A Better Single-Payer Plan

https://www.nytimes.com/2018/02/22/opinion/health-care-medicare-single-payer.html

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First: What does Mueller know? You should have low expectations for how much new information Robert Mueller’s Russia investigation will still uncover, writes Politico’s Blake Hounshell.

No, you should have high expectations, writes Vox’s Matthew Yglesias.

A form of flattery. Why are some conservative media figures criticizing survivors of last week’s mass shooting in Florida? Because the students’ activism is powerful and effective, Ana Navarro argues. The students are “not political hacks. Not paid shills. Not indoctrinated. Not character actors,” Navarro writes. “They are young people of character compelled into action by a horrible crime that cost 17 lives.”

Medicare for all. A new single-payer health care proposal has just come out, and I think it has a better chance of eventually becoming law — in whole or in part — than Bernie Sanders’s plan.

It comes from the Center for American Progress, the influential liberal research group (often known as CAP). The proposal would create a program called Medicare Extra through which any American, regardless of age, could buy health insurance.

Before getting into the details, I want to emphasize one political point. A big reason that Democrats have become so focused on single payer — even Democrats who are to the right of Sanders — is the Republican Party’s scorched-earth response to Obamacare. That response has undermined the private-sector expansion of health insurance that was central to Obamacare, as Abby Goodnough just detailed in The Times.

If you care about expanding access to decent medical care, you’d be foolish to focus on private insurance today. (I made a longer version of this argument in a column.)

The crucial difference between the Sanders plan and the CAP plan is that the CAP version would not force people to give up their current employer insurance coverage. Those who are covered through their jobs could either keep that plan or enroll in Medicare Extra. The Sanders plan, by contrast, would eliminate employer-provided insurance in favor of a single federal system.

Substantively, the Sanders approach has a huge advantage: simplicity. But the experience of the last 25 years — across both Bill Clinton’s and Barack Obama’s presidencies — shows the dreadful politics of pushing people out of their current insurance plan. That’s why Obama promised, “If you like your plan, you can keep it.” And why he got in so much trouble when the promise proved false.

In the CAP plan, people who already have coverage — either through their job or a smaller federal program, like the military’s Tricare — would decide whether or not to switch. Medicare Extra would ultimately become the country’s biggest insurer, but the transition would be gradual and voluntary.

And what about the proposal’s cost? It would be large. The necessary money would come from two main sources.

The first would be taxes, on corporations and the affluent. As one possibility, the plan mentions partially undoing the Trump corporate tax cut.

The second source would be reduced payments to doctors, hospitals, drug companies and other medical providers. That move would obviously inspire intense opposition from those industries, but there is a strong economic argument for it. Medical prices, and many medical salaries, are much higher in the United States than in other wealthy countries.

“We simply can’t finance universal coverage without lowering health care costs,” Topher Spiro, CAP’s vice president for health policy, told me. “The math doesn’t work.”

There is a lot that I like in the CAP plan. It has similarities to a recent plan from Senator Chris Murphy, the Connecticut Democrat, and one from Paul Starr, a health care scholar.

Ultimately, though, I still favor more modest health care proposals to sweeping, ambitious plans, for reasons of realpolitik. The next time the United States has a government interested in improving most Americans’ lives, that government is going to have to choose a small number of big priorities. And I think the top priorities should be areas where Obama made significantly less progress than he did on health coverage — like climate change, income inequality, universal preschool or immigration.

But this burst of health care proposals, including the one from Sanders, has done the important work of pointing the way toward a long-term goal.

The full Opinion report from The Times follows.