ACA Repeal/Replace: Progressives Face Moral Dilemma

[David Horn]

(01-17-2017, 02:51 AM)Warren Dew Wrote: Now, I'm not unsympathetic to David's argument about having paid into the Medicare system for a lifetime and deserving some return on that.  If we take literally David's argument that intergenerational transfer is legitimate, of course, then it's legitimate to say, "okay, the GIs got the benefits but didn't pay in, and the boomers are going to pay in but not get the benefit".  But from an individual fairness perspective, it's fair to give boomers Medicare coverage commensurate with what they (we) paid into the system, if not the current levels which amount to much more than they (we) paid into the system.

In order to limit costs to a reasonable level, it would probably be best to shift as many Medicare customers as possible over to Medicare Advantage type plans, where the customer gets a voucher to use toward traditional health insurance.  These plans could then get less traditional, for example paying for certain beneficial supplements and possibly even for a healthier diet and lifestyle.  The key is that the amount paid should be fixed, adjusted for inflation but not for "average" health care costs, and perhaps scaled to years in the system.  You paid in a certain amount; you get out a certain amount.

If we wanted to keep a traditional form of Medicare as well, then costs on traditional Medicare would have to be limited to the same as that for the Medicare Advantage type plans.  For example, we could seriously enforce the payment limits.  Customers would then have to choose between using low end doctors and facilities, or making up the difference themselves.

Right now, today, Medicare Advantage is more expensive and less beneficial.  People who use it do so to avoid the costs when young, but rue the day when they get older and sick.  All that out-of-network stuff starts to kick in when illness enters the picture.  Unfortunately, moving between standard and Advantage is not as easy as it appears.  There are financial penalties.

Out of fairness, I should note that a few Advantage plans are actually pretty good.  Most are in urban areas with plenty of providers.