Sunday, March 26, 2017

A thought for Sunday: Thank You, Freedom Caucus!!! Plus, Democats should offer a plan to "Reform and Improve" Obamacare

 - by New Deal democrat

First of all, thank the Great Flying Spaghetti Monster for the GOP's Freedom Caucus!!! They have been the best friends Progressives like myself could have hoped for.
Every time the mainline GOP or corporatist Democrats wanted to move the country back to 1929, the Freedom Caucus has insisted that nothing short of 1859 will do.  By refusing to take "yes" for an answer, they have again and again -- in the Debt Ceiling Debacle of 2011, in the "Fiscal Cliff" of 2012, and again with TrumpRyancare this past week -- single-handedly kept the US in the late 20th Century.
Secondly, I hope the Democratic Party does not slip back into passivity on Obamacare simply because they have won this battle.  I strongly suspect that the main reason Trump is implacably  against "Obamacare" is because Obama humiliated him at the White House Correspondents' Dinner once upon a time, and he is nothing if not vengeful. He wants to obliterate Obama's legacy.
So Democrats need to make a big stink any time the Trump Administration undercuts Obamacare provisions to try to make it fail (as they have already done in several respects, e.g., state waivers). 
Beyond that,  Obamacare does have some significant problems.  The individual mandate is hated, and the penalty isn't big enough. More young people need to buy in. Further, some of the Exchanges and health care provider networks are too narrow, and in a few states they are in big trouble. Complacency is not a winning strategy.
If Democrats truly care about making this country better for the vast majority of its population, now that most people are finally of the opinion that health care ought to be reasonably available to everybody, not just if their employer offers it, Democrats should respond to the GOP's deplorable "repeal and replace" efforts with a promise to "reform and improve" Obamacare should they gain a Congressional majority.
How would a plan to "reform and improve" Obamacare work?  There is renewed talk of "Medicare for All" and if the public can be sold on that, I certainly have no problem.  But I suspect the public is not interested in "Medicare for All."  So what is a viable Plan B?
The goals ought to be:
1. universal coverage. Obamacare still leaves about 10% of the population uncovered.
2. better plans.  Too many of the Bronze and Silver plans have sky-high deductibles and copays, making them little more than "junk insurance."
3. administrative efficiency. There are too many potential side-by-side bureaucracies: Medicare, Medicaid, SCHIP, private exchange providers, employer-provided insurance, auto and homeowner medical coverage, and potentially a "public option" provider. The less redundancy among providers, the more the cost savings which can be plowed into cheaper premiums and better coverage.

Two elements of a viable Plan B are well-known: the "public option" and age 55+ (or at least age 62+) Medicare buy-in.  These will ensure wider choices, more competition, and to the extent older workers choose to retire early with the Medicare buy-in, lower premiums and a healthier risk pool in the Exchanges.

Additionally, Plan B ought to include a reform to abolish the individual mandate and penalty and replace them with automatic enrollment in a basic health care plan.
Here's how I envision it would work. Just like SS, Medicare, unemployment and disability deductions to paychecks, establish a Health Care automatic deductible. If your employer offers healthcare, the deductible is reduced by the amount of the premium, all the way to zero if applicable.

If your employer doesn't offer healthcare, if you are under age 40, you are automatically enrolled in the least expensive Bronze plan in your state. If you are 40 or older, you are automatically enrolled in the least expensive Silver plan in your state. 
The deductible would also include a small contribution towards Medicaid. Then, if you are unemployed, you are automatically enrolled in Medicaid, but can continue with the silver or bronze plan as above if you choose.
The  Kaiser Foundation estimated that in 2015, the average worker paid about $1200 per year for their employer provided health care, and the employer picked up another $4800 for a total of $6000 per year.  This out of an average annual salary of about $30,000.  This boils down to roughly a 4% deduction from worker wages, with the employer kicking in 16% more.
So, just for example, let's make the automatic deduction the following:
2% for a 20 year old + another 0.1% for the unemployment medical coverage.
3% plus 0.15% for a 30 year old
4% plus 0.2% for a 40 year old
5% plus 0.25% for a 50 year old
6% plus 0.3% for a 60 year old
Employers would pick up the rest up to a total of $6000. The self-employed pick up both the employer and employee share, with subsidies as per existing Obamacare.
Remember that if the employer is already providing coverage, that is counted against the payroll deduction.  and the deduction ought to kick in gradually, e.g., 1% a year, so that employees do not sustain any acutal nominal losses.

Now you have a social insurance program that provides universal coverage.  And we know that social insurance programs like Social Security, etc., are very popular.
Dems could turmpet such a plan to "Reform and Improve" Obamacare, and campaign on pushing for it if they get a Congressional majority. Heck,call it Trumpcare and President Caligula might even sign on!