Getting From Here To There

Josh Marshall lays out a strong case for why much of the sloganeering around Medicare-For-All needs to be tempered with some sense of reality.  Yes, we need to take the next step on health care, but getting rid of private insurance would be a political nightmare.  Perhaps it would be worth it.  Or perhaps we need to keep pushing the envelope of what the government offers in a methodical, practice way.

The first issue is the idea of "Medicare-For-All."  Medicare is currently a patchwork system of public and private insurance, so it doesn't work to create something like Britain's NHS.  If you want the government and the government alone to offer something, try Medicaid. But Medicaid is run through the states, and we've seen how perilous that can be, with large states like Texas and Georgia refusing the Medicaid expansion under ACA.  One reform would be to re-center Medicaid in the federal government, and then use that as a program for everyone under age 18.  You're born, you're on Medicaid.  The reason is that Medicaid is a more comprehensive health insurance with more experience covering children and things like pre-natal care.  There aren't a lot of people on Medicare having babies.

The second step would be allowing for an extremely robust public option.  Anyone and everyone should be able to buy into Medicaid (or Medicare, if you insist).  That means individuals can buy in on the exchanges, but it also means Exxon could buy a public plan for their employees.  So could school districts and police departments.  So could a mom and pop business. 

If, as we believe, public health insurance is more efficient and cost-effective, any entity with a budget would want to insure through the public option.  In 5-10 years, 90% of the population would wind up on Medicaid, and then it becomes the task of making it tax-based rather than as a benefit through work or Obamacare.

That lacks the sexy sizzle of Bernie's "Medicare-For-All," but as always, Sanders' strength is making a complex plan simple.  M4A is so simple it can fit on an index card, but as the president* noted, "Who knew health care was so complicated?"  But policy is, by definition, complicated.  That's why Sanders has never written a major piece of legislation; he's a big picture guy.  That's fine, but it's not a recipe for success when mucking about with a major part of the economy.

Reclaim Medicaid for the states; insure all children; most robust public option.  That would get us much further down the road to something along the lines of single payer.