One of the lesser known provisions of the $1.9 trillion coronavirus bill is a "temporary" expansion of Obamacare subsidies:
The American Rescue Plan spends $34 billion expanding the Affordable Care Act subsidies for two years. The changes would make upper-middle-income Americans newly eligible for financial help to buy plans on the Obamacare marketplaces, and would increase the subsidies already going to lower-income enrollees.
Subsidies would be increased for the poor and working class while the "subsidy cliff" for higher-income families would be abolished. Instead of federal subsidies ending suddenly at 400% of the poverty level (about $85,000 for a family of three), they would continue for people at all income levels, who would be limited to paying 8.5% of their income for health coverage.
The subsidy cliff has—quite fairly—spawned endless complaints from middle-class families, and for them this change would be gigantic. Today, if you make $85,000 and your health coverage costs $25,000, then you have to pay $25,000. Under the new plan, your maximum payment is about $7,000. In other words, your subsidy has gone from zero to $18,000.
This change has spawned surprisingly little pushback from conservatives, though last month the Wall Street Journal noted—correctly—that "The politics are such that the benefit will never be revoked." Probably so! The Journal also offered up the tired complaint that even a few very well-off families would get some subsidy money, but their heart wasn't in it since, after all, their core audience is the very well off. It was just a pro forma gripe.
On the other side of the aisle progressives are naturally disappointed that we aren't getting Medicare for All, but that was a pipe dream. There were never enough votes for M4A even if President Biden had supported it. Instead, what's likely to happen to Obamacare is the same thing that happened throughout Europe over the last century. Very few countries introduced full-on national health care in a single swoop. Instead, they passed limited programs and then expanded them steadily until, eventually, they were all but universal. And in every case there was lots of path dependence: improvements were all based on the existing system rather than uprooting the entire thing and starting over.
This is almost certainly how things will happen here too. Obamacare built on Medicaid and private insurance because that's what we already had. Biden is now building on that. Most likely, we'll eventually end up like Switzerland, which relies mostly on subsidies for private insurance, rather than, say, the system used in Sweden or France.
Is this the most efficient way of doing things? Nope. Then again, making Medicare universal isn't the most efficient way of covering everyone either. In any case, this is a big change, and it's especially a big change for the middle class, which progressives should pay a lot more attention to. This has been a huge pain point for many of them, and it's about to go away.
POSTSCRIPT: The big question now is whether Democrats will brag loudly about this. They should! It's a big new benefit for a lot of middle-class families.
Alternatively, centrists will be too timid to talk about something that costs a lot of money, and progressives will sulk in their tents because it isn't Medicare for All. It would be nice to avoid that this time around.
There has always been very strong support for a public option. This is the gradual route to a true universal system. But neither Republicans nor Democrats go by what the public wants if the profits of some big business are at risk.
Obamacare protects profits of the insurance and healthcare companies. Most likely Bidencare will continue this. Costs will never come down until that principle is abandoned. The common factor in other systems is control of prices by the government.
No it doesn't. The only way it "protects" them is by letting them live, period.
@Midgard
So you're saying it doesn't protect them, but it protects them?
I believe that the UK is one of few countries where most prices are controlled by the government. In most countries with universal healthcare, providers are private, and the governments negotiate prices. Pharmaceutical makers and medical-device manufacturers are nearly all for-profit private companies; prices are negotiated..
That's part of the problem among the Lefties commenting. They conflate UK system with European and draw incorrect conclusions about goals from that (of course it's the mirror image of the Republicans doing just about the same thing).
Most Continental systems are indeed more universal mandate than UK system.
Given the actual facts available from European systems with quite a variety of mixes (and about none with the truly socialist-trended UK approach [ironic really]) one can take away that rather than erecting an American version of UK system as a goal there are a number of valid paths to get relatively similar results - without playing Don Quixote as the Lefty Left activist commentariat love to do with sweeping simplistic assertions.
Universal coverage as a mandate which has utility to achieve both health goals and economic (risk pool and scale), with a degree of simplification from simplifying market structure, and regulation as well as scale pricing (regulated as per oligopolistic markets) in various flavors achieve similar results - there's no need for Purity Ponyism
More of your bootstrapping assertions... (and zero learning from Drum's wise warnings of over-reading superficial polls).
End-stage capitalism now joins end-stage cancer among things neither our dysfunctional, corporatized, neoliberalconservative government nor the Big Rescission monolith that guides it thru legalized bribery can save.
Defector-dot-com mode off.
One is good, the other not so much.
Is it laughable or pitiful when people use such ridiculous Marxist cant like 'end-stage capitalism.'? I can't decide. Maybe both.
It's the categorical simperative.
This is probably the single biggest thing that can be done to improve the ACA.
There is no improving the PPACA.
-- Alexandria Ocasio-Cortez
A healthcare reform I'd really like to see would be some something to increase transparency and consistency in medical billing, both for individuals and for insurance providers. My mother recently had to visit an emergency room. The hospital was in-network for her but the doctor who treated her (for about 10 minutes) was not. This guy is literally getting paid over $5000 for 10 minutes' work
(mostly from the insurance company but still). Say want you want about lawyers, at least they give you their bill rate up front.
It appears from this source that all but about 17 states provide some degree of protection against 'surprise billing'.
https://www.commonwealthfund.org/publications/maps-and-interactives/2021/feb/state-balance-billing-protections?redirect_source=/publications/maps-and-interactives/2020/nov/state-balance-billing-protections
Hmm. I can't find the full details of this, but it seems to potentially overlap with a big personal bugaboo of mine.
I pay about $11400/yr for a bronze HSA compatible plan that covers my wife and I (both in our mid-50s). That works out to roughly 10% (plus or minus) of my gross income. I don't mind paying 10% of my gross income for health insurance - it's nicely in the middle of the range paid by citizens living in countries with sane health care systems around the world.
BUT ... what I do mind is paying 10% of my gross income and STILL having a per-person deductible of $6600. I'm paying that much money for what is fundamentally catastrophic insurance, not real health insurance.
So, one of the reasons we have this insurance is that a silver or gold plan would cost an even larger amount, and we've chosen to manage the bronze plan for now. But depending on the details of this, it seems that we could switch to a gold plan and pay only 8.5% of some measure of our income. Does anyone know if this is likely to be the outcome, or is there some wrinkle that would prevent this?
BUT ... wait, doesn't that remove any incentive for the existence of gold, silver or bronze plans at all?
Maybe I'm clueless about what this "Medicare for All" slogan is actually supposed to mean. Do you get Part A free and if you want Part B need to pay (totally reasonable) premiums every month? Do you need to shop for and purchase a Part D private insurance plan, unless you want to pay full retail price for your drugs? What about the "Medicare Advantage" policies, where you limit youself to a list of providers, pay more, and otherwise get more? And "MediGAP" supplemental insurance? Does one need to shop for that?
And let's not get into dental coverage, because the costs are absurd for the level of benefits, nor vision coverage. None of those are in "Medicare", either.
Is there a single meaning to "Medicare 4 All", or just whatever the listener wants to envision?
No, there is not a single meaning to Medicare for All, except in the general sense of "a fully funded, universal, single payer health care scheme".
If you want to see one way that Medicare for All could work, look at the Canadian system, also called "Medicare".
"Key Points
- Create a Medicare for All, single-payer, national health insurance program to provide everyone in America with comprehensive health care coverage, free at the point of service.
- No networks, no premiums, no deductibles, no copays, no surprise bills.
- Medicare coverage will be expanded and improved to include: include dental, hearing, vision, and home- and community-based long-term care, in-patient and out-patient services, mental health and substance abuse treatment, reproductive and maternity care, prescription drugs, and more.
- Stop the pharmaceutical industry from ripping off the American people by making sure that no one in America pays over $200 a year for the medicine they need by capping what Americans pay for prescription drugs under Medicare for All." - Bernie Sanders's M4A proposal
Pretty sure that's what everyone understands Medicare for All to mean. (The central idea of course, is that it's comprehensive, and easy to understand and you get it all for free [save overall employment taxes will increase by about that 0-8.5% Drum mentions, I suppose.)
M4A as described would be most efficient indeed!
That isn't what it means. You chanting slogans completely ignoring cost. You better believe some copays will be there
Copays are just a sop to the right wing. As things now stand, health insurance is paid for by a mix of government, employment benefits, and directly by the insured, and medical costs are paid for partly by insurance and partly by the sick person. It doesn't cost more to cut out the insurance companies and just have one source pay the medical bills.
M4A means that the same expenses that are now paid by insurance, or by the sick person, are paid from taxes. That means that taxes go up and the other costs for health insurance and health care go away, with a net savings because administrative costs for a M4A system are MUCH lower than for the present hodgepodge. When you include copays and deductibles in the M4A mix, you just shift a small part of the cost from the taxpayer's left pocket to the taxpayer's right pocket, while complicating bookkeeping and administration and thereby increasing the total cost of the system.
In a single payer system, KISS is a very good principle to follow when setting up the payment structure. Copays are an unnecessary complication.
1) I encourage you to conduct a little survey - ask the next ten people you encounter what they think 'Medicare for All' would be like.
2) The coverage you describe would be far more extensive than any other national health system provide, and the costs, particularly for long-term care, would be significantly greater. Current US spending on healthcare is 18% of GDP, about equally public and private. Some savings can be achieved in administrative costs, and by trimming excess profits in pharma and medical devices, but a substantial part of high cost is high compensation for medical professionals.
The challenges are pretty significant.
Nobody is proposing that M4A would provide more health care than is presently being provided; it will just shift who pays. Since that health care is already being paid for, one way or another, "can't afford it" just doesn't apply.
Nearly a third of US health care spending is for administrative overhead. In a single payer system, administrative overhead is typically 3% of total cost. You do the math.
One of the reasons I've never been a big fan of the slogan "Medicare for All" is that Medicare is a crappy system (at least for the non-wealthy) compared to most of the universal healthcare programs in operation in other high income countries. It's a confusing morass of doughnut holes, copays, coverage gaps and overall unnecessary complexity.
Yung Trustifarians in the Fauxgressive Movement like the idea of Medicare4All because just as they have done well financially via wealth transfers from grandparents & greatgrandparents, they see a likewise extension of their grandma's medical insurance as only right & natural.
Republicans long ago developed 'the Overton Window' as their major political tool. Simply put, when people view society they see things as either common sense or extremist, the window of possibility. The Republicans learned to advocate extremist positions not because they hoped to achieve them but because it extended the Overton Window farther in their direction. As one politician once put it, ask for a loaf and settle for half a loaf. Democrats should advocate for the M4A even if they don't expect to achieve it: what it primarily does is create logical compromise positions in that direction.
Waste of a post. Most Democrats don't want it and thus your point is irrelevant.
@Midgard
Depends what you mean by "most".
"Build on what already exists" is precisely the thought behind Medicare for All. Gradually lower the eligibility age, improve the coverage, subsidize the cost out of general revenue, and keep doing those things until you get to a full single payer program funded by general revenue.
"Gradually".
Yup, "gradually". I would think that it would need at least a couple of years to go to completion.
Hmm "not like France"?
The French system actually evolved from private "mutual insurance" - in various forms. Now of course there is such government intervention that the Mutuelles are not what Americans would call private insurance, but the origins and long evolution their roots and first decades would be very recognizable to a subscriber to the original mutual forms of Blue Cross Blue Shield.
It would be really easy to see a form of this evolve in the US as at least an option.
* Lots of Americans (Lefties and Righties) really have a poor understanding even of European 'government' systems.
Of course Lefty activitists and commentators (see initial) are really deeply ideologically bought into a superficial understanding of European systems - sort of a mirroring ideologically of the equally superficial Republican opposition...
It's no surprise that Corbin & Orban rhyme. Sort of.
Kevin seems super organized and detail oriented, so he probably knows exactly how his own medical insurance works, and can instantly spot when a huge ripoff copay or coinsurance bill arrives, and probably knows exactly what kind of ambulance coverage he has. -‘and all that. Many of us aren’t as sharp as Kevin though, and the insurance and billing department errors or “errors” and the surprise bills, and the complexities and mouse print will let the stupid system keep giving us ulcers and nightmares and real heartache and death as we scramble to figure out if we can call the dang ambulance without losing our life savings.
And the pirates will not be stopped from cruising up and down our American streets, with credit ripoffs and insurance rips and banking rips and “investment advice” rips and scam calls on the phone all day long attacking our seniors, and on and on until we get another FDR type in office.
And, actually, with the ultra fine detail profiles they have on us all by now, companies probably know whom they can attack with a ripoff and whom they better not attack, lest that organized, capable victim, like Kevin, recognizes the attack and takes effective action. In other words, do members of Congress actually get attacked by this pirate crud the way most of the rest of us get attacked? Do they even know what we’re fending off day after day?
So. Yeah, trumpet this Obamacare advance, but don’t stop talking like FDR. ALSO, learn to talk like FDR.
In other words, we’re not done until our medical money stops building first and second palaces for medical insurance middlemen check shufflers. Miles to go before we sleep.
Or something.