(OR) Sen. Jeff Merkeley introduces Medicare for All

[Jim Lane]

11. How could such a plan "operate on its own financial footing"?

There would be a reverse cherry-picking effect. A Medicare option would attract people who could pay the least and/or who needed the most expensive care.

The current Medicare model has one similarity to the private, for-profit plans: A large number of people pay into the system, thereby creating a fund that can be used to cover the expenses of the members of the group who need care (sometimes, extremely expensive care). Optional Medicare would let people stay out unless and until they needed the services.

Therefore, it seems that it couldn't "be fully paid for by premiums." It wouldn't work without significant government subsidies.