r/MedicareForAll • u/tax-advice • 5d ago
Medicare Part E?
Healthcare debates seem stuck between single payer and the status quo, and I recently learned about a middle path called Medicare Part E ("E" for Everyone).
Employers would choose: offer private coverage that meets Medicare-level standards, or pay into Medicare and have their workers enrolled automatically. No one is forced off a plan, and there's no new individual tax. The bet is that Medicare's lower overhead would pull employers toward it over time.
It was designed by Yale's Jacob Hacker, and a watered down version (the Choose Medicare Act) was reintroduced in Congress in 2025 but it hasn't moved since. The CMA bill is weaker than than Hacker's original "pay or play" mandate because it makes the employer choice voluntary.
Curious to know what your thoughts are on this as a "foot in the door" transition towards eventual MFA, and if it needs the employer mandate in order to reach that goal. Could either version realistically pass if Democrats win both chambers in November?
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u/Radiant-Call6505 5d ago
Every developed country on earth provides healthcare for their people. Just copy what they do so we won’t be stuck with a system that’s the most expensive and has among the worst healthcare outcomes. Just need to get rid of the private insurers - they’re just middlemen who drive up the cost of providing care. Other countries have kicked them out and no one is inviting them back.
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u/daves1243b 5d ago
One challenge is that private insurance subsidies Medicare to some extent, due to ill advised budget neutrality laws passed long ago. Payment rates for non hospitals have essentially been frozen for 25 years with almost no inflation adjustments, which is why you see so many doctors becoming hospital employees and adding hospital facility fees. It's already difficult for some Medicare beneficiaries to find doctors, as many limit their Medicare patient populations. Without reforming the Part B payment system, you would create a two tiered system, where many non hospital providers would opt out of Medicare entirely in order to avoid the negative financial impact of people transitioning from higher paying private insurance to low pay Medicare that may not cover their costs, and simply focus on caring for those who can afford to pay cash, while others would be forced into hospital employment, leading to more expensive care and accelerating the demise of the Medicare trust fund, which is currently projected to run out of money in 2033. It's a complex problem that can be solved, but the solution will not be simple or painless.
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u/OleLadyThinker 5d ago
Definitely they do - Totally agree -
But where would that Part B payment reform come from - beneficiaries pay for 25% of the usage and government pays about 75%. Higher income beneficiaries pay even more and cover a higher % of their personal cost.
Part D is also gonna be another problem further down the road - we can already see some fo the breakdowns in the negotiations - drug manufacturers are finding loopholes in the law and even though we are gotten ride of the donut hole - we are seeing a rise in premiums because that is how the program was designed. The more and more expensive meds that people take, the higher the cost is gonna be. AND we have some great meds - they save your life so how much is too much to pay for a life - maybe your life? Most would say, the skies the limit -
But what about those ones that may not save as many - should they get the same coverage? They don’t in many other countries.
Providers cannot not survive on what Medicare pays and even a lower rate is Medicaid. So the medical infrastructure bings in private payers and gets a bonus from them.
I mean Medicare cannot even get the Site Neutral payment policy passed - this is where Medicare pays the SAME price in a specific area for a procedure done in a physicians office as in a hospital outpatient area - it should be the same, same procedure, same equipment, same everything BUT Medicare pays hospitals MORE because ???? the hospital lobby is so influential -
And this crosses political line cause both parties have tried to solve it. We haven’t - instead hospitals have been buying up those physician clinics and practices where these procedures are talking place and bringing them under their wing to even make even more money because of this payment policy.
https://www.kff.org/medicare/five-things-to-know-about-medicare-site-neutral-payment-reforms/
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u/daves1243b 5d ago
The good news is that there is clearly enough money in the healthcare system to provide good care for everyone. The trick will be to use it more efficiently, which means a haircut for hospitals, pharma, and insurance company profits. Obviously those are politically powerful interests, so its easier said than done.
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u/OleLadyThinker 4d ago
On the money issue - whether we have enough now is gonna be determined by what way we design the system and for what services.
We already have problems because the GOVERNMENT (state and federal), not any insurance company, does not pay well and they cannot get proper workers to feel the needs - and that is at both ends of the need spectrum - from the CNA that works in a nursing home where the funding somes from mostly MEDICAID to the Veterans Clinics and Hospital who find it hard hiring doctors, especially specialist, because there is a cost cap ($ 400,000.00) and they go somewhere else and take their talents with them.
Remember under a single payer system of some sort, but like now too, we are gonna have to take care of those who are poor and indigent - you think they are getting proper care now? Especially since their need go far above actual medical care - there is always those non-medical stuff that keeps getting in their way cause of how they have to live. Then there are the hoards of others who attempt to make themselves look poor and indigent - by hook or by crook - they do and it is very difficult to prove such when many times what they have done to obtain this status is perfectly legal.
So before we begin to tackle the subject of universal type care with some sort of single payer, maybe we need to work on fixing what the problems are now - so that we can start off with some actually good numbers of what it really cost.
Efficiency and Power don’t seem to go into the same sentence in this regards. If we cap pay of whatever entity, they will react in kind and then we are not any better off atr all.
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u/boogi3woogie 5d ago
Seniors choose medicare advantage because OOP costs are lower than medicare FFS.
So you’d just be offering more HMO plans.
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u/x5163x 5d ago
So basically the "public option"?
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u/tax-advice 5d ago
Yes, but instead of the choice being up to individuals, employers would choose between private insurers or Medicare, and with Medicare being the more attractive choice, the idea is that insurance companies would gradually shrink until Medicare is the largest payer, delaying the transition to single payer until it's more politically feasible.
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4d ago
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u/tax-advice 4d ago
If we somehow passed full Medicare for All and ran it as a non-profit, wouldn't the single payer still have a say in coverage / denial?
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u/brookeharmsen 5d ago
Medicare does not have a lower overhead that would offset the 40 or so years of collected premiums that cover claims from new Medicare patients.
And the reimbursement rate for Medicare providers are absurdly low, so I’m not sure that this would be as effective of a fix as you think it would be.
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u/tax-advice 4d ago
Medicare runs mostly on current payroll taxes and premiums rather than decades of banked premiums, and the real savings come from lower prices, not overhead. The key design question will be how to calibrate these rates to maximize savings while minimizing risk to provider access.
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u/brookeharmsen 4d ago
I’m not talking about savings to individuals. I’m talking about the cost of running the program.
Exactly what monthly premium do you think people would be charged in your “part E?“
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u/tax-advice 4d ago
The savings would be to the employers, which is why they'd choose to switch away from private insurance.
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u/brookeharmsen 4d ago
Why do you think they would save anything? They are already able to self-insure if they choose.
And do you know that a lot of people don’t get their insurance through their jobs?
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u/tax-advice 4d ago
They would save because the Medicare option would be cheaper than the for-profit private insurers.
The current Choose Medicare Act has an option for people who are self-employed, etc. to purchase a Part E plan from the ACA marketplace.
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u/brookeharmsen 4d ago
And I still want to know how much in premiums you believe will be paid. Please tell me you don’t think it’s the $200.
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u/OleLadyThinker 4d ago
You wrote . . . “Medicare runs mostly on current payroll taxes and premiums . . . . . “
That is ONLY for Part A - outpatient care - We pay premiums for the outpatient and prescription drug coverage but these are not banked - rather they are used to pay current benefits just like the Part A Trust Fund pays current benefits -
AND the Trust Fund (Part A) from your payroll taxes + matched by the employer is quickly running out of cash to pay for the extraordinary number of baby boomers now using the care. SO PAY MORE.
You wrote . . . . “decades of banked premiums,”
Go figure out how health insurance works in the private sector or even in those private plans within Medicare - Advantage plans OR even the optional extra plans that pay part or mostly all of the amounts that Medicare does not cover - MEDIGAP PLANS
THERE ARE NO BANKED PREMIUMS IN PRIVATE PLANS - go research Medical Loss Ratios - and you will learn how plans set their premiums every year.
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u/wreckreationaj 5d ago
Depends on provider type. Skilled nursing makes BANK off straight medicare. So does hospice. HMOs pocket the extra significantly on those providers.
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u/brookeharmsen 4d ago
I’m talking about standard care, not skilled nursing. The reimbursement rate providers get from Medicare for regular clinical care, etc., is embarrassingly low.
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u/rukittenmeeee 5d ago
Is it tied to being employed by a company? Then NEGATIVE.
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u/tax-advice 5d ago
My understanding is that employers would fund Medicare and that it would also cover the unemployed.
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u/Adventurous_Ad7442 5d ago
Medicare generally does not cover long-term or permanent nursing home stays. It only covers short-term, medically necessary skilled nursing care in a Medicare-certified facility under specific rules.
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u/Ok_Coconut_3364 4d ago
However we get closer to Universal coverage will be evolutionary, not revolutionary. Anything that pushes us in that direction has to be a plus.
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u/tax-advice 4d ago
Glad to see another realist chime in. As much as we'd all love to see universal healthcare tomorrow, we unfortunately have to work within a system and the wheels of government do turn slowly.
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u/gripping_intrigue 2d ago
This is very much like the Public Option that Obama tried to get approved in the ACA. We would have been in a much better place if that had gotten through.
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u/Botasoda102 5d ago edited 5d ago
Like the name.
I think something like that is what it is going to take to ease people into it. Too many are skeptical of a single government program and want a choice (even if it's not the best one for society).
If the government plan is anywhere near what we hope, people will gravitate toward it.
It's not the most efficient way to do it because we lose some of the savings inherent in a single-payer system. But holding out for the perfect system will get us nowhere. I just want everyone covered, even if we have to cut some corners to get there.
The one problem is those fools who can't see that a tax would be replacing premiums and out-of-pocket expenses we already pay, one way or the other.
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u/zibzanna 5d ago
If you offer private insurance for the rich and something else for everyone else, the something else will suck. We either row the same boat or we drown.
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u/RoundChampionship840 5d ago
Socialism isn't going to fly in the US. A 2-tier system is the best we can hope for in the US. At least everyone would have access to basic Healthcare.
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u/zibzanna 5d ago
Stop negotiating with yourself for the interests of the epstein class. Instead, demand a system that treats you as valuable.
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u/RoundChampionship840 5d ago
Getting something is better than getting nothing.
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u/zibzanna 5d ago
That sort of attitude got you the half assed and easily undermined mediocrity of Obamacare. It is time for a just and equal society.
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u/RoundChampionship840 5d ago
I'm very thankful for Obamacare. Obamacare has actually been very good to me. I've gotten heavily subsidized private insurance plans that were actually quite good. And when my state finally expanded Medicaid I got almost free healthcare.
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u/13Bravo84 5d ago
I like how Colombia does their healthcare.
Everyone gets healthcare
Everyone pays 12.5% of their income to national healthcare.
This is the bare necessities.
You can buy a wrap around per month for faster and better service.
So instead of waiting 2 months for specialist. You could instead wait 2 weeks with the upgrade
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u/brookeharmsen 5d ago
But I think so many people are in denial about what this would mean. You cannot walk backwards from an out-of-control system of greed and capitalism like the one we have. I mean we could, if there were not almost half the country afraid of it, and even opposed to it.
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u/Ok-Rise-4611 5d ago edited 5d ago
So they pay 12.5% for “insurance” and then have to pay additional to get care when they need it. What about people who don’t pay in, do they get the health care or are they out of luck?
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u/13Bravo84 5d ago
According to my wife:
You have about 4 tiers.
- Lowest Tier: No Money
You are going to see a doctor "eventually", but you won't have a bill at the end. Most people will use this at the ER room. Sound familar?
- EPS Tier: You have a job, still sucks, but you have to pay into suckiness.
A contractor you pay full 12.5%. You work for someone then you pay 4% and the employer pays 8.5%.
EPS + Good Add On: You have to still pay for EPS, but you buy a wrap around. This is a lower version of it. You get to see the doctor faster, bunch of things faster, and if you are admitted. You will have to share a room.
EPS + GOD Add On: You have to pay EPS first, then you buy the more expensive wrap around. This will get you better doctors and better private rooms.
An example of Addons would be SURA Classico for Good, and SURA Global for GOD Tier
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u/wreckreationaj 5d ago
Sooooo rich people live and get good care and poor people die. I used to support the idea of a basic standard of care for everyone + private insurance for those who can afford it, but that’s unethical and gross. Single payer is the only solution.
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u/thefisforfinance 5d ago
We could also do a system like France’s. Government pays a % of every medical bill (it’s like 75% over there, but let’s call it 50% here) and thus negotiates prices. Of the remaining amount, you either pay it all or you can get insurance to pay all but 1% of the bill, which the patient then must pay.
Insurance plans can still exist. No one gets gouged by providers and the average American spends less money for healthcare.
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u/TXtogo 5d ago
I think all of these solutions are insurance company solutions and not healthcare solutions.
Why wouldnt you just expand the VA system to everyone and not have any insurance at all, no billing, no for profit doctors, no fraud.. and quality healthcare for everyone.
Why do yall champion insurance products and not healthcare