Planet Pundit asked a good question about the effect of creating a baseline Bronze for everyone to get into with the option to buy-up:
the impact of moving all 18-64 year old adults over to a Medicare “Bronze” Plan and letting everyone who cared to carry, themselves or their employer paying for, Platinum-Gold-Silver Plan?
In a rational, political world where there was a broad agreement that health insurance was a general public good, this would be a good idea, and it would be a rip-off of several European systems where the state provides or pays for a minimal floor of coverage and people can buy up if they choose to do so. It would cost money and it would be an expansion of Medicare plus it would be multiple layers of additional administrative complexity for billing as most claims would have a primary payer of Medicare for Everyone as the base 60% and then a Medicare-E supplmental policy, but providers are already used to the two tiered billing structure in Medicare, so it would be doable.
A slightly different twist on this proposal would be creating Medicare Bronze as the default coverage for people who otherwise did not sign up for coverage during either Open Enrollment or a special enrollment period and did not qualify for any other coverage (CHIP, Medicaid, employer coverage etc). Avik Roy and other conservative health care reform proposals have similiar minimal catastrophic coverage default options built into those plans. They propose a lower acturial value for the default coverage as they think the problem with American health care is Americans have it too easy, but at that point, it is a technocratic argument over which dial to twist and how far. These proposals would use the funds that would otherwise have gone to pay for premium assistance and cost sharing assistance subsidies if the person applied for coverage and used those funds to pay for catastrophic coverage as a default. It would not be great coverage, but it would be hit by a bus/congrats you have cancer coverage.
Either idea relies on a broad agreement that basic health care should not be a fear and bankruptcy inducing event, and that society has a broad and general interest in keeping as many of its members reasonably healthy. If we have that agreement, than it is a matter of figuring out what to cover, how to pay for it, and what needs to be taxed in order to pay. Some people would want skimpier coverage and broad based consumption taxes to finance private insurance Tin plans, while others would want Bronze plans run by Medicare paid for by higher income taxes.
However, we live in a world where a significant chunk of the political elite either believes that health care is a common market good (and disregard Ken Arrow), is a viable means of social control through fear, functional sociopaths or act as if they believe one of three preceeding statements. Right now, that group has control over the entire legislative process, so good ideas like a baseline catastrophic coverage would be too French and against our freedumbs to die quietly in the corner if we get hit by a bus and don’t have a benevelent employer sponsored health plan.