Thursday, March 21, 2019

Medicare for America...for how many candidates?

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Two months after the Kaiser Family Foundation found 74% support for a "plan similar to Medicare open to anyone" that would "allow people to keep the coverage they have," several Democratic presidential candidates appear to have abruptly converged on the idea. The only bill out there that meets this criteria is the Medicare for America Act, introduced last December by Reps  Rosa DeLauro (CT-03) and Rep. Jan Schakowsky (IL-09), and soon to be reintroduced. 

Medicare for America does much more than create a strong public option that both employers and employees can buy into. It also absorbs Medicaid, transforms existing Medicare, and creates universal long term care insurance.  At , I ask whether candidates who have embraced the core concept, or some whisper or echo of it, will go for the whole package:
Perhaps it’s pusillanimous to balk at healthcare system transformation because of the certain all-out opposition of all major segments of the healthcare industry, not to say the Republican party and Fox News. But the question remains how much to bite off. The beating heart of Medicare for America, the transformative engine, is employer/employee buy-in to a strong public option, paying Medicare-plus rates and accepted by virtually all providers.

Whether that public option drains out a quarter of the employer-sponsored insurance market, half of it, or all of it, it renders public insurance – and public insurance payment rates – dominant. Candidates who embrace that core element – which harks back to the earliest iterations of the public option concept – may opt to carve it out of the near-total system transformation mandated in Medicare for America. Or they may not. Each candidate needs to think hard about how much mandated transformation within a decade or less they think the system can bear.
I hope you'll read the whole thing


  1. Nice article, Andrew!!! Clear and compelling. Thank you!

  2. I do not think that the insurance companies are the real enemy of Medicare expansion. They lose money on ACA plans, they lost tons of money on LTC insurance, they make small profits on group health, etc.

    Their most profitable line is Medicare Supps and Medicare Advantage, where the laws on plan design leave room for commissions. This was assured by the Tom Delay congress in 2003.

    The big challenge for Medicare expansion will be to literally find the money in order to pay for it. There are close to 3 million businesses (mostly small ones, but 3 million) who pay nothing for health insurance now and will resist a payroll tax.

    There are several million persons under 65 who have generous insurance and pay next to nothing (Tricare, VA, city gov't and school district plans, a few union plans), and they will resist any new income taxes.

    People who make over $200,000 a year will face big new taxes under most Med for All plans, and they will resist also. Plenty of them are Democrats and that will be interesting.

    The ACA wars have taught us that it does not take a huge number of opponents to slow down a plan. The weakest link in the chain can break things up.