About 30 million Americans still lack health insurance, and more than 60 million have trouble paying for the coverage they have. Together, that’s nearly one-fourth of the U.S. population.

Health care affordability problems are so pervasive that more than half of Americans say they favor a national government health care system, such as Medicare for all. But moving to a giant, single-payer system would knock 150 million Americans off employer-provided care most of them like, and require sharp tax increases, besides. That makes it politically implausible.

But a more limited Medicare-like program for people who lack other options makes more sense. “It's a lot better to have a public option,” says Sen. Michael Bennet of Colorado, one of the 23 Democrats running for president. “It would more quickly lead to universal health care coverage, which is what we should have as a country.”

Bennet has crafted legislation that would create a new program called Medicare X, which would be separate from traditional Medicare but run by the same agency. Nobody would be required to join, which means private insurance would remain as it is, more or less. But a large pool of enrollees would give Medicare X purchasing power similar to Medicare and help control costs.

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Medicare for all, popularized by Sen. Bernie Sanders of Vermont, would be “free,” with no premiums. But it would cost the federal government more than $3 trillion per year, which would require new taxes on businesses and individuals. Proponents argue that eliminating profits in the private health care system would lead to lower overall spending and better health.

But that’s unproven and shifting to such a huge, single-payer system would be massively disruptive, not to mention politically explosive. “Single-payer health care has no room to move forward in the near term even in the Democratically-controlled House outside of committee hearings,” Beacon Policy Advisers advised clients recently.

A better deal than buying a health care plan

Medicare X would not be free. Enrollees would pay premiums, like regular insurance, set at levels that cover the costs of the program. So it wouldn’t require new taxes. There would be subsidies for lower-income people, as there are with the Affordable Care Act. If it managed to provide routine health care for most people who lack it, the United States would finally have “universal coverage” through a combination of private and public plans.

Even with premiums, Medicare X could be a much better deal than buying an individual plan for people who don’t get coverage through an employer. One flaw with the ACA is the high cost of insurance for people who need to buy their own coverage and earn too much to qualify for ACA subsidies, which fade to 0 at income levels of around $66,000 for a married couple and $100,000 for a family of four. People over 50 can face especially crushing costs, with annual premiums alone costing $25,000 or more for a couple, not including out-of-pocket expenses.

Medicare for all gets a lot of attention, but Democrats have introduced nearly a dozen plans to expand health care coverage—and only four would involve a huge single-payer system. The rest would let people buy into Medicare, or offer other programs like Medicare X for people who don’t have affordable options in the private market.

Some prominent presidential candidates favor Medicare for all, including Sanders, Elizabeth Warren, Kamala Harris and Cory Booker. But others think it’s so divisive and impractical it could stand in the way of improvements for people who need the most help. “Bernie's Medicare for all plan will never become the law of the land,” says Bennet. “And I'm sick of our not having universal coverage.”

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Rick Newman is the author of four books, including “Rebounders: How Winners Pivot from Setback to Success.” Follow him on Twitter: @rickjnewman

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