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Making Medicare For All Palatable For All

Making Medicare For All Palatable For All

by Kevin Kelton

The good news is that Elizabeth Warren has pledged to explain in detail how she would pay for her Medicare For All plan. The bad news is that Warren has pledged to explain how she will pay for her plan.

The truth is, there is no good way to explain single-payer Medicare For All without acknowledging it will require some form of tax increases and abolishing popular employer-sponsored private plans. But there are ways to make it more palatable to a larger swath of its skeptics and make it a winning issue in the general election.

Here’s how Warren (or any candidate) could make a version of the Bernie Sanders’ Medicare For All proposal palatable to a majority of voters, borrowing from the public option Medicare For All Who Want It proposals:
  1. Admit that there will be a cost component, and call it a healthcare surcharge. (Not a “tax.”) Make it clear that the surcharge replaces your current premium, and is guaranteed to be lower than what they’re paying now. Promise Americans that they will get a one-time full tax deduction for any overage between the Medicare healthcare surcharge and your 2025 private insurance premium. (Assuming that’s the fourth and last year of of the roll-in period.) In other words, you can’t lose!
  2. At the end of the four year roll-in period, allow Americans an additional three year “exemption” from switching to Medicare for people opting to stay with their employer-sponsored plans, but charge them a portion of the healthcare surcharge for each exemption year — 20% of the full surcharge for the first exemption year, 40% of it the second exemption year, and 60% the third year. This will induce reluctant Americans to give up their private employer-sponsored plans and opt-in to Medicare coverage.
  3. Write into the law that companies currently offering employer-sponsored plans must devote at least  70% of the savings they get from winding down those plans to salary and benefits increases for their employees. In other words, employers cannot pocket the savings. That will give union workers some confidence that even though they are losing their low-cost workplace coverage that they fought hard and sacrificed for, they will make up for it in higher salaries and benefits.

Done this way, you can still sunset private insurance but over a seven year window instead of four, which would be less jarring for the economy, and gradually bring reluctant consumers into the Medicare For All fold on their own timetable.

Kevin Kelton is the founder of the Open Fire community of Facebook discussion groups and a cohost of The More Perfect Union Podcast.

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