David Dayen and Jon Walker have been doing yeoman’s work keeping track of all the ways that the folks who either depend on Medicaid now or who hoped to have access under the Affordable Care Act are likely to be screwed by America’s dysfunctional political system and dysfunctional health care system.

So far, a rather academic debate about this has been too narrowly focused between three groups:

  1. Those who are worried a lot that those who have no health care options other than through Medicaid will be denied access;
  2. Those who insist that “logic” will prevail and states and legislatures will make sure those who would get access under the ACA if fully expanded will get access, eventually; and
  3. Those who can’t wait to screw the poor again, or at least pretend they might screw the poor, because they’re convinced that a depressing percentage of conservative-leaning American voters believe the poor deserve to be screwed.

Notice any groups missing from this list?  How about:

  1. The poor who are about to be screwed;
  2. People — like Jon and David — who are appalled by that and think something should be done other than wait to see what happens, like religious leaders, health care professionals, ordinary citizens; and
  3. Political leaders, parties, etc., willing to take a stand and say, “this is what we should do to avoid screwing poor people who don’t have health care.”

So, I’d like to start a conversation with the last three groups, because they’re the ones who have the most at stake, both in getting health care coverage and getting public policy refocused on stuff that matters to real people in their real lives.

Why can’t we start asking political candidates at all levels — local, state, federal, Presidential — and all parties, Dems, GOPers, TeaBags, 3rd parties — what they believe we should do to make sure poor people get reasonable access to adequate health care in America?

Of course there are many Americans who wonder why we don’t just expand Medicare for all or something similarly universal. Other countries have nice things; why can’t we?  Let’s hear that argument.  But what if that conversation isn’t feasible yet, because we’re still a bit backwards here?  To flush this out, suppose we start with some relatively modest, basic proposals, not that far from where we are, and see what people think.

Let’s call this, Scarecrow’s No-Brainer Health Care Platform, and it’s open to comment/revision:

1.  First, As FDL’s Jon Walker,  David Dayen and others have urged, let’s federalize the service we now call Medicaid.  If states want to participate in administration or quality oversight, fine, but all the standards for eligibility and all funding should be handled through the federal budget.   Basic health care is fundamental to human decency and fairness, but as Walker wrote, during economic downturns, state and local governments are in no condition to cover the expanded costs of the increased numbers of people who need coverage.  Federalize it.  It will help the poor get care and also help the state budgets.

2.  Next, bring eligibility up to a national level of at least 150% of the Federal Poverty Level.  People can debate whether we should start at the ACA’s level of 138% or something else, but the idea is to have a nationally uniform assurance of coverage.  Start somewhere that’s defensible because it’s humane, and if individual states want/pay for higher levels, fine.

3.  Make Medicaid health coverage equivalent to Medicare health coverage.  That means not only providing the same level of health care across America, but also providing compensation to health care providers at the same levels and using the same means (and options, including regional variations) as those available to providers of Medicare.  We should never again have a condition in which health care providers refuse to cover Medicaid patients because they’re claiming to be underpaid.  This also means that whatever means and experiments Medicare attempts to control costs and make health care more effective and affordable should apply equally to Medicaid.

4. Add a Medicare buy-in option to the Exchanges. If the country retains the ACA’s exchange/subsidy/penalty structure for people in between Medicaid and Medicare and not covered by their employers, then add a Medicare buy-in option to the Exchange. If the nation is not yet able or willing to expand Medicare/Medicaid to cover everyone, then people are going to need something in between.   I personally believe the entire competitive market model when applied to health care/insurance is a crock, but if that’s all the in-betweens have (assuming they can’t get coverage at work), then let’s have an escape value to get Medicare access in case it turns out that whole market theory really is a crock. And who knows, it just might keep the pressure on the private sector to limit how much they can rip off the in-betweens.

There’s lots more one could add, but that’s a start.  Suppose we have a campaign to encourage candidates at all levels and all parties to tell us where they stand on these four principles?  Because so, far, none of them is saying anything relevant, and our abysmal horse-race media is letting them get away with it.   Tax? Penalty?  Flip flop? Who cares?

We have a national election coming up.  We’re going to be electing an entire House of Representatives, 1/3 of the Senate, a President, and hundreds of state legislators and Governors.  Where do they stand on one of the most important issues facing the country? Let’s ask them.