Delaney’s health-care alternative deserves attention



Health care has emerged as the leading point of contention among Democratic presidential candidates, as it is the most important issue identified by likely Iowa caucus-goers. Because the Democratic National Committee and the television networks would like to concentrate on three or four candidates, we are not hearing about what might be the best proposal out there — from John Delaney of Maryland.

On the left with Bernie Sanders and Elizabeth Warren we have Medicare for All, essentially offering Medicare to everyone with no premium. On the corporate side we have several candidates pushing for a public option, which offers an accessible plan that would charge premiums, deductibles and co-pays similar to the basic plans offered under the Affordable Care Act.

Delaney offers a different approach. He calls it Better Care. He wants to offer a free public insurance plan available to everyone under age 65, and fold Medicaid into it (deductibles and co-pays would be means-tested so the poor would not have to pay out-of-pocket). He would pay for it by taking in all the ACA subsidies and Medicaid subsidies and replacing it with a single plan that would look and feel like Medicare. But Delaney would allow you to opt out of Better Care for a private health insurance policy that is more comprehensive or provides supplemental benefits.

“As you can tell, Better Care goes farther than a public option because it provides everyone with health care as a basic right of citizenship,” Delaney told us. “But unlike the strident Medicare for All, it allows private insurance to stay in the mix, which gives Americans choice and increases overall reimbursement rates to hospitals and other health care providers. Better Care is similar to the German model. It’s more progressive than the Pete/Amy/Biden plan but more practical than the Sanders-Warren plan.”

It sounds like Warren and Delaney might be in close company. She has hedged when asked how her plan would be financed. She is trying to remain flexible. She has said that there are any number of paths to get to universal health coverage. Warren said she will introduce her details soon. She might consult Delaney’s plan, because it offers the most practical way to get to universal coverage.

We are attracted to Medicare for All because, as a small business, we cannot afford the health insurance plans offered. Also, we do not want to be health plan administrators; we prefer writing editorials. A public option would be marginally cheaper than our current plan and would guarantee portability with employment. Warren embraced it given her expertise as a bankruptcy lawyer — medical expenses are the leading cause of consumer bankruptcy. She said that is the issue that drove her into politics.

The only person in the field who knows more about health care financing is Delaney. He was an entrepreneur who started a business that financed health care providers. He made a fortune at it by understanding the market. He also got a different perspective from his years in Congress.

Delaney takes away the attack line that you are taking away someone’s solid-gold insurance plan with Medicare for All. He solves the problem of affordability by shifting existing subsidies into a more effective pool. You can’t call him a Communist or Socialist by allowing health insurance to be sold either as a primary or supplemental policy.

Warren and Sanders risk falling into a trap set by corporate interests using fear as their foil. Delaney’s plan is more defensible politically. It takes care of the small business that can’t afford $5,000 deductibles and premiums rising in cost by more than 20% per year. It takes care of the individual buyer who, in Iowa, is left with substandard policies that don’t even meet ACA guidelines. It provides competition in near-monopoly markets like Iowa’s. It gets everyone insured, from birth, with no premiums and no higher taxes (even though Medicare for All would result in lower overall costs, we think, but the “you raised my taxes” line could be a killer in a general election).

This is why we need candidates like John Delaney in the race. Like others, Delaney has not received a hearing because he was not a national brand going into the campaign. He has clear ideas about how to move capital flows back to the Rust Belt and forgotten rural areas. He has aggressive plans for climate change that are founded in functioning private markets. Delaney won’t be on the national debate stage because of the DNC/television network rules. A great swath of America will have no idea what his health care plans involve because he gets in the way of a national media narrative that can focus on four candidates. Yet, nobody understands health care financing better than him. Delaney is working hard in rural Iowa for support. He deserves your attention. Iowans can make a difference in how health care, climate change, reviving rural America and immigration reform get settled.

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