Federal legislative proposals worth thinking about

While getting the policy details right will be important, it is equally important to identify the shared values that should be present in any specific health reform policy. We hope to generate the kind of substantive discussion that will improve consensus on both the principles and policy of health care reform.

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.
  • 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?

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?

Making health care fair, especially economically fair, requires tackling multiple problems. Drug prices and the opioid crisis are just two examples of the many health issues members of Congress are addressing . There are over 20 bills in Congress on the opioid crisis alone. However, we believe that the issue of fairness – the need for affordable universality – is paramount. Once U.S. health care is built on the principle of affordable universality, other problems of excessive prices and administrative frustration become easier to solve. In other words, without first addressing universality, we are only treating the symptoms of our sick health care, not curing the disease.

When can major progress be made?

To get committee hearings and serious attention, the party that supports a comprehensive approach has to be in the majority, with a committee chair who is open to the debate. To actually be enacted, the President and leadership of both the Senate and the House of Representatives have to desire major change.
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. Updated 6/1/2018