13 June 2011

My answer to Republican canard that Progressives have their heads in the sand on Medicare

First off, it's a right-wing frame to call the "problem" a "need to fix Medicare." Medicare doesn't need fixing. It needs cost controls, and it needs a secure funding base.

But, to those who (falsely) claim that Progressives have their heads in the sand and are just putting off the inevitable day when Medicare goes bankrupt, I say, all right then, here's my plan.

1. Expand Medicare to all, adding negotiated RX benefits without ridiculous donut holes and sweet deal pricing for Big Pharma.
2.  Institute a comprehensive system of cost controls to rein in health care costs. (This is very general, obviously, but there are a wealth of ideas out there on exactly how to do this).
3. Assess a progressive tax on workers and employers approximately equal to the average amount of health care premiums currently typical of employer paid health insurance. Businesses with fewer than 10 employees would be taxed at a much lower rate, to encourage employment in that sector. Very low income workers would pay nothing.
(By providing this revenue stream, Medicare, which is 20% more efficient (at least) than private health insurance, would save a ton of money and provide decent health care for everyone, at a net cost saving. There would be firm commitments to a practicable but First World Standard level of medical care for all).
4.  Medicare Advantage would be put on a completely cost-neutral basis. You want it, you (or your employer) pays for it; otherwise Medicare for All is what you get. Unsubsidized private insurance (which would probably be more or less the same thing... coverage for luxury medical care that the new Medicare doesn't pay for, funded by private premiums), would be allowed.

By doing this, we could significantly reduce the percentage of GDP spent on medical care, reduce the per-patient cost and put the program on a sound fiscal basis, (since all the healthy younger workers will be paying into it as part of the insurance pool, not just as taxpayers), and the program would be in a position to regulate costs and negotiate equipment and pharmaceutical prices.

Of course, this would require overcoming deeply entrenched special interests. But if you don't say what you want, and you aren't willing to fight for it, you'll never get it.

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