Health insurance and SS: two major financial related issues that most people do not understand and worse have come to believe a great deal of false information.

Take time to read the comments and responses in that post.

Yes, we need a single pool for any common risk all Americans share. In America, the only common health risk given the current system is the potential for a catastrophic health care claim. So, yes, a single pool with a significant attachment point (I favor $25,000) for all American citizens and all lawfully present here indefinitely.

However, if you are here temporarily or you are here illegally with or withint a pending claim for asylum, that is, you are not certain to remain here indefintely, come with your own health insurance. Americans buy international health insurance all the time – especially those covered by Medicare.

There is no reason for American citizens to cover the medical expenses of those who do not live here beyond EMTALA.

Some prefer a single risk pool, with low or no point of purchase cost sharing and no premiums, where all are covered and it is funded by taxes – a Medicare For All (M4A) solution – but as Dick says, most don’t understand health insurance or its costs, and that includes today’s Medicare system.

My 45+ years of experience with buying and paying for others health care coverage is that those who want M4A generally prefer that alternative ONLY IF SOMEONE ELSE PAYS.

Here are the numbers for Medicare in 2026:
Part A (hospital) premium is $535 per month, per person.
Part A deductible per hospital stay is $1,736.
After 60 days of Medicare-covered inpatient hospital care in each “benefit period”, the daily coinsurance amount is $434 per day for the 61st through 90th day of a hospitalization then, $868 per day for lifetime reserve days.
Daily coinsurance for days 21 through 100 of extended skilled nursing care services is $217

The Part B (physician) premium is ~$812 ($202.90 is the portion paid by current beneficiaries) per person
Part B deductible is $283.

Part D premium (the national average monthly bid amount (NAMBA)) is $239

Part D beneficiary premium is $38.99 per month, per person.
The Part D (Rx) standard plan deductible is $615, with out of pocket costs capped at $2,100.

So, if you look at the premium amounts for Medicare Part A, Part B and Part D, even with the significant deductibles and copays and point of purchase cost sharing, we are talking $535 + $812 + $240 = $1,587 per month. Most Americans would think a premium set at even a third of that amount, $539 per person, or a fourth of that amount $397 per person, would be way too much to pay.

And, keep in mind that to cover the point of purchase cost sharing, most seniors buy a Supplement or enroll in Medicare Advantage – many times with an additional $200 – $300 per person, per month cost.

The M4A designs I have seen, however, would eliminate most point of purchase cost sharing. That would likely skyrocket utilization, and in turn, premiums. So, the per person per month cost for M4A, as proposed, would likely exceed $600 a month.

They like to say Medicare is efficient, that only a small amount is spent on processing claims. Even if that is correct, all it means is that we will efficiently spend our way deeper in debt. Just like unemployment benefits and other cash payments during COVID as well as other social programs in Minnesota, you can see what happens to the cost of entitlement programs from abuse when there aren’t significant controls and limits.

The only way to drive premium cost lower would be to ration care (which no one wants to do) or to reduce Medicare reimbursements even further – below their existing levels (which oftentimes do not fully cover the provider’s cost to deliver services).

And, if everyone is enrolled in M4A, providers won’t be able to offset their losses when treating Medicare beneficiaries by increasing prices elsewhere, as they do today, charging 250+% more, on average, for those where the government doesn’t set reimbursement rates (employer sponsored plans, primarily).

Bottom line, most Americans have no idea what the actual cost of coverage is, nor the actual cost of Medicare. Most Americans also have no idea how Medicare is funded.  

In total, Medicare is funded about 46% by general revenues (mostly income taxes and deficit spending), 34% by payroll taxes (FICA-Med), 15% by premiums paid by Medicare beneficiaries, and 5% by taxation of social security benefits, transfers from states, other revenues and interest on trust fund assets.

For Part A, Hospital coverage, 90% comes from payroll taxes (FICA-Med). For Part B, physicians, 73% comes from general revenues (mostly income taxes and deficit spending). For part D, Rx, 74% comes from general revenues (mostly income taxes and deficit spending).

Keep in mind that 40% of American households do not pay income taxes – so the burden for Medicare Part B and Part D is NOT currently shouldered by most Americans. Further, because our income tax system is so progressive, the bottom 50% of taxpayers (the lower half by income) pay less than 3% of all federal income taxes. They are, for most items in the federal budget, free riders.
https://www.statista.com/statistics/242138/percentages-of-us-households-that-pay-no-income-tax-by-income-level/

https://taxfoundation.org/data/all/federal/latest-federal-income-tax-data-2024/

Bottom line, Congress has succeeded in convincing Americans that folks should be entitled to health coverage, and that someone else should pay.

Many in Congress make the same argument about federal income taxes, exempting lower income American households to buy votes – asserting the Millionaires and Billionaires are not paying their fair share.

However, since enactment of the Patient Protection and Affordable Care Act of 2010 (Health Reform), where Congress bought votes by reducing the number of uninsured through taxpayer paid and taxpayer subsidized coverage for tens of millions of Americans (many who could afford to buy coverage themselves), we have consistently averaged $1 – $2 Trillion a year in annual federal deficits, adding $28+ Trillion to our national debt.

Watch as Congress (and the Obama, Trump 1, Biden and Trump 2 Administrations) attempt to continue to buy your votes, allowing for Health Reform’s expansion in coverage, yet don’t ask you to pay for it, instead they will continue to send the bill to Americans too young to vote and generations yet unborn.

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