The median family of 4 with private health insurance has a household income of around $115k not counting the gross cost of their employer-provided health care. Remember: being on private insurance puts you in a cohort that:

* Excludes everybody on Medicaid

* Excludes fixed-income seniors on Medicare

* Makes it overwhelmingly likely you have subsidized employer-covered health insurance.

Figure your employer "covers" half the gross cost of your $24k/yr health insurance (they aren't, really: that's money they'd be paying you directly without the distortion of employer-provided health care). Do the take-home pay math. Put them in, like, Ohio, or Iowa, or Colorado; just not SFBA or NYC.

Now move that same family to Manchester, take the wage hit for moving to the UK labor market, and work out the take-home pay. They'll of course pay $0 for the NHS.

Are they better off or worse off?

I'm not valorizing the arrangement, I'm making a point about how political tractable changing it is.

You’re moving the goalposts. How many families have private insurance? Considering both families with and without private insurance, is the median family better off in the US?

Idk, speaking as a big Medicare-for-all supporter, this would definitely explain why MfA always polls well at first, until people start asking if they can keep their current plan. I know at this point in the debate we’re supposed to write those people off as either innumerate, a minority, or too risk-averse for their own good, but honestly if it turned out that that stat was true, that would explain a lot.

And it would be exactly the kind of political engineering minmax scheme large corps in the US are great at: petition legislators to cut regulations so you can cut costs and maximize profits, but keep juuuust enough of the right perks in the right places so that a slim majority of people in Wisconsin, Michigan and Georgia oppose shaking things up.

The people who want to keep their own plan are almost definitionally not innumerate! They would be worse off financially under M4A.

That doesn't make M4A bad policy (I think it's bad policy for other reasons), but it does take "people are being irrational" off the table in a discussion like this.

Even if you keep your plan it's getting enshittified every year.

It's that time of year again - enroll for 2026 benefits. My employer raised employee premiums by 10%, raised the deductible, added more administrative burden such as "step therapy" (the insurance company denies your claim for a drug until you've tried a cheaper but less effective drug, even if you've already done "step therapy" while on another health plan!) Your employer will change the plan premiums and structure every single year. They can lay you off, exclude expensive drugs, exclude doctors, etc. Some specialties like anesthesiology and psychiatry are usually not in network. In extreme cases an employer can change health administrators mid-year and your deductible will reset.

https://www.pwc.com/us/en/industries/health-industries/libra... https://kffhealthnews.org/news/article/workplace-health-insu...

Why does Medicare for all mean I can't keep private health insurance? There are countries that have systems like this in place.

There are countries that have single-payer systems and widespread supplemental insurance. But if you universalized Medicare, you'd immediately do at least two big things to the market:

(1) You'd eliminate the system of advantages and supports that cause employers to offer private insurance, which is where most people get their insurance from.

(2) You'd create a huge adverse selection problem --- the more effective/useful Medicare is, the fewer families will want to spent $24k/yr on private insurance, meaning the families left on private insurance have a reason to want it, meaning the composition of the risk pool would shift dramatically.

Like, if we ever did M4A, we'd probably end up with a widespread system of supplemental insurance; we already have it with Medicare! But that's not the same thing as keeping your existing plan.

I don't understand the obsession some people have with keeping your existing plan. Lots of people can't keep there plan under the current system. Insurance companies update their plans regularly. Sometimes they remove plans or exit markets entirely. An existing plan will get small changes over time. If Theseus has an insurance plan for 10 years and the insurance company makes changes every year can we still call it the original plan of Theseus?

If M4A plus supplemental insurance gives me about the same coverage I have now for a reduced total cost that sounds like a win to me. Even if it ends up costing me the same amount the net improvement from everyone having access to basic health care would still be a win.

Every policy is easy to enact if you just define away anybody who'd object to it. But, more importantly: it's unlikely that M4A by itself (let alone with the supplemental plan you'd likely end up with) would reduce your total cost!