The problem with excellent ideas is that they are always implemented according to strict, unchanging laws of doing business in America. No matter what is wanted, the same product is rolled out. The Medicare buy-in is not a bad idea; neither, frankly, is Obamacare. The problem is what rolls off the assembly line, what does it do, what are its parameters.
The rules of American healthcare insist that every improvement will decrease the amount of money paid through certain sources, will please certain constituencies and resonate well among the voters. It will have scrupulous “quality oversight” and aggressive punishment of the “violators.” Given these rules, there’s no way to run anything decent off the assembly line, even if sunshine and rosebuds go into the ideas that fuel the machine.
“Buy-in means that, assuming it is done right of course, it should not cost anything additional.” Of course, but there will me an insistence that it will produce 5%-10% improvement in cost by enacting quality and efficiency standards. Who is against efficiency, and quality?
Sanders is the closest candidate to a “change-the-paradigm” approach, but his followers are naive in the hopeless intellectual way – that those who benefit from unfair actions and principles will recant what they do, once it is pointed out to them. It’s the same idea behind penitentiaries and reformatories that teach criminals not to be bad people. The occasional criminal, in fact, does the the light and go straight.
But none of the masters of American Healthcare are quite so interested in doing the right thing at the right time for the people. They are interested in how to hijack EVERYTHING to benefit their own ways.
Medicare buy-in is no worse than Obamacare, or of many other excellent ideas in theory. But once trust is rallied, the powerful swoop in. That is the law. As like the laws of gravitation, they may be ignored, but only briefly.