Monday, May 27, 2019

Medicare for all who want it: Potential and pitfalls

I have suspected for some time that the longest-lasting Democratic presidential candidates may converge on health care reform plans that enable any American to buy into a strong public option (probably deemed "Medicare") at an affordable price. That would include people whose employers offer coverage -- they would be subsidy-eligible if they opt into the public plan.

The existing bill that fits this description is the Medicare for America Act -- a bill that takes such an open-to-all public plan to its logical conclusion by phasing out Medicaid and revamping the Medicare currently available to seniors and the disabled -- and, crucially, adding long-term care insurance. The bill is rich in promise and not free from pitfalls, which I've been more or less live-blogging over the past couple of weeks. I thought I'd take some space here to index those posts, a step toward making something of a coherent whole of them (including some earlier posts). Here goes, then.

The plan that lets anyone buy into Medicare (3/21/19)
This overview at starts with my core question: Can Democrats bite off as much healthcare reform as Medicare for America encompasses? Might they pare it back to its core -- a public option buy-in for anyone who wants/needs it?

Medicare for America might let private insurance thrive (3/22/19)
The key condition is that healthcare providers would have to accept "Medicare" payment rates from commercial insurers.

A major fix in Medicare for America 2.0 (5/14/19)
In the second iteration of the bill, employers no longer get off scot-free if their employees choose "Medicare" over the employer's insurance offering.

Would Medicare for America phase out private insurance? (5/15/19)
That's an open question...

If Medicare for America passes, some seniors will pay more (5/16/19)
A fearsome political vulnerability lurks in the bill's design

Seniors' costs under Medicare for America, cont. (5/19/19)
How affluent would you have to be to pay more under Medicare for America than under current Medicare?

Folding Medicaid into Medicare for America: Will states pay their share? (5/21/19)
Maybe not; is that a bad thing?

Medicare for America raises the kludge question (5/23/19)
Patch one more fix into our Byzantine healthcare system, or remake all of it?

1 comment:

  1. Thanks for your efforts in this important cataloging. Just for general interest, here are my own guidelines for deciding which option I prefer:

    1. No "Cliffs"....where your benefit declines dramatically if your income goes up by $100

    2. Fewer premiums and more taxes...........premiums can often be avoided, and free riding makes sense (until it doesn't)

    Premiums usually require subsidies, and then subsidies require income cliffs.
    Whereas taxes are just as progrssive as subsidies, and much easier to assess.

    3. Will the program work as well in year 2 as it does in year one? What happens if claims exceed premiums?

    Most analysts assume that a public plan which pays low rates to providers will also be lower cost. However, what if the public plan gets all the bad risks?