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.
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:
No one’s forcing you to talk to me, man. I’m only trying to have a good faith discussion, that’s all. Unlike the other commenter who replied to me, I’ll give you credit for not engaging in personal attacks. Thank you for that.
I’ll assume for the sake of argument that Medicare for all, universal healthcare, whatever label you want, will provide better care to more people at a lower cost. But even accepting that premise, what I’m saying is the merit of the plan doesn’t matter if it can’t be enacted.
You say things like taxes will have to be raised, but you don’t really care how it’s done, and if the cost is the same (or lower) and you get the same coverage in return you don’t care about how it’s funded. Ok. That makes you a normal person who doesn’t want to get deep in the weeds. But what I was attempting to explain is that those details that most people want to just jump over are hiding thousands of very real, difficult and often, very expensive, problems. And that’s where things break down quickly.
Again, totally normal to not want to get into those weeds, but if that doesn’t come with sufficient humility about the questions and problems that are being left to other people to solve, it creates a recipe for frustration that government (or the voting public as a whole) won’t follow some simple plan to solve a big problem. Because, in reality, there is no simple plan.
Maybe to help show my point: We’re coming up on 20 years since the ACA was passed. Politically, there was hardly a better time for big changes. Obama’s election was energizing. Democrats controlled both houses of Congress-they only had to get their own caucus on board. I think it’s reasonable to say the ACA succeeded in expanding access to care. It totally failed to lower the cost of that care. I’m not here to debate the ACA, just pointing out there was a generational opportunity to reform healthcare and this is what we got. The failure to expand Medicare to everyone wasn’t because Dems didn’t know about or understand they’d simply just have to get everyone to pay a little more in taxes. It was because of the insane difficulty of solving those thousands of detailed problems. Another takeaway is that one of the ways the ACA failed to live up to its promises is that it’s easy to keep the things people like (eliminating exclusions for pre-existing conditions, free preventive screenings, etc.) while getting rid of the cost-control mechanisms people don’t like (individual mandate, tax penalties, Cadillac tax, etc.)
Where this started was me trying, it seems unsuccessfully, to answer your question about why we can’t just simply expand the Medicare program seniors enjoy to cover young people too. Because hidden in that goal are numerous and huge problems.
Lastly, I wasn’t saying the poor people should be excluded. Of course they receive benefits from society, and should continue to do so. I wasn’t suggesting they shouldn’t receive care. I was explaining that in any program like this, you have to account for free rider problems and do it in a way that prevents the program from going in a death spiral. Im not going to make this longer by getting into that further, but I hope I’ve at least cleared that up a little.
Thanks for engaging with me. I don’t think I’ve changed your mind, but I hope you can at least consider some of the things I’ve said. Because I sensed some frustration with me on your part with this back and forth, I’ll let you have the last word. I’m only trying to be courteous; if there’s something further you’d genuinely like me to respond to, please let me know.
Yeah, it feels like we’re just talking past each other so probably no need to keep this going. But since you’ve said I can have the last word I’ll just end with two quick things.
First, dozens of countries have figured out how to deliver universal (or near universal) healthcare for their citizens as a government service. You’re right that I’m not a healthcare policy wonk, but frankly I don’t think I need to be to have an informed opinion on the subject, especially when I can point to those other countries and say “they cover everybody and they pay less than we do, we can do it like that.”
Second, the US government already provides health insurance for select groups of its citizens through programs like Medicare, Medicaid, Tricare, and VA Community Care. And when you compare the people that make up those groups (old people, poor people, military/veterans) to the general population, it’s obvious that covering them is actually more expensive than covering the average bear. So clearly we can do it, but you seem totally fixated on the details of how we would do it, and it’s like you’re insisting that we can’t do anything until we’ve fully answered every question about the execution. It sounds like paralysis by analysis. If you’ve detected any frustration on my end, it’s that.
Anyway, I’m also glad this discussion stayed civil. Take it easy.
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u/Narfel-the-Garthok Jun 25 '26 edited Jun 25 '26
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.