The Center for American Progress, one of the nation’s most influential left-wing think tanks, just released a plan to repeal Obamacare. Unfortunately, the proposal would replace the law with something even worse — single-payer health care.
CAP’s plan would impose single-payer gradually, over a period of at least eight years. But the end result is clear — doctors and hospitals would end up having to ration care.
The progressive ideologues at CAP tacitly admit that Obamacare’s exchanges haven’t delivered affordable insurance. So they propose to close them.
In their place, the government would automatically enroll everyone who previously had individual market coverage in a new plan called “Medicare Extra.” The feds would also automatically enroll roughly 29 million uninsured people in the program.
CAP’s policy gurus would then fold Medicaid and the Children’s Health Insurance Program, two entitlements that cover 74 million Americans, into Medicare Extra.
Next up would be newborns — they’d all be automatically enrolled in the program within its first four years. So would every person who turns 65. Seniors already covered by traditional Medicare or Medicare Advantage could either stick with their current plans or switch to Medicare Extra.
While the CAP proposal claims that those with employer-sponsored coverage would not be affected by Medicare Extra, the plan would gradually eliminate the employer-sponsored health plans that cover more than 150 million Americans. The proposal gives employers four options.
They could continue to sponsor their own coverage, so long as they pay at least 70% of plan premiums. Or they could enroll their workers in Medicare Extra and directly pay at least 70% of employees’ premiums.
Third, they could enroll their workers in Medicare Extra and send the government a check for the amount they spent on health care the prior year. This amount would increase each year to account for medical inflation and changes in payroll headcounts.
Fourth, employers could enroll their workers in Medicare Extra and send a lump sum to the government for an amount between zero and 8 percent of the firm’s payroll expenses. The exact percentage would depend on the company’s size.
The options are structured so that the vast majority of companies would eventually find it cheaper to shift their employees into Medicare Extra. Within two decades, Medicare Extra would cover virtually every American.
The program would pay for an extensive list of healthcare services at little direct cost to patients. Preventive care, generic drugs, and treatment for chronic disease would be free. Other treatments and procedures, from emergency care to lab tests, would carry small co-pays and deductibles.
Elective services — like dental, hearing, and vision procedures — would also be covered, as would reproductive health and substance abuse treatment.
All this care won’t come cheap, as even CAP admits.
Medicare Extra would require beneficiaries to pay premiums “through tax withholding and tax returns.” In other words, the government would force people into the health plan — and then garnish their wages to pay for it.
Premiums would be set according to an income-based sliding scale. Households earning less than 150 percent of the federal poverty level — or $37,650 for a family of four — would pay nothing.
For households with incomes between 150% and 500% of the federal poverty level, new taxes — er, “premiums” — would range between zero and 10 percent of annual earnings. Households earning more than 500% of the federal poverty level, or $125,500 for a family of four, would pay 10% of their income each year for Medicare Extra.
Medicare Extra would also require states to contribute amounts roughly equivalent to what they would have paid for Medicaid. Individuals and couples earning more than $200,000 and $250,000, respectively, would face additional taxes beyond the “premiums” CAP has in mind for them.
Even these revenue streams won’t be enough to pay for the program. So CAP contends that Medicare Extra will use its “leverage to set prices administratively.”
In other words, Medicare Extra will set artificially low reimbursement rates for doctors and hospitals. That’s what single-payer systems in other countries do. And it inevitably leads to rationing.
Look at Canada. Patients must wait a median of 21.2 weeks for specialist care after receiving a referral from a general practitioner. In the United Kingdom’s single-payer National Health Service, patients are dying in hospital corridors as they await treatment. The NHS had to cancel more than 50,000 surgeries this winter to make room for people suffering from the flu.
CAP’s plan would erect a single-payer system in stages — a stepping stone to Medicare for All. But patients shouldn’t be fooled by its gradualism. CAP’s goal is a system where everyone has equal access — to a wait list.