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Senators Consider A Menu Of Options, Including Medicare Expansion, As Public Option Alternative
Sen. Harry Reid (D-NV) and Sen. Charles Schumer (D-NY)
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Several outlets are reporting, and I can confirm, that Senate Democrats are considering a Medicare expansion as one item on a menu of concessions conservative Democrats would agree to in exchange for weakening or eliminating the public option in the health care bill.
Currently, Medicare exists as a single-payer system for seniors 65 and older. According to Hill sources, the idea would be to allow people under the age of 65 to buy in to Medicare. The option would be limited to people older than a certain age, though that age--and indeed the entire proposal--has yet to be agreed upon.
If Democrats sacrifice the public option, there will likely be a long list of alternatives in its place. This buy in could be one of them, as could a separate plan to allow the federal government to negotiate premiums with insurance companies for some consumers. These are the two ideas receiving the most buzz.
We'll know more of this in a day or two, when the 10 senators negotiating a public option compromise emerge with a concrete proposal. Follow along.
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Moose49
December 7, 2009 3:07 PM
Expanding Medicare would be BETTER than a public option. It's the path they should have taken all along. Obviously, what's key is how many people and who they'll allow to buy in to Medicare, but at least at first glance, this could be a great development.
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Michael A
December 7, 2009 3:22 PM in reply to Moose49
Ditto. "Medicare for all" makes a simple bumper sticker. I don't know why that wasn't the rallying cry. Also, it would defeat the teabagger nonsense and old people complaining they don't want the guvement in their healthcare. Duh!
They have to get the criminal insurance industry out of the mix one way or the other, whether its over time or now. That has to be the endgame. Just sloshing more taxpayer dollars to them is not the answer.
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masanf
December 7, 2009 4:11 PM in reply to Michael A
How in the world is opening this up to people only over age 55, or as the Huffington Post mentions is more likely, 60 going to be "Medicare for all"? Furthermore, how does this decrease the burden on an entitlement program that will be insolvent by 2018.
And one of the reason no private sector insurance company can "touch" Medicare is because the government has repeatedly cut Medicare reimbursement rates to the point where it is often times too costly to see Medicare patients. The Senate bill further slashes physician reimbursement. There is a reason a growing number of physicians refuse to see new Medicare patients. This will do nothing to address that problem.
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Powkat
December 7, 2009 4:50 PM in reply to masanf
It's a start. And my guess is it will be VERY popular. If they drop it to age 60 people can retire earlier. It would mean I could retire a year earlier - right now I can't retire until age 65 because I can't afford insurance (even COBRA). And there are lots of folks like me.
If they drop it to age 55 I'm guessing a lot of folks who have been successful in one career and would like to start their own small business will be more likely to do so, again because they will have good, reliable insurance.
Both of these actions will open up jobs for younger people and be good for the economy. By putting older (and more likely to need medical services) folks into Medicare, the stats for those still in employer and private insurance should improve and rates should drop. It's a win-win.
After a few years I'm guessing there will be pressure to lower the age again. It's a good start
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mcc
December 7, 2009 3:31 PM in reply to Moose49
Again, what we're hearing is it would only be available to people over 55. So from my perspective it would not be as good as founding a proper public option (even the compromised, "negotiated rates" public option). But it is a step in the right direction and maybe it could expand later. Eventually just make medicare the public option.
If we absolutely have to trade the public option away for something, this should be something near the top of our list.
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lousgirl84
December 7, 2009 6:46 PM in reply to Moose49
I agree it would.
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masanf
December 7, 2009 3:17 PM
Yeah, it would be a great idea to expand a plan that is already rapidly going bankrupt.
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storm
December 7, 2009 3:22 PM in reply to masanf
why would this effect its budget? every proposal i've seen has people buying coverage.
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masanf
December 7, 2009 4:17 PM in reply to storm
The day the federal government takes in more in premiums than it pays out in expenditures is the day pigs fly.
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Michael A
December 7, 2009 3:24 PM in reply to masanf
Yeah, its rapidly going bankrupt because it handles the majority of the people that need medical care. It was started in the first place because insurance would not cover the elderly.
If they took the money that is being paid to the criminal insurance industry and cut them out of the mix healthcare costs would go down over all and medicare would not be going bankrupt. It doesn't take rocket science to recognize the problem.
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masanf
December 7, 2009 4:19 PM in reply to Michael A
Yeah, get back to me when that has a chance of ever happening.
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Tanjaoui
December 7, 2009 6:14 PM in reply to masanf
They should finance it with a value added tax, as they do in Europe. Medicare for all works just fine in Canada. They do need to fix the waste that messed up Medicare Advantage reimbursement rates have caused. This was a 'free market fix', backed by Republicans, that ended up costing Medicare big money.
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lifeofreilly
December 7, 2009 3:25 PM in reply to masanf
As the article says, some people, over a certain age, would be able to BUY IN to Medicare, which presumably means they would be paying premiums into the system at a lower cost than from private companies. This might actually have the opposite effect from what you claim - it could actually SHORE UP the Medicare system by infusing it with new money.
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cuchulain
December 7, 2009 3:38 PM in reply to masanf
It's not going bankrupt. It has a funding issue. It has been handicapped since its inception due to the way it's funded. FICA taxes. If the Department of Defense were stuck with that, it would have gone "bankrupt" even faster.
Unlike Defense, which gets to use BOTH the general fund AND FICA taxes (raiding of that fund has gone on for 40 years) . . . Medicare gets to use ONLY the FICA tax trust funds.
And Defense receives even more in appropriations than it asks for. That never happens with Medicare.
The best thing to do would be end FICA taxes, pour the trust fund into the general fund, and make Medicare and Social Security a part of the regular appropriations process.
Medicare has a very, very low overhead. It's less than 3%. It's actually very, very efficient and well managed, for something on that scale. No private sector insurance company can touch it. No private sector insurance company comes close to it, when it comes to spending the highest percentage of funds on actual health care coverage.
If we went to Medicare for all, made it 100% public and non-profit, we'd save hundreds of billions of dollars a year. If the CBO scored it, that's what they'd find. Roughly 97 cents out of each dollar goes to actual health care in that system. In the private insurance world, it's generally 53 to 70 cents on the dollar, at least in states without a cap.
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George C
December 7, 2009 4:15 PM in reply to cuchulain
Actually, I think the best thing to do would be to means test Medicare, including for people under 65 who buy in. Right now, I think the lowest Medicare premium is $91, and the highest is $300 or so. If anyone can explain why Warren Buffett should pay $300 a month for Medicare, I'd like to hear it. The premiums don't have to be unreasonably high, but people who can afford them should pay. Moreover, income subject to Social Security should not stop at $106K, or whatever it is this year.
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cuchulain
December 7, 2009 4:37 PM in reply to George C
Means testing would be fine. But I think it's time to simplify the system. That alone would save taxpayers a fortune. Have one general fund. End all of these trust funds. Do all government appropriations from the same till. Increase taxes on the top 1% and cut corporate loopholes to pay for it.
Medicare for all. No out of pocket costs. Low copay. Small premium. Taxes cover the rest. And everyone is covered. I would not farm out anything to the private sector. I would administer the entire thing via government employees.
We could then eliminate dozens of programs. Consolidate. Save money. And this would cut costs for providers as well, when they can stop billing arrangements with dozens of insurance companies.
Our government also spends something like 100 billion a year covering unpaid for medical care. Private practices write that off. Taxpayers pick it up, either directly or indirectly. If everyone is covered, we no longer have that unpaid services issue.
Most importantly, we no longer have 45,000 Americans dying each year for lack of coverage. Nor will we have a million plus bankruptcies each year due to medical costs.
Medicare for all would save us all in blood and treasure.
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Tanjaoui
December 7, 2009 6:22 PM in reply to cuchulain
We need the CBO to analyze it, not score it. The difference being a 'score' wouldn't look good because it looks only at the effect on the Federal budget, not total costs. A CBO analysis is more comprehensive. The huge systematic savings of Medicare for All would be clear in an analysis. Careful what you wish for.
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cuchulain
December 8, 2009 2:35 AM in reply to Tanjaoui
Thanks. Analysis would be better. But even if they just scored it, that would show the tremendous savings budget-wise.
But, you're right. They should do both.
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Connor
December 7, 2009 3:50 PM
Another "fuck you" to the working-poor in their 20s, 30s...and 40s!
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Cal Gal
December 7, 2009 4:18 PM in reply to Connor
Absolutely agree. Young adults are less likely than those 40 and over to be employed in jobs that offer health insurance and are more likely to be temp workers, self-employed via the web, etc.
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KingElvis
December 7, 2009 3:55 PM
Thom Hartmann had the "Medicare for All" idea way back when.
If they lowered it to 40 years old, it would be a great idea. Maybe better than the public option.
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Riesz Fischer
December 7, 2009 4:21 PM in reply to KingElvis
My daughter is 21 and she'll be graduating from college next year. She'll be unlikely to find a job that has health insurance in the Obama-Bernanke-Geithner-Summers economy, so I don't think the 40 year old limit is such a good idea.
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tawinmd
December 7, 2009 6:20 PM in reply to Riesz Fischer
Actually, creating a (strong) public option for the oldest segment of the non-Medicare population would probably be good for your daughter. It would most likely result in significantly lower premiums for younger people in the exchange, even if it were completely made up of private plans, since those plans would include very few high-cost (i.e., older) people.
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patmcgrowen
December 7, 2009 9:19 PM in reply to Riesz Fischer
They are also extending Medicaid which sounds like something she would qualify for since it is income based. I think it is a good idea to focus on strengthening our current government-run programs. It is key to make them highly efficient and effective programs. This is how you bridge to single payer.
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Indie Pro
December 7, 2009 4:22 PM
How much is the buy in?
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Eric Jaffa
December 7, 2009 4:27 PM
They should let anyone under 65 buy into Medicare.
They shouldn't limit this to retirees, or people 55-64, or people who don't already have health insurance.
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theone718
December 7, 2009 6:11 PM
If I was a progressive in the Senate I would be pushing for that age to be as low as I could get it.
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Ingoman
December 7, 2009 6:21 PM
Here's an idea, why not allow in people into Medicare a year younger once a month. So in January people aged 64 and older are covered by Medicare, and in February it becomes 63+, etc. In 5 and a half years everyone would be covered by Medicare, and insurance companies have 5 and a half years to switch to covering that which Medicare won't cover.
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