The next big thing for Democrats: Medicare for all

[DonViejo]

By Paul Waldman April 19 at 1:12 PM

When the Affordable Care Act was being created in 2009, many liberals who weren’t too excited about the form it was taking hoped that eventually it could evolve into something more to their liking. They told themselves that the ACA’s reforms may have kept private health insurance central, but over time it could be modified to inch closer to the kind of universal system enjoyed by citizens of every other industrialized country.

Ironically, precisely because Republicans took over the government eight years later and began an attack on the ACA, we may get to that point a lot quicker than liberals anticipated.

Right now Democrats are coalescing around a new model for health-care reform. This November’s election could validate it in a way that practically settles the issue among Democrats. That will then determine the discussion in 2020, and in 2021 it could become the basis for a hugely ambitious overhaul of the system. Right now we could be witnessing the genesis of one of the most important domestic policy changes in our history.

What’s striking is how rapidly this is taking place, especially compared with the last time Democrats did this. After the failure of Bill Clinton’s attempt at health reform in 1994, Democratic health policy wonks began researching, analyzing and debating the issue to figure out what kind of different reform might address the system’s key problems while also being politically viable. It took years before they settled on the “three-legged stool”: Requiring insurance companies to cover everyone without regard to preexisting conditions, an individual mandate to get everyone into the system and subsidies to make sure everyone could afford insurance.

Mitt Romney instituted a form of this in Massachusetts in 2006, and in the 2008 election, all the leading Democratic presidential candidates proposed something similar. There were certainly liberals who didn’t like it, but it was the direction the party collectively decided to go. With that mandate (and a Democratic Congress) in hand, Barack Obama made it one of his top domestic priorities, and it passed in 2010.

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https://www.washingtonpost.com/blogs/plum-line/wp/2018/04/19/the-next-big-thing-for-democrats-medicare-for-all

[Demsrule86]

1. Let's save the ACA and get a public option...let's not throw away our (hopefully) majority.

It is going to take a great deal of effort for medicare for all and we need a supermajority. We don't for a public option...and I am not sure medicare for all would be the best thing in this country. consider only two countries...Canada and the UK have that sort of governmental system.

[Hoyt]

4. +1. Main advantage to public option it gets us to Medicare-for-all without cramming it down throats

of 40%, perhaps more, who are strongly opposed or just too stupid to get it. If it is as good as we think, within a short time most folks will gravitate to Public plan, opening the door for easy transition to single payer or as close as we will get.

I know, why should we care about that 40%? -- Because it's a big enough group of voters to scare off a lot of candidates from aggressively promoting Medicare-for-All.

[Demsrule86]

6. People are stupid about this and can be manipulated. We may end up with some sort of

hybridized system...but it is better than what we had before and we need cost controls for the ACA...by putting those in red states who did not enact Medicaid for all in Medicare via a public option, it would be huge and the GOP would not be able to get rid of health care. Also those states where the exchanges are insufficient and expensive would benefit from a pubic option. It could also be done in reconciliation...thus we don't wait for a super majority which given the Senate could be years.

[dameatball]

2. I think the time has come for this.

First, it is a statement for positive change that I believe the majority of Americans will understand and support.

Second, it forces the Right to actually come up with something better. They have yet to be able to do that.

Third, it is the right thing to do. Maybe that should have been first....

[Greybnk48]

3. It should be called ObamaCare, imo.

In the history books.

[superpatriotman]

5. Go big or go home

Big, big ideas are what the voters want. The closer to home the better

[Demsrule86]

7. We need a public option but not a big stand alone bill...or we won't get it and will lose

our new majority.

[Nanjeanne]

8. The failure of a public option in the ACA at that time was a big disappointment to me. But the more

I researched and went to meetings and listened to experts I also now realize that as wonderful as a public option would be - and I still support is as a compromise measure to get us to a Medicare for All end result - I learned how financially difficult it is when it's not the "all in" method. When offered as an "option", in most cases it will be picked up by the more unhealthy, older people which creates a difficult financial path. Eventually a success could bring younger and more healthy people into it - but it has to survive and be financially affordable to that. Which is difficult without everyone in the pool. "All in" means healthy and unhealthy, young and old. The shared risk is what keeps it financially viable.

So - that being said - I think the call should be "Medicare For All" as the rallying cry. Public option may very well be the compromise - but I think it's not a good strategy to make that the end game in proposing. Medicare For All will be cheaper and more effective as a system and easier to explain and show benefits. As in other countries, insurance companies will still have products to sell outside the Medicare For All system (upgrades, alternative methods, elective surgeries, etc.). But I'm excited if Democrats really get behind a Medicare For All system as a model for real health care reform - and by that, I really mean health care - not insurance.