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I've noticed some progressive political activists in the US demand "Medicare for all" as their desired mode of health care expansion and improvement, while others say they support "Medicaid for all". I am not an expert on the US medical system and the insurance and coverage programs, but it appears there are some valid arguments coming from both sides. Just as an example:

  • "Medicaid" proponents claim people on Medicare often need to cover up to 20% of the costs of their coverage other than it being covered by the Medicare program itself; and that means that some are still effectively denied availability of certain kinds of care.
  • Looking at the comparison of the two programs, it seems Medicaid is a sort of a subsidy more than a (federal-)state-run program. Now, ignoring possibilities such as popular non-profit health care collectives, it seems expanding Medicaid is transferring tax money into the pockets of insurers at whatever price they manage to charge. And while that might drop, it's still significant.

Are these arguments really valid? What are other (both valid and disingenuous) reasons for people supporting one or the other scheme (or putting forward another alternative altogether)?

  • 2
    It looks as if this question is asking a why one v. the other question. But, of course, the reason to adopt either of these two slogans is that it provides a simple solution to the lack of universal health care in the U.S. on a single payer basis with an existing proven administrative structure that it is easy to estimate the cost of creating. – ohwilleke Jul 20 '17 at 3:57
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    They're really just both different ways to say "single payer system". I'm sure many people are very specifically deciding to say one or the other, but I think most people are just picking one or the other as shorthand for the broader concept. (I actually haven't hear many talk about 'medicaid for all') – user1530 Jul 20 '17 at 5:43
  • @ohwilleke: The thing is, "simple" is as far from it as possible. A health care system is complicated, and financing it in a Capitalist economy is even more complicated. Also, it is not possible to estimate the costs by simply saying "oh, we'll multiply by the ratio of program members and get the total", since the way things work now is dependent on there being a large non-covered section of the population and other features of the current system. – einpoklum - reinstate Monica Jul 20 '17 at 7:42
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There's a pretty big difference in the two

Medicare

Medicare is the Federal healthcare system for people 65 and over (some people get Medicare Advantage, where the government pays the premium for a private healthcare plan in exchange for certain policies). It's a huge entitlement but it is also fairly popular because it's been around for a long time and, most importantly, doesn't do a good job of controlling costs (in terms of payments to providers). As such, most people like it a great deal because it acts like people tend to think government programs should. Previous attempts to control costs (by lowering reimbursement rates) were deeply unpopular and ultimately failed. Remember, this demographic covers all Americans, regardless of economic status. As such, it is protected by a cadre of politically active American voters.

Medicaid

Medicaid is a whole different ball of wax. Medicaid is not as popular, but that's because it operates under strict constraints. Medicaid is administrated by the states themselves and does not do full reimbursement to providers like Medicare does. As a result, far fewer physicians accept Medicaid

A 2011 nationwide survey of doctors found 31 percent were “unwilling” to accept new Medicaid patients, with acceptance rates across states varying widely. Across the nation, the study estimated 69 percent of doctors were accepting Medicaid, but state acceptance rates ranged from a low of 40 percent in New Jersey to 99 percent in Wyoming, according to the study published in Health Affairs. This was pre-ACA expansion and prior to any reimbursement fee changes.

Obamacare my have changed that some (it bumped payments for one year to try and increase acceptance rates). Still, Medicaid is not as widely accepted. This sentence describes the difference (emphasis mine)

The fee bump of 2013 to 2014 sought to make Medicaid acceptance more enticing by putting those fees on par with Medicare reimbursement rates.

Policy

Medicare, being the more popular program, is a much easier sell (image source)

With the names being similar, and the programs being poorly understood, it's not hard to see why some would sell "Medicare for all". In reality, Medicaid for all would be the more likely program. Medicaid, which already has mechanisms to control costs, would simply expand to cover all people without private insurance. That's what state efforts like Nevada are trying to do.

The Nevada Care Plan, however, would operate within Medicaid but wouldn’t be Medicaid — meaning reimbursements would need to be hashed out once the bill was signed.

Medicaid — and Medicaid expansion — are specifically set up for the poor, and Nevada has about 600,000 people utilizing it. Of the state’s 2.9 million residents, about 11% remain without any healthcare coverage.

  • Medicare reimbursement is close to cost. Medicaid reimbursement is far below cost and is subsidized by the providers who take it. The money to fund the subsidy for Medicaid comes mostly from private insurance which pays provides somewhat more than Medicare and somewhat more than cost. Also Medicaid serves some very different populations in subprograms. Nursing home care and care for the disabled by Medicaid is very expensive. But, Medicaid for low income non-disabled people who aren't in nursing homes is quite a bit cheaper than private health insurance. – ohwilleke Jul 20 '17 at 3:55
  • This answer confuses me even further. When you talk about "controlling cost" - do you mean cost to the patient, cost to federal government, cost to insurance companies? Also, "controlling cost" can mean that people get less reimbursements, but it can also mean that Doctors must accept patients for lower fees as a condition of their license (or that they pay a tax if they have a low medicare patient fraction etc.) – einpoklum - reinstate Monica Jul 20 '17 at 7:35
  • Also, this polling about program popularity - you're saying that people promote "medicare for all" because medicare of today is a more popular program. I guess that makes some sense propaganda-wise, but - both programs are well-regarded by the population, so it seems strange that the choice of model will not be on the merits. – einpoklum - reinstate Monica Jul 20 '17 at 7:37
  • The link about control of Medicare costs does not seem to be in line with your claim; unless I did misread it, it states that in 2015 the "doctor fix" (the temporal -as in "almost 20 years long"- provisions that delayed cutting Medicare to doctors) were finally repealed and a new payment system was setup. From the link: The "doc fix", which postpones cuts in Medicare payments to doctors, has been an annual ritual in Congress for years. Now a permanent repeal of the doc fix takes care of the problem for good. Could you elaborate a little more on this? – SJuan76 Jul 20 '17 at 7:37
  • @SJuan76 The Doc Fix was a yearly agreement to pre-empt Medicare reform that specified reduced Medicare payments to doctors (and other providers). Essentially, Congress agreed to make the cuts to control the growth of the program, but found it politically impossible to do so. They finally agreed to a permanent change so they didn't have to keep passing that same agreement every year. – Machavity Jul 21 '17 at 0:45

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