Clinton in '93 advocates expanding Medicare to children and persons over age 50?

This might be the sweet spot politically. Plus, it avoids a complex new program which I think was a major weight to both Clinton's attempt and Obama's ACA in 2009.

The sheer complexity of the damn thing. <---I think we underestimate how much citizens object to this aspect.

In addition, Clinton has an up-or-down on expanding Medicare. Not the huge personal rejection like a program he's put his heart and soul into. The political metrics are different?
 
Expect scare tactics directed at current recipients telling them they'll face a huge benefit cuts to pay for this.
 
This might be the sweet spot politically. Plus, it avoids a complex new program which I think was a major weight to both Clinton's attempt and Obama's ACA in 2009.

The sheer complexity of the damn thing. <---I think we underestimate how much citizens object to this aspect.

In addition, Clinton has an up-or-down on expanding Medicare. Not the huge personal rejection like a program he's put his heart and soul into. The political metrics are different?

I think the biggest weight to the ACA is that way too many people experienced significant premium increases for worse coverage. That's the #1 thing (IMO) that Democrats should blame for the last two election cycles.

Medicare works because everyone with an income pays into the system and only seniors (plus some disabled people and family members) are eligible. The larger the pool of beneficiaries, the fewer outsiders are left to bankroll the system.

Biggest argument against lowering the age might be that it's corporate welfare - private insurers get all the young healthy people, then as soon as they get to AARP/Denny's discount age, the government takes them off the insurer's hands.

Universal coverage for children would have been more doable. We took a step in that direction with CHIP, and that was enacted by a GOP Congress (as was the ban on drive through deliveries). The Democrats couldn't even get on board with letting people into Medicare at 55 when they passed the ACA.
 
I think the biggest weight to the ACA is that way too many people experienced significant premium increases for worse coverage. That's the #1 thing (IMO) that Democrats should blame for the last two election cycles.
I'd want see journalism on how many people have gotten worse coverage while on Obamacare.

On the question of cost, health care does rise faster than the consumer price index. Over and above this, how younger, healthy people moved off ACA, leaving the exchanges with a pool of 'sicker,' more expensive people? ? (we're all going to need health care at one time on time! :))
 
I'd want see journalism on how many people have gotten worse coverage while on Obamacare.

On the question of cost, health care does rise faster than the consumer price index. Over and above this, how younger, healthy people moved off ACA, leaving the exchanges with a pool of 'sicker,' more expensive people? ? (we're all going to need health care at one time on time! :))

Here's one from the SF Gate:

http://www.sfgate.com/health/article/Covered-California-clients-have-trouble-finding-5169944.php

That's the exchanges, but there were people with individual plans who were forced off of those and into the exchanges.

This is the data from an online broker:

http://news.ehealthinsurance.com/ne...ed-140-according-to-ehealth-com-shopping-data

The premium and deductible increases really kicked into effect in 2014. It sounds counterintuitive, but that means guaranteed issue and community rating are overrated as cost drivers, since the premiums in the individual market (which was more vulnerable to those changes) increased only slightly more than pre-ACA. However, this also holds up with sharing ministries. Sharing ministries don't vary premiums by risk and in some cases, not even by age. The one I joined at the beginning of 2015 collects charitable donations to cover PEC for new members for the first three years, and that works out to less than $20 a month for most months. The big killer is the lack of consumer choice - they piled on too many "essential" benefits. That takes away the option of having insurance be insurance.
 
To get back to the original subject - in order to be politically popular, you would need to make sure you don't significantly disrupt insurance for people who already have it. If you provide financial support for people who can't afford it, it's just another tax and spend program, and some people will gripe but you won't see them become unhinged. Especially if you cut other areas (and with a premium support system, you could probably shift existing Medicaid dollars to the new program).
 
. . . you would need to make sure you don't significantly disrupt insurance for people who already have it. If you provide financial support for people who can't afford it, . . .
I would argue that this is largely what Obama's ACA did, and look at the passionate and sustained opposition he received.

I think it's well worth asking, what if Clinton or someone even earlier had merely extended an already existing program?
 
I would argue that this is largely what Obama's ACA did, and look at the passionate and sustained opposition he received.

I think it's well worth asking, what if Clinton or someone even earlier had merely extended an already existing program?

The exchanges provided subsidies, but the ACA failed the first part of the equation, and that accounts for a lot of the anger.

Extending an existing program is a lot harder to oppose. People just aren't going to get worked up about that.
 
Expanding Medicare has always seemed to be the most logical way of brining about UHC in the states. An existing, popular, program that is difficult to oppose. It would have been much harder to polarise opinion or identify it with a particular individual as was done with 'Hillarycare' or 'Obamacare'.
 
Extending an existing program is a lot harder to oppose. People just aren't going to get worked up about that.
Expanding Medicare has always seemed to be the most logical way of brining about UHC in the states. An existing, popular, program that is difficult to oppose. It would have been much harder to polarise opinion or identify it with a particular individual as was done with 'Hillarycare' or 'Obamacare'.
I think it's worth noting that the other medi- program, Medicaid, was IIRC essentially envisioned as a Medicare extension for non-seniors; and opposition to that program has been consistent since basically its inception. I feel that extending Medicare beyond seniors would just lead to similar complaints as there are regarding Medicaid. Granted, one major difference between the two programs is one is run federally (Medicare) while the other is run by the states (Medicaid), but if anything that might just lead to calls of "federal overreach" or the like.
 
Expanding Medicare has always seemed to be the most logical way of brining about UHC in the states. An existing, popular, program that is difficult to oppose. It would have been much harder to polarise opinion or identify it with a particular individual as was done with 'Hillarycare' or 'Obamacare'.

Maybe not the best, but a plausible way. I might have to go try to find it, but I read a proposal once where the government would provide a universal catastrophic plan and do away with the tax break for employer-provided coverage to pay for it. You can pay out of pocket to upgrade (or poor people could get a supplement). But that might be even less popular than the ACA. The individual market was disrupted by the ACA...the employer market is much larger. If people are happy with what they have, change is scary, especially when the change in question is a potential threat to your health.
 
Given the state/federal funding formula for Medicare, you'd either have to mandate the increase, which would open up a states rights argument from conservative governors, or you'd have to offer the increase, similar to OTL Medicaid expansion after SCOTUS made the expansion optional. Under the latter situation, you'd have 20-30 states turn down the match, which happened the first time around with Medicare/Medicaid, Arizona being the last hold out until the 80s.
 
. . . Granted, one major difference between the two programs is one is run federally (Medicare) while the other is run by the states (Medicaid), . . .
I'd say the big difference is that Medicaid is for poor people (some exceptions). Who the heck wants to be on that? As one southern politician, I think Russell Long said, A program for the poor is a poor program.

On the other hand, Medicare is for seniors. And even if you're young and can't envision being a senior yourself one day, you probably have people in your family who are. So, you have broad-based buy-in and democracy works much more like it's supposed to.
 
One of the problems with expanding Medicare, politically, is cost differentials. Medicare only pays something like a quarter of the payment for the same services that doctors/hospitals charge insurance companies. (At least that's what my father-in-law reported.)

You'd have LOTS of health providers refusing to sign on to this program, and if you required them to (somehow), hospitals would go broke quickly.

The US health system is massively expensive, and there's no simple fix.
 
The US health system is massively expensive, and there's no simple fix.
But it can't be that different from medical practice in the UK, France, Australia, etc. And I'd even place developing economies such as Kenya, Thailand, etc, into the mix.

It's at this point that I kind of see how conservatives might latch onto U.S. lawsuit culture as explaining the difference, even though most cases of clear-cut malpractice do not lead to a lawsuit.
 
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