Center for American Progress‘ new “Medicare Extra for All” proposal has ignited controversy among healthcare reform advocates. Rejected outright by dedicated single payer advocates like PNHP’s Don McCanne, MD, the plan leaves in place employer-sponsored health insurance – historically a gravy train for the corporate health insurance industry. Yet according to Wendell Potter, former CIGNA Communications Director and founder of Tarbell, the employer-sponsored health insurance market is already shrinking. If he’s right, “Medicare Extra” just might drive it into oblivion less than a decade. Others, such as Jon Walker, see CAP’s plan as a dramatic ideological shift in the Democratic Party as it loses faith in the loosely-regulated corporate health insurance industry.

Liberal Think Tank Unveils New Alternative to Single-Payer Health Care

By Ed Kilgore. New York Magazine.

A new “framework” for a comprehensive health-care plan just released by the prominent center-left think tank the Center for American Progress is drawing attention for two very different reasons. Its heart is a new program based on Medicare, dubbed Medicare Extra, that would be open to all Americans and that would soon absorb Medicaid and CHIP, and presumably the private insurance sold on Obamacare’s exchanges.

One way of looking at it is as a notable shift to the left on health-care policy by a staid, Establishment organization that usually reflects a consensus among staid, Establishment Democrats. That’s Jonathan Cohn’s read on it:

Some will call this plan a single-payer proposal, because it’s easy to imagine, someday, everybody being part of this new version of Medicare. Some will say it’s not a single-payer proposal, because it envisions a permanent, potentially large role for private insurance ― as a provider of highly regulated plans that would function more or less the way private plans for seniors on Medicare operate today.

But whatever the proposal’s label, it’s plainly a more ambitious ― and more progressive ― health plan than the Democratic Party’s most influential thinkers have embraced in the past. And that’s what makes it noteworthy.

Alternatively, you can view the CAP proposal as representing a more centrist entry in the health-care-policy field to compete with full-on single payer, as proposed most notably by Bernie Sanders, which has become the default concept whereby progressives show they are not satisfied with the Affordable Care Act.

Because its displacement of private health insurance would be voluntary and gradual, not immediate and mandatory (as would be the case with single payer), the huge new taxes that provide the sticker-shock element of Medicare for All would be mitigated (indeed, the plan would explicitly depend for some of its cost savings on less money for providers instead of offering them unlimited tax subsidies).

Comment by Don McCanne

(Excerpted)

What is this “Medicare Extra for All” proposal by the Center for American Progress (CAP), and where does it or should it stand in the movement for health care for all?

First of all, it is not a single payer proposal. It leaves in place much of our multi-payer system, including Medicare, Medicare Advantage, employer-sponsored health plans, the individual and small group market plans, TRICARE, Veterans Affairs medical care, and FEHBP – the Federal Employees Health Benefits Program. Private insurers continue to thrive – selling us risk-bearing plans favorable to them and/or excessive administrative services. Their iniquitous tools such as excessive cost sharing and narrow provider networks will not go away. The fundamental health care infrastructure remains in place in spite of the fact that some admittedly beneficial tweaks are recommended in this proposal.

What this proposal really is is a glorified version of the public option – a Medicare-like government plan that would be used to attempt to cover those who are uninsured and could be a replacement for those who are underinsured. If you carefully review the CAP proposal you will see that it adds both costs and administrative complexity to our existing health care financing system. It forgoes much of the cost containment and administrative simplicity of a bona fide single payer system.

. . .

Already the media is jumping on this as a new, liberal, Medicare for All proposal. Even the progressive New York Times columnist David Leonhardt is calling this “A Better Single-Payer Plan.” Worse, he is falling into line with the comment, “I still favor more modest health care proposals to sweeping, ambitious plans, for reasons of realpolitik.” Shades of HCAN and the erection of political barriers to single payer reform. We’ve said repeatedly, single payer policy is right but it’s the politics that are wrong. Don’t change good policy; change bad politics!

We can’t leave this topic without acknowledging the one bit of good news here. Single payer Medicare for All is a vastly superior model of financing health care – a model we desperately need in this nation – and a majority of the public now realizes that. The neo-liberal Democrats realize that they cannot go into an election touting a model that many feel has fallen far short of our needs, especially when the concept of an improved Medicare for all has gained so much traction. CAP recognizes the threat and takes this challenge so seriously that they have elected to “go bolder” by dummying up a fake Medicare for all plan, calling it “Medicare Extra for All.” We just have to be sure that the public is not lured by this siren song. They want the real thing.

No. Obamacare isn’t killing the insurance industry.

By Wendell Potter. March 1, 2016. HealthInsurance.org

(Excerpted)

Private insurer’s best customer: Uncle Sam

Meanwhile, UnitedHealth has been making money hand over fist from federal and state governments, thanks to Obama, just as WellCare has. In fact, far more than half of the $157 billion it took in last year came from Medicare, Medicaid and other government programs (i.e., from you and me, the taxpayers).

While most Americans probably think that the big for-profit insurers get most of their revenue from the private sector – from individuals and employers that provide coverage to their workers – that is no longer true. In fact, if Anthem’s acquisition of Cigna and Aetna’s acquisition of Humana are approved later this year, the remaining big three for-profit insurers – Aetna, Anthem and UnitedHealth – will collect most of their revenues from the government, not from their commercial (private) customers.

Why? As the nation has been aging, enrollment in Medicare has been growing at a fast clip, but enrollment in commercial health plans has been largely nonexistent for years. Just look at how Anthem’s business changed in just one recent year. At the end of 2014, the majority of Anthem’s revenues still came from its commercial health insurance customers. During 2015, however, revenues from the commercial side of its operations actually declined by 4.2 percent, to $37.6 billion, while revenues from its government operations skyrocketed by 21 percent, to $40.1 billion.

So as you can see from these numbers, the biggest customer for the biggest private insurers now is none other than …Uncle Sam. And the states, most of which have turned to private insurers to operate their Medicaid programs, comprise their second biggest customer.

‘MEDICARE EXTRA FOR ALL’ PROPOSAL REPRESENTS TECTONIC SHIFT AMONG DEMOCRATS

By Jon Walker. February 22, 2018. Shadowproof.

(Excerpts)

A tectonic shift occurred in the Democratic Party. The Center for American Progress, the powerful center-left establishment organization which sees itself as the Democratic White House in exile, released their new “Medicare Extra for All” plan.

In many ways, it is nearly identical to the Medical Insurance and Care for All (MICA) plan put out by Shadowproof last year. That is truly remarkable.

. . .

CAP was one of the main intellectual forces behind the Affordable Care Act (ACA). They helped write it, implement it, and sell it to the American people. They were one of the main organizations telling people on the left that the ACA exchanges could work well if we just gave it time and a few small fixes.

They were the group on the left which worked the hardest to convince both elected Democrats and regular voters that it was possible to effectively expand coverage using only loosely regulated private insurance marketplaces. They didn’t frame the ACA as merely the least bad compromise that could get the votes in Congress, they told us it was actually good policy.

While CAP would never explicitly say it, by putting out this new proposal they are effectively admitting they were wrong for the past decade and their policy ideas failed.

. . .

The debate in Democratic circles is no longer whether the U.S. government should expand coverage via private insurance markets or public insurance. It is simply a debate over how far and how quickly to expand public insurance.

. . .

The ACA moved American health care from about a 35 to about a 44. If implemented, Senator Bernie Sanders’ Medicare for All would move us to 81, while by comparison this CAP plan would take us to a 73. That is now the narrow range Democrats are fighting over.

Thanks to the Sanders campaign, increased attention to the inherent flaws in the ACA exchanges, and the Republicans’ ceaseless efforts to sabotage Obamacare, the debate dramatically shifted.