The more complex a system is, the more it is at risk of failing in complex ways that were not anticipated by its architects. It would be hard to imagine a more complicated way of expanding health coverage than the Affordable Care Act.
I say that, appreciating that Obamacare will eventually bring health coverage to tens of millions of uninsured people, that it will end the cruelty of denials of coverage based on “pre-existing conditions” (we all have the pre-existing condition of mortality); that it will allow young adults to stay on their parents’ insurance to age 26; and that it will require free preventive care under all insurance plans.
But there was a much simpler way of achieving this. We could have extended Medicare to everyone. Or if that was politically unthinkable, we could have extended Medicare a few years at a time — first to 60 year olds, then to 55 year olds, then to the young, and so on until everyone was covered.
In the meantime, we could have extended coverage for the uninsured by expanding Medicaid. Or we might have followed through with the so called public option (which the Administration embraced, then dropped) — allowing uninsured people to buy into Medicare or something like it, with subsidies for lower income households. (more…)