The $2.8 trillion path to universal health care - and it's not Medicare for All

The divide over whether to support Medicare for All has dominated Democratic presidential candidates’ health care platforms over the past few months, but according to a Washington-based think tank, there could be an alternative path to universal coverage.

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On Tuesday, the Center for American Progress, a left-leaning public policy research organization, released a projection on how its plan – dubbed “Medicare Extra” – would work. Under the plan, Americans would have the choice of staying on their employers’ private insurance, or selecting a government-run insurance plan (called Medicare Extra) open to everyone.

Avalere Health, an independent consulting firm, estimated that Medicare Extra would achieve universal coverage, extending health care to 35 million uninsured individuals. About 121 million people, Avalere found, would choose to remain in their employer coverage, while roughly 18 million would switch.

Even after the coverage expansion, national health expenditures would shrink by more than $300 billion by 2031, according to Avalere. It would also “substantially” reduce premium and out-of-pocket costs for consumers, across income groups.

That’s a big difference from Medicare for All, which would entirely eliminate the private health care sector in favor of government-run insurance. It's a middle-of-the-road approach to expand health care coverage, while placating some fears individuals have about losing their employer-based insurance.

But CAP’s plan would cost the federal government a lot less money -- about $2.8 trillion over 10 years, a price tag funded entirely by raising taxes on the rich and corporations.

That money could come from several different proposals, including a wealth tax, estimated to raise $2.75 million over 10 years, or by repealing the tax overhaul passed by Republicans in 2017 (and raising the corporate tax rate to 30 percent), raising $1.7 trillion within a decade.

Premiums for middle-income families, meanwhile, would not need to exceed a single-digit percentage of income -- unlike some Democrats’ proposals, which would gut out-of-pocket expenses. According to Vox, Americans under 150 percent of the poverty line would pay nothing, while those making 500 percent of the poverty line (or more) would see their total contribution capped at 9 percent of their income.

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But Sen. Bernie Sanders, I-Vt., for instance, unveiled a plan in April that would entirely eliminate deductibles, co-pays and insurance premiums. One estimate, which Sanders’ campaign shot down, said Medicare for All could cost more than $32 trillion over the course of a decade.

“Designing a universal health care proposal involves many tradeoffs,” the study said. “This proposal is an approach with policy dials that can be adjusted to achieve the desired outcomes or a pathway to an end state. In the coming years, Congress must find the balance that can be enacted into law as soon as possible.”