“Medicare for All” has Dominated the Democratic Party Debate over Health Care Policy for the last few months. But there is an Alternative Path to Universal Coverage that would Create a New Government-run Insurance Plan Open to Everybody while Preserving a Substantial Role for Private Insurers.

The Center for American Progress (CAP), a Think Tank that Developed One of these “Public Option” Proposals called Medicare Extra for All, released a Formal Projection on how its Plan would Work in Practice.

The short version is that under CAP’s Proposal, Everybody would have Insurance and that, by and large, People would have Better Insurance than they do today while Paying Less Individually. In other words, Americans would have Universal Coverage, just as they would under Medicare for All. The Majority of Americans would be in either the New Government-Run Plan or Traditional Medicare. Nearly One-Third of the Population, however, would remain in Employer Plans.

“Medicare Extra for All” looks a lot like the “Medicare for America” Legislation from Reps. Rosa DeLauro (D-CT, 3rd District) and Jan Schakowsky (D-IL, 9th District), which has garnered Explicit Endorsement from One 2020 Democratic Presidential Candidate, Former Texas Rep. Beto O’Rourke and Implicit Endorsement from another, South Bend, Indiana, Mayor Pete Buttigieg.

The CAP Plan also bears a Strong General Resemblance to “Health Care for America,” a Plan that Jacob Hacker, a Yale University Political Scientist, developed with the Economic Policy Institute back in 2007. That’s another way of saying that the Idea has been kicking around for quite a while, although it’s now become more Mainstream than it was a Decade ago.

The CAP Proposal would Create a New Government-Run Insurance Program that would immediately absorb Medicaid and take in all the People who, under the Existing system, Buy Coverage through HealthCare.gov, through State-Run Exchanges, or Directly from Insurers.

But unlike Medicare for All, the Public Option approach would Allow Employers to Keep offering Private Insurance, giving Employees of those Firms a Choice. The Employees could Enroll in the Company Plan or opt into the Government-Run alternative.

Seniors would also have a Choice. They could Stick with Current Medicare, whether it’s through the Traditional Government Program or the Private Insurance Alternative known as Medicare Advantage. Or they could opt into the New Government Plan. Either way, they would get Dental, Vision, and a Cap on Out-of-Pocket Costs, All Benefits that Medicare does Not offer today.

There are some other Important Wrinkles to the CAP Program. It would include Full Coverage of Long-Term Care, which is a Huge, and still Growing, need for the Aging American Population. It would also Leave in Place a Handful of Smaller Government Health Care Programs, including the Veterans Health Administration (VA) System, and the Federal Employees Health Benefits Program, while giving People Eligible for those Programs the Option of Joining the New Government Plan.

The Biggest Benefits would go to Low-Income Workers switching into the New Government Plan. Their Premiums and Out-of-Pocket Spending could fall by 87%, according to the Avalere Projection, because the Plan’s Prices and Benefits would be Tied to Income. But Higher-Income Workers and even those Staying in Employer Plans would also see Savings, Avalere predicts, because the CAP Proposal includes a Form of Price Regulation that would Apply to All Medical Bills.

“A key aspect of the plan is using government regulation of health care prices, as is typically done in other higher-income countries,” said Larry Levitt, Executive Vice President for Health Policy at the Henry J. Kaiser Family Foundation. “The health care system envisioned in this plan would be more complex than Medicare for All, but still a whole lot simpler than our current non-system.”

Regulating Health Care Prices comes with its own Tradeoffs. Drug and Device Makers say that Lower Payments would Leave them less able to Develop New Treatments; Doctors and Hospitals say Cuts would lead to Financial Losses and Closures that Reduce access to care.

Public Option Proposals have already Attracted the Ire of the Partnership for America’s Health Care Future, an Industry-funded Group. “These would drastically change health care in our country,” one of the Group’s Officials wrote earlier this year. “They are nothing less than a slippery slope toward one-size-fits-all, government-run health care.”

Whatever the Merits of their Arguments, these Groups have a Great deal of Political Influence.

Like All Projections, including ones about Medicare for All, Avalere’s is extremely Rough, Subject to Myriad Assumptions that reasonable People can Question. And the Results could vary quite a lot with even Modest Changes to the Public Option Proposal. The CAP Report actually includes Three Different Projections from Avalere, each one considering a Different Scenario for the kind of Coverage and Assistance that the Proposal would offer.

In One Scenario, the Coverage is a Lot more Generous, providing People with Greater Financial Protection from Medical Bills. But the Government would have to Spend More, too, which would mean Raising Additional Revenue or Reducing Payments to Providers more dramatically.

One Reason that CAP Commissioned Analysis of Three Options was to demonstrate the Plan’s Flexibility. “We think of this as an approach that has dials—which can be adjusted over time,” Topher Spiro, Vice President for Health Policy at CAP.

Of course, the same is true for Medicare for All or, for that matter, any Serious Idea for Health Care Reform. Each one is really a Set of Interlocking Concepts that Lawmakers could Modify. And the differences between, say, Sanders’ Bill and the CAP Plan start to Blur if you imagine how Congress might Adjust either Proposal if it ever took up one of them seriously.

The Distinctions between these and other approaches are important, and, especially in the Context of a Presidential Campaign, it may be worth ignoring Political Constraints to sketch out what an Ideal Plan would look like. But if Universal Coverage is really the Goal, there isn’t just One Way to Achieve it.









NYC Wins When Everyone Can Vote! Michael H. Drucker