Medicare buy-in is not a thing

This has been suggested by some for a while, with the appeal being it’s a model somewhat close to single-payer and that the Medicare structure is perhaps behemoth enough now to carry more load ie, doesn’t need to be built really.  And ya know, people say it’s fairly efficient.

http://www.vox.com/2016/5/11/11652900/hillary-clinton-medicare-buy-in

But these people miss the point…Medicare is not an insurance program, IE, it’s not governed by risk actuarials.  It’s just a welfare program (not using that term pejoratively…).  Taxes are paid into a system, and benefits are paid out.  In this case, working people pay into the treasury with FICA, old people consume medical services paid by the treasury.  Maybe the income / expense proposition is harmonious (and it is that or better right now…) and maybe it’s not (say the future with aging demographics), but the discrepancies are not made harmonious with a risk premium adjustment.  It just comes out of treasury.

If you want to let people “buy in”, you’re going to assess a premium to those buying in.  And if the premium is going to be $600/mo as MattY suggests, ie, ‘affordable’ rather than set by risk, it’s not going to be revenue neutral.  I’ll stand on an assertion that’s way too cheap.  And thus you got a Leninist who / whom proposition that makes it “not Medicare” really, because it’s going to be very, very expensive subsidizing these Medicare buy-ins with other revenues.

It wouldn’t be right to say out of hand that isn’t a workable mechanism to deliver some coverage, but if you get 4 years down the road and it’s a cash suck when it was said it wouldn’t be, then no, it’s not ‘working’ at that point.

Point 5, here

http://www.vox.com/2016/5/11/11651848/premium-changes-under-obamacare

No, high premiums don’t mean Obamacare is ‘collapsing’.  But if you don’t have unsubsidized coverees in there paying the premium freight then no, it’s not ‘working’.

 

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