So, someone clued me in recently to the fact that Biden did some health care reform within his COVID bill. Since the guy was talking a big game about how progressive it was, I want to look at it.
Basically, it made some changes to early retirees who aren't old enough to be on medicare yet. Rather than just, you know, lower the eligibility age, they limited costs for premiums to be cheaper. This reminds me of what medicare extra for all does, but you still need to buy private insurance. People between 100-150% of the poverty line pay nothing for silver plans. People over 400% will have premiums capped at 8.5%. This is similar to the premium structure ME4A does. That had no premiums up to 138%, with over 400% capped at 9% of their income. However, I'm not seeing changes to cost sharing, and that's the important poison pill. ME4A addresses cost sharing too, with insurance picking up more than current insurance does, and limiting out of pocket costs to $5000 a year. It baffles me there used to be no cap above 400% FPL. I mean, the article is mentioning some people paying $23k a year in premiums on an income of $50k. That's ridiculous.
How does the ACA expansion control these costs? Subsidies. Basically, the government pays these premiums instead. While this is undoubtedly good for consumers, it's bad for taxpayers and just serves as a band aid on a broken system. The government picking up the tab on the insane costs of private insurance just subsidizes these insurance companies in the grand scheme of things. Whereas medicare extra for all would have a similarish cost structure, but basically be a government run healthcare plan. This would likely introduce competition that reduces costs over time.
So, basically, what does this amount to? A band aid for early retirees, essentially people probably in their 50s and 60s, to help with healthcare costs. It implements a vague medicare extra for all structure to help subsidize the costs of their private insurance. This is great for those seniors, but why not do it for everyone through a government run plan?
I mean, medicare extra for all, coming from me, IS a compromise. I adopted it primarily because I did not want to foot the cost of full on single payer while also funding a $3.6 trillion UBI. This only helps a handful of people in an inefficient way while leaving so many other problems ignored. It doesn't help anyone but early retirees. It doesn't fix the medicaid gaps. It doesn't reduce the overall cost of healthcare but rather subsidizes it. It doesn't help with deductibles and other cost sharing, which are a huge problem too. Medicare extra tried to greatly reduce the out of pocket spending people end up having to do. Another flaw is small incremental fixes like this can easily be reverted by future administrations. I'm pretty sure a public option or single payer would have more stability to them.
It's just more duct tape on a bad system. But that's kind of what I've come to expect from Biden. It's a compromise of a compromise. Again, for me, medicare extra for all is the compromise. I ideologically prefer single payer. I just don't wanna pay for full on single payer. But medicare extra for all eliminates the medicaid gaps, basically forcefully enrolling all of the uninsured onto the plan. It sets costs based on your income and even covers cost sharing too based on your income. And the 400% FPL mark are about as well off as the people here. Premiums would be so slightly higher, but there would be greater cost sharing limits here. And it would apply to everyone. Anyone who doesn't have an employer based plan would have medicare extra.
This plan does a few nice things, but falls way short of that. We need to do better. I know some craplibs are acting like this is so great and is an incremental step toward a Swiss or German universal healthcare system, but those plans kind of suck in my opinion. They have some of the highest healthcare costs in Europe and seem to be the most flawed and incremental approaches that don't even work when applied to the US.
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