Is what Dean said on Maddow tonight feasible? Option c?

[t0dd]

is this something feasible that Dems would truly consider if they have to go the reconciliation route.. letting anyone under 65 buy into Medicare? Let them pay a monthly premium based on reported income and provide subsidies to those that need additional help? There are so many advantages to this since it wouldn't involve the creation of a new program and would obviously qualify for reconciliation because of budgetary impact. I mean, could 51 Senators support this idea? Imagine how popular this would be. Imagine a 50 or 55 year who cannot afford private insurance being told he doesn't have to wait 10 - 15 years for Medicare. And finally, something like this could be up and running in 2010. I mean, help me understand the drawbacks or what the opposition to this would be. Thanks!

[napi21]

1. I think it could be supported by many IF they upped the

Medicare rate of reimbursement. I listened to the markup yesterday and the biggest complaint, by the Sens from small, mostly rural States, was that the hosps in their States would go out of business if they had to depend on the current rate because it's only 80% of costs. There has been some talk of increasing the rates within this HC bill, which would be a great thing.

[Selatius]

6. When they passed the NHS in the UK at the end of the 1940s, they basically did something similar.

They got the bulk of the doctors on board by, essentially, "throwing gobs of money at them." Some doctors were worried the government would pay them dirt cheap to cover everybody, so they held out until they got something out of the deal, too. It passed. The transition took something like five years, but they transitioned over to the current system the UK uses.

Of course, the NHS is nothing like Medicare. The VA system has more in common with the NHS, yet the problem with Medicare reimbursing only 80% of costs is basically not too different than the objections doctors raised when British Parliament debated the National Health Service Act.

Raise the reimbursement rate back up to 100%.

[karynnj]

13. I heard that too - but there is likely more analysis needed before raising the rates

Currently, "costs" are really the loaded cost to cover the people who cannot pay. From some of the numbers thrown around - one being that approximately $1,600 of any premium is really the "tax" for people who can't pay, it is possible that as much as half of gap is because of this load - that should be greatly minimized by this bill extending the percent covered.

I agree with you that it would be great to increase rates to reflect costs. The entire current system with medicare, medicaid and private insurers all negotiating cheaper costs than people unfortunate enough not to have insurance pay is a mess.

[DesertFlower]

2. it makes so much sense. nt

[Oregone]

3. "I mean, help me understand the drawbacks or what the opposition to this would be"

Many people, despite a middle-class income, are on budgets that would not allow them to buy in out of pocket, and therefore trap them into their existing employer provided plan (which may be a piece of shit). A plan like this should also contain legislation similar to Wyden's amendment, such that ALL Americans can not only do it, but they may also get their employer to cover 70% of the cost. Just because one doesn't qualify for subsidies doesn't mean they can freely reject an employer plan and spring for buying in. Other than that, this would work good to mitigate the disaster that mandates would bring.

[DeSwiss]

4. It's the simplest and most efficient way to provide everyone with an affordable healthcare option.

- Which almost guarantees they'll never do it. It makes too much sense.

K&R

[eridani]

5. I think that if you are going to go for incrementalism, this is the only thing that would work

It's main advantage is that people could benefit immediately, thus avoiding the political shitstorm of going through two election cycles with no visible improvement in anybody's situation.

[eomer]

7. The way you've stated this, it would fail.

I'm assuming you mean that you would also eliminate the pre-existing condition exclusion, since everyone seems to assume that is part of the solution.

But if you eliminate the pre-existing condition exclusion and you let anyone who wants buy into Medicare, then why would anyone buy into it while they are healthy? While you are healthy you could just opt out and save the money or spend it on more gadgets. Then later on when you get a major illness you can opt in and there is nothing to stop you.

If the premium that is charged for this program is equal to the full cost of providing benefits or anywhere near that full cost (as is implied by the phrase "buy into Medicare") then it will be way too expensive for anyone to afford because you will have just the people who have already come down with major illnesses trying to share the costs among themselves.

This proposal is lacking a mechanism to get people to pay in in advance in exchange for a promise that, if they are the unfortunate ones who experience losses, those future losses will be covered. In other words, it is lacking any mechanism that turns it into an insurance arrangement where the costs of the unlucky few are spread broadly across a large group who are all exposed to the risk but don't yet know which ones it will end up affecting.

Some may recognize this point I'm making as one that I've posted more than several times so far. Sorry to be a broken record, but I am an actuary and feel obligated to explain these issues and will keep doing so whenever I see this proposal put forth. There surely are ways to remedy the problems with this proposal. Some of the remedies would render it similar to the system we've already got (with a pre-existing condition exclusion). The best remedy, if you ask me, turns it into single payer, universal Medicare for all, which is obviously one of the major proposals that is already discussed. Another remedy would be to require everyone to buy into one option or another and offer the "buy into Medicare" as one of those options, which is similar to HR 3200 but with Medicare filling the role of the public option.

So there are some ways you could turn this into a viable approach. But the simplistic way that it is often proposed, as you've done it here, will not work.

[Cetacea]

8. It's a great plan. Fingers crossed.

[madokie]

9. Me being one of the original Deaniac's I may be biased :-)

but if Dr Dean said it I believe it to be true and very possible. No one in my life time has given me more hope in my heart that if we work together many good things can happen. For instance like us hiring/voting in our present President. Yes America is on the right road, albeit a rocky one and one that is sorely in need of a rebuilding but guess what, we're up to the challenge

[lostnfound]

10. "The Firewall"

What the D's aren't talking about much is 'The Firewall'. That's the term to mean that those of us with private insurance will be STUCK with private insurance and not given the opportunity of getting out of it, because that's how the insurance companies can keep ripping us off and making obscene profits. Otherwise tens of millions of people will flock to public options (like medicare) if it were permitted.

The purpose of this 'firewall' ought to be examined ad nauseum so that everyone understands that it is a means of keeping the likes of us "penned in" like farm animals. It also illustrates the role that "choice" plays in this debate -- i.e., We Aren't Being Given One.

[cascadiance]

12. And with those of us now on COBRA, do we have to keep that or can we opt in for public option?

Though many of us on COBRA now will long have our benefits run out before this bill would take effect.

[cascadiance]

11. Might have to adjust the payroll tax rates though...

Currently as a regressive tax it funds both medicare and social security. And of course we know it is regressive so that it only gets taxed on first $100k or so of income. I would recommend removing the cap altogether and lowering the rate so that it is a flat tax that hits everyone with the same percentage and doesn't raise tax on those between $100k and $250k. If that adjustment can be made and have both Social Security and Medicare solvent for everyone, then that would be the way to go. Would even serve as a tax cut to many under $250k too, since they'd have less liabilities on company payrolls with that adjustment than those making over $250k with the present setup.