Everyone Wants to Reform Obamacare
voiced support for this kind of delay, and Senator Marco Rubio (R- FL) has introduced a bill to that effect.But the more interesting discussion is about long-term plans, looking several years out, that would build on the infrastructure Obamacare sets up while eliminating its worst features. Tyler Cowen breathed new life into this discussion with a recent op-ed that proposed a plan that he thinks could win bipartisan support. At the heart of Cowen’s plan is a bid to essentially eliminate Medicaid by shifting all its users into the subsidized ACA-style exchanges, while modifying the health care mandate so it only requires catastrophic coverage.This model has a lot to recommend it, because it includes key aspects of two of the more successful health care systems internationally: Singapore and Switzerland. Catastrophic plans would force consumers to shoulder more of the financial burden of their own care, just like Singaporeans do, and putting everyone into the exchanges could bring the US closer to Switzerland. In recommending building on, rather than eliminating, the exchanges, Cowen is echoing a suggestion made earlier this year by Douglas Holtz-Eakin and Avik Roy.As Ross Douthat has pointed out, an exchange-based reform is ultimately friendlier to conservatism than most other reforms that are being discussed right now. In an ironic twist, conservatives could have more to gain from seeing the basic exchange approach succeed than liberals would. If the exchanges work, then GOP wonks can use them as a baseline for the kind of reform Cowen recommends. But if they fail, liberals could use them to provide good cover for a single-payer pivot.
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