There is some funny business going on here, although it is not from Paul Krugman. A few days before Democrats Debate Round Two, Krugman sincerely argued
Biden is proposing to build on Obamacare. That can sound like tinkering at the edges. But his actual plan is much bigger and better than is widely realized, with large increases in funding, a public option, and more. It would, arguably, bring the A.C.A. close to the standards of successful European systems.
He's right when he writes "arguably," for the Biden plan probably is not much bigger and better than is widely realized, but probably smaller and worse.
Asked st the debate about the private insurance industry, the former vice-president replied
My response is, Obamacare is working. The way to build this and get to it immediately is to build on Obamacare. Go back and do -- take back all the things that Trump took away, provide a public option, meaning every single person in America would be able to buy into that option if they didn't like their employer plan, or if they're on Medicaid, they'd automatically be in the plan.
It would take place immediately. It would move quickly. And it would insure the vast, vast, vast majority of Americans.
In the meantime, what happens? Did anybody tell you how much their plans cost? My plan costs $750 billion. That's what it costs. Not $30 trillion.
Later in the discussion about health care, Biden remarked
This is not a Republican talking point. The Republicans are trying to kill Obamacare. Obamacare took care of 20 million people right off the bat, 100 million people with pre-existing conditions. And in fact, what we got is a public option that, in fact, would allow anybody to buy in.
No one has to keep their private insurance. They can buy into this plan. And they can buy into it with $1,000 deductible and never have to pay more than 8.5 percent of their income when they do it. And if they don't have any money, they'll get in free. So this idea is a bunch of malarkey, what we're talking about here.
Biden supports a "public option," which reassures Krugman and others who want "universal coverage" without offending private insurance companies. Fortunately, unlike the public option proposed during the Obama administration, even an individual not in the health care exchange would be eligible.
However, there is the non-trivial factor of cost. It's difficult to determine if the $1,000 "deductible" (apparently a recent addition) he mentioned is intended to be paid annually, or merely for the life of the consumer's enrollment. He claims "if they don't have any money, they'll get in free" but this leaves vulnerable individuals who are outside of this category but still poor.
The problem of expense is highlighted when Biden promises to "provide a public option, meaning every single person in America would be able to buy into that option if they didn't like their employer plan." Nonetheless, if the public option were truly public, it's difficult to understand why anyone would opt to maintain health insurance through her employer, which would retain all the obstacles it currently does: not free or portable but with exclusions, wherein the doctor might not be in the network or might leave at some point.
Yet, Biden anticipates many workers opting to remain in their employer-based health plan. However, they would not do so, if the public option were not "public" in the same way that public schools are. The public pays some of the freight, the public is invited in, but services may not be as promised.
It's health care on the cheap, a system designed by politicians who who want to say they're providing universal coverage but only theoretically available to everyone. If enacted, it would be a multi-tiered system in which the insurance industry would continue to profit by denying coverage to a substantial number of Americans. It would rival the ACA as a Rube-Goldberg style contraption maximizing paperwork while doing little to encourage prevention.
Or at least it would do so before eventually being overturned by the Court.