I am definitely not the LGM health care wonk, but I wanted to point out to you all this proposal about how to get to single payer. The left always says, “Let’s have single payer!” but the conversations rarely go into any depth at all. What would that look like? How would we get there? What about the insurance industry? Etc. So I won’t really comment on the overall quality of this proposal, but rather want to point it out so that commenters can work off some kind of proposal in order to hone their ideas.
Our plan, the Medical Insurance and Care for All program (MICA), is a public health insurance program based on Medicare but open to all individuals. Employers will be required to buy their employees MICA or equally good private coverage. If one does not receive employer coverage, they will automatically be enrolled in MICA and charged for it in their taxes.
ny serious move toward a more rational universal health care system will face strong opposition from hospitals, doctors, drug makers, and insurance companies. That’s because they rely on the byzantine nature of the health care system to charge significantly more than providers and insurers in other highly industrialized countries.
There is no way around this financial reality. Consequently, for any plan to be politically viable, it must aim to reduce opposition from outside the health care sector as much as possible while still achieving universal affordable health care.
The Affordable Care Act (ACA) was designed as a large transfer of wealth from the rich and a segment of healthy middle class individuals to the poor, the sick, and importantly, the health care industry. MICA is primarily a transfer of wealth from the health care industry to everyone else.
The guiding political principles behind this plan are intended to make it politically viable by minimizing disruption, making the transition feel voluntary, and ensuring everyone outside the health care sector is noticeably better off (and at least not worse off).
There are two primary approaches to transitioning to single-payer that minimize disruption and the number of losers outside the health care industry.
The first is to slowly lower the Medicare age and/or slowly add specific groups to Medicare. The second is to find a way to transition our current employer coverage system towards single-payer-like health insurance.
This plan does the latter by strongly encouraging the private dollars currently spent on health care to be redirected toward a new, much cheaper, and better quality government program. MICA will be an attractive option for all companies, as the program should cost 20-30% less than what employers are currently spending on insurance.
The existence of a universally better government program will compel the remaining private insurance industry to perform better.
The reasons for this approach over slowly lowering the Medicare age are multifold. First, is the issue of financing. Lowering the Medicare age would need to be combined with a new tax structure while this plan relies on mainly redirecting employer current spending on private health insurance.
This route is also quicker and more difficult to reverse. MICA would be available immediately to all companies and they would steadily start choosing it.
Additionally, one fear with lowering the Medicare age slowly is that opponents could simply freeze it when elected, ending up with our same system—except Medicare now would start at age 59.
Lowering the Medicare age is likely to be disruptive. There might be some point, for example, when the eligibility age reached 45, where larger companies might stop dropping employer coverage en masse, creating a need for an emergency fix.
There’s a lot more detail at the link.