November 17, 2013 by David K. Sutton
Medicaid Expansion Success Means Liberals Should Go On A National Health Care Offensive
It’s time for liberals to go on the offensive. It’s time for a new strategy. Instead of defending progress from 50 years ago, we need to carve out our goals to achieve progress over the next 50 years. And when it comes to social policy, the best defense is a strong offense. Social Security faced fierce opposition in its day, and so did Medicare several decades later, but outside the right-wing fringe, these programs are popular and are examples of progress carved out by politicians who went on the offense to achieve social and economic justice.
So if some Democrats are going to start talking about fixes to the Affordable Care Act that would actually undermine the law, we need to call them out. We need to insist that the ACA is an attempt to address a century old problem, and that it’s a timid attempt at best. We need to demand a more pragmatic approach to universal health care. We need to assert ourselves in making cogent arguments for true national health care, instead of piecemeal consumer-based strategies for addressing a problem that is more easily addressed by one single health care insurance payer, the federal government.
The problem with America’s health care system is not that the market has been stymied by government interference, the problem is that we consider it a market at all. Health care is not a consumer product. You don’t shop for your health care services the same way you shop for a smartphone, or a television, or a car. As soon as we equate health care with consumerism we have headed down the wrong path.
The Answer Is National Health Insurance – Business Insider — The problem, as a ground-breaking article by Steve Brill made clear, is that America’s healthcare providers and insurers treat people differently. If you’re lucky enough to be included in a big insurance plan provided by a huge entity with a lot of negotiating leverage (such as the federal government), you pay low rates and low prices. If you’re unfortunate enough to be in a high-risk group or not to be included in any plan, you pay sky-high prices. Or you get all your “healthcare” from the emergency room and, thus, lay the costs off on everyone else that way.
The answer, as Brill’s article also made clear, is a fully national health insurance system, in which all Americans are covered in the same massive group and for-profit insurers and healthcare providers can’t pick and choose who to cover and how much to charge them. This system would effectively extend the current Medicare and Medicaid system to the whole population, and, in so doing, make it even more efficient.
The ACA’s Medicaid expansion is proof of the success of true national health care, so it’s too bad nobody is talking about it. While the media is fixated on a small percentage of Americans who are losing their health care plans, usually plans that have no business existing in the first place, there’s an absence of coverage about the people successfully signing up for Medicaid.
The Huge Obamacare Story You Aren’t Reading — But there is also a class element to the way this debate has evolved. By and large, the people receiving those cancellation notices and facing large premium increases are at least reasonably affluent. They’re not necessarily rich, particularly if they live in higher cost areas of the country. Many of them sweat monthly bills just like most of the country does. But, by definition, they don’t qualify for huge subsidies that would offset premium increases mostly or completely. By contrast, the people getting Medicaid are poor. They have to be, because it’s the only way to sign up for the program. And as political scientists have shown, the poor don’t command the same kind of attention from politicians that the middle class—and particularly the upper middle class—does.
And the Congressional Budget Office (CBO) estimates 13 million will eventually sign up for Medicaid. But the reason that story is not getting coverage in the media is because only the poor qualify for Medicaid. Oh, and there’s no scandal. There’s nobody to blame for deceiving the country. There’s no bogeyman. It’s a success story, and well, that’s boring.
The amount of energy put forth to defeat universal health care, in any form, is well, shockingly silly in a country that already sees one-third of the population covered by federal health care insurance. And the current system of employer-based health care plans, which covers the majority of Americans, is a relic long past its serviceable life. Since America had no national solution, employers offered health care benefits as a way to attract talent. This of course is a hodgepodge solution, offering no piece of mind when between jobs, but it has somehow stuck with us for the better part of a century.
OKAY, SO HOW ABOUT SOME SPECIFIC POLICY IDEAS
I’d like to offer a few specific ideas in a national debate on our way to true universal health care coverage. Ideally I think we should have a single-payer system like Medicare, but instead of 65 and older, this new system would cover every American. But unlike the current Medicare system that covers 80% of medical costs, I think this new system should cover 100%. This new system would be paid for with an expansion of the federal payroll tax that now pays for Medicare and Social Security. For Americans with employer-based health care insurance, this increased tax would likely be equal to or less than what most people pay in health care premiums. And I think this tax should be applied the same way the current tax is applied where employers and employees split the cost 50/50. For Americans without employer-based health care insurance, but who buy insurance, they would likely win out with a payroll tax deduction smaller than their current health care premiums. For the remainder of Americans without health care insurance, well yeah, they are essentially going to get a free ride here. But hey, who’s to say you might not be one of them one day? This is not a static pool of human beings who live off the system. And most people in this situation are not there by choice, so you can drop whatever disparaging bullshit that might be rattling around in your brain.
And I think we should have an income-specific deductible as a way of means testing coverage as well as to deter people from abusing the system. It would work much the same way as deductibles work with employer-based health care plans. I believe we should set a minimum salary level for the poor where there is no deductible, and this level should be based on some multiple of the poverty line. I leave it up to policymakers to figure out the exact multiple. Then we have a tiered deductible based on income. Let’s say an income of $40,000 means you pay a $500 deductible. After the deductible, all health care services are covered 100% for that year. Then the next level could be $80,000 with a $1500 deductible, and so on. Yes, I’m pretty much pulling these numbers from my ass, but I think you get the point.
This new system could also have copays, just like current private health care insurance plans, but I think copays should be restricted to routine care only. So, a $10 copay to see your doctor, or to get an eye exam, etc. But I think all non-elective medical care should be $0 copay and 100% covered after the deductible. And again, I think we could means test the copay, and set a lower multiple of the poverty line as the cutoff where there is no copay required, even to see your doctor.
The idea of integrating deductibles and copays into a single-payer system is to make sure people are kept honest in a system that could be perceived by some as a free handout. We liberals know that viewing a system like this as a free handout is a distraction, a way to defeat a pragmatic approach to health care insurance, but liberals also must recognize there are some people who would take advantage of such a system. So requiring a bit of coin beyond the taxes that pay for such a system, and making sure we do not overburden the poor in the process, is a good way to move forward with national health care insurance.