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I think he has a point that it's Medicare for All is not achievable as a single, big bill passed all at once that abolishes private health care at a stroke.
But it would absolutely be possible to achieve full, universal single payer coverage for all with a lot of smaller steps.
But it would absolutely be possible to achieve full, universal single payer coverage for all with a lot of smaller steps.
Here's how I'd enact universal health care if I could.
First and most important, I'd pass all-payer rate setting. The biggest problem isn't how we're paying for health care, it's what we're paying for it. Hospital and drug prices have to come down before we can do anything else.
First and most important, I'd pass all-payer rate setting. The biggest problem isn't how we're paying for health care, it's what we're paying for it. Hospital and drug prices have to come down before we can do anything else.
So we need to start with a bill that takes the procedures Obamacare defines as "essential benefits," and mandate all providers charge a fixed, standardized price for it. No matter what insurer is paying.
Virtually every developed country in the world has a law like this.
Virtually every developed country in the world has a law like this.
Next, we would need to address the cost side for doctors and nurses — all-payer rate setting means their salaries would have to come down, and we need to make sure their med school debt comes down with it to compensate, otherwise we'll see a shortage of medical professionals.
The way I'd do that is, provide tax incentives for states to divert more of their own revenue to public universities and cutting tuition, as well as enacting a debt forgiveness program for existing doctors and nurses who had to borrow under the old system.
The next thing I'd do, once these two measures start defraying the cost of health care delivery in general, is Medicaid buy-in on the ACA exchanges. People getting would be allowed, in all 50 states, to buy Medicaid as a public option, and use ACA subsidies toward it.
You'll notice that up until this point, I haven't actively taken away any insurance option that people already have, so these first steps would all be relatively popular politically.
Here's where I start doing things that would be controversial.
Here's where I start doing things that would be controversial.
My next step would be to abolish preferential tax treatment for employer-provided insurance, and making anyone who already has such a plan eligible for ACA tax credits.
I wouldn't be *banning* employer insurance, but this would encourage a lot of companies to stop providing it.
I wouldn't be *banning* employer insurance, but this would encourage a lot of companies to stop providing it.
Then, I'd raise the income limit for expansion Medicaid, and make tax credits for Medicaid buy-in more generous than tax credits for private insurance plans. Then I'd do that again. And again. And again. Until everyone is eligible for free Medicaid in some form.
And boom.
And boom.
The beauty is that this eventually gets us to single-payer, but makes sure nothing changes so quickly as to financially ruin anyone.
Another advantage is that not only does all the politically hard stuff come last, but worst-case, the politically easy stuff can stand on its own.
Another advantage is that not only does all the politically hard stuff come last, but worst-case, the politically easy stuff can stand on its own.
