New Andy Slavitt Project Apparently Rejects Obamacare


Share  Tweet
depthandtime / Flickr

Andy Slavitt, the head of the Center for Medicare and Medicaid Services during the Obama administration, launched a new organization earlier this week called the United States of Care (website, USA Today). This will be an important project to watch going forward because Slavitt is likely positioning himself to be the health care thoughtleader of the centrist wing of the Democratic party.

The United States of Care is so far vague about what exactly it supports. Its slogan is “let’s change the conversation and put health care over politics” and it has articulated three guiding principles for its forthcoming health care advocacy:

  1. Affordable Source of Care: Every American should have an affordable regular source of care for themselves and their families
  2. Protection from Financial Devastation: All Americans should be protected from financial devastation because of illness or injury
  3. Political and Economic Viability: Policies to achieve these aims must be fiscally responsible and win the political support needed to ensure long-term stability

On first glance, it is hard to understand how principles (1) and (2) are different from one another. Doesn’t making health care affordable also ensure that it isn’t financially devastating? It’s even more mysterious how principle (3)’s requirement that health care policy be written with political support in mind is consistent with putting “health care over politics.” Doesn’t this put health care under politics?

More important than these oddities, however, is the implication of principle (3)’s requirement that health care policies “win the political support needed to ensure long-term stability.” This is likely intended to be a call for bipartisanship and moderation, but if you actually applied that principle in good faith, then you would have to reject Obamacare as a viable model for the country. As I wrote back in December, Obamacare failed the survival test because Republicans repealed the individual mandate as soon as they got into power.

The fact that the individual mandate was not politically sustainable poses an interesting challenge to Slavitt’s dual commitment to moderation and universalism. If you put it all together, Slavitt believes that (1) every American should have health care, (2) politically unsustainable mechanisms like the individual mandate must be avoided, and (3) bipartisanship and moderation are the ways forward. The only way to square all three together is by coming up with a mechanism that achieves universal coverage that is more conservative than the individual mandate to buy private insurance was. As far as I know, no such mechanism exists.

Of course, the left has a policy that ticks off all three boxes: Medicare for all. Medicare for all achieves universal, affordable care. If you set the tax level at the right spot, it is “fiscally responsible” and, because it basically annihilates the private insurance industry, it is almost impossible to undo later, meaning it is politically sustainable.