Now that it's Bernie vs Biden I think it's worth discussing Bidencare because it has serious flaws.
www.peoplespolicyproject.org
theintercept.com
Bidencare System Will Kill 125,000 Through Uninsurance
The body count of 3 percent uninsurance is staggering. Insurance must be universal.
www.peoplespolicyproject.org
Joe Biden released a health plan today. Its most significant elements are: 1) the creation of a public option, 2) the increase of subsidies for those buying plans on the exchanges, especially for families with incomes above 400 percent of the poverty line, and 3) the option for individuals in non-Medicaid-expansion states to enroll in the public option for free. Biden claims that the resulting system will insure 97 percent of Americans, meaning 3 percent will still be uninsured.
There is much to quibble with in Biden's plan.
If individuals in non-Medicaid-expansion states can enroll in the public option for free, then won't every state repeal their Medicaid expansion to save state money? I suppose that's fine depending on how good the public option is, but is that really the intended goal?
More generally, Biden's plan has the same problem as any other plan that does not create a national health insurance system: it causes enormous amounts of insurance churn and instability, further immiserating people when they face hardships like loss of job, loss of spouse, loss of Medicaid due to income increase, and every other negative life event.
The most remarkable thing about Biden's plan is that it does not even aim to provide universal insurance coverage. The more moderate wing of the Democratic party has mostly been putting out plans that purport to achieve universal coverage (e.g. through auto-enrollment mechanisms) without national health insurance. But Biden is literally doubling down on "preserving Obamacare" by preserving a class of uninsured people.
His campaign claims that the plan will leave around 3 percent of Americans uninsured. These sorts of estimates should be taken with a grain of salt as it is very uncertain how people will respond to the reforms. For instance, the CBO initially estimated that 22 million Americans would sign up for insurance on the Obamacare exchanges, but only half that many actually did.
Even if you suppose that Biden's estimate is right and the uninsurance rate does go to 3 percent, that still implies an enormous amount of unnecessary death caused by a lack of insurance. One commonly-used (e.g. by CAP) estimate states that 1 unnecessary death occurs annually for every 830 uninsured people. This means that during the first 10 years of Bidencare, over 125,000 unnecessary deaths will occur from uninsurance.
This is equivalent to the death toll of forty-two September 11 style attacks. Needless to say, this is not acceptable. No Democrat should be running on a health plan that does not provide universal coverage.
Why Biden’s Health Care Platform, Expanding the ACA, Won’t Work
Democrats have failed to build on the Affordable Care Act, not from a lack of good intentions, because of the fatal complexity of the law itself.
theintercept.com
Joe Biden has a plan. Forget Medicare for All, he has argued throughout the campaign. The most important thing to do is protect and "build on" the Affordable Care Act: the legislation the former vice president famously whispered was a "big fucking deal" as President Barack Obama put his signature on it.
"I'm surprised that so many Democrats are running on getting rid of it," Biden said in a video publicizing his health care platform. "The Affordable Care Act was a historic achievement for President Obama, and if I'm elected president, I'm going to do everything in my power to protect it and build on it."
His plan to "build" on the ACA is mainly to further subsidize it while leaving the basic structure unchanged: to increase subsidies and put a cap on premiums, to extend subsidy eligibility, and to add a public option. That, argues Biden, is the soundest and most fiscally prudent approach. Yet when it comes to actually making the system operate well, there's a record that can be reviewed to gauge how reasonable a promise Biden is making. Across the country, Democrat-controlled states have had over a decade to work on improving the law, relying on existing authorities or ones they could acquire legislatively or through administrative waiver.
The record is clear. Even without the partisan obstacles of a nihilistic Republican opposition, Democrats have failed to build on the Affordable Care Act — not from a lack of good intentions, but because of the fatal complexity of the law itself. That same complexity has kept the media from reporting on Democratic failures to build on its own law, which has created the space for Biden to be able to pretend that he'll be able to do so. But ultimately, it's as if the party still hasn't figured out how to get the lights to work in the house, but are confident the answer is an expensive addition.
It has been 10 years since the Affordable Care Act was signed into law and six years since the exchanges started, but many Democratic states still aren't effectively managing their marketplaces. This has not been due to malice, budget constraints, or industry opposition. It is mainly because the system creates such a complex series of counterintuitive provisions that most state policymakers don't understand the law or how to maximize every lever at their disposal.
Collectively, these regulatory decisions made in blue states have cost low-income individuals billions, and needlessly caused tens of thousands to go uninsured. The fact that Democratic states currently have the power to make the ACA noticeably better, but simply haven't because they don't understand their own law, shouldn't fill one with confidence about the party's ability to build on it by just adding more money.
When the ACA passed, Sen. Tom Harkin, a Democrat from Iowa, was optimistic. "I like to think of this bill as like a starter home," he said. "And this starter home has plenty of room for additions and improvements." Yet in the past decade, this old house has proven surprisingly difficult to fix up. National Democrats who claim they want to build on the exchanges aren't even talking about fixing its more obvious design issues, just throwing more money at it — all the while arguing that their solution is cheaper than a more holistic approach. Even with ample time, not a single blue state has successfully made even all of the most obvious improvements, needlessly depriving low-income people billions in federal help.
