Health Reform and Nick Bath

Nick Bath is the senior health policy aide to Senator Pat Murray (D) of Washington. I met Nick several times when he was a health policy aide to now retired Senator Tom Harkin (D) of Iowa.

Nick is a Harvard law graduate, a classical pianist (according to his bio), and reminds me in both looks and mannerism of British actor Hugh Grant when Grant was a younger man.

Senator Murray is one of the primary health care advocates and strategists in the Senate. Because of my previous association with Nick and Senator Murray’s important health care advocacy, I compose the following letter to Nick regarding the current health care crisis and unknown future of health care which evolved from the recently failed partisan attempt to repeal and replace the Affordable Care Act (ACA).

Dear Nick,

In light of the recent failed attempt to repeal and replace the ACA with a convoluted replacement law, which was in actuality a tax cut bill and an indirect way to change major public policy—Medicaid—that would have left 24 million Americans without health coverage within 10 years, I humbly present a potential bipartisan proposal to Senator Murray for her consideration.

My proposal would allow uninsured Americans 55 years and older to buy into the Medicare program using federal subsidies or tax credits for those with low incomes. I would restrict these individuals to certain Medicare options; those being Accountable Care Organizations (ACOs) for health care delivery.

This proposal works in four ways to deal with some of the inadequacies of the current ACA.

First and foremost, Medicare for people 55 years old and older would stabilize the individual health insurance market by removing the highest cost segment of the market from the insurance pool.

Second, this Medicare expansion would remove from Medicaid and thus, from the responsibility of the states, a large group of individuals with a high cost of care. For states that have expanded Medicaid, they would see an immediate reduction in their Medicaid populations and Medicaid expenditures. For those states that have not expanded Medicaid, they would see this population covered and the potential for Medicaid expansion for those states becomes less costly.

Third, this limited Medicare expansion allows these individuals to discover and deal with chronic health conditions, as well as preventable and treatable conditions such as colon, breast, cervical, prostate, and lung cancer. Thus, improving the lives of these Americans as well as creating a healthier cohort when they become 65 and enter into traditional Medicare.

Finally, this proposal places these Americans into a value-based health care delivery system. Which, I believe, has the best chance of providing high quality and efficient health care to them.

If we take President Trump at his word that he wants to change the current system in a way that provides affordable health care to previously and currently uninsured Americans, this plan stabilizes the cost of health insurance for all Americans.  I think this proposal would help accomplish his goal.

If we take President Trump at his word that he want to work with Democrats to create a bipartisan fix to the ACA, then I believe this proposal would appeal to moderate Republicans as a reasonable tweak to the current health care system. I have already proposed this idea U. S. Representative David Young (R), a moderate Republican who did not support the failed repeal and replace bill.

If this Medicare expansion plan could be presented and agreed upon, I think Democrats could consider some compromises in other areas, which in the overall calculation, would still make this bipartisan approach worthwhile.

Thank you for your serious consideration of this proposal and for all the good memories I have of our previous conversations when you worked with Senator Harkin.

Best regards,

Dave Carlyle MD