How Biden can keep millions of Americans from losing health insurance | Cognoscenti

But if the Congressional Budget Office is right, once the American Rescue Plan subsidies disappear, enrollments could fall to what they were in Trump’s last year. While Biden hoped to preserve the subsidies in the Build Back Better-on-a-diet plan he’s negotiating with Joe Manchin, they may be sacrificed on the altar of government economizing.

The administration has thrown carrots and sticks at states to keep people covered after it declares the COVID emergency over. Still, like the tax collector and the funeral director, the shortcomings of America’s patchwork health insurance can’t be dodged forever.

There’s a way out for Biden. First, admit the public option can’t do the trick. Second, embrace the solid ideas of revenue-raising tax simplification and prudent budget cuts. Third, devote some of that new money to Obamacare for All: universal, affordable, mostly private health insurance. Germany, the Netherlands and Switzerland offer models. (The New York Times had fun with a March Madness-type competition among national health care systems, asking five experts to pick the best. Germany and Switzerland came out tops.)

There’s no shame in Biden copping to the timidity of his campaign idea. His old boss disdained mandatory insurance, except for children, when he first ran in 2008. Once in office, Barack Obama realized a requirement applying to everyone was essential to keep coverage affordable. Voila — we got Obamacare, with an individual mandate upheld by the Supreme Court. The country’s uninsured hit a record low.

As always, the road to progress is blocked by political bickering. Progressive Democrats can’t contain their dog-chasing-cars pursuit of Medicare for All, even though Democratic primary voters in 2020 said no to its price tag and abolition of private insurance. Biden meanwhile didn’t prioritize health care reform in his original Build Back Better; Manchin worries about deficit-cutting.

A holistic approach — tax and spending reforms, plus government-subsidized-and-regulated private insurance — could deliver liberals’ dream of universal coverage, while averting moderates’ nightmare of Uncle Sam running bake sales to pay his deficits. Who knows — it might also attract some of Congress’s few, sane Republicans.

As for average Americans, they keep dying or going broke from medical bills. Meanwhile, the parade to the insurance cliff marches on.

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