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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Reich: If ACA Falls, ‘Plan B’ Should Include Medicare Option for All

Robert Reich’s blog, “Health Care Jujitsu” at HuffPo Politics presents a plausible “plan B’ if the ACA’s individual mandate is invalidated by the Supremes. As Reich explains it:

…If the Court decides the individual mandate is an unconstitutional extension of federal authority, the entire law starts unraveling. But with a bit of political jujitsu, the president could turn any such defeat into a victory for a single-payer healthcare system — Medicare for all.
…You’ll remember the Administration couldn’t get the votes for a single-payer system such as Medicare for all. It hardly tried. Not a single Republican would even agree to a bill giving Americans the option of buying into it
….Americans don’t mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new health care law.
…Moreover, compared to private insurance, Medicare is a great deal. Its administrative costs are only around 3 percent, while the administrative costs of private insurers eat up 30 to 40 percent of premiums. Medicare’s costs are even below the 5 percent to 10 percent administrative costs borne by large companies that self-insure, and under the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.
…If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.
When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes. If they did this the public will be behind them — as will the Supreme Court.

Reich’s solution may seem simplistic — that’s sort of built into the nature of the single-payer alternative. But the simplicity of the proposal could work to the Democrats advantage. Simplicity is often an easier sell than a complex, multifaceted legislative package, particularly when the public is fed up.
Left Dems will be angry, energized and ready to seize the opportunity to fight for the public option. Many moderate Dems may be ready for the public option, when it finally becomes clear that even the Republican-controlled Supreme Court won’t allow a compromise supported by insurance companies and the responsible segment of the private sector.
It’s a risky strategy, electorally, considering the public was weary of the debate long ago. And, there are other possible compromises short of an all-out battle for the public option, including an “opt-out” provision some have suggested, allowing consumers to chose staying out of the law’s coverage for a minimum of 5 years. Another alternative would be a public option for catastrophic coverage only, guaranteeing, at least, that no one will lose their home or retirement assets to pay medical bills, allowing the insurance companies to compete for all other coverage short of catastrophic illnesses.
Regardless of the ‘Plan B’ Dems chose, however, it should be abundantly clear that rubber-stamping conservative Supreme Court nominees is a luxury we can no longer afford.

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