Medicare is not bankrupt. I’ll repeat, Medicare is not bankrupt. In fact, it’s not even close. Social Security, on the other hand, does have a scheduled date where its benefit payout will exceed its estimated income… but– and this is important to understand– it’s because the SS income from payroll taxes has been put into the general revenue fund. Remember Gore’s much maligned lockbox argument? Never hear that anymore, but that doesn’t mean it’s not pertinent.

As far as comparisons to the NHS, they’re fallacious. In Britain everyone contributes to health insurance and it’s their choice if they want to go outside NHS. In the US 1/5 contribute nothing to their health insurance but do pay taxes to Medicare to cover elderly beneficiaries who sometimes have a lot of money. This makes no sense.

But the most annoying thing about people who do not see that universal care coverage is important is that they never have any better suggestions. The status quo is not workable as health care costs take up 15% of our GDP, businesses go bankrupt because health care is inexplicably tied to jobs, and quality of care deteriorates.

Including everyone in Medicare would actually increase revenue for docs who take Medicare patients. One reason I went into Ob/Gyn way back when was because the reimbursement was better than other specialties that took more Medicare and the problems with Medicare were manifest even back in the late 80′s when I made that decision.

Medicare for all would work like the NHS: Few docs outside of it at first, but as the system erroded for lack of rational market based funding, more and more would elect to not take advatage of the “free” care to which they are entitled and pay privately instead. In a generation it would have devolved to a welfare program for the poor.

Suggesting extending it to all is quite honestly one of the stupidest things I’ve ever heard. It’s like looking at Social Security going broke and saying, wow, let’s enroll more people in it!

2) If everyone had Medicare, then almost all physicians would need to accept it or risk losing their patients.

3) Per capita, the current US system is the most expensive in the world with private insurers making profits on lower risk patients and Medicare covering more expensive care. Adding younger patients to Medicare could improve its sustainability.

4) Medicare has uniform standards of care that could be easily tweaked for younger patients.

5) Medicare’s RVU reimbursement system would make payments more uniform, thus reducing the incentive to cherry-pick patients based on revenue.

6) Medicare-for-all need not be single payer, but it could and should be single payment.

[Note: I'm an OB/Gyn who has very little Medicare in my practice, but I see the need to cover everyone in some way.]

And, as already pointed out by another reader, the $9K contributed by the citizens of publicly-funded health systems most likely is actually less than the premiums that an employee and his/her employer pay in total now. Moreover, I believe that $9K covers a significantly greater proportion of basic services (lab work, prescriptions, screening exams, etc) without the need for a copay by the patient, which should also be figured into how much the average person in the U.S. actually pays for health care here.

We already know that we pay more per-capita for health care here than almost any other industrialized country, and although you may argue that the government and large companies shield the consumer from much of that cost burden now, the fact that such a system is clearly non-sustainable is the very reason that we are having these conversations now.

According to several studies, we in the US pay more per person in taxes for health care than the Canadians pay per person in taxes for health care, and they live longer.

And by the way, most of the Swiss get their health care insurance paid by employers like the lucky 60% of workers in the US who get their health insurance from their employers.

And the Swiss have the most expensive health care behind the US, because its system differs from the US in only two ways: everyone must buy it, and insurers must insurer anyone who applies equally without considering preconditions.

In other words, the Swiss system is NOT “a mostly publicly-funded health system” if that means funded by taxes.

A two tier system would immediately establish itself–but few would be in the higher tier.

Medicare doesn’t cover the cost of decent care now. Where decent care is given to Medicare beneficiaries, it is being subsidized by other payers. Eliminating those other payers would eliminate the subsidy, and what the government pays for is all recipients would get.

It is also noteworthy that the “crises” that gave us Medicare was that senior citizens were paying 21% of their income on medical care. With Medicare, they still pay 20%.

Ultimately, it would solve nothing and create many new problems. In the future things would bet even worse as medical schools would find the applicant pool circling the drain.

Who do they turn to now? I am very well insured, I don’t need a referral for my insurance company so no paperwork for PCP. I don’t feel cared for now. I can’t get appointments when needed, my care is rushed and often a waste of time. I feel the only option I have now is to forgo medical care or find a concierge practice.