This week, Democrats added yet another stack of paper to their ever-growing pile of ideas to fix American health care, should they ever take back control of Washington. The Choose Medicare Act, introduced by Sens. Chris Murphy of Connecticut and Jeff Merkley of Oregon, would create a new public insurance plan under the auspices of Medicare available to both individuals and businesses, but would still compete with private insurance. In theory, the government would charge premiums high enough to cover the program’s costs. But the bill would also significantly boost the coverage subsidies currently offered under Obamacare, making policies generally more affordable for middle-class consumers.
For now, though, the most important thing about Murphy and Merkley’s proposal isn’t its details, but the fact that it exists at all. Democrats are once again showing that they will not rest on being stewards of Obamacare once they regain power, but will almost certainly try to pursue some sort of ambitious health care legislation that expands coverage and increases affordability. The bills they are producing right now aren’t much more than modeling exercises, attempts to figure out what legislative configurations might work. But unlike Obama-era Republicans, who spent an entire presidency promising to repeal the Affordable Care Act while declining to offer any clear vision of a replacement, a sizable chunk of the Democratic caucus is working to offer concrete ideas about how a new system might work, and what sorts of trade-offs could be involved (albeit, often without the uncomfortable specifics about tax hikes). With each additional piece of legislation, more lawmakers are demonstrating their dedication to the cause, their flexibility, and in some cases their willingness to hash out compromises.
If you count Elizabeth Warren’s checklist of Obamacare upgrades, there are currently at least six major Democratic health care proposals out there, all of which would move move policy further to the ideological left of the Affordable Care Act. As Jonathan Cohn writes at HuffPost, “Now, virtually all Democrats talk about creating new government-run insurance programs or expanding existing ones. The only question is how big they will be and what role they will play.” That is, of course, a trillion-dollar quandary, and Democrats aren’t anywhere close to answering it. The moderate Medicare X plan offered by Sens. Tim Kaine and Michael Bennett would provide a public option for rural counties that have been ill-served by Obamacare, before slowly expanding it nationwide while leaving private insurance in play. Bernie Sanders’ Medicare-for-all proposal would fulfill the social-democratic dream and move America to a single-payer system. In-between, you have a suite of compromise plans, some of which are more more ambitious than others.
Obviously, these ideas are competing with one another. But Senators have also been working together to find space where they can agree on incremental progress. Sanders, for instance, endorsed Warren’s Obamacare 2.0 bill as a temporary measure, while Warren endorsed his Medicare-for-all plan as a longer-term goal. Merkley supported the Sanders plan, but Murphy did not. “One of the reasons that we wanted to work together is that we’re in different places,” Murphy told Vox. The attitude, as of now, doesn’t seem to be my way or the highway.
That’s easy when you have no chance of passing anything. When there finally is a Democratic Congress—and who knows when that will be—we have no idea what it will look like, or what political circumstances it might face, making it hard to say what sort of health care legislation it might be able to pass. Eventually, these flexible, easygoing lawmakers will have to answer fundamental questions about the future of our health care system: Should everyone enroll in government health care, or should everyone just have the option to? Exactly what role should private insurance play? Do we want universal benefits or means-tested ones?
Having lots of different health care plans already formulated won’t make those debates any easier. But by drawing legislation up now, Democrats are showing that this is a priority for the party, and that they are thinking through the policy questions seriously, not just as a political show. In my view, they might as well keep tossing more bills on the pile.