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May 23, 2017

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"automatic sign-ups, direct deductions, and high penalties."

For punitive and coercive measures, the political cost is probably not worth what's politically feasible.

"slowly expand Medicaid eligibility while reducing the Medicare age."

This is the path of least resistance. I'd also float the idea of expanding Medicare eligibility to children as a large and politically rewarding move.

I agree on high penalties, but I'm not as sure about automatic sign-ups and direct deductions. (Let's assume for discussion that neither Congressional action nor executive inaction wrecks the program before 2020.)

I think automatic sign-ups with an easy opt out could be politically possible (same for direct deductions). That's probably too marginal to remedy the cracks in the system.

I don't think strict coercion without an opt out is politically feasible. At least not in the long run.

Well, right now the only cracks in the system are developing because the Trump administration is playing games with the subsidy payments. Take that away, and all you need are tweaks.

The easiest one, politically, is to jack up the level of subsidies. In fact, it was stupid of the Democrats not to start with a bigger program --- more middle-class buy-in means more support later. AFAICT, the reason that didn't happen was a combination of a fruitless hunt for GOP support and Joe Lieberman.

A simple non-partisan take:

https://fivethirtyeight.com/features/the-obamacare-marketplaces-arent-in-a-death-spiral/

The cracks in the system were there at the start. The level of subsidies required to save markets in most counties were not political realistic in 2010 and probably won't be politically feasible in the next several years. It's probably unrealistic to assume the marketplaces are healthy in 2020 without those unlikely increases in subsidies.

Moving forward it makes more sense to expand entitlements rather than sinking more political capital into propping up easily sabotaged public-private programs.

If every American who's registered for Selective Service was drafted for eight hours, would they be eligible for veterans' health benefits? Yes, you'd have to raise taxes to pay for this, but you have to support the troops...

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