A new “framework” for a comprehensive health-care plan just released by the prominent center-left think tank the Center for American Progress is drawing attention for two very different reasons. Its heart is a new program based on Medicare, dubbed Medicare Extra, that would be open to all Americans and that would soon absorb Medicaid and CHIP, and presumably the private insurance sold on Obamacare’s exchanges.
One way of looking at it is as a notable shift to the left on health-care policy by a staid, Establishment organization that usually reflects a consensus among staid, Establishment Democrats. That’s Jonathan Cohn’s read on it:
Some will call this plan a single-payer proposal, because it’s easy to imagine, someday, everybody being part of this new version of Medicare. Some will say it’s not a single-payer proposal, because it envisions a permanent, potentially large role for private insurance ― as a provider of highly regulated plans that would function more or less the way private plans for seniors on Medicare operate today.
But whatever the proposal’s label, it’s plainly a more ambitious ― and more progressive ― health plan than the Democratic Party’s most influential thinkers have embraced in the past. And that’s what makes it noteworthy.
Alternatively, you can view the CAP proposal as representing a more centrist entry in the health-care-policy field to compete with full-on single payer, as proposed most notably by Bernie Sanders, which has become the default concept whereby progressives show they are not satisfied with the Affordable Care Act.
Because its displacement of private health insurance would be voluntary and gradual, not immediate and mandatory (as would be the case with single payer), the huge new taxes that provide the sticker-shock element of Medicare for All would be mitigated (indeed, the plan would explicitly depend for some of its cost savings on less money for providers instead of offering them unlimited tax subsidies).
Politically, there’s an even more basic advantage to CAP’s approach, as noted by David Leonhardt:
The crucial difference between the Sanders plan and the CAP plan is that the CAP version would not force people to give up their current employer insurance coverage. Those who are covered through their jobs could either keep that plan or enroll in Medicare Extra. The Sanders plan, by contrast, would eliminate employer-provided insurance in favor of a single federal system.
It is hard to overestimate the political risk of discomfiting people who are happy with their current health insurance, as the fallout from Barack Obama having to backtrack on his “if you like your health plan you can keep it” assurance showed.
As Leonhardt also observes, though, the CAP plan cannot even begin to compete with single payer from another politically important perspective: simplicity. CAP does try to suggest an easy-breezy and universal-sounding label for its proposal: “Medicare Extra for All.”
The big progressive health-care consensus of the future may have to strike a balance between simplicity and consistency with the more popular features of the current system, which is the opposite of simple. When you really drill down into the details of the systems in other countries that are so often labeled “single payer,” they sometimes resemble the CAP plan as much as Bernie’s. If only because this is a big brawling country with many variations in opinion, it’s probably a good thing to have more than one or two items on the left side of the health-care-policy menu.
