There’s a good chance the Supreme Court will rule that the “individual mandate” at the heart of the Patient Protection and Affordable Care Act (“Obamacare”) is unconstitutional. Since the requirement that nearly everyone – healthy and unhealthy alike – buy health insurance is central to the insurance companies’ ability to expand coverage and to cover existing conditions, the ruling will likely mark the unraveling of the entire law.
What then? Absolutely everyone agrees that the current system is disastrously unsustainable. But Republican proposals – primarily focused on “voucherizing” Medicare, it seems – do nothing to address the key issues of coverage and cost containment.
So why not go the other way? Why not expand Medicare to everyone? There are at least two good reasons to consider doing so:
First, unlike Obamacare’s “individual mandate” to buy private insurance, there is absolutely no question about the constitutionality of taxing citizens for a public good. We’re already doing it with both Medicare and Social Security. And despite the passionate views of some that these programs too should be privatized, both Medicare and Social Security are immensely popular in their current form – payroll tax funded public programs.
Second, Medicare has greater potential for effective cost containment than any alternative on the political market. It has a strikingly low administrative cost – 3% compared to a private health insurance industry average of 30% or more, and an 11% average for private plans under Medicare Advantage. In addition, a universal Medicare could use the leverage of scale to negotiate lowered costs of pharmaceuticals and covered medical procedures.
If the Supreme Court effectively guts Obamacare by striking down the individual mandate, the smart move for the president and the Democrats will be to counter with a proposal to universalize Medicare. As counterintuitive as it may sound at first, I think the vast majority of Americans – frustrated by both an out-of-control health care system and ineffective national leadership on the issue – would support the move. And, presumably, so would the Supreme Court.