A tectonic shift occurred in the Democratic Party. The Center for American Progress, the powerful center-left establishment organization which sees itself as the Democratic White House in exile, released their new “Medicare Extra for All” plan.
In many ways, it is nearly identical to the Medical Insurance and Care for All (MICA) plan put out by Shadowproof last year. That is truly remarkable.
CAP’s plan would automatically make everyone eligible for a new and improved Medicare Extra, creating true universal coverage. Employers would have the option to buy Medicare Extra for their employees or buy private insurance at least as good. Most importantly, it would have the government drive down costs by setting provider rates for all payers.
This pulls the Overton window on health care dramatically to the left.
I will save analyzing the actual policy details for another day, since the much bigger story is what this says about the Democratic Party.
CAP was one of the main intellectual forces behind the Affordable Care Act (ACA). They helped write it, implement it, and sell it to the American people. They were one of the main organizations telling people on the left that the ACA exchanges could work well if we just gave it time and a few small fixes.
They were the group on the left which worked the hardest to convince both elected Democrats and regular voters that it was possible to effectively expand coverage using only loosely regulated private insurance marketplaces. They didn’t frame the ACA as merely the least bad compromise that could get the votes in Congress, they told us it was actually good policy.
While CAP would never explicitly say it, by putting out this new proposal they are effectively admitting they were wrong for the past decade and their policy ideas failed.
Medicare Extra for All wouldn’t just replace the structure of the ACA. It would replace all of the logical underpinnings of it. This is a massive ideological shift for CAP.
CAP moved from trying to control cost and expand coverage via the mechanism of consumer choice-driven marketplaces to realizing only the government can effectively control cost by directly negotiating rates via all-payer or single payer. They have abandoned the idea that real bipartisan action on health care is really possible.
The debate in Democratic circles is no longer whether the U.S. government should expand coverage via private insurance markets or public insurance. It is simply a debate over how far and how quickly to expand public insurance.
To further understand why this is a big deal: imagine all possible health care systems ranked on a scale of 1 to 100, with 100 being a super socialized system. All medical needs are fully covered and all providers, hospitals, labs, and drug makers are nationalized. A 1 would be a totally free market, where anyone who is sick is left to die if they cannot pay.
The ACA moved American health care from about a 35 to about a 44. If implemented, Senator Bernie Sanders’ Medicare for All would move us to 81, while by comparison this CAP plan would take us to a 73. That is now the narrow range Democrats are fighting over.
Thanks to the Sanders campaign, increased attention to the inherent flaws in the ACA exchanges, and the Republicans’ ceaseless efforts to sabotage Obamacare, the debate dramatically shifted.
A year ago, my MICA plan was a radical proposal. Currently, it is squarely in the Democratic mainstream.
On a personal level, this is a deeply vindicating moment. For the past decade, I was a rather lonely voice making the methodical argument against the feasibility of a loosely regulated private insurance market model. While others made the moral, health, and economic argument for the superiority of single payer, I was one of the few individuals who advanced a viability argument against the design of the ACA.
While acknowledging the success of systems like Switzerland or Germany, I pointed out the massive regulatory changes needed to make those systems viable, which the ACA lacked. I pointed out how the consumer logic and market ideas behind the ACA had big problems. I explained how making the exchanges work would be even more difficult than single payer. I tried to warn Democrats about the ACA’s inherent structural and political flaws.
I attempted to warn Democrats about the ACA’s inherent structural and political flaws. For this I was rewarded with dismissal, derision, and labels like “firebagger.”
CAP has not only come around to my position, but more importantly, they seem to have come to accept the whole logical framework that makes this path the best option.
After a decade, I feel I did my small part to move an entire political party.