20 January 2010

Alternative Health Care Reforms

Ezra Klein | The other health-care reform option

Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.

And that's it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar.
Regarding the Medicare buy-in: why? I understand that there are people between 50 and 65 who do not currently have health insurance, but that's true of any subset of the population. What makes these people special that we need to include them in a system designed specifically for retirees who can not get insurance as an employment benefit? Why not include 49 year olds without insurance, or 33 year olds, or 21 year olds?

I understand politically why you want to set an arbitrary age threshold for including people in Medicare, but logically how does that make sense? What makes it rational to let a 55 year old buy in to Medicare but not me? If the goal is to get 100% of the population on a government-controlled health care provisioning system then this gets you incrementally closer to that goal, but if the goal is to help people who can't afford health care to be able to afford health care, this is an arbitrary and indefensible thing to do.

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Mean McArdle presents another simple plan which (perhaps predictably) I like much more than Klein's. You can read about it here; the essence is that the government acts as a back-stop insurer and covers medical costs in excess of 20% of your income.

My friends and I have been going back and forth about alternate proposals all day. Maybe I'll clean up what I told them I'd like to see and post it here.

I do think it is important for conservatives that they come up with some alternate plan (and for more than just health care) and soon. The Dems rode a wave of anti-Republican backlash for the last three years; now the Republicans are riding that same wave in the other direction. It won't last. They need some initiatives of their own. Yeah, I know there are some out there, like Paul Ryan's, but the leadership isn't pushing them. I also know they won't actually pass now, but the Red Team can't let the Blue Team keep painting them as mere obstructionists without their own ideas.

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