Why not let people above the Medicaid income threshold buy Medicaid?

[democrattotheend]

7. I'd rather let them buy into Medicare

I think most people who make too much to be eligible for Medicaid would prefer to buy into Medicare. The advantage of Medicaid is that it has lower out of pocket costs for patients, but the downside is that a lot of doctors don't accept it because the reimbursement rates are too low, and the doctors who do take it may be good doctors, but it can be difficult to get an appointment and there are often long waiting times to be seen because they either overbook or tell everyone to come at the same time and wait all day. And in some areas it is difficult to find any doctors in certain specialties who take Medicaid.

I also think a Medicare buy in is easier to sell because Medicare is popular and doesn't have the same stigma associated with it as programs that subsidize the poor do. Letting younger people buy into Medicare might also help resolve the projected funding deficit with Medicare as more boomers retire.

In an ideal world, we would eventually do away with Medicaid and let everyone buy into Medicare for a percentage of their income, and make it free or almost free for the very poor. That way we wouldn't have a two-tiered system like we do now.

IMO, Democrats in 2009 and 2010 made a mistake by pushing a "public option" instead of a Medicare buy-in. Unfortunately, Republicans have made the word "public" a dirty word to a lot of people, whereas Medicare is a popular brand. It would have also drawn on the existing infrastructure of a program that works instead of creating a whole new system.