Here is the doctor's comment: "I think it depends which market you are in. In Florida and some other senior rich states, Medicare pays better than private insurers. In those states it might have an opposite effect to the one you are hypothesizing."

Here is my response:

Not a bad argument, and point taken. But please consider this. Under the current system, there is nothing voluntary about Medicare from a patient’s standpoint. Other than the Medicare Advantage plans, there are no private insurance companies competing to insure 65+ year-old people. There is no market there – since they are all in Medicare. Insurance companies in Florida (and everywhere else) are competing for the under 65 crowd. With this proposed change, which I understand is voluntary, that is, a 55-year-old can “buy into” Medicare if he or she wants, private insurance companies will be competing with Medicare for the same patients (55-65 year-olds). If we assume that one gets what one pays for, and if we assume that a person is not going to buy into a plan (Medicare) with fewer benefits than he or she can get elsewhere for the same money, the private plans will increase benefits so they are no lower than Medicare’s. And along with that will come comparable or superior reimbursement for doctors. (The insurance companies are not going to pay doctors less than Medicare does for fear the doctors will encourage 55-65 year-olds to get into Medicare and abandon private insurance). I seriously doubt that in the long run a doctor treating a 56-year-old Medicare patient in Florida is going to get paid more than a private insurance plan would pay the same doctor for the same patient. To the extent I am wrong, however, it is still bad news, in the long run, for primary care doctors, since, if this plan is successful, eventually “Medicare for everyone” will be the order of the day, and I doubt that spells good news for doctors.