Planet Pundit asked a good question about the effect of creating a baseline Bronze for everyone to get into with the option to buy-up:
the impact of moving all 18-64 year old adults over to a Medicare “Bronze” Plan and letting everyone who cared to carry, themselves or their employer paying for, Platinum-Gold-Silver Plan?
In a rational, political world where there was a broad agreement that health insurance was a general public good, this would be a good idea, and it would be a rip-off of several European systems where the state provides or pays for a minimal floor of coverage and people can buy up if they choose to do so. It would cost money and it would be an expansion of Medicare plus it would be multiple layers of additional administrative complexity for billing as most claims would have a primary payer of Medicare for Everyone as the base 60% and then a Medicare-E supplmental policy, but providers are already used to the two tiered billing structure in Medicare, so it would be doable.
A slightly different twist on this proposal would be creating Medicare Bronze as the default coverage for people who otherwise did not sign up for coverage during either Open Enrollment or a special enrollment period and did not qualify for any other coverage (CHIP, Medicaid, employer coverage etc). Avik Roy and other conservative health care reform proposals have similiar minimal catastrophic coverage default options built into those plans. They propose a lower acturial value for the default coverage as they think the problem with American health care is Americans have it too easy, but at that point, it is a technocratic argument over which dial to twist and how far. These proposals would use the funds that would otherwise have gone to pay for premium assistance and cost sharing assistance subsidies if the person applied for coverage and used those funds to pay for catastrophic coverage as a default. It would not be great coverage, but it would be hit by a bus/congrats you have cancer coverage.
Either idea relies on a broad agreement that basic health care should not be a fear and bankruptcy inducing event, and that society has a broad and general interest in keeping as many of its members reasonably healthy. If we have that agreement, than it is a matter of figuring out what to cover, how to pay for it, and what needs to be taxed in order to pay. Some people would want skimpier coverage and broad based consumption taxes to finance private insurance Tin plans, while others would want Bronze plans run by Medicare paid for by higher income taxes.
However, we live in a world where a significant chunk of the political elite either believes that health care is a common market good (and disregard Ken Arrow), is a viable means of social control through fear, functional sociopaths or act as if they believe one of three preceeding statements. Right now, that group has control over the entire legislative process, so good ideas like a baseline catastrophic coverage would be too French and against our freedumbs to die quietly in the corner if we get hit by a bus and don’t have a benevelent employer sponsored health plan.
Keith G
Even though, I had ACA assisted medical coverage since April, I did not engage with the system until a regularly scheduled round of appointments in late October. As I am an AIDS patient, some pretty expensive works gets done at such appointments.
I just got the invoice from the insurance provider regarding charges and payments (and therefore clinic charges not covered by insurance, etc.) If is very hard to read.
There needs to be a clearer way to present this information. I know the ACA mandated a standardized and easier to digest format for presenting insurance information during the sign up period. I hope they will get around to similar mandate during the post sign up “here’s what we want you to pay” period.
low-tech cyclist
Richard, mind if I ask you about a totally different issue?
You’d probably have a better idea about this than I would, but ISTM that we’re going to have a big wave, around 2030, of people getting afflicted with Alzheimer’s and other kinds of senior dementia.
My logic is (1) based on my small sample of family observations, one’s early to mid 80s are the time of life that many elderly people go from the occasional ‘senior moment’ to needing some sort of regular supervision due to impaired mental faculties, and (2) the leading edge of the Baby Boom generation will be 84 in 2030.
I looked up Terry Pratchett’s Wikipedia page yesterday for other reasons, and noticed a comment of his that we spend about 3% on Alzheimer’s research of what we do on cancer research.
I don’t know how accurate that is, but AFAICT we’re not exactly doing a great job of caring for the current generation of senior dementia patients who were mostly born in the 1920s, so I’m a bit concerned that we’ve got this much bigger wave 15 years away and counting down, and aren’t really doing anything to get ready for it, either in terms of figuring out how to keep elderly people from losing their marbles in the first place, or in terms of caring for them as/after they do so.
I’d be interested in your thoughts, if you have any at this time. (And I’d understand if you don’t.)
Richard Mayhew
@low-tech cyclist: honestly, this is the first time I’ve thought about senior dementia and Alzheimers in years… and the last time I thought about it was when my hometown was proposing a massive brownfield redevelopment for the local university to build a senior memory disease research center. I don’t have anything intelligent to add.
Yatsuno
This is a reasonable improvement. Which means it will never get a day in the House.
Davis X. Machina
@Yatsuno:
If you could somehow draft the bill so that white people alone were eligible, but it still passed constitutional muster, it’d sail through the House.
Because right now, social provision means giving your money to Them.
What was non-white life expectancy when Medicare went through? Less than the age at which Medicare kicks in, I bet.
PlanetPundit (used to be Sir Laffs-a-Lot)
Wow, Richard, thanks for the post! Speaking as someone who sacrificed retirement assets, and frolicked in the delights of BOTh foreclosure and bankruptcy for medical expenses. I think, perhaps, a consensus could be reached.
Thanks for your time respondng and for all your great posts.
Trixie Belden
Thank you for this post and all your other excellent posts, Richard! I really appreciate how generous you are with your knowledge.