Should Everyone Be Able To Join Medicaid? Why Not? – Forbes

WASHINGTON, DC – MARCH 22: Health care activists participate in a rally in front of the Capitol March 22, 2017 on Capitol Hill in Washington, DC. Senate Democrats held the rally to highlight changes being sought in Medicaid in the Republican American Health Care Act. (Photo by Alex Wong/Getty Images)

From the earliest days of Obamacare, a great many Democrats and others on the left have wanted a “public option.” At least one plan offered in the Obamacare exchanges should be a government plan, they proclaimed. The state of Nevada may make that wish a reality, if the governor signs a bill just passed by the legislature – allowing everyone who resides there to buy into the state’s Medicaid program.

Why does the left like this idea? Because they are ideologically committed to the propositions that when it comes to health care (1) non-profit is always better than for-profit and (2) public is always better than private.

Both beliefs fly in the face of reality. Left-wingers got part of what they wanted when Obamacare allowed 24 non-profit coops to compete in the Obamacare exchanges – with federal subsidies! Yet as of today, 21 of those have gone under and only four are left standing. That leaves Democrats now pining for a government run health plan – which means either Medicaid or Medicare. But once again, facts belie the belief.

More than one-third of seniors on Medicare are already in private insurance plans – voluntarily chosen and in competition with traditional Medicare. As more baby boomers retire, enrollment in private Medicare Advantage plans will almost surely grow – since it is now clear that MA plans are more efficient (less costly) than traditional Medicare and they offer more benefits.

[Incidentally, even traditional Medicare isn’t run by the government. It’s contracted out to Blue Cross and other private entities.]

As for Medicaid, about two-thirds of enrollees nationwide are in privately managed plans and the states have turned to private contracting for the same reasons we did in Medicare: the private plans are cheaper and better.

So on the evidence, it would appear that conservative Republicans don’t have much to lose by allowing a public option and they may have something to gain – allowing those currently enrolled in public programs to leave and enroll in better private sector alternatives.


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