I would also argue for lowering the age of eligibility for Medicare to (say) fifty-five, to permit workers to retire earlier and to free firms from the burden of managing health plans for older workers.
They claim that in the Senate health reform struggles “the idea of dropping the Medicare eligibility age from 65 to 55 has resurfaced as a prospect.” They refer to the need for determining exact “funding mechanisms”. They report:
Several progressive members of the House and Senate have confirmed to this reporter that lowering the Medicare eligibility age would have serious appeal in their caucuses. But there is some disagreement about how serious the prospect may be, especially considering the determination of some conservative and moderate members of the Democratic caucus in the Senate to control entitlement costs.
In other words, about 99% of their article talks about this proposal as if it’s a straight expansion of the Medicare entitlement: start collecting your Medicare benefits early. Only in one small sentence do they mention the true nature of the proposal (emphasis mine):
Under the proposal, which is being weighed by Senator Jay Rockefeller, D-West Virginia, and several other senators who are in the thick of the latest negotiations, Americans as young as 55 who lack affordable coverage could buy plans under Medicare.
Got that? Buy. This is not lowering the age of eligibility for Medicare; this is not enlarging an entitlement. This is letting people under 65 purchase insurance “policies” from Medicare just like they now purchase them from Aetna or Blue Cross Blue Shield.
Will there be government subsidies? Maybe. I think that depends on whether the final bill raises the ceiling for Medicaid coverage; it may be that anyone who would have been subsidized to buy into Medicare will simply be eligible for Medicaid instead. Which is, of course, just another kind of subsidy. But since apparently Medicaid reimbursement rates are lower even than Medicare reimbursement rates, it should cost less to subsidize people in Medicaid than in Medicare.
Which brings me to another point. If we’re going down this road it seems to me it makes more sense to let people buy into Medicaid rather than Medicare. Given Medicaid’s lower reimbursement rate, people should be able to buy into Medicaid more cheaply than into Medicare. Medicaid also appears to allow some variation from State to State so issues like abortion coverage could be taken care of at the State level.
Allowing some people to buy into Medicare is just one of the options on the table. Another?
Senate Democrats in search of a health reform compromise Sunday zeroed in on a new alternative to a government-run insurance plan — signaling that the chances a final bill will include a pure public option are diminishing.
The new idea — for the government to create a national health insurance plan similar to the Federal Employee Health Benefits Plan — seemed to gather momentum as the weekend went on, and the differences between liberals and moderates on the public option became even clearer.
That sounds familiar in a half-witted sort of way. Guys, there is no reason to re-invent the wheel. The Federal Employees Health Benefits Plan already exists. Just piggyback on it. Yes, you’ll need a separate risk pool so Federal employees don’t see their premiums rise to subsidize “outsiders” but all the legwork is done. We know which treatments are covered and which aren’t; we don’t need a bill or a separate government agency to figure all that out. Whatever Federal employees get - and that includes Congress - outsiders who buy in get. That should take care of fears that Congress will end up rationing care. Reimbursement rates are set; the insurance companies are already in. Just use what’s already there. Figure out some formula for subsidies based on the cheapest rate available in each State and let ‘er rip. Really poor people get subsidized decent coverage. People with more money can buy higher end policies.
This approach would also obviate the need for “the Exchange” so beloved by the various Democratic health reform bills. The Exchange, like this new “national health insurance plan”, simply replicates FEHBP. This is not necessary. We’re all supposed to be green now, remember? So refill, reuse, recycle. FEHBP already exists. Don’t waste all that energy building it anew.