While Considering Medicare For All: Policies For Making Health Care In The United States Better

While it is fascinating to think about “Medicare for All” (and one of us strongly favors it), it is unlikely that the United States will move quickly to fully publicly financed health insurance when Congress next considers health policy after the 2020 presidential election. Despite its theoretical advantages, passage of Medicare for All would require a massive political battle to make feasible the shift from private to public funding, to develop enough public trust to expand an entitlement program for all Americans, and to mitigate the disruption (for many) of substituting public insurance for familiar, existing health insurance policies. That will take time. Fortunately, even while the Medicare for All saga rolls out, much can be done in the meantime that is politically plausible to augment and improve the Affordable Care Act (ACA) and make health care work better for all Americans. 

 

The House of Representatives has begun passing legislation to bolster the ACA, but these proposals are unlikely to pass the Republican-controlled Senate. There is a great need for a set of bipartisan proposals that can move us forward now. In that spirit, we offer our thoughts about a package of reforms that we believe would be both achievable and impactful.

 

The most pressing problems are three: affordability of insurance, access to care, and pervasive defects in the quality of care. These challenges are becoming increasingly intertwined.