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8 Roads to Universal: [Democratic Health Care Plans]
Astaereth
In the belly of the beastRegistered User regular
In the belly of the beastRegistered User regular
Vox posted an article about the details of eight different Democratic health care proposals. Which do you favor and why?
All plans involve government regulation of health care prices; one of the reasons Medicare is cost-effective is that as a large payer the government can negotiate for lower prices. The plans differ in other respects, however.
Options:
Medicare for All - Bernie Sanders and Medicare for All - House Progressives
The Sanders plan is a true single-payer plan—after a short transition period, every American would be on Medicare. This would end employer-based insurance. It would be truly universal, which many of the other plans don’t actually accomplish, would cover basically everything (including dental, vision, mental health, prescription drugs, abortions, and long-term nursing home care), and like Canada would have no premiums or co-pays. Sanders has suggested paying for this with higher taxes on banks and the wealthy.
The House and Senate plans are very similar and getting more so over time. They are basically the same plan at different stages of development (the House plan is not ready to suggest how to finance this, for instance). I would expect them to merge into one Democratic proposal by 2020.
Medicare Part E - Senators Merkley and Murphy
This would expand Medicare by essentially adding a public option. As an opt-in program, this would not achieve universal health care coverage right away, but would be a “glide path” toward it as people slowly opted in and didn’t go back. Under this plan, employers would decide whether they wanted all, or none, of their employees to be able to turn down employer insurance and choose the public option. But you could buy in to Part E if you were unemployed, and once enrolled at any time you could continue to keep it even if you change jobs. Unlike the MFA plans, Part E would cover the 10 essential benefits of Obamacare but nothing more (no vision, dental, etc). It would cover 80% of health costs, so patients would still pay 20% up to a deductible, and patients would also still pay monthly premiums. Essentially Part E allows everyone to buy into the equivalent of what a Gold plan is under the ACA.
The CHOICE Act - Rep. Schakowsky and Sen. Whitehouse
Like Part E, this is also an optional buy-in plan. Unique specifics: the CHOICE plan allows small businesses to buy in, but not large ones; and it would feature several public plans ranging from covering 60-80% of costs. Same level of coverage, premiums, etc as the Part E plan.
Medicare X - Sen. Bennet, Rep. Higgins, and Sen. Tim Kaine
This is a slightly more small-c conservative plan than CHOICE. It is also a Medicare buy-in option, but for the first few years would only be available to customers in areas with a single insurer or unusually high cost areas, with a later expansion to everybody. It covers the same 10 essentials and will have at least two plans, at 70 and 80% cost coverage, with a possible addition of 60% and/or 90% plans. Patients would still pay premiums.
Medicaid buy-in - Sen. Schatz and Rep. Lujan
These matching House and Senate proposals would expand Medicaid, rather than expanding Medicare. That might be cheaper overall, as Medicaid has lower reimbursment rates and might have lower premiums as a result. Unlike Medicare, Medicaid is partly administered by the states, and the states would ultimately decide premiums, deductibles, and copays, under federal caps. As we saw with the ACA, red states could probably fuck with this quite a bit. Like the other buy-in plans, this would cover the 10 essential benefits, be paid for by patient premiums, and as an optional program would not reach true universal coverage.
Medicare Extra For All - The Center for American Progress
This Medicare buy-in plan would ultimately cover all legal residents. Most unique feature: all newborns would be automatically enrolled in the buy-in, ensuring an eventual transition away from private insurance. Employers would be allowed to buy-in via a simple payroll tax, but the plan does not yet have details on what premiums and cost coverage would be like. Benefits would include prescription drugs, dental, vision, and other ancillaries. Patients pay premiums above a certain income threshhold, capped at 10% of income. Additional financing suggestions are similar to the Sanders plan, as well as a proposed tax on unhealthy foods and beverages.
Healthy America - The Urban Institute
This plan assumes it would politically unfeasible to cover illegal residents, who make up about half of the 30 million currently uninsured. This plan would cover the other half by combining Medicaid with Obamacare and allowing lower income patients to buy in to a public option, but would basically not disrupt the employer-based insurance market. It would cover the 10 essential benefits, would have subsidized premiums and co-pays for lower income patients, and cover 80% of costs. Funding suggestion is a 1% Medicare payroll tax increase spit evenly between employers and employees.
—
There are a lot of considerations here—who gets health care, how we pay for it, what it looks like and costs and covers, and how we handle the political difficulties of transitioning to a new system. But as a party, Democrats need to figure out before the 2020 general election what they want the future of health care in this country to be. What do you think?
All plans involve government regulation of health care prices; one of the reasons Medicare is cost-effective is that as a large payer the government can negotiate for lower prices. The plans differ in other respects, however.
Options:
Medicare for All - Bernie Sanders and Medicare for All - House Progressives
The Sanders plan is a true single-payer plan—after a short transition period, every American would be on Medicare. This would end employer-based insurance. It would be truly universal, which many of the other plans don’t actually accomplish, would cover basically everything (including dental, vision, mental health, prescription drugs, abortions, and long-term nursing home care), and like Canada would have no premiums or co-pays. Sanders has suggested paying for this with higher taxes on banks and the wealthy.
The House and Senate plans are very similar and getting more so over time. They are basically the same plan at different stages of development (the House plan is not ready to suggest how to finance this, for instance). I would expect them to merge into one Democratic proposal by 2020.
Medicare Part E - Senators Merkley and Murphy
This would expand Medicare by essentially adding a public option. As an opt-in program, this would not achieve universal health care coverage right away, but would be a “glide path” toward it as people slowly opted in and didn’t go back. Under this plan, employers would decide whether they wanted all, or none, of their employees to be able to turn down employer insurance and choose the public option. But you could buy in to Part E if you were unemployed, and once enrolled at any time you could continue to keep it even if you change jobs. Unlike the MFA plans, Part E would cover the 10 essential benefits of Obamacare but nothing more (no vision, dental, etc). It would cover 80% of health costs, so patients would still pay 20% up to a deductible, and patients would also still pay monthly premiums. Essentially Part E allows everyone to buy into the equivalent of what a Gold plan is under the ACA.
The CHOICE Act - Rep. Schakowsky and Sen. Whitehouse
Like Part E, this is also an optional buy-in plan. Unique specifics: the CHOICE plan allows small businesses to buy in, but not large ones; and it would feature several public plans ranging from covering 60-80% of costs. Same level of coverage, premiums, etc as the Part E plan.
Medicare X - Sen. Bennet, Rep. Higgins, and Sen. Tim Kaine
This is a slightly more small-c conservative plan than CHOICE. It is also a Medicare buy-in option, but for the first few years would only be available to customers in areas with a single insurer or unusually high cost areas, with a later expansion to everybody. It covers the same 10 essentials and will have at least two plans, at 70 and 80% cost coverage, with a possible addition of 60% and/or 90% plans. Patients would still pay premiums.
Medicaid buy-in - Sen. Schatz and Rep. Lujan
These matching House and Senate proposals would expand Medicaid, rather than expanding Medicare. That might be cheaper overall, as Medicaid has lower reimbursment rates and might have lower premiums as a result. Unlike Medicare, Medicaid is partly administered by the states, and the states would ultimately decide premiums, deductibles, and copays, under federal caps. As we saw with the ACA, red states could probably fuck with this quite a bit. Like the other buy-in plans, this would cover the 10 essential benefits, be paid for by patient premiums, and as an optional program would not reach true universal coverage.
Medicare Extra For All - The Center for American Progress
This Medicare buy-in plan would ultimately cover all legal residents. Most unique feature: all newborns would be automatically enrolled in the buy-in, ensuring an eventual transition away from private insurance. Employers would be allowed to buy-in via a simple payroll tax, but the plan does not yet have details on what premiums and cost coverage would be like. Benefits would include prescription drugs, dental, vision, and other ancillaries. Patients pay premiums above a certain income threshhold, capped at 10% of income. Additional financing suggestions are similar to the Sanders plan, as well as a proposed tax on unhealthy foods and beverages.
Healthy America - The Urban Institute
This plan assumes it would politically unfeasible to cover illegal residents, who make up about half of the 30 million currently uninsured. This plan would cover the other half by combining Medicaid with Obamacare and allowing lower income patients to buy in to a public option, but would basically not disrupt the employer-based insurance market. It would cover the 10 essential benefits, would have subsidized premiums and co-pays for lower income patients, and cover 80% of costs. Funding suggestion is a 1% Medicare payroll tax increase spit evenly between employers and employees.
—
There are a lot of considerations here—who gets health care, how we pay for it, what it looks like and costs and covers, and how we handle the political difficulties of transitioning to a new system. But as a party, Democrats need to figure out before the 2020 general election what they want the future of health care in this country to be. What do you think?
Astaereth on
+1
Posts
the "no true scotch man" fallacy.
I don't like Sanders plan- eliminating the current insurers in one go will make it harder to pass, and TBH I don't trust it to pass without some conservative asshole shoving in anti LGBT and/or or anti abortion components. What it covers is the best option though.
Part E is mostly fine but everyone should be able to buy in. Most of the rest are fine, except the Medicaid options. I'd prefer to roll the good stuff from Medicaid into Medicare and abolish Medicaid.
Extra for All is probably my preferred option?
I think I like the first two and this one the best. The fact that we're starting to talk about rolling out medicare for everyone is a huge deal I think. This is what the ACA should have been from the get go and I think this was Obama's eventual plan. I think Bernie has the right idea but you're not going to be able to fund healthcare just on the wealthy, that's politically not viable I feel.
My biggest question is how employees are going to be able to capture all that money that their employers are currently paying to the insurance companies.
Edit: I should say that I'm in the "hard no" camp for providing healthcare to illegal immigrants.
Raise the business tax, use that on premium reduction or elimination.
Yeah im thinking there would have to be a serious worker movement to claw back that compensation.
As for illegals though, just think how much cheaper tax payer funded preventive care is than personally eating unpaid hospital bills
Effectively this is the government dramatically lowering my compensation package though. I negotiated for a package that includes benefits at a certain rate... if we Medicare for All, eliminate the employer contribution to my health, and then tax them to run a healthcare plan... what happened to the benefit I negotiated? I'm now working for notably less compensation.
I don't want to derail the thread on page 1, so I'll just say that a comprehensive reform package would solve this without the optics of a "doctors for illegal immigrants" proposal.
"comprehensive reform package" is so much nothing.
Maybe allow for painful opt out that requires dealing with a bunch of terrible bureaucracy and actually paying the fine if you don't want to be auto enrolled.
Just do the thing.
Autoenrollment could be fairly simple or as simple as a lot of other government services poorer people use for most people who want it to be simple while letting people cling to their guns and bibles employer provided health care and choice.
So you’re okay with covering illegal immigrants, just a hard no on saying that out loud?
That seems like something you could bring up at your annual review, and or when you inevitably move job as we all do now. Decoupling healthcare from your employers is only a good thing in a world of shit collective bargaining in the workplace.
Depends on how the funding is based. You could structure a corporate tax hike to basically exactly match current company payments for healthcare*. That would shift the healthcare funding from direct company payments to taxes that feed federal healthcare and in essence would provide you the same benefits from the same money source.
*With the caveat that you would be using averages for company size/type, so some companies would absolutely see their costs go up, and some companies would see costs go down, but most would be about the same.
I'm not sure how well a robust universal public option can survive and thrive if you let insurers continue as a significant part of the market. The lobbying would be effectively endless.
Dental is still considered mostly cosmetic by a lot of people and was considered cosmetic enough and not important enough that it was excluded from most UHC systems in countries that instituted them decades ago.
It doesn't make sense to exclude it now because it is a big cost for the poor and one of the ways the poor get harmed when it comes to health care given how much bad teeth can harm a person.
Edit: From a purely political standpoint, I don't think excluding it does anything positive. Any additional cost that makes the cost of UHC look higher is probably not enough to matter at all. The total cost of UHC is high enough that few people would mentally see the additional cost as making it much more costly. Nobody is going to go "Wow, $Texas is fine, but $Texas+much less than $Texas is too high!" All the arguments about efficiency, already paying for it, net savings on average, etc. would apply either way.
The fear from insurers would be people who would have private insurance from the exchange otherwise going with the public option. People who would otherwise just not get insurance and eat the penalty wouldn't really mean anything to the insurers and are likely not considered lucrative enough for insurance companies to really care about. Autoenrollment and the public option wouldn't necessarily be huge to them from that standpoint.
I think the auto-enrol on a public option has the best chance for success at getting people comfortable with "government" health care.
Lobbying will br effectively endless regardless. See also: conservative attempts to gut health care systems elsewhere.
Well yeah, and they'll turn their powerful lobby towards making sure the public option is as unappealing as possible to fight that.
Its no coincidence that getting rid of the public option was a big priority for them with the ACA. To a significant degree the problem with our health care system is the presence of profit seeking middlemen. It's like trying to contain a house fire instead of putting it out.
the only way private insurance would survive would be if they start behaving as they ought to be to begin with; fight to maximize benefits/payouts for their clients and minimize the monthly payments.
otherwise the public option is just going to be the better insurance
Would they? Given the choice to either be more consumer friendly/less profit driven or go out of business it seems to me in America wealthy interests choose the third option every time, change the rules.
Why is it superior negotiating to start from a weaker position than what we actually want?
No it is not. If it ever happens it would your company providing a benefit you no longer care about. Your compensation is identical to what it was before, and now your healthcare goes with you everywhere for the rest of your life, no matter what job you do.
Talk of "how will we pay for it" is entirely a red herring
"Access" is a weasel word implying that we're not going to cover everyone
Because I want something that actually works and don't trust them not to blow it. The other plans accomplish the same goal without the downside.
I'm still not sure why you believe that to be the case. The ACA is already a conservative plan and the Republicans still fought it tooth and nail. Why is it advantageous to offer concessions out of the gate?
*chokes*
I want a hybrid system a'la Germany where everybody qualifies for basic public coverage but has the option of purchasing supplemental private coverage if they're willing and able.
The countries with the best healthcare outcomes have hybrid public/private systems (though they differ widely in how the hybridization works exactly).
the "no true scotch man" fallacy.
They didn't get there from the same point we're at now though. Moving from the meat market we have now to a system where health insurance just operates as the good faith financiers of extended care requires serious cultural changes in an industry that has shown no inclination for it so far.
Because they aren't concessions. Maybe understand that different people have a different view of what's desirable here.
Aside from the additional coverage, which the alernate plans should add, I view the Sanders plan as inferior. In general my ultra preferred option would be to have everyone on Medicare with private plans as extras. It allows a greater level of flexibility and removes a lot of potential problems.
When you add that to it being less likely to pass and more likely to be screwed up, it just doesn't have enough upsides.
That's a fair point
the "no true scotch man" fallacy.