Given the fact that conservative health policy advisor Avik Roy and I have disagreed so vehemently and so often, RBC readers might be surprised by the civil conversation we conducted over at healthinsurance.org about Roy’s new health plan.
I hope my fellow liberals will read what he has to say–not because you will agree with him, but because he offers an instructive and well-articulated vision of what conservative health policies might look like that build on the platform created in ACA. I am a firm believer in Mill’s idea that if you only know your own side of the argument, you really don’t know that.
Roy rightly acknowledges that Republicans will not outright destroy ACA at this point. That question was decided by the 2012 election and by the (eventually) successful roll-out of ACA this year. Whatever the polling numbers on “Obamacare,” the on-the-ground progress is impressive. Medicaid expansion and the new marketplaces are embedding within the fabric of American life.
Where it gets interesting and disconcerting is to note the generative conservative possibilities opened up by ACA. Roy would limit ACA in various ways. But his real quarrel is with Lyndon Johnson not Barack Obama. Once 64-year-olds are enrolled in the health insurance marketplaces, why the abrupt transition at age 65? Roy would raise the Medicare eligibility age by four months every year, retaining the subsidy structures provided by the exchanges and Medicaid. Over time, this would turn Medicare into much more of a means-tested program with dramatically reduced actuarial subsidies to the top half of the income distribution.
I don’t support this or see it as politically attractive for Republicans. But Roy’s plan raises fundamental questions about what we want Medicare to be and do. More here.