Editore"s Note
Tilting at Windmills

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December 7, 2009

MEDICARE BUY-IN ON THE TABLE.... The story of the day is not Ben Nelson introducing a Senate version of the Stupak language -- the smart money is on it failing (I'd put the over/under at 43) -- but rather a "sweetener" for the left, to make another public option compromise more palatable.

Sam Stein, Ezra Klein, and Brian Beutler are all reporting the same thing: an expansion of Medicare eligibility is on the table.

Senate Democrats are discussing the idea of expanding Medicare by lowering the age at which the elderly could enter the government-run insurance program, Democratic sources on the Hill tell the Huffington Post.

The proposal would lower the age of eligibility for Medicare from 65 to 55, though an age limit of 60 has also been suggested. Crucial details -- such as the timing of the implementation of such a reform -- were not provided due to the sensitivity and ongoing nature of the deliberations. A high-ranking Democratic source off the Hill confirmed that such discussions are taking place.

Lowering the floor for Medicare is one of several ideas being discussed as a way to pacify progressives upset over the potential elimination of a public option for insurance coverage, one of the sources added.

Negotiations are, of course, still very much in flux, and all kinds of details would have to be worked out -- most notably, financing -- but in general, this will be appealing to many progressive lawmakers. After all, Medicare is a socialized, single-payer system that Americans know, love, and trust. Indeed, the starting point for many liberals is "Medicare for all." This, obviously, doesn't go nearly that far, but expanding eligibility brings that many more Americans into the system.

Ezra also helped connect this to the larger context of the talks: "The broader point is that the public option compromise is increasingly becoming a health-care reform compromise, and the focus is returning, usefully, to the goals of the bill. That's good for both moderates and liberals, as everyone who votes for this bill has a stake in seeing it work, and the intense attention to the increasingly weakened public option had begun to distract from the need to improve other elements of the legislation."

Steve Benen 4:05 PM Permalink | Trackbacks | Comments (34)

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HEY!!!!!!!!!! I am 55 and far from elderly!

Posted by: mat1492 on December 7, 2009 at 4:09 PM | PERMALINK

yah hoo!

all i got to do is throw my two daughters and three grandkids under the bus and go for the early medicare!

such a deal...not even sophie's choice...

whatta a country!

Posted by: neill on December 7, 2009 at 4:17 PM | PERMALINK

"Medicare for all."

But first, we have to mess with a couple of generations while we fidget and fine tune.

Posted by: Kevin on December 7, 2009 at 4:23 PM | PERMALINK

[...] expanding eligibility brings that many more Americans into the system. -- Steve Benen

And those Americans are younger and, presumably, a tad healthier than those currently in. Which would bring the costs down a bit. Not as much as Medicare for all would have done but...

Posted by: exlibra on December 7, 2009 at 4:32 PM | PERMALINK

So lower it to 55 and what else? mandatory private insurance for everyone else? What does that accomplish? Other than getting people pissed off?

Posted by: jay on December 7, 2009 at 4:40 PM | PERMALINK

As I approach 58 I do not think I am elderly either, but the notion of working full time until I am 65 is still awfully damn depressing. Whether I will have the money to safefully retire from full time work before then is in doubt, but the idea that I would have to work until 65 regardless of retirement savings because of health care would go out the window if they lowered Medicare to 60. If I retire at say 63, that means some young person will have a job opening up in the labor force two years earlier than would be the case without the change. I am hardly unique--there are a lot of people in their 50's and early 60's who want to work less hard or retire and keep on plugging away because of health care. And yeah a lot of are relatively healthy, but at our age can not run the risk of being wiped out by a single uninsured illness or have a good chunk of our retirement income go to pay insurance premiums.

Posted by: Terry on December 7, 2009 at 4:41 PM | PERMALINK

The argument that removing older people from the private market will lower costs assumes costs are drivin by something other than greed. They won't lower prices unless forced to through actual competition or a cap on costs.

Posted by: Jay on December 7, 2009 at 4:43 PM | PERMALINK

I really didn't expect to read the blogs today and being left with the desire to see Democrats and progressive bloggers burn. So this is what it feels like to be sold out?

You want to disenfranchise the up-and-coming progressive generations? This is a fantastic start.

Posted by: Sojourner on December 7, 2009 at 4:46 PM | PERMALINK

If 55 is elderly then shoot me now.

Posted by: Danny on December 7, 2009 at 4:49 PM | PERMALINK

I like this. It is not ideal because of the people left out, but ultimately a national health program that is basically Medicare For Everyone makes sense to me. This would be a good start, and could easily be expanded. Medicare For The Kids would be a comparative no-brainer, and if Medicare-For-The-Mature-MiddleAgers brings per capita costs down, then extending it to everyone who got left out the first time shouldn't be difficult.

Posted by: N.Wells on December 7, 2009 at 4:59 PM | PERMALINK

If 55 is elderly then shoot me now. -- Danny, @16:49

I'll be happy to oblige but, before I grab my gun, tell me: is your only objection to this version based on "God forbid someone notices I'm no longer 25"? Reminds me of my own father who, when told I was pregnant, objected loudly: "you mean I'm going to be a *grandfather*??? At my age???" He was well over 65 then...

Posted by: exlibra on December 7, 2009 at 5:03 PM | PERMALINK

The moral of this story is that when progressives in Congress actually make waves about proposed legislation not being in line with their values, rather than wringing their hands and crying “oh no how can we possibly get progressive legislation with a mere 60 Democrats in the Senate?”, the result is legislation that more closely conforms to their values.

Posted by: Seth Gordon on December 7, 2009 at 5:03 PM | PERMALINK

How 'bout we lower the eligibilty one year, per year? In 2074 newborns would be covered, and the incremental creep in coverage would be like the frog in the pot of water; too small for the Average American to notice.

Paying for it is another matter; however, it's late in the day, and my brain hurts.

Posted by: DAY on December 7, 2009 at 5:04 PM | PERMALINK

One side benefit: It will lower the size of the employment pool, which in turn would lower the unemployment rate.
And the people who would retire would be the relatively wealthy (net work > $1 million) who are in good health. These are the people who in the last generation retired early and enjoyed their golden years.

Posted by: RZ on December 7, 2009 at 5:12 PM | PERMALINK

Day @ 504pm
If you start to enroll newborns as well as regularly lower
the upper eligibility age it will happen faster.

This idea was in Max Baucus' paper from fall 2008
(The good Max Baucus) on HCR. It disappeared for ten months and now it re-appears.

I wonder what other items in that paper we will see again.

It disappeared for ten months.

Posted by: catclub on December 7, 2009 at 5:28 PM | PERMALINK

"Medicare is a socialized, single-payer system that Americans know, love, and trust."

No, not exactly.

Know and trust, to be sure; love? Not so much. Medicare suffers from problems not all that different from the rets of the system - it is the basis of "fee for service" and it's fees do not necessarily cover all of the expense of any procedure. Ask your mom or grandma about Medigap and co-pays and the billing systems involved... and it's not exactly love. What Medicare is, most of all, is politically unassailable - Medicare offers certainty, older voters like that, and when you tamper with it, they will vote in someone else. What that means is, serious attempts to reform Medicare will be hamstrung... and even more hamstrung when more people are in it.

Lowering the age by 5 or 10 years is simply cost-shifting; it's not the worst idea... but it's problematic, absent any serious attempt to figure out how to rethink how Medicare's whole program works (one thing this would easily do is hugely expand Part D, since the 55-65 bracket is about a lot of prescription drug care). The more you make the remaining pool of insured younger and healthier, the more you create artificial risk pools - one could argue that the insurance companies are successfully transferring the older (Medicare) and the sicker (poor people, via Medicaid) into plans where the government pays for care... that seems like exacerbating existing problems, not solving them.

Unfortunately, because so many progressives have not really examined all the complexities of our healthcare puzzle, this will look good and fit easy slogans (Medicare for all, or almost all, or something!), I suspect leaders are right that this will effectively squelch the rabid "Public plan or kill it" line of the left. That's what you get for making the public plan the be-all, end-all of discussions... alll anybody wants to do is figure out how the left, too, can be paid off for silence, and not ask other pesky questions (like "how can the states shoulder more Medicaid expense when they don't pay for what they're supposed to now?"). This may well be it.

Posted by: weboy on December 7, 2009 at 6:00 PM | PERMALINK

weboy @ 6:00 PM -

"...its fees do not necessarily cover all expenses..."
Oh, its fees definitely cover the expenses; they may not provide the profit margins some wish for, but that isn't the government's problem.

"...serious attempts to reform Medicare will be hamstrung..."
Only by those whose income will decrease; ie, pharmeceutical companies. Those who charge $1000 for a procedure/test that only costs #200-300 to do. You get my drift...

"...because so many progresives have not really examined the complexities of our healthcare puzzle..." weboy @ 6:00 PM.
Progressives HAVE examined the complexities of healthcare and that is exactly why the vast majority of us are in favor of government-run single payer health care insurance.

Posted by: Doug on December 7, 2009 at 6:32 PM | PERMALINK

Lower it to 35 and we'll talk.

Posted by: Steve Simitzis on December 7, 2009 at 8:56 PM | PERMALINK

"So lower it to 55 and what else? mandatory private insurance for everyone else? What does that accomplish? Other than getting people pissed off?"

Think of it as a public option at Medicare rates +0%, fully tied to Medicare acceptance, national in scale and open to a much wider percentage of the public than had been on the table hitherto.

It's not ideal, but it's a damned sight better than what it looked like we'd get last week.

Posted by: Anthony Damiani on December 7, 2009 at 9:12 PM | PERMALINK

Ask your mom or grandma about Medigap and co-pays and the billing systems involved... and it's not exactly love. -- weboy, @18:00

I asked my husband, who's been on Medicare for the past 20 years and the only thing he doesn't love is his age; at 85, everything hurts, no matter how good your healthcare. But, although we have the same doctor, he still gets half an hour or more for his annual while I, on a private plan provided by his U, now get 15 minutes. It used to be 20, but the U switched to Blue Cross/Blue Bullshit in search of savings... I'm 60 and can hardly wait to get to Medicare coverage, Medigap an'all...

Posted by: exlibra on December 7, 2009 at 9:55 PM | PERMALINK

Those 25y/o's that knocked on millions of doors for "Change!" will now be forced to pay a tax, err premium, to private insurance companies. They're supposed to take solace in the baby boomers getting the free goodies?

The compromise is always to give more to the baby boomers, that same generation that voted for Reagan and the Bushes, to cut their own taxes, to not pay for their retirement, to leave a massive economic burden on their children, to ignore the climate crisis, and to generally just trash the place.

Hope you boomers enjoy your greed till the glorious day you die, I can't wait!

Posted by: miguel on December 7, 2009 at 11:12 PM | PERMALINK

Well the public option was misnamed from the start because it's not an option to very much of the public. The public option should be to either enroll in Medicare or arrange for your own private insurance.

Posted by: FGS on December 8, 2009 at 12:10 AM | PERMALINK

Jeez Miguel, last time I looked the Democrats controlled Congress and the White House.

Posted by: Took on December 8, 2009 at 12:28 AM | PERMALINK

A step in the right direction.
ABOLISH Medicare Part D. That's the privatized part that enriches insurance and drug companies. Just scrap it. Medicare was in pretty good shape until Bush pushed that thru (and AARP.....ugh).

Clamp down on Medicare fraud.

Then roll it out to more people.

This makes sense as it doesn't create a new bureaucracy. It wouldn't require a 2000 page bill with lots of legal loopholes for Big Pharma and Insurance Companies.

AND enforce antitrust laws for insurance companies. Why should these vultures be exempt?

Posted by: clem on December 8, 2009 at 7:46 AM | PERMALINK

This isn't worth the public option. If they were full-on lowering the age, it would be one thing. I wouldn't do it, because shrinking the coalition for healthcare is the surest way to make sure further reforms never get accomplished. But at least it would be something.

All this is remove the ability to buy into a government program based on NEED and replace it with the ability to buy into a program based on AGE. That is a far inferior method.

Posted by: soullite on December 8, 2009 at 9:02 AM | PERMALINK

For younger people in good health, Medicare would actually be a good deal. Many healthy younger people just want a catastrophic plan.

When I'm saying younger people, I mean the 25 and up crowd.

Right now the elderly and disabled pay 25% of the premium. The young and healthy people could be charged a premium based on a sliding scale according to age, income, etc. If someone wants more coverage they could either buy a Medi-gap policy or go to a commercial insurance co and pay more.

The more healthy people that are in the system paying full premium prices, the closer to having the system be self-sustaining.

Posted by: wbn on December 8, 2009 at 9:11 AM | PERMALINK

Most importantly, to oppose this proposal, it requires the Republicans to argue against Medicare as an effective provider. They are now arguing against a public option and in favor of Medicare, which of course makes no sense.

Posted by: geodahir on December 8, 2009 at 12:01 PM | PERMALINK

How about instead we increase eligibility from the bottom up? You can be in Medicare if you are 0-10 or 65 or older.

Posted by: Kid Charles on December 8, 2009 at 1:03 PM | PERMALINK

removing older people from the private market will lower the costs assumes costs are driving by something other than mercenary.

Posted by: cristine on December 10, 2009 at 4:12 AM | PERMALINK

Hey, ok, I get it, I guess - but does this really work?

Posted by: rulett strategiak on January 3, 2010 at 10:57 AM | PERMALINK

This brings me to an idea:...

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Posted by: Maddox on March 12, 2010 at 10:31 AM | PERMALINK

Lustig, ich htte garnicht fr mglich gehalten, dass dies wirklich auch wirklich funktionieren kann :)

Posted by: roulette gewinnen on December 1, 2010 at 3:10 PM | PERMALINK

Da fragt man sich beim groben Durchlesen von www.washingtonmonthly.com ja schon, ob man selbst doof war. Danke fr Ihre Erluterungen

Posted by: gewinnen roulette on December 29, 2010 at 4:32 PM | PERMALINK



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