Which do you Favor and Why: Medicare for All or ACA expansion?

[kennetha]

I’ll go first. ACA expansion.

Reason: Medicare for All is a political loser and ACA Expansion is a potential big winner.

Given the political difficulty of starting from scratch in the American political system, given how heavy a lift the ACA was already ... what with the blue dogs causing the Democrats to lose nerve on the public option, and the Supreme Court dealing the ACA a serious blow on Medicaid expansion. ... and given that the ACA is now broadly supported, and given the public option seems now like it can be easily framed as the moderate sensible alternative in comparison with Medicare for All, and given the added fact that Medicaid expansion has actually gained some momentum, the public option would be much less of a political lift than Medicare for All and together with a renewed push on Medicaid expansion would get us to universal coverage from where we are now much more quickly, with far less division and disruption.

And remember the public option was once derided by the right as a stealth way of moving us toward “socialized medicine.” And even some on the left explicitly saw it as a foot in the door for single payer. It was in fact that combination that caused the blue dogs to lose their nerve and torpedo it.

It is a measure of political progress that the public option can now be sold not as the “radical” proposal of the burn it all down and start over Sanders-Warren left, but as a sensible, centrist, mainstream proposal that even a blue dog could love and embrace!

Politics is the art of the (really) possible, not the merely conceivable. The (really) possible is highly path dependent. Public Option, given our path, is really possible, perhaps even likely. Medicare for All is not.

Finally at least for Sanders and to a much lesser extent perhaps Warren as well, part of what seems to drive them to Medicare for All is a distaste for corporations and profit and wealth. Sanders in particular seems to be deeply personally offended that corporations make profits and obscene profits off selling health insurance. But it is still much easier to regulate corporations than to just eliminate them. In ACA the corporate share of the total health insurance “market” is limited and regulated. And in ACA+ you still get the best aspects of markets ... competition and innovation. Especially if the Public Option has to and gets to compete with private insurers for business both the private insurers and the Publuc Option would be forced to try to be more efficient and cost effective.

Ask yourself whether you preferred the old US Postal Service when it was the only game in town or the new US Postal Service that has to compete on all but first class mail with the likes of UPS and Federal Express and you’ll see what I mean.