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Good News in the health-care debate

Word that Senate negotiators are thinking of adding a Medicare buy-in to the health-care bill is good news in general, and it should be heralded by supporters of the public insurance option who are glum over the prospect that the option will disappear from the bill.

The Medicare buy-in, which Bill Clinton proposed long ago, has always made sense. The idea is that older Americans who have not yet hit retirement age (say, people in their mid- to-late 50s or early 60s) have a hellish time buying private insurance if their employers don’t cover them. There’s no conspiracy here: Older people are more likely to get sick than younger people, so they are more expensive to insure.

The buy-in is what it sounds like: People could pay premiums to get Medicare coverage. This would be much cheaper for them than any private insurance they are likely to find. Having that choice would be helpful to an enormous number of people. And it builds on a program everybody knows and understands.

You can also look at it another way: If the program worked, over time, the age at which people could buy into Medicare might be dropped to 50, then to 45, and so on. Before long, the Medicare buy-in could become the public option.

I almost don’t want to say that because it could scare people away from what is a very good idea. So let’s just start by offering the Medicare buy-in for people between 55 and retirement. It would, as Ezra Klein has pointed out, allow people to ease into retirement without having to switch doctors or otherwise disrupt their care. It is as logical a step. I hope the Senate takes it.

By E.J. Dionne  | December 8, 2009; 12:32 PM ET
Categories:  Dionne  | Tags:  E.J. Dionne  
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The Repblicans will still vote no on it.

Posted by: jjj141 | December 8, 2009 12:54 PM | Report abuse

You can also look at it another way: If the program worked, over time, the age at which people could buy into Medicare might be dropped to 50, then to 45, and so on. Before long, the Medicare buy-in could become the public option.

I almost don’t want to say that because it could scare people away from what is a very good idea. So let’s just start by offering the Medicare buy-in for people between 55 and retirement. It would, as Ezra Klein has pointed out, allow people to ease into retirement without having to switch doctors or otherwise disrupt their care. It is as logical a step. I hope the Senate takes it.


This would make it all worth it. So long as we ease into everyone getting the option to buy into it of course. In fact that's how the Dems should have started the negotiations in the first place....Medicare for all. Then the Repubs could have kicked and screamed and while it would've been scaled back we'd be in a much better place than we are now.

Posted by: theobserver4 | December 8, 2009 12:55 PM | Report abuse

I'm all for the Medicare buy in, except that it should be extended to all citizens and paid for with Medicare taxes on all income, no matter the source, with no cap, and automatic increases and decreases based on the previous years deficits or surpluses. I also think that Congress should let Medicare negotiate just like any other insurance company, with health care providers and pharmaceutical companies, for goods and services, and that Congress should also provide Medicare with the resources to stop fraud, and make the penalties for defrauding Medicare extreme enough to put an end to Medicare fraud.

Posted by: Chagasman | December 8, 2009 1:08 PM | Report abuse

Great idea, let's put an even sicker, poorer population onto an unsustainable program that WILL go bankrupt sooner that it was going to go bankrupt before.

Horrible idea. Health care in this country is expensive prescisely because of government meddling and subsidies, this will make the problem even worse.

The Feds ARE the problem, not the solution.

Posted by: NoDonkey | December 8, 2009 1:23 PM | Report abuse

Amazing, where do you people come from? So a person still working and still paying medicare/social security would buy into a program that is already overtaxed, ill managed, and short of doctors willing to participate. Amazing, absolutely amazing. I sometimes wonder what reality many in today's media exist?

Posted by: staterighter | December 8, 2009 1:33 PM | Report abuse

The only good news there could be about the health care debate is that the Senate had decided to dump the Reid bill and start over from scratch.

Posted by: mike85 | December 8, 2009 1:54 PM | Report abuse

I hope that everyone is aware that Medicare only pays about 80% of most charges. Anyone who buys Medicare will need a good supplemental insurance policy or they will be in for some very surprising co pays especially from hospitals and labs. These supplemental policies are not cheap, but many doctors will not accept Medicare unless you have a good supplemental policy or cash in hand. In addition, remember that there are no Medicare family policies. Being able to purchase Medicare would eliminate the pre-existing clauses etc. and would allow everyone able to pay the premiums to buy insurance. In addition, Medicare does set prices and if a doctor accepts Medicare, he accepts the payment that Medicare is willing to pay. Some Senators claim that prices are raised to private insurance companies to cover the cost that Medicare does not pay. My question is why is Medicare going broke if the doctors really should be charging more. Personally I think Medicare payments are fair and hospitals' and doctors' charges are too high. Granted defensive medicine causes a good deal of this and new laws governing lawsuits would go a long way to correct this problem.

Posted by: ihopenot | December 8, 2009 1:55 PM | Report abuse

May be a worthwhile idea, but the key question is affordability. Dionne, in his seemingly never ending optimism and faith in Obama, the Democratic party, assumes premiums will be low enough for people between 55 - 64 to afford. We'll see.

Posted by: Aprogressiveindependent | December 8, 2009 1:57 PM | Report abuse

Well at least the insurance companies won't fight it - they don't want to insure this age group anyway.

As far as doctors not accepting Medicare patients that is a bunch of baloney. In 40 years of practice I never personally met another doc who would admit to turning away patients based on their Medicare coverage.

The Congressional Budget Office and Center for Medicare and Medicaid studies as recently as this fall did a study that showed less than 3% of Medicare recipients that relocated had any problem finding a physician to care for them. They commented in the report they thought these folks were in areas of high density retirees such as Florida, Southern Cal. and Phoenix.

If the progression to lowerin the age is fast enough fine otherwise we would just be providing another boondoggle to the Insurnce industry.

I agree with the post that thought payment should be a Medicare tax on all taxpayers with no upper limit and on all income (not just *earned income*.

Posted by: sauerkraut | December 8, 2009 2:09 PM | Report abuse

increasing coverage of the uninsured is a moral imperative, but one which die a stillbirth without the removal of the 21% cut in Medicare reimbursement due in three weeks. In addition there will be a severe shortage of physicians without an inducement to in- crease the number of Internists and FPs. At this time, with thew present number of insured, the primary care provider is being asked to see 60 office patients a day. This is untenable as it begs for mal-practice in the truest sense.

Posted by: Toppell1 | December 8, 2009 2:10 PM | Report abuse

Well, I can see the death panel crowd (aka, the "No idea is ever too good to lie about" folks) have jumped on this without missing a beat.

This is all I ever wanted from the beginning. (Realizing this country is still a decades away from a real solution.) Having seen medicare up close for some time looking after parents accounts, and comparing it to other options available to the self employed...where do I sign up?

Posted by: tfspa | December 8, 2009 2:15 PM | Report abuse

I agree with you on this, but the two fundamental problems with our health care are:a) the number of persons affected by the metabolic syndrome is higher here than in any european country and it can be prevented; b) the dishonesty of our MD's (performing services probably non needed) is also higher than in Europe. This is why the Mayo Clinics give even better health care at less cost: they doctors are on a fixed salary with no incentive to order questionable services.

Posted by: ThishowIseeit | December 8, 2009 2:24 PM | Report abuse

It would be good public policy, AJ, so Republicans will without doubt vote against it. It might help some middle class people, the horror!

Posted by: drindl | December 8, 2009 2:29 PM | Report abuse

sure, its always made sense...if you're eager to expand a system which is unsustainable and on the course to bankrupt the country.

i thought all public policy experts agreed at the outset of this legislative undertaking back in the summer that the one thing that we couldn't do is use the medicare payment system as a model for expanding coverage.

yet here we are, two weeks before christmas and the ineffectual, incompetent and void-of-legit-ideas democrats are turning to medicare as a model for "reform".

very revealing.

Posted by: dummypants | December 8, 2009 2:48 PM | Report abuse

Only 27% of voters nationwide favor the public option and most of those are either ACORN-type "community organizers" or those who have been dumbed down by a substandard and politicized education as per the warnings of Soviet defector Yuri Bezmenov.

In 1985, Bezmenov told us that our enemies were working hard at brainwashing us (dumbing us down) and would succeed if we did not defend our principles:

The dumbed down are obviously unable to understand that Obama's scams like Obamacare have as their main objective “the American descent into Marxism,” which “is happening with breath taking speed, against the back drop of a passive, hapless sheeple…”

Fortunately, most Americans have NOT been dumbed down! Most Americans are NOT sheeple! Most Americans are ready to defend their FREEDOM and the freedom of their children and grandchildren from Obama's scams and socialism/Marxism.

Posted by: AntonioSosa | December 8, 2009 2:54 PM | Report abuse

Did you know the criminal guidelines for Obamacare are in the book “Stand Up Straight: How Progressives Can Win,” written before Obama was even elected? Who wrote the book? Robert Creamer, a convicted felon. He says he wrote the book inspired by Saul Alinsky.

The guidelines for Obamacare are in this book! He suggests that a bogus health crisis be created! He suggests – point by point -- the lies, manipulation, intimidation, and coercion we have witnessed from Obama and his accomplices to force us to swallow the Obamacare scam!

This convicted felon, Robert Creamer, was among the “distinguished” guests at the dinner party in the White House where the Salahis were declared “intruders.”

Posted by: AntonioSosa | December 8, 2009 3:09 PM | Report abuse

This is wonderful news! I'm excited. Those of us who have lived in countries with universal single-payer health care know that if a system like this ever gets going in the US it will quickly become a huge success. Twenty years from now the crazy lunatics opposing "socialized" medicine will be screaming at anyone who threatens their government-back care, just as they are doing now with Medicare, VA health benefits, social security etc. Yes we can! Go Obama, go!

Posted by: gposner | December 8, 2009 3:20 PM | Report abuse

Medicare for all would be a disaster---much bigger in fact than the current one, which is already tens of trillions in the hole with projected liabilities. What on Earth are you people thinking ? Double down on this huge Ponzi scheme ? Create hundreds of trillions in liabilities ??

Posted by: dan1138 | December 8, 2009 3:40 PM | Report abuse

@theobserver4: "In fact that's how the Dems should have started the negotiations in the first place....Medicare for all. Then the Repubs could have kicked and screamed and while it would've been scaled back we'd be in a much better place than we are now."

I disagree, strategically. If the debate began at this point, there would not have been much to 'scale back' to.

The debate has moved as it should, moving to an idea that will ultimately receive the number of votes for passage.

Posted by: 1EgoNemo | December 8, 2009 3:55 PM | Report abuse

Everytime Reid opens his mouth he sounds like an idiot. Now he is comparing the public option to slavery. Start over and I hope Nancy Peoosi throws you under the bus along with the other democrats who don't go along with this witch.

Posted by: farmsnorton | December 8, 2009 4:02 PM | Report abuse

Based on the guidelines for Obamacare, contained in the book “Stand Up Straight: How Progressives Can Win,” Obama and his accomplices will “compromise” on everything and anything. Their objective is just to gain control of our health care (and our lives). Once in control, they’ll do as they please.

The book “Stand Up Straight: How Progressives Can Win” was written by Robert Creamer, a convicted felon. Like Obama and most of his czars, Creamer found inspiration in radical Saul Alinsky. Creamer, the husband of Socialist Progressive Democrat Jan Schakowsky, was busy training Organizers for Obama in 2007, and can now be found dining with our nation’s “distinguished” citizens at Obama’s State dinners.

Regardless of what they say now about abortion and any other issue, we can see the horrors they have in store for us based on Obama's pro-abortion and pro-infanticide (late-term abortion) stand, and the aberrant stands of Obama's Health Care Czar Ezekiel Emanuel and Science Czar John Holdren.

Obama's Health Care Czar Ezekiel Emanuel, rightfully called "Doctor Death," would make Dr. Kervorkian proud.

Dr. Emanuel has said that "Medical care should not be given to those who are irreversibly prevented from being or becoming participating citizens."

As per Dr. Emanuel, your mother suffering from Alzheimer’s or your child diagnosed with Down’s Syndrome SHOULD NOT receive medical care.

And Obama's "Science Czar" John Holdren has called for population-control policies such as forced abortions, mass sterilizations, and mandatory population controls.

Lies do not change the FACT that we are broke and Obamacare will further destroy our economy, our future and the future of our children and grandchildren.

Additionally, lies do not change the FACT that Obamacare is another scam to enslave us.

Posted by: AntonioSosa | December 8, 2009 4:12 PM | Report abuse


You are an idiot.


Posted by: manbearpig4 | December 8, 2009 5:38 PM | Report abuse

Sunday the Republicans were railing against any medicare cuts.
Monday they were railing against any medicare expansion.

Posted by: JRM2 | December 8, 2009 5:53 PM | Report abuse

Let me remind all of you idiots that it is a "buy-in", not free.

It would also take a lot of higher risk people out of the pool resulting in either higher profits for insurance companies or lower premiums for the privately insured.

Posted by: JRM2 | December 8, 2009 5:55 PM | Report abuse

It may not be a BAD idea, but the priority MUST be in reducing he direct cost of health care first.

We need more Doctors, skilled health care workers and health care facilities. An increase in supply is extremely important.

We also need to streamline other costs, such as malpractice insurance. That means tort reform.

Reduce costs first, then try the "wise" ideas.

Posted by: primegrop | December 8, 2009 6:14 PM | Report abuse

It might help at some percentage level, 55year olds and up find a job easier. That particular "age statistic" is suspect anyway. I've been around awhile and I've known some very healthy older folks. I've also been around some relatively young people who were in terrible health. I wonder what other countries do about the "older workers"? ... I'll bet they don't deny them coverage.

Posted by: deepthroat21 | December 8, 2009 6:29 PM | Report abuse

Toppell1: there is no cut in Medicare, period. no reduced benefits, no increased costs, nothing. what the repubs are trying to scare seniors with is the cut in payments to hospitals and other providers, cuts which the hospitals and other providers AGREED TO contribute to the health reform effort, because they more than make it up for it with additional insureds instead of more bad debts (that get passed on to the rest of us now).

and just by the way, Medicare is actually run quite well, at a fraction of the overhead of any private insurance plan, and most seniors are for it. (AARP has some conflicts of interest, but they are for the cuts too). it's regulations are mind-numbing for docs and hospitals, but having more folks buy in to the system at cost wouldn't make it's financial solvency any worse, and again, Medicare reimbursement to hospitals and docs is not great, but it beats an uninsured patient every day of the week.

Posted by: JoeT1 | December 8, 2009 6:33 PM | Report abuse

Why didn't somebody just offer this option to start with. In order to insure the general public, if this is the objective, some form of public option is a must. Couldn't these legislators just offer something for those working people who don't earn enough to pay premiums on their families.
I still maintain that the government waited until the worst time in history of our country to try to adopt a health plan. The USA is broke and living on borrowed money. They should fix the economy first.

Posted by: johntu | December 8, 2009 8:07 PM | Report abuse

Sure, let's start bailing people out even earlier.. .makes sense... since the old and rich will get free care eventually, let's give them subsidized care early... great.

oh, nevermind, I do not and will not accept medicare

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

I think it would be a good idea, for some the only worry about retirement is making it medicare. The problem is that it sometimes is subsidized in other patient bills (higher), that with billing restrictions in place (need law to reduce costs not shift them). Like chasing the cat that bit you, it might bite again providers refuse medicare patients as in hospitals.

Posted by: bwcolq | December 8, 2009 8:55 PM | Report abuse

1. MedPac has determined that 98.6% of all physicians in the US will take new Medicare patients.
2. There are 6 qualified applicants for every place in Med Schools.
3. Uwe Reinhardt on "Medicare is going banktupt":
"If economic sustainability," then exactly what do people have in mind with that phrase? During the past 4 decades or so, the long-run, smoothed average annual growth rate in real (inflation-adjusted) GDP per capita has been about 2%. Suppose that fell to only 1.5% for the next four decades. The current average real GDP per capita of about $40,000 would then grow to about $72,500 by 2050 in constant-dollar terms. Medicare now absorbs about 3% of GDP, leaving a non-Medicare real per capita GDP of $38,800. It was estimated by the CBO about a year ago that Medicare will absorb about 9% of GDP by 2050. Let’s make that 10%. At these numbers, the non-Medicare real GDP per capita available to today’s little critters who will run America in 2050 will still be close to 70% larger than is our current non-Medicare GDP per capita."
4. We waste over $200 Billion each year on the high overhead of private insurance as compared to the Federal part of Medicare.
5. We Waste $200 - $400 Billion a year on physicians and patients filling out 1500 different forms for private insurance companies and fighting to get paid.
6. We waste $100 Billion a year on drug company "marketing." (Alan Sager).
7. Because of 4., 5., 6., and 7. we could give every man, woman, and child an improved Medicare, and it would noy cost us any more than we are now paying, probably less. ( among many others)
8. States with tort reform not only have no lower health costs, but the frequency of tests and treatments is similar to those states without tort reform. Trot reform , caps on malpractice suits, does not save money. If you go to page 150 ff of, you will see much of the data.

Posted by: lensch | December 8, 2009 10:11 PM | Report abuse

regardless of the bill they pass we are going to have to deal with this just be prepared

Posted by: evony93 | December 8, 2009 11:26 PM | Report abuse

There may be more interest in this than the Senate realizes.

I am married to a small businessman who offers health benefits to his employees (he pays 75% of the premium); I work full time at a public library that does not offer benefits.

For decades, he has selected his benefits package from the insurance exchange offered by CBIA (CT Business and Industry Assoc.). This year, the least expensive option available to us as a family at our ages (60 and 58) is THIRTY THOUSAND DOLLARS A YEAR (that includes a modest surcharge for our two daughters still in college). (We have no existing health problems.)

Now who the hell can afford that??? We're stuck with it this year, but next year - if there's a medicare buy-in, we'll certainly be considering it!

If this is an example of the way insurance exchanges operate, buyer beware! I presume that the insurance companies are offering much more reasonable packages to big companies and taking financial advantage of small businesses - because I can't believe that big corporations are subsidizing such ridiculously high premiums!

Posted by: mhd51 | December 9, 2009 8:51 AM | Report abuse

The more I think about this -

I have a concern with the Medicare System anyway- insuring the population that needs and utilizes the system most.

The ROI- Return on Investment for a young person- who pay their DOLLARS into a for-profit Insurance – and do not or rarely use or need. More profit for Private Companies.

Yet- the older citizens- when they will need the care most- will be in a system that is paid at minimal premiums- Seniors on fixed income and the system is used the most and most costly.

Private insurance companies - insuring the HEALTHY- NO PAYOUTS

Medicare - TAKING on the population that will increase their usage and needs-using more than their premiums pay for-

This really makes no sense- Where is the Cost Curve Driver?

Posted by: sasha2008 | December 9, 2009 12:17 PM | Report abuse

Although this sounds like a good idea on the face of it, EJ is popping off again without checking the facts, and the liberals are jumping up and down in agreement. Why does the WaPo encourage this kind of misinformation?

Medicare is safety net coverage for one person - it doesn't offer family coverage. The coverage is basic and in no way stacks up to what most people are used to under the plans that they had from employers. Most buy supplemental coverage (making the AARP very wealthy) to cover the large number of things that Medicare fails to include.

I'm in the target group for this plan: self-employed, not yet eligible for Medicare, paying about $650/mo for individual coverage. If I had Medicare, the combination of Medicare payments, plus prescription drug coverage, and supplemental insurance, would be close to that same amount, but be more complicated to deal with. My doctor don't accept Medicare, so I'd have to file all the claims separately and wait for reimbursement. I would likely pay more out of pocket than I currently do.

Medicare is a good safety net but it proves the adage that government is the problem, not the solution. It has driven all the alternatives and competition from the market for seniors, making prices higher.

And, the unfunded liability to the Federal Treasury would EXPLODE if this goofy plan were enacted and then expanded. But the left doesn't seem to care when they spend other people's money.

Posted by: parkbench | December 9, 2009 5:33 PM | Report abuse

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