The liberal-ish think tank, Center for American Progress (CAP), released a healthcare proposal, Medicare Extra For All: this is essentially a public option (here’s a good take). It also does much more to directly regulate healthcare prices. Overall, it would be an improvement over the ACA, especially if Republicans are successful in damaging it. That said, I still think Sanders’ Medicare for All plan is better* (though that plan isn’t as good as a Medicaid plan for all would be).
But I have several doubts about CAP and its co-travelers’ Medicare Extra plan. First, I simply don’t trust their judgement. While the ACA did some very good things, we warned them, based on Massachusetts’ experience, that lower-middle class and middle-class people wouldn’t like it: they would be forced to buy health insurance they couldn’t really afford that wouldn’t provide them much actual insurance, other than against catastrophe (remember that many people have very limited savings, so any co-payment or deductible hurts).
These problems were not only predictable, but predicted. In fact, they were observed. And the political backlash would be obvious, especially as those above the Medicaid cutoff would be angry at those who were ‘fortunate enough’ to receive Medicaid (and that’s before the Fox News propaganda machine fired up). Speaking of politics, it’s clear in hindsight that the ACA was constructed in such a way that Republicans could damage it very easily. That’s a hallmark of shitty policy.
So when CAP and their allies ([cough] Paul Krugman [cough]) argue this is a good plan, I don’t trust them. In fact, that makes me more skeptical of Medicare Extra.
The other thing I’ve noticed about Medicare Extra is that it has that “you can keep your existing plan” crapola. This is unintentionally elitist: if you have de facto or de jure job tenure, then the terrifying specter of losing your existing coverage seems scary. But for most people, they change their coverage all the time. Even if their employer doesn’t suddenly decide to change their plan (or terminate coverage entirely), most people have to change plans when they change jobs. I’ve been fortunate, in that my job changes have been either upwards or laterally, and in the last two decades, I’ve changed my insurer (or had my insurer changed by my employer), seven times. If CAP et alia don’t recognize this lived experience, then I wonder what else are they missing or fucking up, especially in light of the previous point about the ACA.
The final issue is that it’s not clear what the ‘user experience’ would be under Medicare Extra. As is the case with federal budget deficits, most people don’t care about the overall costs. What they want is a system that’s easy to use–you just show up, establish your identity, and the system begins to work–and that doesn’t require a lot of paperwork. The KISS principle is something liberal-ish wonks seem constitutively unable to understand. People have to like this crap, and ease of use and access must be a key, if not the key, component.
As best as I can tell, losing existing coverage is the reason CAP thinks Medicare for All is politically untenable. If that’s all they’ve got, then I’m still for Medicare for All. That said, Medicare Extra would be an improvement.
*For this Dirty Fucking Hippie, Sanders’ plan is the compromise plan.