You might not have heard, but the AHCA crumbled and burned, gone like tears in the rain, as they say. In the wake of the bill’s collapse, there’s a push on the left to try and get something more progressive–I’m getting a lot of emails asking me to sign a petition encouraging members of the House to support John Conyers’ (D-MD) Medicare for All proposal.
I have questions.
Below are some excerpts from Rep. Conyers’ bill (emphasis mine).
Question #1: How Free is “Free”?
This bill establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care…
Okay, this is a quibble, but it won’t be free, right? Don’t misunderstand me–I fully support the state’s authority to tax citizens, and I also believe that a healthier population will not only lead to lower costs, but to better societal outcomes in general. But I do want there to be a full and open discussion about the costs this will entail.
For example, when conservatives argue against universal coverage (or universal healthcare, whichever you prefer) by saying “the government shouldn’t be involved in healthcare,” I lose it. That’s a moronic argument. First of all, why not? Second of all, if you truly believe that, I don’t want to see another emergency room receive tax dollars–in fact, I have a better proposal for you.
But if you want to make an argument that centers on cost, that’s a discussion I want to have. If you want to point out that providers would receive less money under broad Medicare, and maybe that would lead to problems for the healthcare industry; if you want to point out that we aren’t sure if health insurance even works, so maybe we shouldn’t be paying for it; if you want to say that look, we just can’t afford it, all that’s fine. If it’s about numbers, we can have a discussion. If it’s about numbers we can propose solutions as long as it’s about ideology, we’re never going to get anything done.
Question #2: What Happens to All the Insurers?
Health insurers may not sell health insurance that duplicates the benefits provided under this bill. Insurers may sell benefits that are not medically necessary, such as cosmetic surgery benefits.
I don’t know about you, but I don’t like the idea of pulling the plug on an $800 billion industry. I’m no expert, but I feel like that’s bad policy.
I’m still researching this, so don’t expect to see my post anything about it soon, but I like the idea of Medicare For All as a public option, with private insurance still being available. I was imagining deductible premiums for individuals in the same way employers can deduct their costs; that might just take the form of subsidies. Either way, I can’t imagine a bill that destroys the private insurance industry will be anything other than a nonstarter.
Question #3: How Are We Paying for This?
The program is funded: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% of income earners, (3) by instituting a progressive excise tax on payroll and self-employment income, (4) by instituting a tax on unearned income, and (5) by instituting a tax on stock and bond transactions. Amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), are transferred and appropriated to carry out this bill.
I actually don’t have a problem, conceptually, with anything except the third one–a tax on payroll and self-employment income, and not just because I’m self-employed. The full text of the bill isn’t clearer, just calling it a “modest and progressive” tax, so I’d want to know a lot more about that before I’d be willing to throw myself behind this.
Categories: Get Wonky