throw in your lot with everyone else” a good idea or a bad idea, in your opinion? ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [August 2, 2019, 4:28pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/34 "2019-08-02T16:28:54Z")
> [@Snowboarder\_Bo](#): > > Is having to “throw in your lot with everyone else” a good idea or a bad idea, in your opinion? Bad. That’s why to do so it would require force by the government. If it were good, people would have done so voluntarily. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [August 2, 2019, 4:32pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/35 "2019-08-02T16:32:25Z")
> [@steronz](#): > > But making participation in M4A mandatory solves this problem without necessarily requiring private insurance (to go above and beyond what M4A covers) to be banned. I suppose if those that opt out would still be forced to pay for a service they weren’t using it would solve the adverse selection problem. There would still probably be people who would be opposed to private insurance because they don’t want anyone to get anything better than them. Consider, Canada has banned much of private insurance, what are their reasons? ---
**Author:** ![JohnT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnt/32/15048_2.png) [@JohnT](https://boards.straightdope.com/u/JohnT)\ **Post date:** [August 2, 2019, 4:37pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/36 "2019-08-02T16:37:44Z")
> [@Snowboarder\_Bo](#): > > Is having to “throw in your lot with everyone else” a good idea or a bad idea, in your opinion? It is, literally, the entire theoretical and mathematical basis of pooled risk. ---
**Author:** ![Wrenching\_Spanners](https://avatars.discourse-cdn.com/v4/letter/w/ecb155/32.png) [@Wrenching\_Spanners](https://boards.straightdope.com/u/Wrenching_Spanners)\ **Post date:** [August 2, 2019, 4:51pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/37 "2019-08-02T16:51:52Z")
With any publicly funded benefit program, the program has to have rationing. It costs some amount to provide typical cafeteria style school lunches. It would cost much more to provide restaurant style and restaurant quality school lunches. It would cost even more to provide each student with a personal chef. Similarly, allowing supplemental health insurance creates tiers of medical care. The societal risk is that those at the lowest tier receiving “basic care” will be receiving insufficient care that wouldn’t be acceptable to those in a higher tier. In other words, I don’t care if food in the employee cafeteria is shit because I’m eating in the managers’ restaurant. Banning supplemental insurance mitigates that risk. However, it doesn’t stop people from paying directly for additional health services, so it doesn’t remove it. It also takes freedom away from companies that would like to offer supplemental health insurance, and from consumers who would like to purchase it. Is the mitigation worth the denial of freedom? I personally think it isn’t. ---
**Author:** ![JohnT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnt/32/15048_2.png) [@JohnT](https://boards.straightdope.com/u/JohnT)\ **Post date:** [August 2, 2019, 4:59pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/38 "2019-08-02T16:59:21Z")
I love how people who live in a world with $7,500 deductibles and $15,500 family max out of pocket, with “my insurance company denied X!” as a constant daily refrain, with the concept of co-insurance a thing, and doctors and clinics split into a bewildering array of networks… I love how they warn us of “rationing” in a public system. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [August 2, 2019, 5:00pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/39 "2019-08-02T17:00:07Z")
> [@Bone](#): > > If you are a person who is in the lower risk categories, like, age 24-40, non smoking, no previous health issues, you really don’t cost much to insure. Why would you want to be pooled with 70 year old smokers with a history of heart disease and cancer? Eliminating private insurance forces you to throw in your lot with everyone else. Because, if all goes well, that 20-40 year old will become a 70 year old. Even if they do not smoke, they may still end up having heart disease or cancer. As it is, private insurance doesn’t have to pay for 70 year olds, those are already paid for by the govt system, and yet, insurance is still barely affordable. > [@Bone](#): > > Bad. That’s why to do so it would require force by the government. If it were good, people would have done so voluntarily. They do do so voluntarily, that’s exactly what insurance is. If you work for a company with health benefits, then you pay for the treatment of someone who is sick, even if you are not. That is how the vast majority of people currently get their insurance. The bigger the company, usually the better the benefits, specifically because they have a larger pool of people who have thrown their lot in. The number of people who forgo insurance due to not wanting to “throw in their lot” is a much smaller number than you may think. Definitely far fewer than those who forgo insurance because they cannot afford it. MFA would just be a larger collective bargaining. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [August 2, 2019, 5:23pm UTC](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057/40 "2019-08-02T17:23:50Z")
> [@JohnT](#): > > It is, literally, the entire theoretical and mathematical basis of pooled risk. This is over simplified. Pooled risk can also mean pooling of similar risks. This is how insurance rating works. Good driver discounts for auto, home security discounts for home, lower rates for life insurance for non-smokers, etc. All of these are means to segregate populations into similar risk pools and charge a commensurate premium. It’s still pooled risk, but it more normalizes the risk profiles of those in the pool. All other things being equal, the group of homeowners that have home security systems are paying less than the group that doesn’t, because the risk profiles are different. Eliminating this discount would group all homeowners together and the premium would be more of a blended rate than it would be if they are segregated. Those with home security systems would subsidize those without. > [@k9bfriender](#): > > Because, if all goes well, that 20-40 year old will become a 70 year old. Even if they do not smoke, they may still end up having heart disease or cancer. > > As it is, private insurance doesn’t have to pay for 70 year olds, those are already paid for by the govt system, and yet, insurance is still barely affordable. People who are 70 can still pay for insurance, if they choose. They don’t have to pay for Medicare. In any event, I think people should pay commensurate with their risk. If you have a group of low and high risk people, creating a separate risk pool for each would yield lower and higher costs, respectively. Blending them into a single risk pool would yield somewhere in the middle. Disallowing people to opt out of the combined pool and form their own low risk pool means that those in the lower risk pool would pay more than they otherwise would. [Previous page](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057.md?page=1) [Next page](https://boards.straightdope.com/t/i-get-the-argument-for-medicare-for-all-but-what-is-the-argument-for-abolishing-private-insurance/838057.md?page=3)