I have sea lions myself. Mine have a tendency to flag everything I say with which they disagree. Some I no longer respond to at all.
Medicare and Medicaid are both “discounted” from “reasonable and necessary” costs; Medicaid more than Medicare. The “plush” end of medicine is insured care or the self-pay of a wealthy person. But Medicare is much better pay to providers than Medicaid. In some places, Medicare is really good pay, especially if it’s accompanied by supplemental insurance. In theory, it averages about 60% of “reasonable and necessary” costs, but in some places, it’s a lot more than that.
Medicare costs the insured person, but not very much compared to what it pays out.
But Medicare is only provided to about 15% of the population. Medicaid is provided to about 21%. Supposedly, Medicaid only pays about 1/3 of “reasonable and necessary” costs. Medicaid actually is a discounted payer, and most providers don’t really want to have very many Medicaid patients for that reason.
One needs to remember, that the Medicaid system only works because others are paying more. The privately insured and self-pay are paying a lot more. About 67% of the population has private health insurance, including all government worker programs except VA.
The private sector and the government together are paying the “discounts” for Medicaid. If we suddenly insure another 67% of the populace with government insurance, there is no “source” for the “discount” other than the government. The government will have to greatly increase its outlays for health coverage even if it does not fully replace the private “discount payers”. Even then, the great likelihood is that quality will go down in a way somewhat similar to the way it does in “free” clinics generally.
In some countries, a “private sector” exists alongside a “government sector”. Most of Europe (except Britain, I believe) is that way. The private sector in France, for example, is about 1/3 of the total, and it’s the superior third. France has a number of ways to “economize” to deal with that. One of them is that doctors in the public sector are paid about a half what they are paid here; a little less than $100,000 on average. Another is that the government doesn’t pay when the service is delivered. The patient pays, then bills the government. Illegals get no government pay at all, and ER use is very much discouraged. Deductibles are about 20% on average.