"The Second Best Plan"
By the way, defenders of the G.O.P. plan often assert that it resembles other, less unpopular programs. [. . .] I’ve been seeing claims that Vouchercare would be just like the system created for Americans under 65 by last year’s health care reform [. . .]
[. . .] First, Obamacare was very much a second-best plan, conditioned by perceived political realities. Most of the health reformers I know would have greatly preferred simply expanding Medicare to cover all Americans. Second, the Affordable Care Act is all about making health care, well, affordable, offering subsidies whose size is determined by the need to limit the share of their income that families spend on medical costs. Vouchercare, by contrast, would simply hand out vouchers of a fixed size, regardless of the actual cost of insurance. And these vouchers would be grossly inadequate.
(Emphasis supplied.) Let me make 2 points in response - (1) The exchange/subsidies reform created by ACA do not forward us towards the best plan - Medicare for All. They take us toward the path of VoucherCare. What's more realistic? That Medicare will be made to resemble the exchange/subsidy reform or that the exchange/subsidy reform will be made to look more like Medicare? I think the former. (2) The size of the subsidies under ACA will be much more dependent on defeating the "Austerity Now! crowd than on the affordability of insurance on the exchanges. The reality is ACA will likely end up looking like VoucherCare when it is all said and done. Krugman's critique of VoucherCare is spot on. But he has a blind spot on the weakness of the exchange/subsidy reform in ACA, which likely will become VoucherCare.
Speaking for me only
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