Yeah and I think Medicaid actually is a much more simple plan because there was no donut hole or supplemental offerings. People on Medicare tend to still have way higher liability for prescription drug coverage.
Which is silly, they have privatized Medicare so much that it's ridiculously complicated. And servicing government contracts for Medicaid and Medicare have become a huge growth area which is why HMOs supported Medicaid expansion.
What we should do is simplify Medicare to make it more like Medicaid in terms of no deductibles, no donut hole, but then just eliminate the age bracket. Automatically opt everybody in..
Preferably that would be the end of it but if you absolutely had to have like a German type system if someone wanted to opt out they would have to demonstrate their ability to afford private care but that's a much less efficient way. But it's still better than the US model.
I mean literally we could make a map of the 35 OECD Nations and throw a dart at it and wherever it lands it would be a better system than what the US has.
There's a few public hospitals and there is a law that mandates if you show up in emergency room they have to provide you with emergency care, although they can bill you for it. Medical debt is the leading cause of bankruptcy in the United States. It's basically not existent in the rest of the industrial planet. And even then it's just emergency care, doesn't cover follow-ups, doesn't cover any referrals.. but that is essentially the insurer of last resort is an emergency room.
People that make less than 128% of the poverty level are eligible for Medicaid. Some people are stuck trying to stay below the poverty level literally so they don't lose their health care. In United States you're better off making 16K a year if you have serious health expenses then you would be making 25k a year.
People over 65 are eligible for Medicare. Everyone else has either no insurance or employee based insurance which is terrible for obvious reasons. That jobs are incredibly temporary. It also is a huge point of leverage for workers that want better conditions but can't afford to quit or they could lose their health care.
But yes it is very lame and peculiar that the United States is basically the only major industrialized nation that doesn't have some kind of centralized universal health care plan where everyone is automatically opted in.
It's disgusting, and it's also grossly inefficient with a third of our cost going to paperwork and we spend 20% of our GDMP on health care when the average OECD nation spends about 10% and covers everybody.