Panel 1 — Who Covers Whom?

To help you get ready for the panel, here’s a list of questions to think about as you go through the book chapter and the private and public insurance slides. There’s nothing to turn in — just look them over so you’re ready to join in. The questions I put to the panel come from this list.

From the reading

You can find these in the chapter and slides.

  1. What are the main sources of health insurance in the U.S., and roughly what share of the population does each cover?
  2. How did employer-sponsored insurance become the dominant source of coverage for working-age Americans? What did World War II wage controls and the 1954 tax treatment have to do with it?
  3. Why is a dollar of employer premium contribution worth more to a worker than a dollar of wages spent on the same policy?
  4. What is the “non-group” (individual) market, and what did the ACA change about how it works?
  5. Who is eligible for Medicare, and what does each of its four parts (A, B, C, D) cover?
  6. Who is eligible for Medicaid, and how are its financing and administration different from Medicare’s?
  7. Whom do the Veterans Health Administration and TRICARE cover, and how does the VHA deliver care differently from the other programs?
  8. For the same service, how can Medicare, Medicaid, and a private insurer each pay the provider a different amount?

Bigger questions

No single right answer here — these are the ones we’ll talk through together.

  1. The U.S. covers people through a patchwork of private and public programs rather than one system. What does that patchwork buy us, and what does it cost us?
  2. Employer-sponsored insurance ties your coverage to your job. Who does that link affect most, and how might it shape decisions about changing jobs, starting a business, or retiring before 65?
  3. The tax exclusion for employer premiums is one of the largest items in the federal budget that never comes up for a vote. Who benefits most from it?
  4. Medicaid eligibility and benefits vary widely by state. What are the trade-offs of a safety-net program whose generosity depends on where you live?
  5. Medicare covers people over 65 regardless of income, while Medicaid is means-tested. Why is public coverage split that way?
  6. More than half of Medicare enrollees now choose a private Medicare Advantage plan over traditional Medicare. Why might someone prefer it, and what does the government gain or give up by paying private plans to cover them?
  7. If you were designing coverage for the country from scratch, would you keep employer-based insurance at the center?

Your take

Where does your own coverage come from — a parent’s plan, an employer, a public program, the marketplace? Have you noticed anything about what it does or doesn’t cover? If you could change one thing about how you get covered, what would it be? Anything from your own experience is welcome.