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Comment by msla | Hacker News Reader

> Medicare For All

Nobody who relies on Medicare would say that. The people who say it want a fantasy Medicare that doesn't exist.

https://www.medicare.gov/providers-services/original-medicar...

Some of the items and services Medicare doesn’t cover include:

    Eye exams (for prescription eyeglasses)
    Long-term care
    Cosmetic surgery  
    Massage therapy
    Routine physical exams
    Hearing aids and exams for fitting them
    Most dental care: In most cases, Original Medicare doesn't cover dental services like routine cleanings, filings, tooth extractions, or items like dentures.

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I rely on Medicare as a disabled person. I love it. The reduction in stress I experienced when I got to transition from my former employer plan to Medicare is pretty indescribable. I want every American to have at least this as a baseline.

Most of the complaints around Medicare come from those who get sold (conned) on takin Medicare “Advantage”, which is a privatized option for Medicare that denies a lot of coverage.

IIUC, the difference (for USG) of Medicare vs Medicare Advantage is that Medicare subsidizes the cost of a procedure done by a provider while Medicare Advantage (MA) pays a fixed rate per treatment to an insurer.

So if the MA rate is less than the provider changes then the insurer is highly incentivized to deny you coverage. While for Medicare you'd have a higher co-pay.

This also leads to scenarios where MA insurers upcode patients so that the treatment is at a higher rate [1]. (ex. Marking patients as recovering drug addicts when prescribing opioids to get both money from both counseling and the opioid treatment).

[1]: https://www.healthcaredive.com/news/unitedhealth-grassley-me...

Just as a data point, depending on a country of course, the European public healthcare systems don't cover some/most/any of these either.

For example the eye exams for glasses are usually done at the store where you buy the glasses and included in the price, dental might be covered only for children, routine physical exams may not exist as a concept, etc.

My bad. I used that as a stand in for a single payer system like Medicare. Good idea, yes? Or do you object to that?

BTW There can still be a for-profit, premium health insurance market alongside. if you’re rich spend as much as you want on healthcare.

> My bad. I used that as a stand in for a single payer system like Medicare. Good idea, yes? Or do you object to that?

My objection to that is putting too much power over healthcare in the hands of the Federal government ends badly when someone like RFK Jr is in power in the Federal government.

My ideal is closer to the German system, with state-level public options which preserve private insurance.

But it covers everything that isn't those things? For free? Still sounds pretty good.

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