politics

Oz co-wrote a Forbes piece in June 2020 with former Kaiser Permanente CEO George Halvorson endorsing a “Medicare Advantage for All” system that called for eliminating employer-provided insurance and Affordable Care Act coverage and putting “every American who is not on Medicaid” into Medicare Advantage, which uses private plans to cover enrollees. They proposed to fund it with a 20% payroll tax split between employers and workers.

I mean, if they actually did this, this would be great. Which is actually why I'm skeptical of it ever happening.

Still, our political system is really weird right now. We're fundamentally in an era of political realignment. The old coalitions have failed, and new ones are sorting themselves out. The Republican Party of today isn't the Republican Party of 30 years ago. Who would have predicted Republicans becoming the champions of ending free trade? Free trade helps corporate profits; Republicans were the original proponents of post-Reagan free trade agreements like NAFTA. And Republicans won on the issue so thoroughly that Democrats as well fully embraced it. After a few decades, Republicans now realized that neither side was opposing free trade, and thus there was a huge political opening. Despite corporate interests, Trump was able to lead the party to be against free trade.

Political parties ultimately seek power above all else. And Democrats have largely ceded the ground on transformational Social policy. If Democrats aren't going to produce serious medical reform plans, there is now a huge pool of voters out there who want bold change, but currently have no one to vote for. It's a huge political opportunity that Republicans could seize.

Of course, the big objection people would have to this is, but what about corporate influence? True, I don't see Trump becoming a trust-busting Theodore Roosevelt any time soon. But this kind of reform is actually the kind of thing that corporations might welcome. But imagine a plan like this passes. Now businesses don't have to worry about healthcare. They simply pay a flat tax, and that covers everyone's healthcare costs. They don't have to worry about costs rising unpredictably every year. They don't have to fight insurers over coverage. They don't have to hire more HR employees to manage enrollment. Nope, just pay a flat payroll tax, and you're done. The number you deduct from your employees' pay stub jumps up, but that's about it. They have to pay their share of the payroll tax. But the amount they will pay in tax is likely far less than what they are currently paying for insurance. Companies stand to profit from this.

Employers who don't offer healthcare to their employees would stand to lose, but every other company would benefit immensely from a federal health insurance program. Hell, Trump himself has probably personally battled with the inanity of dealing with health insurance plans as business owner. As long as the corporations or wealthy aren't being taxed to pay for it, there may not actually be much corporate opposition to this plan. The healthcare industry gave more money to Kamala than to Trump. There are different kinds of corporate interests, and they do not always align. And for many corporate sectors, offloading the burden of healthcare to the government, in exchange for a flat payroll tax, could be quite tempting.

I don't know if something like this will really happen, I'm probably just being optimistic. But perhaps, if we're lucky, the sheer strangeness of the moment might allow for political options that would previously be unthinkable. If Trump actually wanted to have as his legacy some serious change to the healthcare system...this would be the way to do it. It's something that would genuinely improve the system, but done in a way that doesn't fall hard on the wealthy, and would be at least neutral in its overall affect on corporations. It's the kind of thing that might actually get through Congress, pushed through on a strange coalition of ride-or-die MAGA Congress people and progressive Democrats. Sanders hand-in-hand with MTG, somehow finding a way to work for the betterment of all.

Back in reality, however, my more pessimistic side thinks they would insist on adding bullshit to it that would make it an abomination. This plan would effectively kill the private insurance market. Private insurers would still exist, but they would all operate through Medicare Advantage. The entire population, outside of those already on Medicare or Medicaid, would be enrolled in a Medicare Advantage Plan. The only plans that existed outside of this would be boutique luxury supplement plans (plans that offer services on top of what Medicare provides.) But it would effectively kill the market for purely private basic insurance.

They would probably start adding culture war requirements to these new Medicare Advantage plans. Expect plans to be prohibited from covering abortion, contraception, gender-affirming care, etc. Which would mean that no insurance plan would be able to cover these things. Hopefully that kind of crap would have to be left on the cutting room floor as the bill worked its way through. But it's the kind of thing I would be wary of.