People (including Democrat politicians) seem to forget that Medicare Advantage (I think a Republican idea with a Republican propaganda name) even exists. A third of new Medicare recipients choose it. I did. Traditional Medicare and Medicare Advantage: two different things with the same permitted fee schedules.
With Medicare Advantage you don’t have to add hospitalization or prescription drug options. They are included in the basic premium, which is the same or about the same (premiums differ slightly in all of Medicare for reasons I don’t understand) for MA and basic Medicare.
The typical MA deal includes a dental and a vision program, neither total insurance. The dental deal includes free cleanings and Xrays, and everything else is charged according to the Medicare fee schedule, which in my case is about 20% cheaper than the regular fees the dentist would charge. The vision program pays for the eye doctor and certain amounts for frames, lenses, etc. All of this stuff is almost exactly the same as the Aetna federal employee plan I used to have. That’s because with the federal employee plan I chose was an “HMO” plan, although not a real HMO like Kaiser Permanente. When I lived in Kaiser Permanente areas I picked that. It’s real Socialized Medicine, but unlike a national deal it has to compete with other kinds of plans.
Another factor in medicine today is that, at least in the big city, big hospital organizations are taking over a lot of different kinds of practices and the docs end up on salary instead of running their own small business, so they are sort of becoming Kaiser Permanente themselves.
Even traditional Medicare contracts with private companies to do a lot of their work. It’s not all done by federal employees.