A Proposal that's Affordable, Universal, Equitable, Understandable -- and Acceptable
We start with a program that's already demonstrated its success and achieved a high degree of trust: Medicare Advantage, the private plan option that more and more seniors are choosing. Suppose we adapt this to the under-65 population, giving every American--including today’s Medicaid recipients--a choice of health plans, free of employer or government dictates. Suppose we limit costs by making our proposal a premium subsidy model, with subsidies dependent on need. And suppose we pay for these subsidies, not with massive new taxes, but simply by redirecting current spending and existing tax subsidies?
The result? It’s a system in which insurance is a right, not a mandate. It’s one that encourages individual responsibility. It’s one in which insurance is owned by individuals, allowing employees to choose the coverage they need. It’s one that ends the stigma of Medicaid. And it’s one which ensures that every American is “in the pool,” eliminating the problem that’s bedeviled the Obamacare exchanges.
Let’s call it Advantage for All.
Every civilian American, old or young, rich or poor, will receive federally funded premium subsidies. For seniors, these will reflect benchmark costs by area for existing Medicare benefits. For under-65s, the subsidies will be sufficient to provide no-cost basic coverage based on individual needs. Each individual or family will be able to apply their subsidy to the coverage of their choice.
For seniors, the ADVANTAGE FOR ALL subsidy will be the same for all in a region, independent of plan selection. For under-65s, the subsidy will reflect only age, income, and family size, will be independent of employment, and will be tax-free for all. The least well-to-do will be freed from the stigma of Medicaid and be able to purchase mainstream healthcare.
Rather than today's muddle of hundreds of public and private healthcare programs, each with different structures and different rules, ADVANTAGE FOR ALL will have a single basic structure, with everyone receiving a premium subsidy and everyone having a free choice of coverage. The premium subsidy will belong to each individual, regardless of employment or government program entitlement. Every American will know the amount in advance and how it can be used to meet their needs, with help available in choosing the most appropriate coverage. Over-65s will continue to be able to opt for the traditional fee-for-service plan, and their subsidies will be independent of age or income.
ADVANTAGE FOR ALL premium subsidies will be sufficient to ensure that every American can afford to purchase coverage appropriate to their age and income. Premium subsidies for the least well-to-do will be sufficient to cover the entire premium, while better-off individuals will receive subsidies that partially offset premium costs, with the option of applying their own funds to buy more comprehensive coverage. Affordability will be reinforced for all as ADVANTAGE FOR ALL encourages price competition among insurers and providers.
Unlike other reform proposals, ADVANTAGE FOR ALL recognizes the roles and strengths of healthcare system stakeholders. Insurers will face increased price competition, but overall there will be more insureds. Providers will find that insurer competition will impose new standards for effective care, but again the size of the patient universe will grow. Consumers will be required to take more responsibility for their coverage choices and their care, but will own their coverage and most will have far more choices. The biggest change will be for employers, who will lose their "job lock" hold on their employees, but be freed from the responsibility of providing health insurance for their workers. It's a far, far more acceptable solution than the right-wing's slashing of coverage incentives, or the left's proposals that would increase taxes by more than thirty trillion dollars over a decade, put a hundred thousand insurance company employees out of work and eliminate all choice and responsibility for providers and consumers.
And It Works!
ADVANTAGE FOR ALL takes the same approach that we treat as the norm for almost every other purchase of goods or services: individuals have a free choice in a marketplace in which sellers must compete in terms of price, quality, and convenience. It's an approach that will work for healthcare, too!