A few weeks ago I floated the proposal – which I swiped from Cenk Uyger – of using reconciliation to pass meaningful health care by vastly expanding Medicare. Now it seems that Ezra Klein is warming up to the idea:
My preference is that House Democrats pass the Senate bill and then run their fixes through the reconciliation process. But I think there is an argument that the current health-care bill has been terribly compromised by the months of controversy, the shady deal with Ben Nelson, the ambivalence of key legislators, the endless meetings with industry players, the wasted time, and the collective freak-out of congressional Democrats in the aftermath of Scott Brown’s election.
There is another option.
Democrats could scrap the legislation and start over in the reconciliation process. But not to re-create the whole bill. If you go that route, you admit the whole thing seemed too opaque and complex and compromised. You also admit the limitations of the reconciliation process. So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.
And that’s it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar. Medicare buy-in had more than 51 votes as recently as a month ago. The Medicaid change is simply a larger version of what’s already passed both chambers. This bill would be shorter than a Danielle Steel novel. It could take effect before the 2012 election.
I realize that reconciliation is tricky, and it can’t do things like eliminate discrimination based on preexisting conditions. It can only deal with budgetary items. Also, Medicaid is no panacea. It’s second-class health insurance in some pretty major ways. Many doctors won’t accept it.
Still, a massive expansion of Medicare would also be a massive step toward affordable health care for all. It would establish the principle of universal coverage without making millions of Americans essentially captive to private insurers. It could set the stage for further expansions of Medicare.
Regulatory reform could still be achieved, though probably in a more piecemeal way. How many congresscritters would come out in favor of preserving the insurance industry’s right to discriminate on preexisting conditions, if that were the centerpiece of a bill? (This would obviously assume the prior existence of an individual mandate, because otherwise people would try to game the system, only buying insurance after they needed it.)
Anyway, just ’cause Ezra Klein likes it doesn’t mean it will happen. But his suggestion does mean that the policy wonks who have a voice in the debate haven’t declared “game over.” It means that we could accomplish meaningful reform without the likes of Ben Nelson and Scott Brown and (shudder) Joe Lieberman. It could mean thousands of lives saved.
Patron cat of Kittywampus (1985-2001)
I think that would be an excellent idea. I’ve been ambivalent about whether or not to support the HCR as it ended up, because it seemed more designed to channel profits to big companies than to efficiently provide medical care to citizens. I know Jane Hamsher has come in for a lot of flak for her ‘no reform without a robust public option’ stance, but I really admire the work she’s done in trying to make the bill something that was minimally progressive. The Medicare expansion suggested sounds like one of the few non-public option, er, options that might be worth supporting.
On a related (and somewhat less happy) Medicare note, this article by Paul Craig Roberts is worth reading. (h/t Ian Welsh)
I agree that it’s been important to have Hamsher (and a few others) taking the hard line. After all, the public option was already less than what she and I and lots of other progressives wanted – a single-payer system. I’ve very reluctantly concluded that the Senate bill is probably better than nothing, but Hamsher has helped keep some pressure on the Dems. Without that, Ben Nelson would be running the whole show (if he isn’t already). Whatever happens from here on out – whether a flawed health care bill is passed, or none – Hamsher will be scapegoated for the failures.
Thanks for the linked article. I’m afraid Roberts is right about the problems with Medicare reimbursement and the pressure on independent physicians. And I noticed he’s a former Reagan aide – now saying that capitalism is even more out-of-control than Karl Marx could have foreseen!
LOVE the proposal!
I’m one of those people who has such a bleeding heart that I don’t care how much it costs OR if people scam the system, I just want EVERYONE TO HAVE AFFORDABLE and ACCESSIBLE health care. Cut the military! Cut NASA! See if I care! Put the pharmaceutical companies in escrow! Tax the living daylights out of the rich! Legalize & regulate/tax marijuana!
In Massachusetts, Medicaid is pretty sweet. Nor have we totally self-destructed or filed bankruptcy despite the public option (*and* same sex marriage–haa!). But in most other states Medicaid is a Total Joke. The feds need to DO something about that. Seriously. It costs sooooo much more to have the uninsured showing up in emergency rooms with major crises.
But see, you don’t even have to be bleeding heart to want everyone to have health care. Having just spent Wednesday night in a couple of ERs, I saw once again how many people use emergency care because they can’t afford a regular doctor. Someone is paying for that, too. It would be cheaper and far more effective if everyone could see a regular doctor instead.
Having said that, I’ll admit to feeling the same as you. Health care is a human right. I love the idea of putting the big pharmas into escrow!