Without Medicare, people over 65 would have to pay an absolute fortune for insurance. Most would go without, further driving up the costs of everyone else's premiums as the elderly ill streamed into emergency rooms minus insurance.
Without Medicare, people who are disabled and cannot work would have no insurance. They haven't the income to afford premiums that would be outrageous considering their health--if they could get insurance at all.
Medicare is in trouble because it provides insurance to people who use it most often--and because the costs of medical care have risen sharply across the board in recent years. Without Medicare, the system would collapse under the burden of the uninsured. Furthermore, without Medicare, we'd see more and more middle-aged people bankrupted and stressed beyond belief as they attempted to help their elderly parents with their medical costs.
The public option would be government-provided insurance, like Medicare, paid for by premiums made lower with subsidies. If the insurers are successful in killing off the public option, THEY will provide insurance to the population that would be served by the public option: the self-employed, employees of small businesses, the unemployed. Here's the rub: the taxpayer subsidies will still be there--going to Blue Cross, Aetna, Cigna, etc. So taxpayers will be subsidizing private companies. Personally, I'd rather we subsidize ourselves.
And speaking of the costs of insurance and small business owners, this is interesting:
My best friend just received his insurance renewal. He has a small business (the um, backbone of the American economy), his renewal was 22%. So now he's at $1865.00 a month....
So what's my friend going to do?
I laid out his really bad options.
I told him to increase the deductible, increase the co-pays, and lower the reimbursement for out-of-network providers, and he could probably reduce the premium increase from 22% to around 10-12%. I also explained that by doing this, he’d be moving deeply into the land of the dangerously underinsured.
He laughed. "Only a 10% increase, how lucky, but business is down 30% this year".
When the dreaded annual premium renewal arrives, scaling way back on health insurance, and going to what amounts to a bare bones policy, has become the only path most Americans can take. The choice is to become dangerously underinsured or drop insurance entirely.
People who think that they do not have a looming problem with health insurance are naive. We all do. It is becoming increasingly unaffordable for businesses and for individuals. This is why about 40% of people declaring bankruptcy today do so because of health care bills. Many of them HAVE insurance, but they've either cut it to the bare bones, like the people will likely have to do in the example above, or the insurer simply refused to pay their claims. This is how they make money.
If the opponents of health care reform win, one day they, too, will regret it.
In addition to being pissed off at the people who either want to keep the status quo or who think that private insurers really care about our health more than making $$$, my worry is that the Obama administration is going to make a deal that is a blessing for the private insurers--mandated coverage and no competition from a Medicare-like option. The government will be herding vast numbers of new customers toward private insurers, particularly the young and healthy, who usually do not cost insurers anything in claims. (This is somehow socialism to those who are woefully ill-informed.) And if the new customers have limited incomes, the insurers don't have to compete for their business by lowering the costs of their premiums because the government will help pay for their premiums. See? In the public option, we're subsidizing those who otherwise would not be able to afford insurance. Without it, we're subsidizing those who otherwise would not be able to afford insurance AND the insurance companies, who only have to spend 65% of their income on claims. The rest can go to administration and CEO pay and advertising. In a government-run program, there is much less fat in the paid-outs: the money goes to paying health care claims, not astronomical profits and ads and layers of expensive management.
In return for an influx of new, cost-effective customers, the insurers will agree to stop denying coverage to people with pre-existing conditions. I've also read that the insurers will stop denying claims (rescission), but I'll believe that when I see it.