Medicare for America includes premiums of up to 10 percent of a person’s annual income and out-of-pocket maximums of $5,000. In a country where four in ten people don’t have the savings to cover a $400 emergency, these costs will either prove to be financially devastating or deter people from seeking needed care.
The proposal’s proponents argue that allowing Americans to opt into public insurance will gradually chip away at private insurers’ clienteles until the vast majority of Americans — or even all Americans — are covered under the same public plan. O’Rourke claims that the public option will become “the program of choice.” But by allowing private insurers to compete with the public plan, Medicare for America ensures that care will remain unequal and segregated.
This is why Medicare for America is not a pathway to single payer. Its multitiered and means-tested approach will inevitably pit working people against one another.
Imagine a situation in which only poor and working-class Americans utilize the public plan, while wealthier people can afford better plans. This is a breeding ground for resentment, which can be mobilized towards defunding the public option. Once that happens, patients enrolled in it will experience shrinking coverage and higher costs. This will naturally lead to the growth of private supplemental plans and leave Medicare vulnerable to further privatization with the encouragement of a still-powerful private insurance lobby. (We see this already with costly Medicare Advantage plans.) If the public plan is as good as O’Rourke suggests, why not enroll everyone in it now?