MOUNT VERNON — In February 2017, President Trump famously said: “Nobody knew health care could be so complicated.” Nobody other than about 99.9 percent of the almost 300 million people in the U.S. with insurance, that is. Yesterday, I received a copy of “Get to know your benefits,” the 236-page “booklet” for my new health plan. Like most people, I’ll never read the book, but its weight alone says “complicated.”

And it’s safe to guess that Trump also will never read his Federal Employee Health Plan information, even though one Aetna choice available to him has a “brochure” of only 184 pages. Thinking about the amount of information available to health insurance plan consumers, I began to wonder what Health and Human Services Secretary Alex Azar meant, also last February, when he said, “Americans need more choices in health insurance so they can find coverage that meets their needs.”

Presumably, were we to have more choices, we could study the hundreds of pages of information about each available plan and make better choices. According to the federal Office of Personnel Management, federal employees who live at 1600 Pennsylvania Ave., Washington, D.C. 20500, have a choice of 35 monthly plans. Too bad the president doesn’t live in Maine, where he’d have only 20 plans to study!

How does the average American deal with this? The same way the average lawmaker does: with a bumper-sticker narrative. Keep the government out of my health care, but don’t touch my Medicare. If you like the Division of Motor Vehicles, you’ll love the Democrats’ plan. Or, as President Trump said last February: “We have a plan that I think is going to be fantastic. It’s going to be released fairly soon. I think it’s going to be something special. … I think you’re going to like what you hear.” Who could be against that?

So, why do many Democrats push for a single-payer plan? Broader access, lower prices, less administrative burden, consistent claim payment rules all make sense, but a “single-payer” plan (read “socialized medicine”) is a target on the back of its supporters. What most Americans want is a “fantastic” (read: “covers a lot and costs less”) plan. I just want someone else to pay for most or all of the cost when I get sick. I don’t want to have to give up the plan I have now for something new and untested.

Instead of pushing for “single-payer,” the policy wonks should work on the narrative. How about a “great, less costly plan that is available, but not required”? Or a plan where “your employer continues to pay the lion’s share of cost and there is not one cent of government funding,” where “the prices you pay for hospital care are 40 percent to 50 percent lower than what you pay now,” or that “has the largest percentage of in-network doctors and hospitals of any plan in the country”?


These bumper stickers describe what would happen were private employers allowed to pay for and offer an exact duplicate (a “clone”) of the Medicare plan to their 157 million covered employees and their families. The plan that fits the above narrative would not be government-run, and enrollment would not be required. Most importantly, it would be promoted by employers because it would maintain or improve benefit levels and save them and their workers money. It might be called a Medicare Public-Private Partnership plan.

Employers know how to move employees to new plans “voluntarily,” i.e., by using short-term financial incentives like reduced premium payments to encourage enrollment in preferred options. Over 14 years starting in 1982, employers increased enrollment in so-called managed-care plans from 0.3 percent to 86 percent. If employers offered the Medicare Public-Private Partnership plan starting in 2019, a similar rate of adoption would mean an enrollment of roughly 135 million “private members” added to the projected 80 million Medicare beneficiaries.

With over 200 million Americans enrolled in the same plan (differing only by who pays the premium), virtually everyone in the U.S. would have a family member enrolled in Medicare or have a friend or relative enrolled in Medicare Public-Private Partnership; i.e., we’d be well past a “tipping point” when Medicare for All is as comfortable as an old pair of slippers.

Compare this scenario to a push today for “single-payer,” remembering that Medicare came in 1965, about 20 years after Harry Truman became the first president to propose a national health insurance plan. And then it took another 45 years for President Barack Obama to get the Affordable Care Act enacted by a hair. Ask yourself: Will we be closer to a single-payer plan just 15 years from now by pushing single-payer or a narrative that gives us Medicare Public-Private Partnership?


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