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To fix U.S. healthcare, we need Medicare for all

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Caroline Poplin, M.D., writing in Med Page Today, says that “Republican ‘repairs‘ are unlikely to make things better, either for the insurers or the currently insured.”

”Insurers will be able to charge their oldest customers five times more than younger ones for identical policies, and significantly reduce benefits in plans with lower premiums. There will be new restrictions preventing people from waiting until they are sick to sign up (insurers contend this is a big problem), but the IRS will not enforce the individual mandate, which was intended to force healthy people to sign up.

”So people will likely pay more for policies that cover less. Insurers will be able to charge higher premiums, but people who find the new policies too expensive may drop them without necessarily paying a penalty. If the healthy leave disproportionately, premiums will rise higher. This dynamic can result in a ‘death spiral,’ or simply the status quo ante, where insurers offer policies attractive to only the healthy and the wealthy; the poor and the sick, though they retain ‘access’ to health insurance, cannot afford it.

”But at the end of the day, what people want is not access to health insurance, but to affordable healthcare when they need it. It is not clear why policy analysts thought private for-profit insurers offering people a choice of plans would accomplish this.

”A choice of plans — so each family can choose the plan ‘best for it’– allows people to splinter the risk pool: healthy people at low risk can choose meager plans, forcing up the cost of more comprehensive plans the sick need. Also, the purpose of insurance is to cover the risk of a future event.”

“The fairest and most efficient way to get affordable healthcare for all is through social insurance, Medicare-for-all …just as Social Security ensures every American a modest retirement however long he or she lives. Everyone is in the same risk pool, everyone pays, everyone gets what they need.

“The healthy subsidize the sick, the rich help the poor, automatically. No money is diverted to insurance company underwriting, profits or administration. The federal government controls costs in a transparent, accountable way. People who hate government can sign up for Medicare Advantage.

“Although details vary, social health insurance works for every other developed country — each of which covers all its people and gets better health outcomes for far less than we pay. If that’s what we want, in the end, that’s what we must do.”

To read her entire piece, please hit this link.


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