Federal legislative proposals worth thinking about
Why expand large public programs, such as Medicare?
- Private “insurance” markets have high administrative costs. As middlemen, they make money from complexity, confusion, and frustration, which they inflict on both patients and clinicians. Hundreds of insurance companies have tens of thousands of different policies, reducing their negotiating power against big pharma, hospital systems, and medical product suppliers.
Larger insurance programs, like Medicare, can guarantee choice where it matters, such as choices for patients among clinicians and hospitals. And, because of their size, they could negotiate better prices for drugs and services, and be adjusted to better cover prevention, if Congress let them.
Expanding large public programs just makes sense – why reinvent the wheel when you can just improve on something that already works?
What current bills expand and improve Medicare?
Medicare for All (Sanders, I-VT): Medicare enrollment for all Americans, regardless of age. This proposal would start with lowering the age of Medicare over four years, until all Americans are covered.
Expanded and Improved Medicare for All (Ellison, D-MN): Medicare enrollment for all American, regardless of age, and an improvement on the existing Medicare program to cover additional services, such as dental, vision, and long-term care.
Choose Medicare (Merkley (D-OR)/Murphy (D-CT): In this plan, individuals and employers can purchase Medicare for people of all ages, “ Medicare Part E,” but people would still have the option for private insurance.
Medicare-X Choice (Bennet, D-CO/Kaine, D-VA): This plan allows for a public insurance plan offered to individuals and small business through the health insurance exchange. It also allows Medicare to negotiate fairer drug prices.
What bills expand Medicaid?
State Public Option Act (Schatz, D-HI/Luján, D-NM): This bill allows states to have public buy-in for Medicaid plans, regardless of income level.
What about states?
States can be important models. About two dozen states have bills to expand coverage, a number through universal care. For better and worse, the model adopted in the 2010 Affordable Care Act was modeled on the bipartisan 2006 Massachusetts reform legislation.
Why aren’t other bills on this list?
When can major progress be made?
There is a tendency for activists to get into intense debates about the merits of the policy particulars of different proposals. There is a time for this, but later. The challenge we have now is to gain broader support for a commitment to affordable health care for all. We must mobilize those who already recognize the need for larger government roles. But, additionally, we must help those who believe otherwise to understand how deeply unfair American health care is and the need to work towards effective solutions for all of us.