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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Medicare for all…with a Public Option?

You’ve read the arguments for Medicare for All, and you appreciate the inclusiveness of the proposal, note the success of it in many other countries and believe the economies of scale it would provide make it the most cost-effective system for the U.S. But you are also familiar with the reality that polls indicate millions of voters are happy with their private health insurance and a public option system is a much easier sell.

But if you are wondering if there is a range of policies in between these two choices, read “Here’s how we can have ‘Medicare for all‘ with a private option” by Dr. Thomas Bodenheimer, professor emeritus at the University of California San Francisco School of Medicine and co-author of “Understanding Health Policy.Bodenheimer shares some recent data points:

According to CNN 2018 exit polls 41 percent of voters named health care as their most important issue. A Kaiser Family Foundation poll found that 56 percent of the public supports “Medicare for all,” but 74 percent wants to keep their existing insurance. Seventy-seven percent, including 69 percent of Republicans, favor allowing everyone to choose Medicare as their health insurance.

When asked which health-care legislation Congress should focus on, 52 percent of Democrats and Democrat-leading independents chose improving the Affordable Care Act versus 39 percent picking Medicare for all.

Of course most such polling data is profoundly influenced by the phrasing of questions. But Bodenheimer’s data does suggest that many Americans are ambivalent about picking one with wholesale rejection of the other option. As a political junkie, I favor the public option, politics being the art of the possible and all that. But do we really have to pick one and ditch the other? Like Peggy Lee asked, ‘Is that all there is?’

Bodenheimer says no, “These seemingly opposing stances can be reconciled with a united front for health care. A united front means that progressives and moderates put aside their differences for now.” I doubt it’s as simplistic as ‘progressive vs. moderates’ — lots of progressives favor the public option, and I’m sure there are some moderates who have eperienced economic ruin because of crappy private health insurance, and are way ready for Medicare for All.

Bodenheimer cites three principles of a middle way forward:

1) Providing immediate relief from the burden of health-care costs

2) Over time, offering an improved Medicare to all Americans

3) Allowing people to keep their private health insurance – the “private option.” Most urgent is health-care cost relief.

Bodenheimer cites compelling data illustrating the unacceptable costs of halth care policy paralysis – skyrocketing premiums, the heavy burden of deductables and endless out-of-pocket expenses. Then there is sdrug company price gouging, coverage shortfalls in Medicare etc. He acknowledges that “any Medicare for all plan must improve Medicare to reduce the bills that Medicare patients have to pay themselves.” Further,

If the Medicare age went down from 65 to 55, we would receive a Medicare card shortly after our 55th birthday. Or Medicare might automatically cover children under 18. Over time, everyone would receive a Medicare card in the mail. We would have the private option. But we would be insured from the moment we are born until the day we die.

The details of financing must be debated. A couple of things might be important. First, to keep taxes down, employers whose employees choose Medicare should pay into Medicare the same amount that they were paying for those employees’ private insurance. Otherwise, employers would save a lot of money at taxpayers’ expense

Second, the social security contributions employers and employees pay to support Medicare would rise, especially for higher-income people. When we are young and healthy, we pay so that when we become old and sick, we benefit.

It’s not hard to envision widespread support for all of those approaches. You could also chuck into the mix catastropic coverage for all, with a public option approach for preventative and maintenance care. It’s not an either/or choice, unless that’s all that makes it to floor votes in the House and Senate.

As Bodenheimer concludes, “If Democrats win the White House and Congress, a transition to Medicare for all with the private option becomes possible. In the meantime, Democrats need to come together in a united front that can defeat Donald Trump and relieve people’s suffering from health-care costs.”

Medicare for All advocates Sens. Sanders and Warren surely know this, as does former V.P. Biden and the improve Obamacare and public option supporters. But they also know they have to strongly argue one or the other to push the debate. So far it’s working well, with the side benefit of revealing how utterly bankrupt the Republicans are in terms of both morals and ideas for health care reform.

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