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Medicare for all sounds interesting, but the one thing the system has today is a high level of competition for large businesses. So insurance company rates for large companies are significantly lower than other segments. A lot of them are self insured. So whatever is done needs to make sure there’s competition that providers care about, because if it’s just the individual negotiating for themself, then all companies will just raise rays with no governor because they can withstand losing an individual rather than a company. It allows the providers to essentially price fix.

Just now, Dbeasy said:

Medicare for all sounds interesting, but the one thing the system has today is a high level of competition for large businesses. So insurance company rates for large companies are significantly lower than other segments. A lot of them are self insured. So whatever is done needs to make sure there’s competition that providers care about, because if it’s just the individual negotiating for themself, then all companies will just raise rays with no governor because they can withstand losing an individual rather than a company. It allows the providers to essentially price fix.

M4A should be a universal catastrophic coverage, imo. Let the witches figure out what the max OOP should be for coverage to kick in. Divorce insurance coverage from employment, and let insurers figure out a market to insure people up to the gap amount. Or people can free ball it up to the OOP max if they want. Safety net programs like Medicaid continue, with a focus on coverage up to the max OOP. Every american should have access to HSA with a very generous contribution limit. Force some price transparency and make certain regulatory changes at FDA to require cost-effectiveness analyses be conducted as part of the drug approval process. It's not a perfect solution, but it would be a good start.

I'm old and on Medicare; Mrs Fairway turns 65 mid 2026, and no ACA plan pays MD Anderson, so she will has been working the last year+ for medical insurance. At some point her small employer plan will be dropped because her claims are well in excess of $1,000,000. But she will be gone by then, and Medicare covers MD Anderson. Medical insurance, premiums, oop, deductibles co-pays, and limitations are very difficult to understand for all but the broker and underwriter who make a ton of money off the obfuscation.

1700 per month here with a max 9K deductible for 2.

for me only, premium up 50% for worse coverage. Higher deductible, higher co pay. PC office visit went from 20 to 50.

1 hour ago, Wally Fairway said:

Medical insurance, premiums, oop, deductibles co-pays, and limitations are very difficult to understand for all but the broker and underwriter who make a ton of money off the obfuscation.

Because for-profit professionals will almost always have an insurmountable advantage over health care consumers in a free market system, especially with senior health care consumers who need it the most.

My wife works for a small company, under 50 employees. I dont know the exact dollar numbers because she and the kids are on my insurance, but the company owner told her the premiums had tripled for 2026.

Was paying $2900/mo for my COBRA PPO plan (was considered an “Cadillac plan when I was employed) including dental and optical for me, wife and 2 teens and bill in January jumped to 3500/month. Luckily my new employer insurance kicks in Feb 1 for 1800/month for similar coverage. Was about to use my EU passport to move to Spain to get on “free” healthcare with about $2000/year for additional private insurance until I could qualify for Medicare here…

Edited by Grimas

11 hours ago, Wally Fairway said:

I'm old and on Medicare; Mrs Fairway turns 65 mid 2026, and no ACA plan pays MD Anderson, so she will has been working the last year+ for medical insurance. At some point her small employer plan will be dropped because her claims are well in excess of $1,000,000. But she will be gone by then, and Medicare covers MD Anderson. Medical insurance, premiums, oop, deductibles co-pays, and limitations are very difficult to understand for all but the broker and underwriter who make a ton of money off the obfuscation.

We have the same issue. We both get care at Mayo Clinic, and no Texas ACA plans accept it. So despite being pretty well off financially and no need to work, my wife works so we have access to Mayo. It’s ridiculous. Oh, and Mayo costs are as low or lower than any other provider on Texas so it doesn’t even financially make sense.

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Turning 65 a few years ago was the best decision I’ve ever made. Health insurance, even with IRMAA went down by 2/3rds, property taxes have been cut in half as has car insurance. This year I will take social security so keep working all you millennials and GenXers.

1 hour ago, Dbeasy said:

We have the same issue. We both get care at Mayo Clinic, and no Texas ACA plans accept it. So despite being pretty well off financially and no need to work, my wife works so we have access to Mayo. It’s ridiculous. Oh, and Mayo costs are as low or lower than any other provider on Texas so it doesn’t even financially make sense.

I believe the issue is that ACA plans are at least partially state administered and funded and, for the most part, coverage stops at state borders.

48 minutes ago, TwiceHorn said:

I believe the issue is that ACA plans are at least partially state administered and funded and, for the most part, coverage stops at state borders.

This was my experience. I am ten miles from one state border and 60 from another one. And I don’t like my hometown hospital. Ended up running a BC/BS plan through my c-corp.

Texas. The small group policy for PPO coverage is very expensive. We are older, have homes in two states and need PPO coverage. Sucks but will be short term. I bail out into Medicare next January.

17 hours ago, Chewbacca said:

We have roughly 100 employees and about half are on our company plan. We managed only a 2.6% increase this year, but we had to switch insurers from UHC to Aetna to do that. Would have been 11% if we stuck with UHC. We offer 4 different plans (2 traditional PPOs and 2 high deductible plans). Premiums for a family cost between $2,776-$3,412 per month (before we pay the employer portion) for deductibles from $1,500 for individuals to $7,000 family deductibles on the cheaper high deductible plan. We have good insurance but it's absurdly expensive.

Healthcare costs are completely out of control in this country. There is no reason for healthcare to be tied to employment and there is no reason we can't figure out how to get everyone on Medicare (other than big, fat campaign contributions from the healthcare companies).

If we manage to decouple insurance from employment, what are the odds that the employers move all of the cost savings to employee pay?

You might do it with your company of 100, but how many would work the numbers and deliver that money to employees to pay for their own health care rather than keep some or all of it?

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Combining my Medicare premium and my part B Medigap and part D premiums and Irmaa, I pay about $550 a month now.

A couple hundred dollars is the deductible for the year for all of my medical providers that are not dental or vision. I have a $2000 deductible for what will be around.$60k in prescription drug costs.

Given that I have several pre-existing conditions that would be a problem for self-employed me, the Medicare system literally prevents me from spending all of my disposable income on medical care. When I was in my 60s before I got on Medicare, I took advantage of a pharmacy near New Zealand that did not really care about prescriptions. They would sell me bronchodilators and anti-inflammatory /asthma drugs for less than my deductible (if I had been on a plan). $12 ventolin inhalers, etc.

In-house pharmacy. it takes a while for the international shipment, but if you don’t have insurance, not having to pay for doctors visits to get a prescription and then pay full pop prescription - using that Pharmacy was often a cost saver. They don’t offer everything, and they certainly don’t give narcotic pain relievers, but they covered basically all of my respiratory meds without the need for a prescription.

I give no opinion about the legality of the process, but if you or your family have no access to medications that you cannot do without and no access to doctors, that is an option that some here might want to explore.

https://www.inhousepharmacy.vu/

28 minutes ago, Pato del Muerto said:

If we manage to decouple insurance from employment, what are the odds that the employers move all of the cost savings to employee pay?

You might do it with your company of 100, but how many would work the numbers and deliver that money to employees to pay for their own health care rather than keep some or all of it?

You think Medicare for all will be funded without additional taxes on employers?

Maybe its a net reduction in costs to employers, but it sure as fuck isn't a complete removal of the cost.

18 hours ago, Chewbacca said:

Healthcare costs are completely out of control in this country. There is no reason for healthcare to be tied to employment and there is no reason we can't figure out how to get everyone on Medicare (other than big, fat campaign contributions from the healthcare companies).

One of the major drivers of healthcare increases are the massive increase of medicare patients over the last 10 years as the youngest baby boomers are quickly approaching 65. Doctors and more importantly hospitals at best break even with medicare patients and often perform services at below cost. The result is that younger (<65) people and their insurance have to pay more in their healthcare to cover the old people on medicare. The CMS website tells me that medicare recipients grew from 53m in 2013 to 68m in 2024.

The move from traditional medicare to medicare advantage also has pros and cons for total costs as well.

Moving everyone to Medicare creates some interesting efficiencies but Medicare would be much more expensive for everyone if it became the default.

Group insurance through my employer. I have a $1700 deductible, $3500 oop, Dental and Vision are included. It went up a few dollars this year. I honestly cant believe what some of you are having to pay. My wife keeps insurance through her employer which covers her Orencia medication at no cost. ($6000/month biologic)

Screenshot 2026-01-07 at 10-50-01 Current Coverage - Goodyear.png

1 hour ago, Pato del Muerto said:

If we manage to decouple insurance from employment, what are the odds that the employers move all of the cost savings to employee pay?

You might do it with your company of 100, but how many would work the numbers and deliver that money to employees to pay for their own health care rather than keep some or all of it?

I would imagine any move to Medicare for All would have employers still paying for a lot of it (as well as increased income taxes on everyone), but we can figure that out. Everyone else on earth (peer countries, at least) has figured out how to do this. We can do it, too so people aren't stuck at a job just for insurance, and so people do not go broke because they got hurt or sick.

1 hour ago, Nice Guy Eddie said:

One of the major drivers of healthcare increases are the massive increase of medicare patients over the last 10 years as the youngest baby boomers are quickly approaching 65. Doctors and more importantly hospitals at best break even with medicare patients and often perform services at below cost. The result is that younger (<65) people and their insurance have to pay more in their healthcare to cover the old people on medicare. The CMS website tells me that medicare recipients grew from 53m in 2013 to 68m in 2024.

The move from traditional medicare to medicare advantage also has pros and cons for total costs as well.

Moving everyone to Medicare creates some interesting efficiencies but Medicare would be much more expensive for everyone if it became the default.

So let's roll all those younger people into Medicare to get the per person costs down.

3 minutes ago, rpspeed said:

Group insurance through my employer.

I think it would be useful perspective for everyone in the discussion if people would disclose the type of employer they are getting healthcare through. The baseline assumption would be that only a large employer(I'm not sure what the line of delination is there) can get such pricing.

Of course only if the poster can do so without fear of doxxing themselves.

My husband and I are in our early 60's. We keep our MAGI purposefully low to qualify for a subsidy. I'm not happy about that, but it's the way the game is structured.

ACA Blue Cross/Blue Shield TX HMO, $0 premium, $6,000 individual deductible ($12,000 family), and $10,800 max out of pocket individual ($21,200 family). Last year, the monthly premium was $708.30, no deductible, and $1,200 max out of pocket individual (family $2,400). Crazy how it jumped from one year to the next.

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12 minutes ago, 86txex said:

ACA Blue Cross/Blue Shield TX HMO, $0 premium, $6,000 individual deductible ($12,000 family), and $10,800 max out of pocket individual ($21,200 family). Last year, the monthly premium was $708.30, no deductible, and $1,200 max out of pocket individual (family $2,400). Crazy how it jumped from one year to the next.

if you guys stay healthy this year, that is absolutely a win when you subtract the $708 monthly premium. If your family experiences significant medical problems this year it could be far more expensive than last year. Good luck to you.

1 hour ago, Incredulity said:

You think Medicare for all will be funded without additional taxes on employers?

Maybe its a net reduction in costs to employers, but it sure as fuck isn't a complete removal of the cost.

Fair point. My post assumed the entirety of the healthcare cost was moved to the individual, and paid for by either individual taxes or by having the individuals opt in and pay 100% of their cost.

Obviously (I think) if there is still a burden on companies to help pay health care, that would be factored in.

Addendum: my family had never used health insurance for anything major until last year, when my son was gifted with a kidney laceration via a soccer injury. Even with our higher deductible HSA plan, it wasn’t too financially painful to cover his 3 days in ICU and further week in a hospital bed. Paying 5k or thereabouts into the system for 20 odd years probably was surpassed in billing by this one incident.

Edited by Pato del Muerto

Medicare for All would almost certainty remove all healthcare costs for employers and there's no chance that they would have a new or increased tax placed on them. Politicians would tell you that it's up to the employer to pay their employees more now that healthcare costs are zero for the employer. And if your employer doesn't give you a corresponding raise, then that's your problem to work out.

1 minute ago, Nice Guy Eddie said:

Medicare for All would almost certainty remove all healthcare costs for employers and there's no chance that they would have a new or increased tax placed on them. Politicians would tell you that it's up to the employer to pay their employees more now that healthcare costs are zero for the employer. And if your employer doesn't give you a corresponding raise, then that's your problem to work out.

They might phase it out down the road, but any viable plan has to start with employers paying a big chunk since that's how our current system is set up.

6 minutes ago, Nice Guy Eddie said:

Medicare for All would almost certainty remove all healthcare costs for employers and there's no chance that they would have a new or increased tax placed on them.

What? you are basing this on what exactly?

39 minutes ago, Incredulity said:

I think it would be useful perspective for everyone in the discussion if people would disclose the type of employer they are getting healthcare through. The baseline assumption would be that only a large employer(I'm not sure what the line of delination is there) can get such pricing.

Of course only if the poster can do so without fear of doxxing themselves.

Both ours are very large employers, both over 50k

Edited by rpspeed

2 hours ago, Chewbacca said:

So let's roll all those younger people into Medicare to get the per person costs down.

Then quality of care will then drop. Doctors and hospitals will need to decrease staff to accommodate less revenue. And not just office staff but direct care.

Someone above made a comment that the rest of the world has solved healthcare so why can't we. It's a bit simplistic to say that they've solved it when there is most likely 180 systems for the 180 countries. There isn't 1 solution out there, and each one of them has their deficiencies. Not to mention that the US indirectly subsidizes the rest of the world's healthcare since our model creates new drugs and treatment. And now that the US govt is out of research as of 2025, healthcare is even more dependent on the US capitalist system.

I don't have the magic answer either. No one does. I've never even heard the Medicare for All side define if they mean traditional medicare or medicare advantage. They're not the same. Personally I think Medicare Advantage sucks.

3 hours ago, Nice Guy Eddie said:

Then quality of care will then drop. Doctors and hospitals will need to decrease staff to accommodate less revenue. And not just office staff but direct care.

Someone above made a comment that the rest of the world has solved healthcare so why can't we. It's a bit simplistic to say that they've solved it when there is most likely 180 systems for the 180 countries. There isn't 1 solution out there, and each one of them has their deficiencies. Not to mention that the US indirectly subsidizes the rest of the world's healthcare since our model creates new drugs and treatment. And now that the US govt is out of research as of 2025, healthcare is even more dependent on the US capitalist system.

I don't have the magic answer either. No one does. I've never even heard the Medicare for All side define if they mean traditional medicare or medicare advantage. They're not the same. Personally I think Medicare Advantage sucks.

Why is quality of care going to drop? Are we magically going to lose all the healthcare professionals we have? And I never said anyone solved anything. I said they figured it out. I'm confident we can as well. Never said it would be perfect, but it would be a damn sight better than what we have today.

I want everyone to have healthcare coverage so they don't have to file bankruptcy because they get cancer, or get in a car wreck.

9 hours ago, Incredulity said:

You think Medicare for all will be funded without additional taxes on employers?

Username checks out.

On 1/6/2026 at 6:38 PM, Wally Fairway said:

I'm old and on Medicare; Mrs Fairway turns 65 mid 2026, and no ACA plan pays MD Anderson, so she will has been working the last year+ for medical insurance. At some point her small employer plan will be dropped because her claims are well in excess of $1,000,000. But she will be gone by then, and Medicare covers MD Anderson. Medical insurance, premiums, oop, deductibles co-pays, and limitations are very difficult to understand for all but the broker and underwriter who make a ton of money off the obfuscation.

Brokers aren’t making bank off of single health insurance plans, they make their money on volume. I’m not going to say what the broker commission is on our plan, but I will say I charge them more for their tax work than they make on my 250 life plan.

On 1/6/2026 at 6:17 PM, Anastasis said:

Agree, physicians and other providers are not driving the increases in health care costs. It's hospital and pharmacy spend. From KFF:

annual-percent-change-in-consumer-price-index-for-all-urban-consumers-cpi-u-for-medical-care-by-category-june-2023-june-2024.png

You might want to check the stock values of the largest insurance providers and see where a good deal of the money in the system ends up.

From a hospital perspective, my wife and I were both in the hospital this year for different issues. Neither stay in total equaled one treatment of the current top bladder cancer treatment drug being used. Mine didn’t even come to the monthly costs of some of my employees maintenance drugs. Now my dad was in the hospital earlier this year and passed after a week or so. He was on Medicare and they loaded him up with everything they could think of while running through a ton of tests and treatments. He was never walking out of there and it was easily a mid 6 figure stay.

Premium increase of $16 a month.

56 minutes ago, Brew said:

You might want to check the stock values of the largest insurance providers and see where a good deal of the money in the system ends up.

Top 3 insurers plots against the two largest for profit hospital groups and two admittedly cherry picked pharma. 5 and 10 year plots.

image.png

image.png

swap out Lilly and Abbvie for JNJ and MRK on the 10y and that covers the top 4 pharma by market cap.

image.png

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