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.