Sunday, February 3, 2019

Medicare for All (Who Want It)

You can't swing a dead cat these days without running into another of the Medicare for All plans offered by various Democratic presidential candidates and liberal think tanks. What should we think about all this?
First, I think we should differentiate between Medicare for All as a campaign slogan and these various plans. As a slogan I think it's got a great deal of power. But it is important that the plan to which such a slogan is linked be perceived by voters as a clear advance and not as a threat to their current situation.
Fundamentally, I think this comes down to whether the plan is Medicare for All Who Want It or Medicare for All, Whether You Want It or Not. This, in turn, comes down to whether the plan is a vast expansion of Medicare-like availability or simply replaces the existing system, including private health insurance, with a government-run system based on Medicare.
There is a strong case that the political sweet spot--what the public is really ready for--lies in the former not the latter. Ron Brownstein in his latest Atlantic article explains:
"After the ACA’s passage, Obama—who had famously promised that those who like their insurance plan could keep it—faced a huge backlash after only a few hundred thousand people in the individual insurance market were forced to give up coverage that did not meet the law’s standards. Ending private insurance would affect the 181 million Americans who today receive health insurance through their employers, according to census figures.
The share of Americans who receive coverage through work is significant: about two-thirds of adults with a high-school diploma, three-fourths of those with a two-year college degree, 87 percent of those with a four-year degree, and 90 percent of those with graduate education. Not surprisingly, that means extremely large percentages of adults receive health coverage through their employers in many of the affluent suburban districts that powered the Democratic takeover of the House last November.
More than four-fifths of the population receives employer-provided coverage in a wide range of districts that Democrats flipped from the GOP in 2018, including suburban seats in Northern Virginia and New Jersey, and seats in Chicago, Minneapolis, and Detroit, according to census results. And roughly three-fourths receive health insurance through their employers in districts that Democrats won elsewhere: in northeast Iowa; Irvine, California; Salt Lake City; Virginia Beach, Virginia; and the suburbs of Richmond, Virginia; Atlanta; Des Moines; Kansas City, Kansas; and San Diego. By contrast, in the much more working-class New York City district won by the liberal champion Alexandria Ocasio-Cortez, just 56 percent of the residents have employer-provided insurance.....
In the latest monthly health-care tracking poll by the nonpartisan Kaiser Family Foundation, four-fifths of Democrats (and 56 percent of all adults) said they supported “a national health plan, sometimes called Medicare-for-All, in which all Americans would get their insurance from a single government plan.”
But the same survey found much more hesitation, even among Democrats, when respondents were told that such a plan could mean higher taxes, longer waits for treatment, and the elimination of private insurance companies. Support among the general public in the Kaiser poll plummeted to just 37 percent when respondents were told it could eliminate private insurance companies."
This implies we should not let the best be the enemy of the good. It is quite possible to have a Medicare for All Who Want It-type plan that really does provide universal coverage, would contain costs and all the rest, but does not immediately wipe out private insurance. These probably make more sense to push at this stage of the game.
Two good ones to look at are Reps. Rosa De Lauro's and Jan Schakowsky's Medicare for America plan (explained by Jacob Hacker, who helped devise the plan, in a good interview on Vox and the Center for American Progress' (if I may be allowed a moment of institutional chauvinism) Medicare Extra for All plan.
Links to the Hacker interview and the CAP plan are provided below.
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The policy’s supporters could run up against the same problems that Republicans faced in trying to repeal Obamacare.

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