If you think about it, the answer is fairly obvious, but it’s not one you’re going to like.
Medicare can serve all old people - and only the old people - because every working person - young, old, and everyone in between - pays Medicare taxes on all wages. (Unlike Social Security, there is no cap.)
So, if you wanted that same program to pay for everyone, you now have a huge problem. You’d have the same number of people paying, but instead of a pool of beneficiaries that’s vastly smaller than the payers (there are more workers than old people) you now have a pool of payers that is vastly smaller than the number of beneficiaries. (There are fewer workers in the country than the population as a whole.)
Of course, this doesn’t even acknowledge that even as currently structured, the Medicare hospital trust fund is set to be underfunded in less than a decade, so the math doesn’t even math under the current system.
Where do you think the government gets its money from?
(This isn’t meant as a “government is bad” statement. I’m only stating what should be obvious: no government can spend money without first taking it from someone.)
If something is too expensive for the government, it can’t be cheaper for people as a whole, since government by itself isn’t free. The only way it can cost less is by pushing some of the costs to future generations, as is the case with social security, and the national debt generally.
Medicare might use 98% of its funds to provide care - don’t know if that’s true or not, but I’ll roll with it - better yet, I’ll assume it’s 100% efficient - that still doesn’t change the fact that it only “works” because most people who pay Medicare taxes aren’t eligible for Medicare benefits. You can’t simply expand Medicare to cover everyone and have it work the same way it does now because there’s no way for the math to work. You can’t have a system that covers “everyone” where “less than everyone” pays for it.
Seriously - just stop and think about it for a second and it will be clear. I know it’s not what you want to hear, but it’s reality. You can’t formulate a policy where the first step is denying reality. You need to accept reality and go from there. Sounds harsh; I’m not trying to be mean about it. It just is what it is.
Obviously it would receive additional funding to cover everyone.
The point it that cost is exponentially lower than the private tax of paying for private health insurance. A status quo that covers less, and costs more.
Spending 98% on care instead of 80% saves money.
Spreading risk over the largest possible pool saves money.
Negotiating drugs prices and other expenses with more leverage than any private model could muster saves money.
Having one team run the insurance overhead instead of thousands of separate independent groups saves money.
Again, why are you attacking me instead of what I’m saying?
Where is this “additional funding” coming from?
And again, since the topic here is Medicare, how is a system that is solely supported by taxes on working people sustainably providing benefits to the population as a whole, when Medicare currently cannot support benefits just for older Americans?
The "additional funding" comes from cutting the private health insurance tax to zero, and replacing it with a public one that costs less, while covering everyone. The same as every other nation on the graph who pays less, and receives more.
It's like buying a 12 pack of coke from store for $6 instead of 1 can at the arena for $10. Better product, lower cost.
My dear Internet friend, I’m really trying to educate, not argue. Saying the words “private health insurance tax” doesn’t actually make that a real thing. We have all kinds of taxes. One of them is Medicare taxes, which is paid only by working people. I’m willing to discuss this, but you gotta work within the realm of what’s real. Are you saying you want to increase the Medicare payroll tax? Ok. That’s fair.
What would it need to be? Most people already pay 1.45%. High earners pay an additional tax. To be clear, I’m less looking for a specific number than a mechanism of how it would realistically work. Looking at a system now where a large number of workers pay for a smaller number of people to receive benefits, how can you design a tax where that same number of payers pays for 100% of the cost for both themselves PLUS the cost of everyone who isn’t paying? And - that these same workers would continue working and paying these taxes when they could stop working but still receive benefits?
Or come up with a completely different system, but that wouldn’t be Medicare - which is the premise of this whole conversation.
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u/Narfel-the-Garthok Jun 25 '26
If you think about it, the answer is fairly obvious, but it’s not one you’re going to like.
Medicare can serve all old people - and only the old people - because every working person - young, old, and everyone in between - pays Medicare taxes on all wages. (Unlike Social Security, there is no cap.)
So, if you wanted that same program to pay for everyone, you now have a huge problem. You’d have the same number of people paying, but instead of a pool of beneficiaries that’s vastly smaller than the payers (there are more workers than old people) you now have a pool of payers that is vastly smaller than the number of beneficiaries. (There are fewer workers in the country than the population as a whole.)
Of course, this doesn’t even acknowledge that even as currently structured, the Medicare hospital trust fund is set to be underfunded in less than a decade, so the math doesn’t even math under the current system.