Monday, February 25, 2019

On modular Medicare expansions

On the BlueWaveNJ blog, I have a post ruminating over where a successful Democratic presidential candidate might land with respect to various bills and plan outlines to establish Medicare for All, Medicare for All Who Want or Need It, Medicare for More, etc. I speculate that such candidate might want to make a build-out as modular as possible:
A candidate who seeks flexibility might seek to make her plan as modular as possible. First steps might include a strong public option introduced into the ACA -- one tied to Medicare rates,that providers who accept Medicare would have to accept.  Such a plan would probably also entail raising the value of a benchmark ACA plan, as the Merkley-Murphy Choose Medicare Act does. The ACA's silver plan benchmark, designed to cover 70% of the average enrollee's costs, clearly has not cut it with the public (in some cases, it now includes deductibles as high as $6,000). Incremental steps could include allowing small business buy-in and then large employer buy-in.  Integrating first steps with an ACA upgrade enables next steps to be contingent -- on need, budget and system performance. 
The case against this would be losing a window to mandate sweeping systemic change. I can see that. In any case, I hope you'll take a look at my view of the spectrum of possibility.

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1 comment:

  1. You wrote an excellent summary of the Medicare Option plans.

    I do fear that some Democrats are preaching to the choir on health care.
    In order to win actual elections, you need a lot of senior citizen votes, and a lot of votes from well-off citizens with inexpensive (to them) employer coverage.

    The Jonathan Cohn article referred to DeLauro and Schakowsky getting strong input from disabled persons advocates in the design of their plan. And this is fine, but are you going to win elections on votes from the disabled? A little bit of Karl Rove/David Axelrod cynicism might be in order here.