In America, there are two critical—even existential—problems that stem from the high cost of health care.

The first is that nearly 30 million Americans cannot afford health insurance at all. Tens of millions more have coverage, but are barely able to make ends meet, as rising health insurance premiums walk off with their stagnant wages.

The second is that, because nearly every American receives health insurance subsidies from the government in some form, America’s deficit and debt problems stem entirely from growth in public spending on health care: Medicare, Medicaid, the Affordable Care Act, military and veterans’ health care, and even the exclusion from taxation of employer-sponsored insurance, the largest expenditure in the tax code.

Hence, it is not merely important that we make health care affordable for every American living today. We could do that by papering over our problems and spending tomorrow’s money on today’s people. It is also imperative that we make American health care affordable for future generations—by ensuring that the promises we make today are fiscally sustainable for our children and grandchildren.

Affordable health care for every generation, in turn, can best be achieved by advancing three additional core principles:

Personalized insurance. All Americans should have the freedom to choose among a wide variety of private plans that suit their needs. Most employer-based coverage fails this test, as do plans for single-payer, government-run health care.

All Americans should have the freedom to choose among a wide variety of private plans that suit their needs. Most employer-based coverage fails this test, as do plans for single-payer, government-run health care. Fairness to taxpayers. Taxpayer-funded subsidies should be reserved for the poor, the sick, and the vulnerable—not the wealthy. Today, nearly every American with health insurance gets some form of government subsidy, regardless of need. To make our system fiscally sustainable for future generations, we must phase out taxpayer-funded subsidies for those who can easily afford coverage on their own.

Taxpayer-funded subsidies should be reserved for the poor, the sick, and the vulnerable—not the wealthy. Today, nearly every American with health insurance gets some form of government subsidy, regardless of need. To make our system fiscally sustainable for future generations, we must phase out taxpayer-funded subsidies for those who can easily afford coverage on their own. Innovation and competition for patients. Enabling competition and curtailing the power of health care monopolies will lower patients’ costs and increase innovation in patient care. If we do nothing, the power of health care monopolies—especially hospitals and pharmaceutical companies—will only expand with time, making health care even less affordable than it is today.

The good news is that we already have a model in the United States that achieves these goals: Medicare Advantage, the part of the Medicare program that enables seniors to choose private plans to deliver their health coverage. Medicare Advantage is highly personalized, with seniors enjoying dozens of choices among competing health plans. Medicare Advantage is already means-tested, though it could be more so, to ensure that taxpayer resources are focused on the most vulnerable populations. And Medicare Advantage plans have more robust tools than other forms of private insurance to combat the rising problem of hospital monopolies.

Medicare Advantage for All vs. ‘Medicare for All’

Many Americans have heard of the concept of “Medicare for All,” a plan for government-run health care most associated with Sens. Bernie Sanders (D., Vt.) and Elizabeth Warren (D., Mass.). What Sanders, Warren, et al. mean by “Medicare for All” is a plan that would abolish all forms of private insurance, including Medicare Advantage plans, and replace them with a single, government insurer (a single payer).

By contrast, Medicare Advantage for All evolves the U.S. health care system in the opposite direction: enabling more Americans to choose among a wide variety of innovative private insurance plans that suit their needs, just as seniors enrolled in Medicare Advantage can today.

Medicare Advantage for All is a wide-ranging initiative at FREOPP that seeks to improve every aspect of American health care. Its ideas can be divided into two parts. Part One details ways to improve and expand personalized health insurance coverage. Part Two addresses ways to reduce the cost and improve the quality of American health care. Part Three examines legislative proposals based on the policies described in Parts One and Two.

Introduction

Health Insurance for All, The American Way

Americans want a universal, affordable, innovative, and sustainable system with a broad range of private options.

Part I: Personalized Health Insurance

Bringing Private Health Insurance Into the 21st Century

A plan for blending the best aspects of American health care with market-based models abroad.

Medicare Advantage: A Platform for Affordable Health Reform

Medicare plans run by private insurers have lower premiums, broader benefits, and better outcomes.

Achieving Health Care Independence for Veterans

Veterans deserve the same health care options that all other Americans enjoy.

Part II: Higher Value at Affordable Prices

Affordable Hospital Care Through Competition and Price Transparency

Combating — and even reversing — a decades-long trend towards hospital consolidation will reduce health costs for patients.

The Competition Prescription: A Market-Based Plan for Affordable Drugs

The key to lower costs for patients is to remove federal barriers to pharmaceutical competition.

What Medicare Can Learn From Other Countries on Drug Pricing

Market-based policies from countries like Denmark and Singapore can make medicines more affordable in the U.S.

Bringing the Digital Revolution to Health Care

It’s time to modernize outdated laws that prevent tech entrepreneurs from improving patient care.

Part III: Legislative Proposals

Bruce Westerman’s Fair Care Act: Market-Based Universal Coverage

H.R. 1332 would expand health insurance coverage while reducing costs and increasing innovation.

A Fiscal Analysis of Elizabeth Warren’s Health Care Plan

Without rosy scenarios, “Medicare for All” could increase the federal deficit by $15 trillion through 2029.