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Andrew Samwick thinks Democrats have done a lousy job of selling healthcare reform, and it’s hard to argue with that.  But then he goes on to ask for evidence that any of the bills currently moving through Congress are better than a simple reform consisting only of:

1. Community rating
2. Guaranteed issue
3. Ex post risk adjustment
4. An individual mandate, with Medicaid for a fee as the backup option

I’ve seen a bunch of criticisms along these same lines, and I don’t really get them. Granted, the bills now on the table have more to them than just these points, but not a lot more.  The core of all of them is insurance industry reform (#1-3) combined with subsidies for low-income families (#4).  With the exception of the much-debated public option, the additional stuff lies in the details (the subsidies aren’t all Medicaid, children get treated differently than adults) or in modest expansions of Samwick’s list (out-of-pocket caps, tax credits for small businesses).  The fact is that current reform efforts are already fairly modest.

Unless, of course, I’m misunderstanding Samwick and he means “Medicaid for a fee” literally.  That is, no subsidies and no attempt to expand coverage to the currently uninsured at all.  If that’s the case, then the answer to his question is “Because they expand decent health coverage to millions of poor people.”  If it’s not, then I’m not quite sure what the problem is.  Putting the public option aside for the moment, are the additional details in the House and Senate bills really so abominable that he thinks they should torpedo the whole project?  Why?

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