Medicare Part E: Everybody

[thomhartmann]

The President this morning admitted on national television that he lost control of the message with health care. It's time to reboot - and use a very, very, very simple message so all Americans can understand it.
Let's use Medicare, which nearly every American understands. Just create "Medicare Part E" where the "E" represents "everybody." Just let any citizen in the US buy into Medicare.

It would be so easy. No need to reinvent the wheel with this so-called "public option" that's a whole new program from the ground up. Medicare already exists. It works. Some people will like it, others won't - just like the Post Office versus FedEx analogy the President is so comfortable with.

Just pass a simple bill - it could probably be just a few lines, like when Medicare was expanded to include disabled people - that says that any American citizen can buy into the program at a rate to be set by the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) which reflects the actual cost for us to buy into it.

Thus, Medicare Part E would be revenue neutral!

To make it available to people of low income, Congress could raise the rates slightly for all currently non-eligible people (like me - under 65) to cover the cost of below-200%-of-poverty people. Revenue neutral again.

This blows up all the rumors about death panels and grandma and everything else: everybody knows what Medicare is. Those who scorn it can go with United Healthcare and it's $100 million/year CEO. Those who like Medicare can buy into Part E. Simplicity itself.

Of course, we'd like a few fixes, like letting negotiate drug prices, and fill some of the other holes Republicans and AARP and the big insurance lobbyists have drilled into Medicare so people have to buy "supplemental" insurance, but that can wait for the second round. Let's get this done first.

Simple stuff. Medicare for anybody who wants it. Private health insurance for those who don't. Easy message. Even Max Baucus and Chuck Grassley can understand it. Sarah Palin can buy into it, or ignore it. No death panels, no granny plugs, nothing. Just a few sentences.

Replace the "you must be disabled or 65" with "here's what it'll cost if you want to buy in, and here's the sliding scale of subsidies we'll give you if you're poor, paid for by everybody else who's buying in." This creates Part E.

And if this fails - if the Congress can't get out from under their corporate overlords - at the very least pass the Kucinich amendment that will allow individual states to create their own single-payer systems, as was done in Canada a generation ago.

[Overseas]

1. K&R. Yes please. I agree.

I just wrote my senators and congressperson to let them know--

Headline: The triggers have already been blown off their hinges.

Last time they defeated Democratic attempts to introduce national health insurance, the private insurers told us they could do better. They have failed miserably.

The triggers for fair behavior have blown off their hinges-- millions more are uninsured and millions more are bankrupt from medical bills.

Private insurers have been given decades to show us they could manage things better than the government. Enough is enough. They have definitely failed. And yet they have gone ahead and spent millions on very reckless professional bullying to protect their private profits. I'd say professional bullying is blowing another trigger of decency and should not be rewarded.

I need Medicare now. Age is a pre-existing condition. My premiums cost employers 300% more than those of a 30-something. So my 25 years of experience and good references have a lot to overcome in this job market.

I sincerely hope President Obama stands strong on the public option. I want Single Payer, Medicare for All who choose it, as the public option.

Sincerely yours,

So yes, I'd love to be able to apply the nearly 300 per month I pay for a very high deductible just-in-case I meet a devastating health emergency (in which case I don't even know how much coverage I'd really get), to get Medicare Part E.

Yes, please! Medicare Part E sounds great.

[Doctor_J]

2. Yes! It's simple, familiar, proven, and all of those teabagging seniors

will be brought back from Beckland to the real world.

[Boku-Wa]

3. This certainly reasonable and I suspect achievable (I'm not a health care wonk).

This is the type of proposal the Obama administration SHOULD have floated at the start, given their unwillingness to even entertain single payer.

Clearly the 'debate' has been controlled by the wacky right, Repugs, blue-dog traitors and corporate interests, though the latter appear to have taken a back-seat regarding public comment. (Why do THEY need to say anything with the 24/7 right-wing media and the others - including turncoats like Baucus - doing their bidding?)

The Medicare proposal addresses a number of issues the administration neglected to address. A major and critical issue is simplicity to insure the public understands the proposal and make it more difficult for the opposition to malign.

It also would have neutralized retirees who have been an element of the shock-troops at town hall meetings, assuming they were assured from the start that their rates would not increase as a result, nor would services be reduced. Increasing the number of people in the system, especially younger workers, could be beneficial.

Obama has made a grave error by framing the issue as health insurance reform and focusing on the costs. He should have led with it being an expansion of health care coverage and a way to insure that the coverage everyone is both affordable AND provides real security.

[glinda]

4. Agreed. Health Insurance is a Ponzi Scheme.

[drm604]

5. I've heard that Medicare is relevant to the budget

and therefore can be modified in reconciliation. Anyone have any cites as to whether or not that's correct?

If it is correct then this could be done without needing 60 votes.

[silverweb]

6. Please.

:thumbsup:

[tex-wyo-dem]

7. Perfect!

I would love it if tonight Obama said "the Public Option is dead," instead the Democrats in congress and the WH will promote a new plan...a Medicare buy-in program open to anyone.

This makes perfect sense. In addtion to making simple modifications to an existing program, one could argue that, if designed properly, revenes from the buy-in could help keep Medicare solvent (revenue neutral) and reduce costs even more due to the suddently larger and ever growing pool.

Politically speaking, it basically blows up all of the stupid talking points and scare tactics the RW has been relying on to fire-up their base.

[LSK]

8. Thanks Thom, feel free to steal my avatar

:hi:

[wildflower]

9. I heard the discussion on the show today of Walmart and the public option

Or the public option as it's currently written. Very depressing.

[drm604]

10. Walmart and the public option?

What were they saying? How are the two related?

[wildflower]

11. I'm sorry, I should have expanded on that...

He was saying that right now, people working for Walmart can opt out of the Walmart insurance plan (because it covers so little with high cost), and get Medicaid.

But under the current plan, they wouldn't be allowed to opt out and get Medicaid or the public option. Because all the bills have a provision that says if your employer offers insurance you can't get the public option or Medicaid.

[OwnedByFerrets]

12. Yeah, that part sucks big ones

[Overseas]

13. President Obama used the bully pulpit for a noble purpose.

While I longed to hear a clear public option endorsement, and bristled when he called out The Left (what was the center 20 years ago), he said a lot of things that needed to be said. Especially in this era of the dominance of broadcast media, sadly conglomerated into right wing hands. So the speech was quite effective-- The Emperor Has No Clothes. This is not a game for most of us. It is as serious as Homeland Security. So President Obama's call to Republicans to cut the crap and come to the table and get real was actually quite effective.

And let's face it--

The private insurers really went to town during the Bush years-- got more and more bold about jacking up their profits by dumping the sick and charging companies 300% more for daring to hire older workers. They zoomed right along, taking full advantage of the Bush Cheney pro-corporate mandate. I hadn't heard the new term "recision" (even spell check doesn't have it) until recently-- aka dropping coverage, but recision sounds so much more clinical and dispassionate, doesn't it?

They figured out how to increase a 4% overhead nonprofit system into one that gets 25% !! Woo hoo !!

They figured out how to lobby really well. How to support the legislative process. Backed up with how to hire the right folks to bully and intimidate the opposition. Amoral right wing PR firms that gin up dangerous fear and hatred in vulnerable populations, "genuine grass roots groups" that have "been around for years" (just oddly dormant during Republican administrations).

They have clearly demonstrated their power for decades. So our President seems to have been trying to find a way around that block of bullies. And we always said we would like to have what those politicians themselves get, and by golly, he's setting that up for us. That will be interesting. How will Republican Congresspeople be able to go around telling us we shouldn't have what they now get? They look pretty healthy to me. Even Boehner and his spray tan.

So although I want the leeches out right away, there were indeed some magnificent aspects to his speech. Our President told us all what the conservative-dominated media has been trying to promote as the dominant topic was a fraud. That needed saying. The Emperor has no clothes. People with whom we have been trying to have a meaningful debate have been distorting the issues. We all know it. Yet the main broadcast news channels pretend it is not so. Unfortunately, all that needed to be said. Calling the right wing out on their posturing fake dialog and delay tactics was a great use of the bully pulpit.

Republicans warned him not to go after them. It wouldn't be seemly, I believe Mitch McConnell said. Gee, why not have Pull the Plug on Grandma Grassley give that statement? I'm glad President Obama ignored those warnings. He said a lot that needed to be said. What we know in our living rooms. This is not about ideology-- this is about national security. Real terror we feel at our kitchen tables.

((That's why I'm pissed that we don't just do Medicare for All, from our taxes, pure and simple. A national security issue-- health security for all. BUT I REALIZE-- that is the anathema of the right because it would be a tangible good feeling from the abominable act of paying taxes. We can't jump in there because that's where the mega-machine of private profits roars to the fore full fury. And even their cheap bullying this summer has been dangerous enough.))

So I guess we've got to take baby steps. So I'm glad we're actually taking adolescent steps. To reassure everyone, we'll start with the existing framework. Give our constituents what those in congress have-- an insurance exchange. It's what our congressmen get. I haven't heard any complaints from them. That plus a tiny public option-- letting me buy into Medicare, would be just fine.

[ThorDem]

14. A good idea

and I support it. It's succinct, it grabs the senior citizen vote and it wins.

[Mithreal]

15. Enthusiastic K&R nt

[Libertas1776]

16. That sounds like a very reasonable, lucid, realistic and fiscally responsible proposal ...

...which means Congress will never vote for it.

[AllyCat]

17. As always, I agree with you on health care for everyone. Great idea.

What do we do? I call my Congress Critters WEEKLY, write LTTEs, am active in my union's work to get health care reform, talk to all my co workers (including the MDs, all except 3 of whom support single-payer). What else can we do?

[eomer]

18. Call it Medicare Part "S".

"S" for sick-people-will-be-the-only-ones-who-will-opt-in.

Maybe that should be Medicare Part "SPWBTOOWWOI", but that would be harder to remember and less catchy.

Because there would be no reason for well people to pay for health insurance if they know they can get it later when they get sick.

That system would be great except for the fact that it will surely come crashing down in a huge failure. Why? Because the rates you would have to charge if only sick people are paying will be wildly prohibitive.

You are missing an essential element of any insurance system: a way to get people to pay for the protection during the time that they don't know yet whether or when they will end up needing it.

Edit to add: Whoa! I didn't notice your forum name. Welcome to DU from a great fan!

[ima_sinnic]

19. wrong. I'm not sick but I want some routine preventive tests like mammograms, etc.

I haven't seen a doctor in years, and I have no idea of the status of things like cholesterol and so on--the things you're supposed to have checked periodically?
I'm self-employed and would jump at the chance to enroll in Medicare.
As a matter of fact, in 1-1/2 yrs I'll be 65, so will finally get to see a doctor. I am hopeful nothing serious comes up before that time in my health.

[eomer]

20. Wouldn't it be cheaper for you to just pay for the checkup?

If you knew that you could sign up for Medicare, no questions asked, no pre-existing conditions excluded, then it would probably be cheaper for you to just pay for a checkup a couple of times a year and only sign up if and when you find that you need a treatment whose cost will exceed the annual premium. I say this in the context of some new Medicare Part E as proposed in this thread.

[ima_sinnic]

21. I haven't really priced checkups but assume they are exorbitant

In addition, I believe it is fairly difficult for uninsured people to even be seen by doctors. I have grown to hate doctors with every fiber of my being anyway. I remember years ago accompanying an uninsured person to an orthopedic surgeon. The doctor was condescending and rude and demanded money up front before she would even see this person. Doctors are greedy pigs, in it for the money only. Now they get great kickbacks for peddling drugs that later end up as the subject of lawsuits because the testing process has been so truncated, so I would also question the necessity and wisdom of all the pills they are so quick to prescribe.

[eomer]

23. You also don't know what the cost would be of this proposed Medicare Part E.

In the simple form proposed here in the OP I believe it would be very expensive because it would end up as a dumping ground for people rejected by private insurers due to pre-existing conditions and every other cherry-picking technique they can dream up.

I'm betting it would cost more to buy in to this kind of Medicare than it would to pay for a couple of checkups a year.

[Lydia Leftcoast]

29. Or for people who are price-gouged by private insurance

as just about anyone over fifty years of age on the private market.

I'd say lower the age of eligibility by five years every year. The influx of younger, healthier people would shore up Medicare's finances.

For just about any self-employed person over the age of fifty, Medicare would be a better deal than anything private insurance has to offer.

I mean, I have to pay $13,000 out of pocket per year (premiums plus deductible plus co-pay) before I'm 100% covered, and I have a $2 million lifetime cap. If I'm silly enough to get sick out of network, my out-of-pocket goes up to $28,000.

And I have it GOOD compared to a lot of people my age. I hear of many, many people who pay such exorbitant premiums that seriously, they'd be better off without insurance and just putting the money in the bank.

Don't tell me that only sick fifty-year-olds would take Medicare. Even though it's not free, it's a hell of a lot better than $13,000 out of pocket.

[Bette Noir]

25. Doctors don't accept private-pay patients.

Once a therapeutic relationship is established, a doctor isn't allowed to refuse treatment. Therefore, they don't accept new patients who might, sometime in the future, come down with something they can't afford to pay for.

[eomer]

26. Thanks for that information.

You got me googling it and it looks to me like the law is a bit more complicated than you imply (isn't it always). For example:

Even given these limitations, there are some circumstances when a physician can "fire" the patient in non-emergency situations. One such circumstance is the patient’s unwillingness or inability to pay. However, caution must be exercised in this situation. Courts are split on whether a patient’s inability to pay or lack of insurance justifies a physician’s termination of the physician/patient relationship, especially when the patient continues to require medical attention.

If the patient is not currently receiving treatment and fails to pay, the physician may terminate the relationship after giving the patient reasonable notice and sufficient opportunity to secure another physician. Similarly, at least one court has found that a physician may terminate treatment when the physician no longer participates with the patient’s health plan by informing the patient of the change and giving the patient a list of providers that participate with the health plan or obtaining the patient’s agreement to pay out-of-pocket for the medical services provided.

http://www.physiciansnews.com/law/202.html

But perhaps the end effect is the same anyway -- that doctors won't take private-pay patients. Although, even that I would question whether it is as absolute as you imply -- are there no doctors anywhere who will take private-pay patients? There is one doctor here in S. Florida who recently was awarded the President Medal of Freedom. http://en.wikipedia.org/wiki/Pedro_Jos%C3%A9_Greer">Dr. Greer treats homeless and other disadvantaged people. I'm sure there are doctors here and there who will treat a patient without insurance. But perhaps they are hard to find, meaning you would still be substantially right in what you said.

[bertman]

22. It'll never work. Too simple and easy. Congress is incapable of legislating anything that

beneficial to ordinary citizens.

But it's a MAGNIFICENT idea and I wish the President had listened to you, Thom.

Recommend.

[Bluenorthwest]

24. Sad that our leadership positions are such bad gigs

that good minds reject the public sector and electoral politics. Which means that instead of this wonderful idea we get great rhetoric about terrible policy.

[dccrossman]

27. Force the congress critters onto it as well

I think a part of getting that would be to force all congress critters and their aids onto the Medicare rolls from their current exchange.

That would "encourage" them to make sure its fully funded.

:kick:

[change_notfinetuning]

28. Or make Congress critters independent contractors. They'd have to get

their own damn insurance. Who knows what options they might come up with then?

[midnight]

30. Beautiful.... Why do the K street, insurance industry, have their

big agendas in the way. American's for access to real medical treatment has got to get on the tracks. This could get the engine back on line. I regret that I did not read this within that 24 hour period because it deserves more recognition.

[GOPBasher]

31. I'm upset that I was too late to recommend this. I completely agree.

What you're saying is better policy AND better politics than having a new, separate program just for people who don't qualify for Medicaid and Medicare. I say put it all together into one government program. The people who now qualify for Medicaid will get Medicare for free. For seniors who already qualify for Medicare, nothing changes. And for the people in between, they can all buy into Medicare for an amount that is on a sliding scale according to their income and wealth. End of story.