The Road Not Taken

The people who say a single-payer health care system would be better than the kind of kludgy mishmash that the proposals currently in congress would create are correct. At the same time, the people who say that the political impediments to shifting to a single-payer system are insurmountable are also correct. But that second statement doesn’t, on its own, establish the case for the approach to reform that’s dominated the progressive movement for the past several years. As I’ve been saying for some time, it seems to me that the most reasonable moderate alternative to “Medicare for All” would be “Medicare for More People than Have it Now.”

As Brad DeLong says “There are times when I wonder if the right thing to do on health care reform is simply to raise the Medicare tax rate and drop the Medicare eligibility age to 50.” Or some other variant of that strategy. Maybe you’d only have the votes to do 55. But whatever, you’d take what you could get and then try to get more in the next Congress. But the animating spirit would be steady improvement in, and expansion of, America’s existing national health insurance plan—a plan that whatever its flaws appears to deliver better results at lower cost than the private sector.

The problem with this approach is that it’s harder to fit into the “bend the curve” conceptual framework, but it’s really not clear to me that said framework has accomplished very much.