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Yr Wonkette is generally in favor of single payer healthcare of some sort -- there are a bunch of different models used around the world, and they all manage to cover more people at lower cost than the patchwork of systems the US has. But if the electorate isn't able to bring itself to embrace Medicare for All in 2020, the Center for American Progress has an alternative proposal, "Medicare Extra," that would achieve the goal of universal coverage while allowing private insurance to continue. Think of it as a Really Big Public Option. The CAP is betting its alternative would prove so popular that employer-provided private plans would, over time, gradually fade away as more people go with Medicare Extra. Let's get wonky on it!


As the first Democratic primary debate revealed, one supposed talking point against Medicare for All is that it would mean the end of private, employer-paid health insurance. Honestly, we don't know that many people who are so in love with their employer-provided plan that they'd be horrified by an alternative that covered their healthcare with no deductible or co-pays, but yes, anxiety about change is always one of the biggest things working against any proposal to reform our current terrible system. Medicare Extra takes the "Dems want to kill your insurance" argument off the table by leaving private insurance alone, mostly. (Like Obamacare, it would require private plans to meet certain coverage standards, though.) Reps. Rosa DeLauro (D-Connecticut) and Jan Schakowsky (D-Illinois) have introduced a very similar proposal in the House, calling it "Medicare for America."

So what is it, if it's not M4A? It's essentially an enhanced version of Medicare that would include "dental, vision, hearing, and reproductive health care benefits." Unlike M4A, it would require enrollees over a certain income level to pay in to the system, with the limits on using services that supposedly result from people having "skin in the game":

Premiums and cost sharing (such as deductibles, coinsurance, or copayments) would vary by income on a sliding scale. Premiums would range from zero for families with incomes below 138 percent of the federal poverty level to a maximum of 9 percent of income for families with incomes above 400 percent of the federal poverty level.

An analysis of three levels of Medicare Extra -- each with various amounts of government cost -- by healthcare consulting firm Avalere Health found that even the lowest-cost version would cover a higher percentage of health costs ("actuarial value") than Obamacare currently does. Look, a table!

Employer-based health insurance would stay in place, as long as it covered 80 percent of workers' healthcare costs and the employer covered 70 percent of the premium. (Again, we have NO IDEA who would want this.) Or employers could decide to pay into Medicare Extra for their employees instead. Small employers would be exempt from those pay-in requirements. And employees of companies that provide insurance could choose to get Medicare Extra; their employers' premium contributions would go to the new socialist grandma-killing plan.

Over time, CAP projects that more employers and consumers would choose Medicare Extra, because it would be gooder. Yes, we're simplifying that summary a bit.

Speaking of Grandma:

The current Medicare program, TRICARE (for active military); Veterans Affairs medical care; the Indian Health Service; and the Federal Employees Health Benefits Program (FEHBP) would remain. Individuals who are currently covered by these programs would have the option to enroll in Medicare Extra. The current Medicare program would be improved by adding dental, vision, and hearing benefits and a limit on out-of-pocket costs starting at $5,000 in 2022.

Medicaid and the Children's Health Insurance Program (CHIP) would be integrated into Medicare Extra. States would be required to make maintenance-of-effort payments to Medicare Extra based on the amounts that they currently spend on Medicaid and CHIP.

Once the plan went into effect, it would automatically enroll the uninsured, new retirees at the age of 65, and all newborn infants. (Republicans: Innocent babies, HOW HORRIBLE.) Eventually, it would be the nation's biggest provider of health insurance:

Avalere estimates that the proposal would achieve universal coverage, covering 35 million uninsured individuals, within three years of enactment. By 2031, 232 million Americans, or 66 percent of the population, would be enrolled in Medicare—either original Medicare or Medicare Extra.

Although the current Medicare program would remain an option, many Medicare beneficiaries would switch to Medicare Extra to take advantage of its lower premiums and cost sharing. Because individuals turning age 65 would be enrolled in Medicare Extra automatically, enrollment in original Medicare would shrink and enrollment in Medicare Extra would grow over time.

The Avalere analysis projected that, after increased costs from expanding coverage, the system would cut healthcare costs over time, eventually resulting in $300 billion less annual healthcare spending by 2031, as compared to our current patchwork. Those savings would come from paying providers at Medicare reimbursement rates, and through negotiating prescription prices for both Medicare Extra and regular Medicare. (Hospitals, however, would get 110 percent of Medicare rates.) That sounds good, although we'd note that one of the ways European countries keep their universal coverage affordable is by broad regulation of all healthcare costs, which American health reformers should be talking about, too.

Here's the summary of what this sucker would accomplish:

  • Achieve universal coverage
  • Enroll the majority of the population in a Medicare plan
  • Allow employees a choice of plan
  • Reduce national health spending
  • Reduce consumer costs substantially across income groups
  • Increase federal costs by less than $3 trillion
  • Hold premium or tax financing to single-digit percentages of income for middle-income families
  • Reduce the cost of hospitals without resulting in negative margins
  • Reduce the cost of prescription drugs

Yes, of course, the Usual Suspects would whine that it's all just an evil scheme to provide healthcare to people they don't like, and that it would eventually lead to European Style Socialism, not to mention death panels, probably. But Medicare Extra might be an attractive choice for candidates who want something a lot fairer than the current system, but are skeptical of the prospects of switching the entire country over to single-payer in just two to six years, as most M4A proposals aim for.

Or maybe Trump's dumb Obamacare lawsuit will eliminate coverage for tens of millions, and the beautiful free market will make everyone instantly healthy or dead.

Now jaw in the comments, it's your OPEN THREAD!

[Center for American Progress / Vox / Photoshoop based on image by William Warby, Creative Commons License 2.0]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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