So today’s news is that the gang of ten have come up with something. (If you haven’t been following along, the gang of ten are the five “liberal” Democrats and the five DINOs asked by Harry Reid to come up with something to break the deadlock and get some type of compromise that will pass the Senate). More details are here from Brian Beutler at TPM
So it might vanish like a Clinton-era trial balloon, or it might be a stayer, but the core of the new concept is to allow the 55–64 crowd to buy into Medicare, and to ask/allow/mandate a non-profit insurer(s) to provide a substitute public option. Exactly what the second point means is unclear to me. It may turn out to be some collapsing of Kent Conrad’s notion of the cooperative with an extension of the Federal Employees’ Plan (presumably minus the for-profit carriers) and somehow cramming that into the exchange. Of course providing something like the choice among private plans that Federal Employees now get was at the heart of Ron Wyden’s plan. We’ll see if it can last a couple of days scrutiny, or the wrath of the House Democrats.
The Medicare buy-in seems both sensible politics and half-decent policy.
As Suzy Khimm points out, associating the public option with Medicare improves its polling scores. But it’s also not bad policy as many of the most desperate uninsured are those in that age group. Although the rate of uninsurance is relatively lower amongst those 55–65, in most states it’s very hard for them to get insurance in the individual market and of course they have the highest costs of those below 65. The other good political and policy news is that they’ll be able to buy-in in 2011, not having to wait until 2014. It also appears that Medicare will be offered to people 55+ in the exchanges post 2014, so they’ll be able to use subsidies to buy it then. What the premiums required to buy into Medicare will be is also uncertain. Currently the 65+ population average around $16,000 a year while those 18–64 cost about $6,000 (my rough extrapolations from 2004 numbers). So perhaps the unsubsidized age-adjusted premiums would be $10,000 a year. A hell of a lot but not completely out of the question for many near-seniors who are working, may have paid off the mortgage and can’t get insurance at all now.
Writing on THCB six weeks ago (and on Health Affairs blog too) Jeff Goldsmith suggested the Medicare buy-in and to be fair he noted that it has had something of a life as floated-but-never-enacted-proposal over the years. Presumably some bright staffer read his article. And that’s why it’s in the mix today. After all in the past two years of campaigning and debate it never seemed to come up.
I’m somewhat reminded of the stories about how LBJ crammed Medicare and Medicaid into the bill in 1965 when both groups (the former New Dealers supporting Medicare for all and the AMA opposing it) both got some aspect of what they wanted. But although Medicare and Medicaid solved some problems, that whole mess created lots of others—all due to the political necessities of the time. I suspect that if this compromise holds true, there’ll be some improvement, but also plenty of unintended consequences too.
But is this any way to create sensible social programs? Stop me before I go off into vague ramblings about how Stalin won World War Two by collectivizing the Kulaks…..
Categories: Matthew Holt