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Lieberman: Medicare buy-in 'duplicative'

liebduplicative.JPGBenjamin Sarlin at the Daily Beast gets a more substantive response from Lieberman's office. Lieberman, it seems, will filibuster this bill because he considers Medicare buy-in to be "duplicative":

"Senator Lieberman has long been concerned about making health care more affordable, especially for those over the age of 55 and not yet eligible for Medicare. One idea that has been discussed for years is expanding Medicare to people younger than 65," Masonhall explained to The Daily Beast via e-mail. "Senator Lieberman's comment reported by the Connecticut Post in September was made before the Finance Committee reported out the Baucus bill, which contained extensive health insurance reforms, including a more narrow age rating for pricing health insurance premiums and extensive affordability credits that would benefit this specific group of individuals.

These health insurance reforms and affordability credits have been strengthened in Senator Reid's Patient Protection and Affordable Care Act and will provide even greater relief for those 55-65 years old. Any inclusion of a Medicare buy-in for that same age group would be duplicative of what is already in the bill, would put the government on the hook for billions of additional dollars, and would potentially threaten the solvency of Medicare, which is already in a perilous state. The senator also has concerns that this provision would result in cost-shifting that would drive up premiums for others, including those with employer-based coverage."

There are a lot of policy words in that response, but not much that clarifies his opposition. The "duplicative" argument is peculiar enough that it should probably just be ignored. Letting people choose Medicare as an option is no more duplicative than letting people choose to mail packages at the post office. As Lieberman has said previously, the point is that Medicare is cheaper than private options, and that's still the case. And if it wasn't the case, no one would buy it, and none of this would matter.


Next up: Would the government be on the hook for more money? No. In health-care reform, the money follows the people, not the other way around. Subsidies are guaranteed to people without employer-based insurance and beneath a certain level of income. Whether the people use those subsidies to purchase Medicare coverage or buy a plan from Cigna doesn't matter from the point of the government. And the subsidy levels are tied to the price of the cheapest qualifying plans, no matter who offers them. Medicare, in other words, could drag the price of the subsidies down, but not up.

Would this harm Medicare's solvency? Again, no. The Congressional Budget office examined a similar proposal and concluded that it would improve Medicare's finances. First, Medicare would get healthier customers, which means they'd spend less. Second, Medicare currently spends more than necessary because it gets a lot of people who haven't had access to health insurance for years, and thus have expensive conditions that could have been prevented. Now, CBO figured, those conditions will be caught earlier, which again means Medicare will spend less, and also means that the people will be healthier.

And finally, it's hard to credit the idea that these concerns formed the basis for Lieberman's objections. The CBO is expected to render a verdict on the Medicare buy-in proposal later this week, and then we'd know the precise answers to these questions. Lieberman moved in advance of the CBO's proposal, which is to say, he did not wait for the answers to the questions he now says drove his decision. It is a measure of my respect for Lieberman, actually, that I don't buy this explanation.

Photo credit: By Jonathan Ernst/Reuters

By Ezra Klein  |  December 14, 2009; 5:54 PM ET
Categories:  Health Reform  
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Comments

Lieberman ALWAYS is thinking deep and standing on principle...he is the last Honest Man in the Senate. Here's another example of his judgement and moral courage: "Sen. Joe Lieberman praises pastor who said Holocaust was God's work"

http://www.haaretz.com/hasen/spages/1004845.html


Posted by: brucds | December 14, 2009 5:58 PM | Report abuse

If the Medicare buy-in and public option trigger could both pass with reconciliation, why not drop those now, pass the rest of Reid compromise bill, with Sen. Lieberman's blessing, then come back later with the buy-in and public option trigger in a reconciliation bill in a few weeks? I agree that Sen. Lieberman's stated reasons for opposing the gang of 10 compromise do not hold water, but wouldn't this strategy get what most people want in the shortest amount of time?

Posted by: DavidDavidovich | December 14, 2009 6:00 PM | Report abuse

To DD. I have been proposing this for weeks. Get the popular parts of HCR through the 60 vote process in the senate and then use the 51 vote route for the public option and medicare for 55-64 (Why not let anyone who wants to buy into medicare, each young person in medicare makes the program stronger because young healthy people pay more than they get.) I know it offends the comity of the senate to use reconcilliation but the senate survived when bush used it for tax cuts.

Posted by: srw3 | December 14, 2009 6:07 PM | Report abuse

"Any inclusion of a Medicare buy-in...would put the government on the hook for billions of additional dollars, and would potentially threaten the solvency of Medicare, which is already in a perilous state."

This would have been true 3 months ago, when Joe supported the idea of a Medicare buy-in, so it can't be used now to justify his current opposition of the idea.

Posted by: tnoord | December 14, 2009 6:10 PM | Report abuse

The question isn't what Joe considers ideal or possibly "duplicative" - the issue is why does this guy feel a need to scuttle any legislation that he doesn't 100% agree with by threatening a filibuster. He is welcome to vote against the bill, but this prima donna narcissism that sets up Joe Lieberman as the man who determines not whether he approves of the bill in its entirety but who gets to decide whether other Senators even get to vote on it is nauseating. The fact that he supported the medicare buy-in three months ago shows it not to be the type of issue that one can claim extreme objection to justify one filibustering the entire bill on "principle." This is bull - Ezra was right from the start. It's a personal drama starring the indispensable man, "Lieberman!"

Posted by: brucds | December 14, 2009 6:22 PM | Report abuse

Nice conclusion.

“I won't insult your intelligence by suggesting that you really believe what you just said.” -- William F. Buckley.

Posted by: eelvisberg | December 14, 2009 6:25 PM | Report abuse

Medicare already has a $37 trillion unfunded liability and is projected to be insolvent by 2017 - and perhaps sooner if tax reciepts prove lower than previously expected due to continued weakness in the economy. Any savings generated from reductions in waste and fruad in the current Medicare program should be applied to improving Medicare's finances, not expanding coverage.

The suggestion that expanding the number of beneficiaries will improve Medicare's finances because the newcomers would be healthier is specious. Any improvement would come largely from subsidies from still-younger and healthier taxpayers who would not be eligible for the benefit, some of whom are currently uninsured and may remain so. It's perverse to tax the young to benefit the comparatively wealthier late middle-agers, most of whom already have coverage.

What's more, the CBO's 10-year cost projection for the plan is tantamount to fiscal fruad because it has been asked to tally 10 years of new tax reciepts against only approx. 5 full-year's worth of benefit.

When you are in a hole - as we most assuredly are - the first order of business is to stop digging. While it is highly desirable to extend coverage to more Americans we can't afford it at this time. Let's not put trillions more on the country's credit card. Any expansion of coverage should be paid for out of actual savings achieved from reforms to government programs, cuts in other, less vital government programs and new taxes, not from *projected* savings that may well never materialize as Congress has repeatedly demonstrated it lacks the will to cut fees to physicians and hospitals.

Obama and the Democrat leadership are trying to pretend we can have our cake and eat it, too. We can't afford to play along. Make them come back with an fiscall-responsible plan.

Posted by: tbass1 | December 14, 2009 6:26 PM | Report abuse

tbass, you take a stab at making a good argument, but almost all of the health care reform bill DOES pay for itself with either tax increases or spending cuts, and does not assume much in the way of projected savings. You should read Atul Gawande's new New Yorker article, which eloquently makes this point as part of his larger thesis: http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande?currentPage=all

Posted by: Chris_O | December 14, 2009 6:41 PM | Report abuse

Make them come back with a fiscally responsible plan to make sure there's enough left in the bank to fund the next Republican war...

Posted by: NS12345 | December 14, 2009 6:47 PM | Report abuse

Not to mention that Lieberman actually opposed the Finance Committee bill itself.

Now you could argue that adults ages 55-64 would save more from the Exchange's generational subsidy from the House's and the Bay State's rating rules (2:1 age rating, no smoker rating) than from basically an individual rating -- hey, we're putting those ages 55-64 in a pool of people their age -- with Medicare's bargaining power. But not with a 3:1 age rating (the current Senate bill) and a 1.5:1 smoker rating -- let alone the 4:1 age rating in the Finance Committee bill that Lieberman said he opposed.

If Joe Lieberman wants the power of the 60th vote, he ought to accept the responsibility of being the 60th vote. That means coming to terms with and accepting responsibility for the human consequences of his actions. As Spiderman learned, with power comes responsibility.

I'm just glad Joe Lieberman doesn't have to worry what happens when you're a waitress, and all you can afford is a $10,000 deductible policy, and you suddenly receive a phone call that your 14-year-old son is in the hospital after having a blackout in class. I wish more people had Joe Lieberman's luxury over fighting over who does the paperwork.

Posted by: BradGabel2002 | December 14, 2009 6:50 PM | Report abuse

Ezra,

You make an important point that you should tell David Himmelstein:

"Would this harm Medicare's solvency? Again, no. The Congressional Budget office examined a similar proposal and concluded that it would improve Medicare's finances."

Himmelstein recently wrote in the New York Times' Room for Debate:

"Now the Senate plans to take some of these high-cost patients off private insurers’ books, and make them Medicare’s problem. Consequently, the costs of this Medicare buy-in will be high — both for patients and for the taxpayers who will subsidize the near-poor starting in 2014."

He also wrote, "Medicare for All won’t grow from the Senate compromise, but from its ashes." Apparently, he's unphased by the fact that single payer didn't arise from the ashes of the last one-hundred years of failed attempts, and the trend has been for each new attempt to become less, not more, modest. He also seems to be unphased by the many success stories of initially weaker programs becoming progressively much stronger and better over time, like Medicare and Social Security for our seniors.

Quotes at: http://roomfordebate.blogs.nytimes.com/2009/12/10/medicare-for-50-somethings/

Posted by: RichardHSerlin | December 14, 2009 6:57 PM | Report abuse

If any serious, Sen. Lieberman's office have to rebut answers provided by Ezra. In wonkery and policy analysis; I do not thing Sen. Lieberman's office has any chance of succeeding against what Ezra is arguing rightly here.

Question is with what 'powers be' at WaPo will come back.

Posted by: umesh409 | December 14, 2009 7:00 PM | Report abuse

Just more Lying Lieb. Once one lie is exposed, come up with a new one. When that's exposed, then a new one.

I look forward to Fred Haitt giving Joe a spot on the Op-Ed page in the next few days to "explain" himself, without there being an equal rebutal piece.

John

Posted by: toshiaki | December 14, 2009 7:09 PM | Report abuse

Chris_O,

Ezra himself has previously conceded that there's very little in the way of real cost control in these bills. Because the bills aim to cover tens of millions more people, many of whom cannot pay their own way and have been underserved in the past, total costs are going to go up significantly -- much more than the $900 billion Obama suggests.

I commend the Democrats on demonstrating some concern with (at least the appearance) of paying for the additional cost but I think they have relied heavily on accounting tricks and heroic assumptions to do so. What's more I fear, as with the Medicare program itself, costs will prove to have been significantly underestimated.

Therefore, I would like to see a much more modest plan the expands coverage incrementally as savings are achieved and I would like to see it married with reform of the Medicare system to put it on sounder financial footing. It strikes me as the height of irresponsibility to create a massive new entitement that builds on a program only years from insolvency as the country's deficit is ballooning to historic levels. Indeed, I think it may push the country itslef closer to insolvency.

Posted by: tbass1 | December 14, 2009 7:58 PM | Report abuse

Ezra, I don't suppose there's any chance you could cover Joe Lieberman without showing a picture of him for awhile? I find that simply looking at the man raises my blood pressure these days. It's coming to the point that Lieberman isn't just damaging the country's health, he's damaging mine.

Posted by: bcamarda2 | December 14, 2009 8:01 PM | Report abuse

But tbass1, if they proposed MORE reforms of the Medicare system, you would just regurgitate the same rote argument: the savings are "illusory" so we might as well not try.

Frankly, nobody cares what you think. Lives are at stake. Your masturbatory ideological hang-ups aren't an issue.

Posted by: eleander | December 14, 2009 8:01 PM | Report abuse

@bcamarda2: Perhaps instead of photos of Joe Lieberman, stories about him should be accompanied by photos of uninsured Americans lining up for free clinics.

Or else cute photos of fluffy orange kittens.

Posted by: billkarwin | December 14, 2009 8:20 PM | Report abuse

In the last paragraph in my comment above, please substitute in, "and the trend has been for each new attempt to become more, not less, modest."

Posted by: RichardHSerlin | December 14, 2009 8:44 PM | Report abuse

"Duplicative, yeah, that's the ticket! It's duplicative!"

Posted by: JPRS | December 14, 2009 10:18 PM | Report abuse

Now that medicare-buy-in and the public option are officially dead, there is no further need for the mandate.

The mandate was only needed to help fund a gvmt-run safety net such as the PO or medicare-buy-ins.

If the mandate remains in any final bill without a gvmt safety net, this is final proof that Democrats have sold out the country to the insurance lobby. In this case, I would urge and support all Americans stop paying their taxes.

Posted by: Lomillialor | December 14, 2009 11:05 PM | Report abuse

--"As Lieberman has said previously, the point is that Medicare is cheaper than private options, and that's still the case. And if it wasn't the case, no one would buy it, and none of this would matter."--

That's fairly moronic, even for you, Klein. And dishonest.

Medicare couldn't exist on its "cheaper than private options". Medicare's true costs, not just the costs to its subscribers, are astronomical. Medicare and Medicaid are THE reasons we ostensibly need "reform".

Posted by: msoja | December 14, 2009 11:10 PM | Report abuse


--"As Lieberman has said previously, the point is that Medicare is cheaper than private options, and that's still the case. And if it wasn't the case, no one would buy it, and none of this would matter."--

That's fairly moronic, even for you, Klein. And dishonest.

Medicare couldn't exist on its "cheaper than private options". Medicare's true costs, not just the costs to its subscribers, are astronomical. Medicare and Medicaid are THE reasons we ostensibly need "reform".

Posted by: msoja

///////////////////////////

Based on what metric?

The entire reason that Medicare exists is because the private market could not profitably cover the 65+ population.

Medicare has more leverage with providers, so it gets better rates. It has no overhead for marketing costs; it doesn't have administrators finding ways to rescind coverage after people have paid their premiums; it saves providers time and money in doing paper work.

The moronic conclusion is to think that our patchwork, private insurance system is somehow efficient when we spend 18 percent of GDP on health care compared to what other industrialized nations provide at half the cost.

Part of the irony here is that the most costly parts of the program are give aways like Medicare Part D (any guesses how Lieberman the guy concerned about "costs" would vote on decreasing the costs of this program?) Medicare Advantage too -- is privately run and delivers care at a much higher cost than regular Medicare.

Most non-partisan analysis is absolutely clear -- single payer is the less costly option for providing universal coverage. Even the watered down public option reduces health care costs for consumers and taxpayers. Lieberman and the industry just want to maintain the quasi-back door tax that the industry levies on the general public though its inflated costs for an inferior product.

Posted by: JPRS | December 14, 2009 11:22 PM | Report abuse

I have to assume you had your tongue firmly in cheek when you wrote "It is a measure of my respect for Lieberman ...." How can anyone have any respect for this fraud anymore? He has brazenly and unequivocally established that he is an unprincipled hypocrite and liar. The only way he could earn my respect is to admit that he is motivated by only two things: Rewarding the insurance companies that have been his steadfast benefactors and exacting revenge on the liberals who opposed his reelection in '06. He gets my vote for the most despicable politician in D.C.

Posted by: BigIsleDemocrat | December 15, 2009 1:06 AM | Report abuse

BigIsleDemocrat,

I suspect it's along the lines of "measure of respect [for his ability to tell lies with a straight face];" which implicitly means that on some level Lieberman is intelligent enough to know what the impact of the policy really is.

Not sure that I'd give Lieberman the nod for most despicable politician -- there's a lot of competition for that one. He's pretty much par for course with the lower forms of life that inhabit the swamp. But it's hard to say that he's any more hypocritical or venal than someone like Billy Tauzin, Tom DeLay, or every single Republican legislator who for years has placed a higher value on insurance industry profits over the lives and financial well-being of their constituents.

Between Iraq, his long-standing protection of the financial sectors excess, his complete failure in providing aggressive oversight of Iraq War and Homeland Security spending, and now this, the man's karmic balance sheet is pretty much beyond any 11th hour redemption. The next few lifetimes he'll be turning tricks in Bangalore -- if he's even fortunate enough to come back in human form.

Posted by: JPRS | December 15, 2009 1:20 AM | Report abuse

My solemn vow: if Lieberman filibusters this bill, I will devote every last drop of my savings to financing his opponent in the next election, even if they are Republican. I will not cease campaigning against him until he is sent back to the health care industry that funds him with his tail between his legs. I will seek to have his name expunged from the Senate record, his political corpse burned and its ashes spread by the corporate winds to the four corners of the earth.

Posted by: brazilnote | December 15, 2009 9:12 AM | Report abuse

The implication is clear: we need lots of corporate welfare (but call it "subsidy") if we want to rally self-serving politicians behind healthcare reform.

Posted by: Sanssouci1 | December 16, 2009 3:21 AM | Report abuse

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