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Comment by bmelton | Hacker News Reader

> It's as if the rich assume that things will change for the worse for them if universal health care is enacted.

Well, it depends on the implementation, but Bernie Sanders has been on record numerous times as stating that his Medicare-for-All proposal would absolutely ban private insurance. Elizabeth Warren is another Democratic front-runner who indicated that she's on board with that, though her proposals didn't necessarily reflect it.

For what it's worth, the M4A _plan_ from Bernie's camp that I've seen didn't actually specify that it would eliminate private insurance, but he's also been keen on reminding us that he wrote it, and knows best what's in it.

So while it seems unlikely to me that political reality in America would prohibit banning private insurance, there are definitely those who espouse banning it for the greater good, so perhaps that fear isn't wholly unwarranted.

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It's a slight misstatement to say that any of the M4A plans would have "banned private insurance." None of them prohibit supplemental coverage that would be secondary to Medicare.

This doesn't apply to procedures that are covered, though, does it? Like, a private plan that provides higher-quality / reduced wait times for all services you'd normally get from the public system.

Regarding the implementations I was talking about, the private market would exist exclusively for elective procedures "like cosmetic surgeries." [0]

For any of the services covered by Medicare. Quoting the Kaiser Family Foundation, "private insurance would be prohibited from duplicating the coverage under Medicare."

[0] The full quote here is "If you support Medicare for All, you have to be willing to end the greed of the health insurance and pharmaceutical industries. That means boldly transforming our dysfunctional system by ending the use of private health insurance, except to cover non-essential care like cosmetic surgeries."

[1] - https://www.bloomberg.com/news/articles/2019-07-05/harris-ke...

> For any of the services covered by Medicare. Quoting the Kaiser Family Foundation, "private insurance would be prohibited from duplicating the coverage under Medicare."

That's correct. Supplemental insurance can still cover copays and other out of pocket expenses. It can also cover procedures not covered by Medicare.

Now, tell me, how is that "banning private insurance" if insurance companies can still sell those policies?

From a Bernie Sanders interview with NPR.

Q: "Does private insurance go away under Medicare for All?"

A: "Yes, it does, because you're not going to a have a need for private insurance"

A tweet[1] from Bernie Sanders: You're damn right we're going to get rid of greedy health insurance companies.

CNBC describes Bernie Sanders plan as "Bernie Sanders is pushing a “Medicare for All” bill, which would create a government-run program and end private insurance."[2]

The Hill's headline covering Bernie's policy is "You're Damn Right Health Insurance Companies Should Be Eliminated"[3] and references a quote in an interview from MSNBC in which Bernie says universal health care can't be achieved "unless you get rid of the insurance companies."

So feel free to quibble over the nuances of what "eliminate," "end," and "abolish" mean as much as you like, but if you're a person who is concerned that your private insurance is going to be eliminated, and you're listening to Bernie Sanders talk about it, it seems like his statements would reinforce that fear.

[1] https://twitter.com/berniesanders/status/1111363118867927040...

[2] https://www.cnbc.com/2019/07/18/these-2020-democrats-want-me...

[3] https://thehill.com/policy/healthcare/436033-sanders-youre-d...

Why are we still talking about Bernie Sanders?

His ideas are still relevant, even if his candidacy is not.

Nonetheless, the fact remains, no M4A plan proposed by any candidate in the 2020 race would disallow insurers from offering supplemental coverage. Bernie is just simplifying for purposes of making himself understood to the general public. Nobody would "need" private insurance under his plan:

> In other words, while Sanders' plan doesn’t ban supplementary coverage from private insurers, it does offer such generous coverage by the government that there's not much room left for private coverage to fill any gaps. This is the logic upon which both conservative critics — and supposedly nonpartisan mainstream reporters and pundits — hang the logic that Sanders' plan would "ban" private coverage. It's a dramatic "gotcha" question.... [0]

You're essentially reinforcing a right wing talking point that completely mischaracterizes what Bernie's M4A plan actually does.

---

[0]: https://theweek.com/articles/850638/no-really-wants-ban-all-...

Whether he's simplifying or restating seems orthogonal to my point, which is that people who are worried that things are going to change and if they'd like to "just go to a private hospital instead," well - if Bernie is to be believed - in his vision of America, those may not be allowed to exist.

Where did anyone, Bernie included, say that private hospitals would not be allowed to exist?

Firstly, it's implied when he proclaims that companies shouldn't be profiting off of health care. But to answer the question less obliquely, here's a quote of him saying it (from Politifact):

"I could whack pharmaceutical companies, and I don’t need Medicare for All to do it, but I do need Medicare prices for all to deal with what the real profits are — whether you call them profits or not — which is hospitals."

https://www.politifact.com/factchecks/2020/jan/15/bernie-san...

Where does that say private hospitals shouldn't exist? All it implies, and which the article explicitly states, is that private hospitals will have to deal with making lower profits under M4A, which is obvious.

You're reaching. Why are you trying to push a right wing spin on M4A, when studies show that it would reduce costs and increase access to care?

I'm not pushing a spin at all. I care approximately zero about the current healthcare debate or its future direction. I think my initial statement was apolitical and factual. If it's being interpreted otherwise, that's by inference, not implication.

But to the point of why people might be wondering about changes to their healthcare policies, well, perhaps it's because they've been listening to the politicians. If folks would like to obliquely sidestep what I feel was a rather small, simple point and have an argument about efficiency gains in healthcare, you're free to, but I'm not trying to participate in that argument.

Edit: Actually, consider this my last post on the topic at hand, as I'd rather not engage in any argument where reputably sourced facts and direct quotes are regarded as "right wing spin."

Mischaracterizing M4A as a policy is what I'm considering "right wing spin," not "reputably sourced facts and direct quotes." Yours are exactly the words I would expect to hear from scaremongers in Washington telling people M4A "takes your freedom of choice away." If you can go to any doctor or medical facility and have your coverage accepted, and also have as much supplemental coverage as you want, again, how is that "banning private insurance," or "banning private hospitals?" Please explain.

> Mischaracterizing M4A as a policy

I did not do that

> Yours are exactly the words I would expect to hear from scaremongers

I quote the author and it's scaremongering? Yeah, count me out of this conversation altogether. You've uncharitably interpreted what I'm saying, and are doubling down on the sort of rhetoric I explicitly stated having no interest in.

You are spreading deliberate falsehoods. That is literally the definition of "mischaracterizing." As for "scaremongering," or "right wing spin," do you have a better word for amplifying the "you're going to lose your freedom of choice" meme by saying private insurance and private hospitals would be banned?

And, as for the conversation, you were supposed to be out already. It would be better if you stayed out rather than amplifying false statements. If you want to critique M4A, then quote the actual policies put out, not the rhetoric.

a) I'm not spreading falsehoods.

b) I've made no critiques of M4A.

c) You're wrong to the point of malice, perhaps deliberately.

I didn't say that any of the M4A plans would ban private insurance. That doesn't change the fact that Bernie has stated that his M4A plan would, even where the plan he's put forward doesn't show that.

I think it's fair (if a bit naive) to take politicians at their word on occasion. Moreover, I think it's more than a bit disingenuous to assert that plans that are disallowed by law from competing with Medicare services still being allowed to exist for only elective operations as "not banning them." If I disallowed Netflix from streaming any videos longer than a minute in length, I guess technically I have not banned Netflix, but in practice, I have totally banned Netflix, and that's exactly the scale of disallowance we're discussing here.

Your analogy is false, though. A more correct one would be "Netflix is allowed to show all initial movies in a franchise, but sequels are fair game to anyone."

Do you understand the difference between primary and secondary / supplemental insurance coverage?

I don't believe that my analogy is false, or that supplemental coverage would be allowed for the kinds of care being provided by M4A. I think perhaps a more on-the-nose analogy would be that "Netflix is not allowed to distribute anything that Apple TV is distributing or claims to distribute."

Again, I'm not making the claim that it's what's in the policy, but it's what Bernie has said, and others have echoed. Reasonable people can disagree on what policies are practicable or likely, but if you're a person who believes their health insurance might change based on those statements, then it seems like a warranted fear.

For what purpose would they not ban it?

To be clear, I misspoke in my closing sentence, and intended to say "It seems likely to me that the political reality in America would prohibit banning private insurance" -- but got mixed up in my negatives and now it's too late to edit.

That said, answering your question, they would presumably not ban it because a) the aforementioned arguments upthread make it pretty silly to do, and because b) it seems impossible to me that banning a wholly legal service just because it competes with the government would ever be deemed as constitutional.

Well, not ever -- but not today, and not with the direction that the Supreme Court has been taking for decades now in regards to government power. Licensure seems possible, but I think even prohibitive licensure intended to dissuade private entities from competing with the government would be tossed out, and we already have such programs for insurance providers anyway.

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