I'm not sure we can say that to end all these needless debates, everyone should just change their minds and settle on the solutions that I consider to be the best ones. Let's all be a bit honest here and say that the left wing is never going to drop M4A. Why would they? It's popular for its base, it serves as a defining factional wedge, and you just don't maintain a policy position for 10+ years only to drop it when the momentum finally gets hot. That being said, this provides perfectly fertile ground for center-leaning candidates to propose a public option as the more pragmatic direction. The left will, likely, ultimately accept this compromise (as shown by AOC), but there is simply no universe where they are the ones heading to the middle first.
Plus - Biden claimed he was in favor of a public option during the 2020 campaign and then proceeded to ditch the idea once in office. Voters might be thinking to themselves, who can really trust any of this? They won't do it anyway!
The fundamental reason why health care in the US is subpar is because of its capitalistic approach: insurers have a built-in incentive to limit health care. Any improvements must therefore either eliminate this impediment, or work around it. MFA eliminates this impediment and would therefore be my top choice if it could be enacted, but it does come with some downsides: a degree of economic disruption and added unemployment due to the elimination of the entire health insurance sector, possible tax increases, and potential increases in wait times since there would no longer be any economic disincentive. I agree with the author that for various reasons—some completely illogical (people have shown a penchant for voting against their own self interest lately) that MFA is not viable politically at this point. So that leaves two approaches: (1) improving and building on the ACA, or (2) the creation of a public option. Regarding (1), the primary problem with the ACA as it now exists is the cost of insurance, which is why subsidies are a part of it. In order to reduce the cost of health care, the ACA must evolve beyond this. This evolution could include capping provider payment rates, making the cost of procedures site-neutral (same cost anywhere), and addressing drug costs. Something must also be done to encourage more healthy enrollees, which could include auto-enrollment (collective rebub gasp), or late enrollment disincentives (higher rates if you delay). Another improvement would be to require standardized plans (Biden made this optional). However, the best improvement to the ACA would be to add the second approach—the public option, in which the governemnt offers its own insurance plan. This offers many built-in advantages over any private health care plan. First, the government is not profit motivated, and so all else equal the cost of insurance would be less. Second, the government would be able to negotiate down both drug and procedure prices. Third, anything the public option does to lower costs would cause private insurers to do the same in order to stay competitive. Fourth, if MFA is truely the best option (and I believe it is), then the natural evolution of the public option will be to gradually force out private insurance, thus getting us to MFA in a more orderly fashion.
What I find annoying, is that the Medicare for all proponents pitch it like that is all a person needs to avoid big medical bills. Since medicare by itself does not have an annual out of pockets maximum, unless one purchases private gap insurance, you could be staring down some huge medical bills.
I'm not sure we can say that to end all these needless debates, everyone should just change their minds and settle on the solutions that I consider to be the best ones. Let's all be a bit honest here and say that the left wing is never going to drop M4A. Why would they? It's popular for its base, it serves as a defining factional wedge, and you just don't maintain a policy position for 10+ years only to drop it when the momentum finally gets hot. That being said, this provides perfectly fertile ground for center-leaning candidates to propose a public option as the more pragmatic direction. The left will, likely, ultimately accept this compromise (as shown by AOC), but there is simply no universe where they are the ones heading to the middle first.
Plus - Biden claimed he was in favor of a public option during the 2020 campaign and then proceeded to ditch the idea once in office. Voters might be thinking to themselves, who can really trust any of this? They won't do it anyway!
Let's start by paying for Medicare/ACA that we haveby replacing the wage tax with a VAT.
The fundamental reason why health care in the US is subpar is because of its capitalistic approach: insurers have a built-in incentive to limit health care. Any improvements must therefore either eliminate this impediment, or work around it. MFA eliminates this impediment and would therefore be my top choice if it could be enacted, but it does come with some downsides: a degree of economic disruption and added unemployment due to the elimination of the entire health insurance sector, possible tax increases, and potential increases in wait times since there would no longer be any economic disincentive. I agree with the author that for various reasons—some completely illogical (people have shown a penchant for voting against their own self interest lately) that MFA is not viable politically at this point. So that leaves two approaches: (1) improving and building on the ACA, or (2) the creation of a public option. Regarding (1), the primary problem with the ACA as it now exists is the cost of insurance, which is why subsidies are a part of it. In order to reduce the cost of health care, the ACA must evolve beyond this. This evolution could include capping provider payment rates, making the cost of procedures site-neutral (same cost anywhere), and addressing drug costs. Something must also be done to encourage more healthy enrollees, which could include auto-enrollment (collective rebub gasp), or late enrollment disincentives (higher rates if you delay). Another improvement would be to require standardized plans (Biden made this optional). However, the best improvement to the ACA would be to add the second approach—the public option, in which the governemnt offers its own insurance plan. This offers many built-in advantages over any private health care plan. First, the government is not profit motivated, and so all else equal the cost of insurance would be less. Second, the government would be able to negotiate down both drug and procedure prices. Third, anything the public option does to lower costs would cause private insurers to do the same in order to stay competitive. Fourth, if MFA is truely the best option (and I believe it is), then the natural evolution of the public option will be to gradually force out private insurance, thus getting us to MFA in a more orderly fashion.
What I find annoying, is that the Medicare for all proponents pitch it like that is all a person needs to avoid big medical bills. Since medicare by itself does not have an annual out of pockets maximum, unless one purchases private gap insurance, you could be staring down some huge medical bills.