With 12 Senate Democrats and Independent Joe Lieberman lined up against allowing an early buy-in into Medicare, the idea is basically dead.
When Rep. Anthony Weiner, D-NY, said it would be “the mother of all public options,” he called the Democrats’ hand. “Expanding Medicare is an unvarnished, complete victory for people like me who support a single-payer system,” Weiner boasted. “Never mind the camel’s nose – we got his head and neck in the tent.”
A Medicare buy-in has all of the problems of a public option, especially below-cost payment rates. Hospitals and doctors responded quickly and came out forcefully against the proposal. The Mayo Clinic sent a letter saying, “Any plan to expand Medicare, which is the government’s largest public plan, beyond its current scope does not solve the nation’s health care crisis, but compounds it.”
The Washington Post took on the idea in a scathing editorial last week. “The only thing more unsettling than watching legislative sausage being made is watching it being made on the fly,” the editors wrote. “The irony of this late-breaking Medicare proposal is that it could be a bigger step toward a single-payer system than the milquetoast public option plans rejected by Senate moderates as too disruptive of the private market."
And even without the proposed buy-in, Medicare Actuary Rick Foster said in his latest report released last week that the Senate bill would increase health spending, cause millions of people to lose their current coverage, and cause at least 20 percent of Medicare providers to go under.
Clearly senators heard from their constituents who told them that expanding Medicare is a very bad idea.
It is a clumsy response to a problem that needs a much more sophisticated solution. Subsidies should be targeted to those who need help in purchasing coverage. Those with lower incomes, limited options to obtain group coverage, and difficulty purchasing insurance because of health problems, whatever their age, should be the first focus of reform.
Allowing everyone from an age group to buy in to Medicare is a blunt approach that would cause a cascade of unnecessary distortions in the existing market. The goal should be to help people purchase coverage they can keep over time, with security that comes from ownership of the policy and a guarantee that it can be renewed at a fair price.
Published in National Journal Online, Dec. 14, 2009.