Here’s an idea-so-crazy for a big, Trump-like move on health care of the sort Peggy Noonan seems to call for: Lower the Medicare eligibility age to 55 (from 65) as part of the deal. Why?
1) This would remove the costliest, highest risk cohort (older people) from the Obamacare risk pool, allowing Obamacare insurerers to lower prices. The near-poor who are served by the program would find it easier to afford. Ditto the healthy young. The unsubsidized middle class would feel less ripped off.
2) The deal could still include many things Republicans want:--e.g. replacing the individual mandate with some other incentive, offering tax credits instead of subsidies, paring down the list of “essential benefits” (that anyone who buys an Obamacare policy must purchase–including substance abuse treatment), eliminating the rightly controversial Independent Payment Advisory Board. Or bolder: Make selling Obamacare insurance a nationwide market (rather than in 50 state markets),
3) Medicare-at-55 wouldn’t just be a halfway house on the way to Bernie-style Medicare-for-everybody. It’d be a way to give the competitive Romneycare/Obamacare model a chance to work. It’s not working now. We could decide later whether to apply it to Medicare or expand Medicare to absorb it. Let the best model win.
4) It would add to the federal budget. (Medicare isn’t cheap.) Since when has Trump been Dr. Cut-the-Deficit-Now?
5) How would it pass? Straight down the middle. Medicare-at-55 will be very popular with voters, including Trump supporters. That’s a big engine to power any deal through (just as voter hostility to welfare powered the 1996 welfare reform through, in another down-the middle play). Democrats (and many Republicans) would have a hard time voting against a deal that included Medicare-at-55. In the 1996 welfare debate, President Clinton was a passive triangulator, oppposing, but not actively denouncing, the pro-welfare views of his own party in Congress. You’d expect Trump to be far less passive dealing with recalcitrant GOPs who don’t get on board. Arguably that’s what voters expected when they elected him.
Just a thought!
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Here is a question: why don’t the Republicans just kick it down to the state level? Here is the proposal: take the money the federal government spends on Medicaid and Obamacare subsidies add it up and divide by the U.S. population to get a per capita figure for those two programs, then issue block grants to each state based on their population times the per capita figure and let it grow each year according to nominal GDP growth figure (so inflation plus real GDP growth). Then each individual state can decide what to do.
Just to emphasize the benefits of the solution:
1. States will have flexibility to implement what they prefer (single payer, exchanges with or without public option, health savings accounts, …).
2. If needed additional funds can be raised by taxing health benefits in the payroll tax.
3. This will be very popular with ideological conservatives of the GOP.
Yeah, and money grows on trees. The problem with this idea is Medicare is going broke (along with the other entitlements). Are you willing to double (or more) the Medicare portion of your paycheck?
How many folks might lose their jobs because some employers can’t afford to take that hit. Then that will increase welfare and unemployment costs… etc, etc…
Re Seipherd:
Nobody is going to cut Medicare and what I outlined has nothing to do with it. I am just proposing to let the states spend the money that is already being spent.
The federal government should sign us all up to a basic baseline health care plan that covers routine medicine and preventative care. If people want more coverage for extreme treatments and transplants and IVF and sex change surgery, they can buy supplemental insurance.
Another thought is to dismantle the dirigiste elements, all of the regulator impositions, mandates, and closet redistribution. At the same time preempt state limitations, force price disclosures (no more rack rates, insider prices etc.) and let the free market work.
Final step – for the deserving needy, such relief as a humane society may knowingly vote for. And if they vote less than what some may feel is “fair” then that is the price of democracy; may God have mercy on them.
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