• Medicaid for all?

    On Monday I tweeted:

    Yesterday, Ross Douthat answered:


    Why Not Medicaid For All?

    My Sunday column on the potential consequences of Obamacare’s botched rollout ended by sketching a scenario in which the program’s Medicaid expansion is deemed a success while its reform of the individual market leads to much-higher-than-expected costs and much-lower-than-expected participation rates. This combination would no doubt be politically helpful to the Republican Party in the short run, but (I argued) it would actually leave liberals with a fairly clear path forward: Keep pressing the Medicaid expansion on states that haven’t taken it (and look for John Kasich-style Republicans to partner with), return to the Joe Lieberman-killed idea ofexpanding Medicare to 55-and-overs, and basically try to further shrink the percentage of Americans who aren’t eligible for one or both of those single-payer programs. This wouldn’t amount to the full-on push for single payer that some people expect from the left if Obamacare fails or gets repealed, but it would move the U.S. toward the closest thing to single payer that we’re ever likely to get: A system in which both the late middle-aged and the lower middle class gradually get folded into government-run insurance alongside the poor, the disabled, and the aged; the individual market survives as a kind of de facto high risk pool (overpriced but technically accessible); and the employer mandate helps prop up employer-based health insurance for a shrunken but still substantial share of the population.

    It’s a long and thoughtful piece, and worth reading in full.


    • I just can’t wait until the demo-socialists come up with a program of single-payer food and sex insurance!

    • Mr Caroll:
      Later in the piece he argues that while we spend more, we do get benefits from that, namely higher innovation. IE, we lead the world in medical advances, and pay for it, fronting the costs for benefits to the world.

      I though you had discussed, and dismissed this, in your piece from 2010 on why we spend so much, and where that money goes.

    • The problem with medicaid is that it does not phase out slowly enough. Of course the NSA in the UK is like medicaid for all. You can opt for stingy tax paid for care or pay for private care.

      BTW I see no reason to subsidize the premiums for people with above median income. If subsidize the premiums of people with above median income, you are subsidizing them with their own money (that is if you consider tax incidence).

      My business partner had an alternative idea to the PPACA. In his plan you would let people remain uncovered and the Fed Gov. pays their medical bills at the medicare or medicaid rate and treats the money spent as a loan on which you collect/amortize through the IRS.

    • expanding Medicare to 55-and-overs

      Seems like a very bad idea. The older a person is the more he spends on Medical care (up until about 75) and the older a person gets the less effective the care is. Also 55 to 62 are prime earning years! I would rather see more coverage for preemies and children.

      The voters might be selfish and rationally ignorant but that is no reason for wonks to go along with illogical proposals like more tax payer funded care for the elderly. Political reality may be what it is but that is not reason for us to not point out the stupidity.