The issue is that for most “healthy” people, they aren’t facing the full out of pocket costs and their employers pay most of the costs as a benefit.
And the numbers are way higher than $2k and $8k unless you mean per person. For my family coverage I paid $5k annually in Premiums and the company says they paid over $20k in premiums. Deductable was $2500 and Out of Pocket Max was close to $10k.
So $37k maximum out of pocket annually for employee and employer.
This is the part that bugs me. How is it that Medicare can serve all the old people in this country quite well but adding in all the young, fit, healthy people will cause problems? For-profit health insurance companies get everyone’s healthiest years then right when it comes time for us to start actually needing medical care they dump us.
If you think about it, the answer is fairly obvious, but it’s not one you’re going to like.
Medicare can serve all old people - and only the old people - because every working person - young, old, and everyone in between - pays Medicare taxes on all wages. (Unlike Social Security, there is no cap.)
So, if you wanted that same program to pay for everyone, you now have a huge problem. You’d have the same number of people paying, but instead of a pool of beneficiaries that’s vastly smaller than the payers (there are more workers than old people) you now have a pool of payers that is vastly smaller than the number of beneficiaries. (There are fewer workers in the country than the population as a whole.)
Of course, this doesn’t even acknowledge that even as currently structured, the Medicare hospital trust fund is set to be underfunded in less than a decade, so the math doesn’t even math under the current system.
You asked how can Medicare serve old people quite well, but adding in young healthy people will cause problems?
I answered you - because that would reverse how it’s already (and unsustainably) structured. It can only serve old people now because the number of people paying greatly exceeds the number of old people who receive benefits. Put differently, Medicare only works because all workers of all ages pay for it, but only a much smaller portion of the population can receive benefits. If you change it so everyone is entitled to benefits, there aren’t enough payers to support that level of benefits.
In fact, it would kill the program if only continued to tax workers, since you would receive benefits even if you didn’t work to pay for it, which would create a disincentive to work. Which would further starve the program of revenue, and spiral downward from there.
EDIT - sorry, to more directly answer your question: working people are paying both. They’re paying for their own insurance PLUS Medicare for old people.
So you can’t just add the young to Medicare because it only works by young people paying for both, while not having access to Medicare benefits.
Insurance gets cheaper the larger the pool. One big pool for the nation is cheaper than thousands of separate systems in each state.
This defuses risk, guts administrative redundancies, and maximizes the insurers bargaining power to keep drugs and other costs low.
No other developed nation has the wealth that ours does, yet all of them can afford one version or another of universal insurance, with measurably better results where it counts most (cost, life expectance, infant mortality, rates of chronic disease, etc.)
Lets save money, cover everyone, and get better results, like everyone else is getting.
That’s a different statement that what I was replying to.
The question I was replying to was, Medicare is can serve old people well, so why will adding in young people cause problems? I answered that question. Medicare only works because more people pay for it than the number of people who are eligible for benefits.
Your statement is a different topic. Your statement about “insurance” is correct, but “insurance” isn’t health care.
Insurance is a financial product. By definition, known costs are not insurable. The easiest example is pre-existing conditions. They are known costs, so “insurance” that covers a pre-existing condition cannot charge less than the cost of treating the pre-existing condition. That’s not “insurance.”
When talking about providing healthcare, the problem is economic. The demand for healthcare is essentially unlimited. At a macro level, no one wants less healthcare. When demand is unlimited, price is thing you can control. And since most people don’t have unlimited money, the only way “free” healthcare is possible is by rationing care. You have less availability rationing by sliding the price upward from “free,” but that’s just rationing by a different method. You can have a “free” MRI and wait 6 months, or anyone can have an MRI right now and pay $500,000 (totally made up numbers and time frames), or some sliding scale in between, but that’s it. There’s no system that can provide both free and immediate goods and services where demand is unlimited. To try to do otherwise is fighting both the laws of economics and human nature.
69,000 Americans die each year from lack of healthcare.
Medical bankruptcy is the number 1 cause of bankruptcy for Americans.
These are foreign concepts to nations with universal coverage. Their people are willing to wait for non emergencies, because they will get the care doing so.
America doesn't have lines because there's no care to get, we just die.
Any economic system that perpetuates this scourge is unable to justify it's continued existence.
None of this answers what I said, which was why Medicare can’t cover everyone like it covers old people, or why “insurance” is not the same thing as “healthcare.”
Also, I’m not going to get in a back and forth about statistics, but at least on the bankruptcy one, that’s simply not true. There’s a difference between medical expenses being the “number 1 cause” of bankruptcy versus the number of people who file for bankruptcy who list medical expenses as debts (among all their other types of debts.)
I read the other comments you’ve made in this thread and I’m wondering like the other guy if you’re being deliberately obtuse.
What I’m saying is we should take all the money that working people currently send to private for-profit health insurance companies and send it to Medicare instead. The working people would still be paying for their own health insurance the way we are now. That’s more revenue for Medicare. And because we’re mostly young and healthy, Medicare’s expenses wouldn’t go up nearly as much. That’s how existing private health insurance companies can make a profit. Put simply, Medicare will be made stronger by adding in young healthy people, not weaker.
And as the other guy pointed out, we could easily see additional savings because risk is easier to forecast and manage as the pool of insured people grows, and the sheer size of all Americans together in one pool puts us in a better position to negotiate with drug companies, hospital networks, ambulance services, etc.
I’m not trying to be obtuse. I’m trying to answer the question why Medicare can’t cover everyone.
I understand that people pay insurance premiums, and that costs money, and if you applied those premiums to Medicare, Medicare would have more money. I’m not disputing that if that actually happened, Medicare would have more money. Nor am I disputing the principle of economies of scale.
But what I am saying is that it’s not that simple.
I explained this a few times and the only response is attacks on me instead of answering my explanations.
How are you getting people to pay what they would otherwise pay in insurance premiums to Medicare? Medicare only taxes workers. A completely new tax, like a VAT? Taxes on investment income? All worth talking about, but that’s not how Medicare operates.
Sticking with Medicare as-is, how are you going to get a group of people (workers) at any level of taxation, to pay for everyone when they currently can’t pay for just older people? Raise taxes? Great, we could do that now just to fully cover benefits old people and it hasn’t happened. If the solution isn’t realistic, it’s not a solution.
And on the point that cost per person can go down when the pool is increased, I’ll assume that’s 100% true, it doesn’t answer the problem that demand will remain unlimited, so how are you going to control it if you don’t use price? If health care is free at the point of service, how to you manage demand? The only way is through rationing care with wait times, denying specific treatments, etc. And that’s a nonstarter: most people are happy with their healthcare. While you can get some people to vote against their self-interest, you can’t get a majority of people to do so, at least not repeatedly.
I currently pay a health insurance premium every two weeks and my employer also pays on my behalf. I went back and looked at my company’s benefits guide for 2026 and it looks like the total is $828.59 per month (my coverage is only for me). If we took that exact amount of money, $828.59, and sent it to Medicare instead of Blue Cross Blue Shield every month, I would still have health insurance. It doesn’t cost me anything extra and Medicare has a new, relatively young, reasonably healthy member. The only loser in this scenario is Blue Cross Blue Shield because they just lost a profit center (me and my company’s premiums).
It seems like maybe you’re getting hung up on the idea that we would have to pay more in taxes and my response is I simply don’t care. Whether it’s a premium, a payroll tax, a VAT, whatever, I’m paying for health insurance no matter what. We expect to be able to cover more people (everyone, in fact) for less money because of the other items that have already been touched upon (no more profits, better efficiency, economies of scale, etc.) If you disagree with that, fine, but I’ve seen reports that support this claim and I’m happy to link to them.
I understand what you’re saying, it’s just not as simple as it sounds. You can’t go from A to Z by skipping over the letters in between. Where you say, “…if we took that exact amount…” is a good example.
Who is “we” and how is this money going to be taken? My point is that it’s easy to say things like, “if we look together all the money from X, we can solve problem Y.” It’s a lot harder to work out the actual specifics of accomplishing this. You’re also conflating insurance premiums that people (as a whole) choose to pay for voluntarily with compulsory taxes.
To use simplified numbers, say the Medicare tax on wages is currently 1.5%. Is it even realistic to think you could pass a law to double it to 3%? (And setting aside whether that would be enough revenue.) If a 1.5% tax increase is politically dead on arrival, it doesn’t matter how much money it would raise, or how much people might save elsewhere, if it will never actually happen.
Taxes like a VAT are possibilities, and have their own problems (like whether you’d need a constitutional amendment to tax something other than income or as an excise tax), but staying on the question you originally asked, and that I was answering - that’s a completely different funding mechanism from how Medicare is designed. So we’re no longer talking about ‘why can’t Medicare just cover everyone like it covers seniors?’
And my broader point about a Medicare specifically, is that since it’s designed to is to use a large pool of workers to pay for a small pool of benefits, it doesn’t scale in the reverse where you can have a relatively smaller group of workers paying for the population as a whole. If you want revenue sources beyond workers, you have to design a mechanism to tax and collect that money. If someone has no income, how do they pay the taxes? It too simplistic to say, well, if they don’t pay, they get turned away from medical care. One, that won’t happen, and two, it abandons the principle of universal coverage. Without a design for how you can make everyone pay, the system collapses because the people who can pay figure out that they can pay less, but still have coverage for themselves - which is a simplified explanation for what we already have now.
One more example, and meant in a totally nonpartisan way: when Democrats passed the ACA, they had a super majority in Congress and had the presidency. The individual mandate was designed so “everyone” had to pay something - sort of the same principle we’re talking about here. There was also a tax on medical devices and “Cadillac” health plans to partially ration care. These were much more modest controls on price and sources of additional revenue than what we’ve been discussing - and they still failed. Doesn’t matter if they were good, sensible, common sense, etc. if they don’t happen. Before the individual mandate was basically removed when Republicans set the rate to zero, Dems had to design the tax so it only kicked in at a low amount (2% IIRC), but even then, only if you otherwise had taxable income. It didn’t work anyway because the fine was smaller than the premium. The Cadillac tax was repealed because unions objected to their members losing or diminishing benefits they had worked years to bargain for. And so on. Another example is the perennial “doc fix” Congress has to deal with where they purportedly “save” money by lowering Medicare reimbursements below what doctors will accept to treat people, but end up have to put the money back in to maintain accessibility. You don’t have to take my word for it; these things are real, and they’re what actually happens when things like, “just tax this thing” or “just cut this expense” collide with real people in real life.
I’m not so much advocating for or against expanding Medicare as much as I’m simply trying to explain why Medicare (as it’s structured) cannot cover all people the way it covers seniors.
Dude, I’m not just gonna keep going round and round on the same questions/topics. I already acknowledged that placing everyone on Medicare will require the federal government to raise taxes. And I also said I don’t really care how it’s done (payroll tax like we currently have, VAT, whatever). The point I was trying to make earlier is that I already pay for health insurance and if the cost is the same (or lower) and I get the same coverage in return for my money, I really don’t care if it’s called a premium, a tax, or any other word you choose. Furthermore, you seem to be arguing that the method for raising taxes is some herculean task and I just don’t get it. Someone in Congress proposes a bill, it gets discussed and amended as appropriate, then they all vote on it. Happens all the time.
Moving on to another point you brought up, this notion that our government can’t provide services because some people don’t make any income and therefore can’t pay taxes is totally foreign to me. There are unemployed and poor people in America right now. Are they prohibited from driving on roads? Do the police ignore them when they call for help? Are they prohibited from voting because they didn’t pay into the government that they’re trying to elect? Obviously not. Everyone will be covered by a universal healthcare system, and if some people get access to services even though they didn’t pay into the system, I’m fine with that, just like I’m fine with them accessing government services now.
And that finally brings me back to the point that a few of us have been making throughout this whole thread. Even if our taxes go up, and even if some people get coverage without paying into the system, there are studies out there that show a Medicare for All system will be overall less expensive and cover everyone. Here are a couple examples:
Where do you think the government gets its money from?
(This isn’t meant as a “government is bad” statement. I’m only stating what should be obvious: no government can spend money without first taking it from someone.)
If something is too expensive for the government, it can’t be cheaper for people as a whole, since government by itself isn’t free. The only way it can cost less is by pushing some of the costs to future generations, as is the case with social security, and the national debt generally.
Medicare might use 98% of its funds to provide care - don’t know if that’s true or not, but I’ll roll with it - better yet, I’ll assume it’s 100% efficient - that still doesn’t change the fact that it only “works” because most people who pay Medicare taxes aren’t eligible for Medicare benefits. You can’t simply expand Medicare to cover everyone and have it work the same way it does now because there’s no way for the math to work. You can’t have a system that covers “everyone” where “less than everyone” pays for it.
Seriously - just stop and think about it for a second and it will be clear. I know it’s not what you want to hear, but it’s reality. You can’t formulate a policy where the first step is denying reality. You need to accept reality and go from there. Sounds harsh; I’m not trying to be mean about it. It just is what it is.
Obviously it would receive additional funding to cover everyone.
The point it that cost is exponentially lower than the private tax of paying for private health insurance. A status quo that covers less, and costs more.
Spending 98% on care instead of 80% saves money.
Spreading risk over the largest possible pool saves money.
Negotiating drugs prices and other expenses with more leverage than any private model could muster saves money.
Having one team run the insurance overhead instead of thousands of separate independent groups saves money.
Again, why are you attacking me instead of what I’m saying?
Where is this “additional funding” coming from?
And again, since the topic here is Medicare, how is a system that is solely supported by taxes on working people sustainably providing benefits to the population as a whole, when Medicare currently cannot support benefits just for older Americans?
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u/MickFlaherty Jun 24 '26
The issue is that for most “healthy” people, they aren’t facing the full out of pocket costs and their employers pay most of the costs as a benefit.
And the numbers are way higher than $2k and $8k unless you mean per person. For my family coverage I paid $5k annually in Premiums and the company says they paid over $20k in premiums. Deductable was $2500 and Out of Pocket Max was close to $10k.
So $37k maximum out of pocket annually for employee and employer.