The Medicare buy-in now under consideration is a nice idea, but it's not a public option. Or is it? Yesterday on MSNBC Countdown, Ezra Klein made an important point. If premiums for the Medicare buy-in are competitive--and they should be, I think, if it's done right--then a 56-year-old selecting that option is going to see, right away, what a good deal it is. That's going to have precisely the effect that public option proponents always wanted, both on popular perceptions of public versus private insurance and, in the aggregate, on the market for insurance. Private insurers may not covet the 55-64 demographic, given its high health risks. But they also won't want to develop a reputation as inferior.
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Interestingly, the other half of the public option alternative--having the Office of Personnel Management oversee a network of private, non-profit plans--won praise yesterday from a Republican yesterday. Appearing on ABC News Now, former senator Rick Santorum talked up the idea:
As a matter of fact, … most of the Republican alternatives actually are modeled after the Federal Employees Health Benefits Plan I don't think Republicans have a problem with a plan if you're going to have the government pay--which is what the Federal Employees Health Benefit Plan is--as long as it's a private-sector system.
Rest assured, this doesn't mean the OPM idea is a bad one. But it does mean that it's not a substitute for a public plan. Not even close.
By the way, I was also on Countdown last night, making the case not just for starting a Medicare buy-in, but for starting it even before the new insurance exchanges are ready:
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COMMENTS (1)
It's important to note that some of the potential costs (either to the consumer or to the government) of insuring those aged 55-64 will be offset by future savings in Medicare costs once these folks reach age 65. JM McWilliams et al (2009) found that among patients in a national longitudinal cohort who lacked insurance prior to getting Medicare at age 65, costs of expanded coverage before age 65 years may be partially offset by subsequent reductions in Medicare spending after age 65 years, particularly for those with cardiovascular disease, diabetes, or severe arthritis (Ann Intern Med. 2009 Dec 1;151(11):757-66.). The authors concluded that if the current population of uninsured adults aged ... view full comment
It's important to note that some of the potential costs (either to the consumer or to the government) of insuring those aged 55-64 will be offset by future savings in Medicare costs once these folks reach age 65. JM McWilliams et al (2009) found that among patients in a national longitudinal cohort who lacked insurance prior to getting Medicare at age 65, costs of expanded coverage before age 65 years may be partially offset by subsequent reductions in Medicare spending after age 65 years, particularly for those with cardiovascular disease, diabetes, or severe arthritis (Ann Intern Med. 2009 Dec 1;151(11):757-66.). The authors concluded that if the current population of uninsured adults aged 51 to 64 had continuous insurance coverage from now through age 65, the value of subsequent reductions in future Medicare spending between age 65 and 74 for these adults would be approximately $98 billion. This represented nearly 50% of the $198 billion cost of expanding insurance to this group. Thus, beyond the moral imperative to cover this vulnerable and high-cost group, there may be a hidden economic benefit down the road as they age into traditional Medicare eligibility.