What you are forgetting, or failing to mention, about Medicare Advantage is that the federal government directly subsidizes insurance companies to the tune of >$1000 per month per enrollee with the enrollee kicking in another $135+ for part B and another $34 for part D. This, of course, is largely because it is only available to those who qualify for Medicare who represents the highest cost/risk demographic. This is also a large part of the reason the federal government already pays slightly over half of all healthcare dollars in the US currently.
Many claim that this is not a cost to the government because it was already taken from their wages over their working lifetime, but those people also don’t understand how Treasury bonds work. They are simply a swap for more liquid cash reserves that promise the federal government will “create” the needed currency to repay the bond on its maturity with a small dividend added. Ditto for Social Security’s “trust fund”.
It’s fairly common knowledge that the benefits of both programs are fully paid directly from Treasury’s general spending fund as part of the non-discretionary budget, showing that there is no “money” waiting in those funds to pay benefits. Both are nothing more than accounting entries of contributions and outlays, but no money exists in them. Bond proceeds, like all “revenue” of the federal government, decrease the debt and are destroyed by it, unable to lay waiting to pay for anything.
“Finding” the money is never a problem for the monopoly issuer of the currency. There are problems with M4A that aren’t being addressed because so much focus is directed to irrelevant “payfors”. Those are not completely predictable, which is why Bernie wants to phase in the program over his first term beginning with those who will soon qualify for Medicare anyway.
Instead of getting tunnel vision on the numbers of deficit and debt, we should be asking “Do we have the required resources and skills available to provide a high level of healthcare to all Americans?”, or “Can we assure that the savings being offered to consumers will be sufficient to provide an economy that is able to absorb the million+ workers now employed in insurance and administration for providers that will be made involuntarily unemployed?”. If the answer to either of those is no, then “paying for” the program with taxation may be the worst possible move. I somewhat doubt it, but it could be that M4A is deflationary enough to warrant a “TAX CUT” on top of the additional income now being directed to non-productive premiums that consumers will gain. It may depend entirely on how much of their savings they direct to paying down private debt.
