Medicare buy-in compromise reached

by: Chris Bowers

Tue Dec 08, 2009 at 21:29

I will be on Live on the Left Coast at 9:40 p.m. eastern to discuss the Medicare buy-in compromise

On its most abstract, ideological level, the fight over the public option is about moving people off private insurance and onto public insurance.  And, on that level, neither the "level playing field" public option nor the negotiated rates national public option are the primary means of getting more people onto public health insurance in either the House of the Senate bills.

The CBO analysis of both the House and Senate bills projects that either one would result in another 15 million more people receiving health insurance from Medicaid and the Children's Health Insurance Program.  By comparison, the CBO projection for the public option in the House bill would cover 6 million people, and the public option in the Senate bill would cover 4 million people.  Kind of makes you wonder what the real public option has been all along.

Now, it looks like a deal has been struck in the Senate to replace the opt-out public option for a weak Medicare buy-in.   There were reason to be interested in the Medicare buy-in, but the current deal will only be open to Americans between the ages of 55 and 64 who are uninsured:

Democratic senators say they have a tentative deal to drop a government-run insurance option from health care legislation. No further details were immediately available.

But liberals and moderates have been discussing an alternative, including a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage. Additionally, talks centered on opening up Medicare to uninsured Americans beginning at age 55, a significant expansion of the large government health care program that currently serves the over-65 population.

There are about 3.24 million uninsured Americans between the ages of 55 and 64 (that's 7% of a total uninsured population of 46.3 million).  If, as per an earlier CBO projection, 33% of those eligible for a public option tied to Medicare rates (which, in this case, would actually be Medicare) enroll, then this public option "compromise" would only cover 1.08 million Americans, or only about 25-33% of what the opt-out public option would have done.

So, it looks as though the buy-in compromise is indeed worse than even the opt-out compromise.  However, the next play should not be to fight to save the opt-out, "level playing field" public option, but rather to expand the Medicare buy-in to all Americans between the age of 55 and 64 (inclusive).  Such a buy-in would cover 13 million people under public insurance, more than double the amount under the House public option.  The 13 million number was derived from there being roughly 39,000,000 Americans between the age of 55-64, and the earlier CBO's estimate listed above of 33% of those eligible opting in.

Ideally, we would have the public option and the Medicare buy-in.  However, if you have to choose which one to try and save during the conference committee, I am simply going with whichever plan gets more people on public insurance.  And, by a long way, that is making all Americans between the ages of 55 and 64 eligible for the Medicare buy-in.

Update: There are a lot of different claims about the details of the agreement floating around right now.  Very hard to know which ones are accurate.  Reid won't release the details until the CBO reports on the new agreement.

What little we do know suggests that there is a triggered co-op (that will do a lot of frakking good), and the Medicare buy-in starts in 2011.  I have heard wide ranging details on of the buy-in itself.  Until we know the specifics, it will be impossible to tell if the buy-in will cover more people under public insurance than the opt-out level playing field would have done.

But, even if the buy-in doesn't cover more people than the opt-out, it will cover them better (with Medicare rates) and sooner (in 2011) than the opt-out would have done.

Chris Bowers :: Medicare buy-in compromise reached

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Well, good for them... (4.00 / 8)
...but looks like those of us under 55 are screwed entirely.

Keep in mind (4.00 / 5)
It is okay for people under 55 to die of lack of insurance.  

[ Parent ]
higher premiums too (4.00 / 2)
This provides price competition for the 55 and over group, but none at all for those of us younger than 55. What is there in this bill to "bend the cost curve" for our premiums? It looks like the answer is "nothing."

[ Parent ]
Sure, we can fight (4.00 / 4)

 But the problem is that we're leaderless. All of the "progressives" in Congress seem to have joined in the cave.

 I mean, it should have been easy to put the conservatives in an awkward spot by forcing them to explain WHY they opposed the opt-out. They wouldn't have had a rational excuse.

 There was never any attempt to do such a thing. By either the White House or the non-conservative Dems.

 They just laid down and let the right frame everything to their convenience.

 So we can press on and try to salvage something, but if we manage to push this bill in a more progressive direction, it will be the first time in the process this has ever happened.

 Who knows, it might happen... if we could count on somebody in a position of power actually holding his ground for a change.  

"We judge ourselves by our ideals; others by their actions. It is a great convenience." -- Howard Zinn

People asked Leiberman why he didn't support the cop-out (4.00 / 2)
His responses were nonsense. It didn't matter. The media certainly weren't going to call him on it. And what can we do? As God ordained in the Constitution, you need 60 votes to pass anything in the Senate.

[ Parent ]
His responses were nonsense... (4.00 / 3)

 And Harry Reid's response to Lieberman's nonsense was...


"We judge ourselves by our ideals; others by their actions. It is a great convenience." -- Howard Zinn

[ Parent ]
it's not in the constitution (0.00 / 0)
just thought i would reiterate that, even though i think ? you were aware? :)

[ Parent ]
So no Medicare buy-in for me? (4.00 / 1)
Dammit. And I was really hoping for at least something resembling a viable public option. So all we may get is this? What exactly were we fighting for anyway?

Yes, Virginia, there are progressives in Nevada.

Still intriguing... (4.00 / 6)
One effect of this, even with a weak buy-in, I think, is that it makes the age of eligibility for Medicare totally arbitrary. Whereas before, Medicare was for "old people" (65+, aka people past working age), now it would be "old people, and some middle aged people, but only to a point." There's just no easily graspable intuitive logic to an age cutoff of 55. If 55, then why not 50? If 50, then why not 45? Etc. In other words, I think it puts us on a slippery slope where there's just no a priori reason that Medicare shouldn't continue to be expanded down the age scale. And that's a good thing.

sure, and you could do it through reconciliation anytime (4.00 / 1)
but will Democrats? I suppose they can't say so now, nor do they seem capable of looking ahead.

New Jersey politics at Blue Jersey.

[ Parent ]
Then why not just open Medicare buy-in to everyone? (4.00 / 1)
I don't get it here. This is what's making this debate so pointless. The answer is obvious on what we really need to solve health care, but no one in the meaningless "mainstream" wants to mention it: single-payer.

But anyway, why can't we just expand Medicare to anyone who so chooses now? What's the point of all this "reform" if most of us are forced at gunpoint to buy insurance from the HMO fat cats?

Yes, Virginia, there are progressives in Nevada.

[ Parent ]
It's not pointless at all. (4.00 / 5)
Opening Medicare to 55+ will be an effective economic stimulus.

As a former executive recruiter, I can tell you employers don't want to hire anyone over 50, mostly because they don't want to pay the higher premiums. When you have a group of employees, the older their average age, the more likely you're seeing claims for heart attacks, diabetes and cancer. Your premium rates are assessed on the group usage and risk.

If you look at the unemployment numbers, the middle-aged unemployed are having the hardest time getting hired. I guarantee you that's because of the health care costs.

So there's a good case to be made for this.

[ Parent ]
Of course, it's good for them... (4.00 / 3)
But what about all the young people with no insurance? We just get forced at gunpoint into an HMO? That's NOT what I was expecting from Obama & Reid. Reid's now saying the public option isn't dead... So I'm waiting for him to prove it tomorrow. If it is, then why exactly did we throw our support to all these Democrats?

I just feel so demoralized right now... It's like we keep getting beat down every time we simply ask for a promise to be fulfilled. If they're expecting this forced HMO BS will motivate young Democratic voters to turn out next year, they'll be sorely mistaken.

Yes, Virginia, there are progressives in Nevada.

[ Parent ]
WTF (0.00 / 0)
Where is this FORCE HMO stuff coming from?   You guys are flipping out over vague reports...   Keep pushing to improve but we need some actual details.    

1) Why isn't medicare offered to everyone... because douche bags and lobbyists won't let that pass.  Look how 4 Senators held the PO hostage.    Yes it sucks, but that's the way it is right now.   You have 0% chance of changing this until 2010 elections.  

2) There are some amendments that can actually make healthcare cheaper for all Americans.   The OPM national plans from private insurers, similar to what Congress has.  The Amendment to force healthcare spendings at 90%.   Allowing the importation of cheaper drugs.    I'm not saying this will insure cheaper coverage, but there was no insurance that the PO would be cheaper, especially the Senate incarnation.     The PO is NOT the only way to bring about cheaper costs (in fact if I had my choice and taking Single Payer off the table, I'd rather do strong price regulation than the PO).    

[ Parent ]
The Force HMO is what happens... (4.00 / 2)
... if there is a mandate to purchase health insurance, which there undoubtedly will be.

1) You're right we can't change this until 2010, but I sure as hell wish that I hadn't wasted so much time campaigning in 2008.

2) I disagree on this point.  Price regulation by whom?  Congress?  Whoever the regulators are they are absolutely going to be bought off.  A PO is supposed to be designed to take the profit incentive out of the equation.

We need more details for sure, but I have to say that it doesn't sound good right now.

[ Parent ]
Not just healthcare (0.00 / 0)
Older workers are also naturally more expensive because of experience. The longer they've been working, the higher up the pay scale they will have traveled, forcing their employers to dish out a higher salary. I think this has more of an effect than the potential higher premiums because for the most part, this is transfered to the workers...


[ Parent ]
MediKid? (4.00 / 1)
Medicare for kids from ages 1-18 sounds like a good extension of Medicare.  I agree that it's so arbitrary but if we keep adding age groups, Medicare for kids could be the next step.  

[ Parent ]
UM... (4.00 / 1)
Isn't that SCHIP?   Provide healthcare for uninsured kids.   Yes its more similar to medicaid, but similar results.

[ Parent ]
Thats true (4.00 / 1)
but I think health care should be a right for all kids (well should be everyone but we can add kids).  The alphabet soup nature of the public insurance system should all be rolled into Medicare and finally establish health care for all.  One day ... (sigh)

[ Parent ]
In some ways (4.00 / 1)
this is the best of the public options.

Because it is the most likely to be effective for the people with access to it.

The logic you describe is pretty clear about its expansion over time.

[ Parent ]
most in need? (4.00 / 4)
One of advantages of focusing on the 55-64 is that I presume this cohort has much more substantial health care/insurance needs than younger aged folks.  I wonder for example what percentage of the medical bankruptcy cases happen in this age cohort?  How much medical costs are expended by this age group?

On the flip side. (4.00 / 1)
  Which age group has a lower-rate of health insurance?  It's not the 55-64 age group...

[ Parent ]
True... (0.00 / 0)
But then what percentage of those can't GET insurance vs those who choose NOT to have insurance.   I will bet money the percentages skew much more to the can't get it as people age.  The other problem with just looking at those numbers is most of the data sets are from 18-29.  There are several factors that could skew those numbers.     One of the Amendments I have seen is allowing coverage on parents insurance until age 25 if the kid is still living at home.  If this is true, that removes a lot of people from that group.

[ Parent ]
In addition (4.00 / 1)
There are studies that show that 20% of the uninsured make 75K or more per year.     So some of these are penalized by preexisting conditions, which is fixed in every bill.  Some choose not too have insurance, which will be fixed with mandates.   Some are self employed or work for an employer who doesn't have insurance.   Yes, this doesn't cover all people, but it does cover more than what we currently see.  The more we can add to chip away, the better.   YES, I concede there are better ways... but that doesn't mean the current proposals are worse than what we have.

[ Parent ]
So it is a good thing (4.00 / 3)
to be forced to buy faulty insurance products?  How's a captive buyer going to get favorable terms with toothless market makers?

[ Parent ]
Hey, I have an idea (4.00 / 2)
Let's fight for yet another thing we won't get and let them take a sh*t in our hands!  Won't that be a great Xmas gift?

Time to flip and start drumming to kill this turd.  At this point it would be better to pull the progressives away and hang the failure around the necks of the moderates and Leiberman in particular.  Let them wear the crown of the scapegoat in 2010.  I don't care if there are Democratic losses, at this point we damn well deserve it.  If the moderates don't want an ass kicking in 2010, let them come to us and start talking about what we want to see in a passable bill.

Count me out, I'm calling my senators tomorrow to bury this crappy bill.  This dysfunction just can't go on, Obama should hang his head in shame at his total lack of leadership on this issue.

Don't let the door hit you on the way out... (1.33 / 3)
Your post is one of the absolutely stupidest posts I have read.  You clearly have not read the bill or done any research outside of a few talking points.   Check your ignorance and educate yourself.      

[ Parent ]
We lack details (0.00 / 0)
but what details have been released sound bad enough to scuttle this thing.  Once we know which 55-65ers are actuall eligible for Medicare under the plan, then sink it.

But frankly, if the Senators from the insurance industry like it, chances are good it's better for the industry than for those of us not invested in the industry.

[ Parent ]
Here's your details wise guy (0.00 / 0)
*  Every citizen is mandated to buy private insurance (BTW - shouldn't this already be enough to bury it?)

*  No real way to control costs those private costs without a public option (which is now gone)

*  Stupak WILL slip through in some form no matter what the senate passes

*  Any other olive branch offered (like Franken's nice addition) will be yanked at the last minute when combining the bills.

Everything else is a load of crap and there will be loopholes galore for the insurance companies to drive trucks full of money through.  If you'd like to provide your own details, let's talk.  Otherwise, thanks for the trolling.  This bill is regressive, oppressive, and may well be WORSE than keeping the status quo (where at least I can choose to walk away and have no insurance without being a criminal.)

Time to flip, time to kill it.  Time to admit when we've been buggered and start salvaging what we can for the fights after 2010.

[ Parent ]
Well, I don't agree. (4.00 / 2)
  And that's a rarity.

 I would really like to know the reasoning behind a medicare buy-in restricted to 55-64-year-olds.  How do you explain that the to the public?

 A public option is better because it is more easily expanded incrementally than a medicare buy-in.  

Maybe (4.00 / 1)
but using Medicare and continuing to drop the age rate gives us a better public plan than whatever lump of crap would invariably have surfaced if the public option did survive.  As it was suggested elsewhere, if they start to blur the line about who gets Medicare and who doesn't, we can slowly win a media narrative that everyone deserves medicare.  Medicare for all beats the public option.

[ Parent ]
55 is entirely arbitrary (4.00 / 2)
Which may mean this inevitably gets expanded to lower that age threshold over time.  After 65 was the retirement age, you had worked your whole life and had earned some government cheese.  What is the specific rationale for 55?  Why not 45?  25?

For the conservatives who feared the public takeover of health care I think lowering the Medicare eligibility age is a much better slippery slope to that than the opt-out negotiated rate PO was.

[ Parent ]
Yeah, and why not 65? (4.00 / 2)
I can easily see this in a few years: "We just don't have the money to pay for pre-retirement health care. Rather than cut benefits to our retirees we have to roll back eligibility to historical norms."  Whoops!

A lot of liberals seem to be rationalizing a horrendous bill by dreaming up fantasies that it will magically get better in the future.

The only reason we are getting anything done is that we now have something to bargain with: extensions of patents and the individual mandate.  Once liberals bargain those away there will be no bringing this issue back to the table.

[ Parent ]
I would also mention though... (0.00 / 0)
...that neither Dems or Reps ever like to take "entitlements" as they are sometimes referred to away, hence the deficit.  Dems love to add expenses, Reps love to cut taxes but neither group is very good at cutting expenses.

[ Parent ]
The idea that "entitlements" are a third rail is only (4.00 / 2)
about 20 years out of date.

They're coming for Medicare and Social Security and if takes a bipartisan commission to roll back the glory of the HCR bill, so be it.

[ Parent ]
2005 was only 4 years ago... (0.00 / 0)

[ Parent ]
Well... (4.00 / 2)
Just to point out 55 is a common starting point for the term Senior.     I mean Active Adult communities start at 55 and these communities can legally discriminate according to federal housing guidelines.    55 was and sometimes is still considered the retirement age although its rarer and rarer.  

Ultimately though I'm guessing they are using Census breakdowns.   55+ is considered in the the "special" group OLDER population, with 65+ as Elderly.  These are ACTUAL census terms.  SO they are offering MEdicare buyins to the OLDER population group.

[ Parent ]
To the point above (4.00 / 1)
it covers those most likely to suffer from chronic conditions who would have trouble affording private insurance.  

If, over time, you show that adding this group to Medicare controlled costs better AND provided better quality for this group, you will have both employers and employees screaming to be let int.

[ Parent ]
but your own logic and the claims made in this thread show how easily medicare can be expanded to others (4.00 / 1)
if you're not a member of a group that's going to get it, then you end up feeling slighted, which then provides the space to advocate for a further expansion of medicare.

look, i'm not happy with this - especially this mandate bullshit - if it's a mandate, it should be a mandate on the government to PROVIDE care as well- since when are unfunded mandates on individuals okay when they come with no benefits attached?

but both the direct benefits (to 55-64 year olds) and children if they're included as well as the indirect benefits (to adult children of 55-64 year olds and to adult parents of children) are worth taking into account to.  Plus actually regulating insurers so they use their money to provide care is extremely important - as with the public option discussions, simply having insurance is not enough - you need good health insurance because the issue is access to care, not access to insurance.

However, that's all assuming that any of this actually makes it in the Senate bill, that it passes, that it doesn't have a bunch of crap in it, and that the House and the Senate together are able to come up with something that doesn't make you want to hurl.

It doesn't seem ideal by what I would want, but nothing would have been.  It doesn't seem ideal by what I could have had, and there are strategic evaluations to conduct now and post mortem (what woudl have happened if the house progressive caucus had pushed for 'medicare for all' from the beginning instead of 'public option' and 'robust public option').  It does seem to be okay given what has transpired so far, if what is written above is an accurate representation of the sense of the bill.  which is a big if - i don't know.

[ Parent ]
i forgot to mention though (4.00 / 1)
why do the new people on medicare have to pay premiums for medicare? that's f"£ked up.  that should be reduced too.

[ Parent ]
Ezra Klein reports differently.... (0.00 / 0)
He says that the uninsured limitation only applies until the exchanges take effect, at which point, medicare will be available to ALL 55 year olds on the exchange.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!

that sounds too good to be true (4.00 / 1)

[ Parent ]
Where does he report this? (0.00 / 0)
I can't see it on his blog.

[ Parent ]
here... (4.00 / 1)

In his update...

Update: Senate sources say that the limitation to the high-risk pool would only be for a transitional Medicare buy-in starting in 2010, but that the program would move to the exchanges come 2014. So never mind!

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!

[ Parent ]
Not so sure (4.00 / 1)
Brian Beutler at TPM:

That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized--people will have to pay in without federal premium assistance--and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

My reading of that is that in 2014 the Medicare option will be part of the exchanges, however I seriously doubt all people 55-64 will be eligible for the exchanges, so...  The only real change in 2014 is that subsidies will become available.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
But will people below 55 who are on the exchange be able to get it? (0.00 / 0)

[ Parent ]
No (0.00 / 0)
That would be a true public option based on Medicare rates. Oh, wait...

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
Better (0.00 / 0)
The exchange itself isn't open to everyone, but it is slightly more than just the uninsured, like self employed currently with insurance.  (I suspect those people could just drop their insurance to qualify, too.  Sounds like a loophole.)  If the House language makes it in, the exchange will slowly expand in size, so that will help, but I doubt that language will make it.

[ Parent ]
Signing Statement.... (0.00 / 0)
I hate to suggest a Bush trick, but too bad a signing statement couldn't be used to say that all people qualify for the exchanges.

[ Parent ]
Yes, a loophole indeed (0.00 / 0)
I could see 55-65ers getting fired around open enrollment time for Medicare and hired back on once they buy their own Medicare.  A very clever way for employers to offload health insurance costs, no?

[ Parent ]
compromise (4.00 / 1)
But Democratic aides said that the group had tentatively agreed on a proposal that would replace a government-run health care plan with a menu of new national, privately-run insurance plans modeled after the Federal Employee Health Benefits Program, which covers more than eight million federal workers, including members of Congress, and their dependents.

A government-run plan would be retained as a fall-back option, the aides said, and would be triggered only if the new proposal failed to meet targets for providing affordable insurance coverage to a specified number of people.

The agreement would also allow Americans between age 55 and 64 to buy coverage through Medicare, beginning in 2011.


will the buy-in expire in 2014?

So is this it? (4.00 / 1)
I'm just getting confused now. What is this f*cking deal anyway? I'm almost ready to just give up and start opposing this whole "deform". Will there be a public option or not?

Yes, Virginia, there are progressives in Nevada.

[ Parent ]
IF this report is true (0.00 / 0)
and thats a HUGE if, then this is much better than the weak Opt-out. And regarding your question which expiration in 2014, there is NO WAY thats policy...the democratic party will not be responsible for taking entitlements away from people, which is exactly what an expiration date will mean. Even conserva-dems would be against that idea since they would suffer politically, which is all that drives them. I don't take those rumors seriously at all. The more accurate concern is the medicare buy-in being available to all 55-64 olds vs just the ones who are uninsured.

[ Parent ]
Political suffering (4.00 / 2)
While I agree with your point in general, we have a few people involved who are completely undeterred by public opinion.  Like Joe Lieberman.

[ Parent ]
Why not? (0.00 / 0)
Politics don't drive squat.  Money, on the other hand, does.  Look at Feinstein, one of the Senators stomping her feet and pouting for the catfood commission.  She's cozy enough with the big corporate donors that the seat is essentially hers for as long as she wants it, and when she doesn't, she can probably have her pick of better-paying lobbyist jobs afterward.  What are we gonna do then, fire her?

[ Parent ]
If we get a decent plan out of this (4.00 / 3)
it will only be through a patchwork of ideas.  It has to be a combination of increasing the rate for Medicaid, guaranteeing some strict regulation on insurance companies, increasing the uninsured child provisions as far as possible (up to 30?) and opening the Medicare buy in for all those between 55 and 65.  This one idea of letting uninsured individuals between 55-65 buy-in as a stand-alone piece of reform plus massive subsidies and perks for insurance companies won't fly.  What's the rational, that "socialized medicine" is ok for older folks but us younger folks need to subject ourselves to the whims of insurance profit margins?  

If it turns out that the public option really can't be saved, progressives need to lobby for a comprehensive patchwork program that legitimately provides health care reform for ALL Americans.  But considering that progressives haven't stood firm on anything throughout this debate, our congress critters don't have any legs to stand on.

new tpm post on tonight's confusion (4.00 / 1)

Other news outlets are walking back reports that the public option has been scotched from the Senate health care bill, after Senate Majority Leader Harry Reid insisted the popular provision is still alive.

Apparently the confusion isn't just among the news outlets.

We hear from a Senate Democratic aide that offices are being deluged with calls after the "tentative deal" the health care gang of 10 reached tonight.

The aide tells TPMDC even Reid senior staff are trying to piece it together.

The bottom line is they "swear" the public option is "not dead," the aide said.

"Few outside ten members themselves have details, including Reid," the aide said, adding that staffers were kicked out of the negotiating room when they neared a deal.

New Jersey politics at Blue Jersey.

OK, I'm now even MORE CONFUSED! (4.00 / 1)
Who's telling the truth here? Reid? Carper? Harkin? Obama? Anyone?

So will there be a public option or not?

Yes, Virginia, there are progressives in Nevada.

[ Parent ]
I'd guess (4.00 / 2)
that at best it's off in distant trigger land.

New Jersey politics at Blue Jersey.

[ Parent ]
come the hell on (4.00 / 1)
"Ideally, we would have the public option and the Medicare buy-in.  However, if you have to choose which one to try and save during the conference committee, I am simply going with whichever plan gets more people on public insurance."

And to hell with anyone under 55?  This is getting insane.

but what if they offer you the federal govt health care plans (0.00 / 0)
That wouldn't be bad. There's the cost control problem in the long term, but private insurance plan with subsidies from the govt and no pre-existing condition exclusions is not bad.  

New Jersey politics at Blue Jersey.

[ Parent ]
how much will premiums be? (0.00 / 0)
the subsidies won't help most working people if they're based on the hilarious federal poverty line

[ Parent ]
Just curious... (0.00 / 0)
Do you not have any insurance now?   Does your employer not offer it?   Do you have a pre-existing condition keeping you from being covered?    

[ Parent ]
I don't, I can't afford it, and probably (0.00 / 0)
anything else?

[ Parent ]
Freebie (4.00 / 1)
Travis has been pretty clear he wants free insurance despite making an okay wage.

[ Parent ]
I'd pay $50 a month (4.00 / 2)
and only then would I be happy about doing so if my money didn't go to a for-profit company

sorry I can't get all warm and fuzzy about redistributing my income (under duress) to the companies that caused this problem in the first place

[ Parent ]
It doesn't matter what his wage is... (4.00 / 3)
it doesn't matter if he has gold plated cadillac insurance or not.

Look at Dr. Elizabeth Warren. She has stated time and again that 75% of medical bankruptcies in this country happen to people who already have insurance. They think they're covered but they're not, and it ends up costing them big time.

Now, the government will be able to force Americans to buy shitty insurance policies, and penalize them if they don't. And that same government seems uninterested in making sure the insurance companies live up to their end of the bargain, when their customers get sick.

Woot. That was worth it.

[ Parent ]
Take the long view, kiddo (0.00 / 0)
See Operative086's comment above -- the Medicare eligibility age is no longer set in stone but is now vulnerable to political pressure, almost all of which, barring a catfood commission, is downward.

[ Parent ]
says who? (4.00 / 1)
Where will this groundswell of support for a lowered medicare age come from?

65% to 75% of the American people have consistently said they want a public option, what did that get us?

Are we going to wait another 15 years before we drop the age to 50? another 20 years before it goes to 40?  

[ Parent ]
it will come from the 65-75% of people who now SEE a public option being extended to people 55-65 that they're kept out of (4.00 / 1)
and yes, it will probably be a decade or more.  but we can speed it up?

look, it's a $hit country.  and the political system is even worse!  there's no two ways about it.

so i suggest getting on the bandwagon for medicare for all now.  and pushing hard now to say, lower the age to 50 NOW or raise the eligibility age to 30.  

[ Parent ]
the other long view (0.00 / 0)
is that this sets the precedent for paying for medicare, no?  or do people already pay?  i thought it was free and therefore useful.  it also reemphassises that the programme is means tested, which is not good, uniless that can be changed to being universal by the time progressives are out of power (20 years? 30 years?).

[ Parent ]
Medicare is not free (0.00 / 0)
Premiums are deducted from Social Security checks. Prescription coverage is extra. If you do not enroll in this coverage immediately upon retirment, the cost will be higher (on a sliding scale, I think) when/if you join later. There are also "supplemental" insurance policies that are selected from a very wide range of providers. Purchasers choose between paying a lot per month for "best coverage" and paying the least per month for a high-deductible policy. I chose that, and consider it to be "catastrophic coverage."

You may be thinking of Medicaid, for lowest-income and disabled persons, which goes to people who cannot pay anything for health insurance.

[ Parent ]
yes but the point of both medicare and social security is (0.00 / 0)
that you don't have to have a separate income to receive them, which serves as protection (insurance).  the substance of what you're talking about sound like an opt-out.  that's different from allowing people to buy in.  unless my confusion is better the better of me.

thank you for the details.  it's helpful.

with social security, my understanding is that you're theoretically receiving what you've earned based on what you've paid in, but that's not actually how social security works. the pay-in pay-out system is just a convenience to (have made) the programme politically sellable.

[ Parent ]
We wouldn't want young, healthy people buying in... (4.00 / 1)
This pisses me off but it isn't the worst.  

We can fight again to have the age lowered further later.  And actually we could probably justify younger people having the option to buy in on the grounds that it would be profitable for the program and sustain it.

tpm on the compromise (4.00 / 2)
If this trade-off carries the day, the opt out public is gone.

In its place will be many of the alternatives we've been hearing about, including a Medicare expansion and a triggered, federally-based public option.

As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would offered on the exchanges in every state. However if insurance companies don't step up to the plate to offer such plans, that will trigger a national public option.

that last part is not bad (4.00 / 1)
You can certainly run on "health insurance plan like Congress has." In fact, I think our guys did. And generally people think government employees have good insurance.

New Jersey politics at Blue Jersey.

[ Parent ]
Medicare language (4.00 / 2)
That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized--people will have to pay in without federal premium assistance--and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

It appears as if liberals lost out on a Medicaid expansion that would have opened the program up to everybody under 150 percent of the poverty line. That ceiling will likely remain at 133 percent, as is called for in the current bill.

This 2014 stuff is complete and utter madness.  

New Jersey politics at Blue Jersey.

[ Parent ]
re: buy-in (0.00 / 0)
This 2014 stuff is complete and utter madness.

you mean the unsubsidized 2011-2014 part?

[ Parent ]
yes (4.00 / 1)
plus, the entire concept of putting off the exchanges until 2014.

New Jersey politics at Blue Jersey.

[ Parent ]
It's not madness, it's shrewd accounting (0.00 / 0)
Pay for ten years, get 5.  It's a great deal if you're on the seller side of the table.  In 2020 things might look a bit more interesting...

[ Parent ]
Does the individual mandate go into effect immediately (4.00 / 1)
or in 2014 along with the exchanges?

Also, am I the only one who thinks this is a lot more complicated and confusing than it has to be?

[ Parent ]
Heh. (0.00 / 0)
Also, am I the only one who thinks this is a lot more complicated and confusing than it has to be?

You, sir (or madam; no offense intended), are neither insane nor a member of "The Greatest Deliberative Body in the World"(TM) i.e. a U.S. congressperson.

Oh, and to answer your question, the short answer is 2013.  At least according to the House bill, that is.  The Senate bill is so messed up, I'm not going to even bother.

The long answer:
The relevant sections are 401 and 501.  401 is under Title IV, Subtitle A--Individual Responsibility, and says, "see section 501."  Yes, really.  Okay okay, it's more wordy than that, but not much.

For an individual's responsibility to obtain acceptable coverage, see section 59B of the Internal Revenue Code of 1986 (as added by section 501 of this Act).

And that is the entirety of section 401.

Sec 501 is what talks about the requirements for "acceptable coverage."  That section's a bit longer, so I'm not going to paste all of it here.  The relevant part is at the very end.

(1) IN GENERAL.-The amendments made by this section shall apply to taxable years beginning after December 31, 2012.
(2) RETURNS.-The amendments made by sub-section (b) shall apply to calendar years beginning after December 31, 2012.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
Haha, thanks (0.00 / 0)
And yes, it's sir. :)

[ Parent ]
nyt says the same (0.00 / 0)
Mr. Reid refused to provide details. Other senators said the tentative agreement would allow people ages 55 to 64 to "buy in" to Medicare. Under the agreement, a federal agency, the Office of Personnel Management, would negotiate with insurance companies to offer national health benefit plans, similar to those offered to federal employees, including members of Congress.

If these private plans did not meet certain goals for making affordable coverage available to all Americans, Senate Democratic aides said, then the government itself would offer a new insurance plan, somewhat like the "public option" championed by President Obama and liberal Democrats in Congress.

[ Parent ]
tell me I'm not the only who laughed (4.00 / 3)
when I read "like the "public option" championed by President Obama"  

New Jersey politics at Blue Jersey.

[ Parent ]
If true, this confirms I am dropping out of politics (4.00 / 2)
this country is fucked. No country long survives when plutocrats take over. They eventually eat away at the basic fabric.

Don't let the door hit you on the way out... (4.00 / 1)
Sorry, I have no patience anymore for those kinds of Armstrongesque Statements.    

[ Parent ]
I am going off to focus on my businesses (0.00 / 0)
and family. If in your mind that makes me a loser, so be it. Peo like you are not my standard anymore. The fact is I spent too much o fmy life wasting time on people who don't even want to save themselves. So, my theory is I need to just focus on my business and making money. Good luck with your failed strateges that will result in the same result year after year. This will all depending ont he outcome of what is happening now. My view is pretty simple- this is a plutocratic move. it is not a close call.

[ Parent ]
Never said you were a loser (0.00 / 0)
I said I was sick of people whining that if they don't get there way they are dropping out.     JUST DROP OUT.   THe grand statement isn't needed.... You sound like a jerk off when you do that.    just don't show up anymore.   Its as bad as the people who said they'd leave the country if Bush or Obama was elected, none of which ever did.  Its just annoying whining.

Good luck working on your business and family though.  I hope you are successful in your endeavor.

[ Parent ]
And by the way (4.00 / 1)
even as you are being a dick towards me, the party is already losing voters and facing a lot of voter apathy going into 2010- a base year election. Guess what- shitty attitudes such as yours will guarantee bigger loses. The fact is I am the rare exception- a guy interested in the private sector rather than the public who actually gave a damn versus a shill like Dtzone who is here mostly because he wants to kill the PO and has for months.  Yet here you are saying it does not matter. Good to know.  

[ Parent ]
And by the way (0.00 / 0)
even as you are being a dick towards me, the party is already losing voters and facing a lot of voter apathy going into 2010- a base year election. Guess what- shitty attitudes such as yours will guarantee bigger loses. The fact is I am the rare exception- a guy interested in the private sector rather than the public who actually gave a damn versus a shill like Dtzone who is here mostly because he wants to kill the PO and has for months.  Yet here you are saying it does not matter. Good to know.  

[ Parent ]
Nope (0.00 / 0)
Just tired of whining.    

And seriously, DTOZONE is one asshole on a blog.  What possible difference do you think he made or would make on the PO as a whole?     Your giving him WAY WAY WAY too much credit.    We're posting opinions on a blog... not writing editorials in the NEw York Times, which have little influence anyway anymore.

[ Parent ]
FTR (0.00 / 0)
That's not just aimed at you  Just something I've seen people do for the last 6 years for various reasons and its just really annoying.

[ Parent ]
Uninsured. (0.00 / 0)
Anyone can become uninsured. All you have to do is cancel your insurance. How is making it available to "uninsured" people different from making it available to everyone?

guessing if your employer offers insurance you'll be forced to take it or pay penalties (0.00 / 0)
my company's insurance is $100 every two weeks

penalty here I come

[ Parent ]
if your employer (4.00 / 2)
no longer has to cover people 55+ because that population is covered by Medicare then that automatically lowers the cost of your monthly premium from your employer because those higher risk clients are no longer on your company's health plan. The reality is that younger people can get insurance at much lower costs than people who are 55+ even if they are forced to do it by mandate. For instance, I'm self-employed and I pay $$185 per month for my insurance and just $80 per month for my 17 year old. My 21 year old gets insurance through his college for only $99 per year. I understand that mandates appear not to be fair at the outset, but the only way to lower costs for everyone is to spread the risk to the widest population possible. I wish we had true universal coverage but that ain't gonna happen. So getting more older aged people on a public program like Medicare helps everyone in the long run.

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...

[ Parent ]
but Travis just said (0.00 / 0)
He won't pay $200/mo for insurance, the same what you consider pretty good. His would be pre-tax too, so it's actually less than yours.

Personally I think we need a discussion of what we want. If no one is willing to pay $200/mo then you might as well forget reform, become Republicans and complain about taxes.

New Jersey politics at Blue Jersey.

[ Parent ]
"willing to pay $200" (4.00 / 2)
I forgot about my Scrooge McDuck-like vault, loaded with gold dubloons.

[ Parent ]
I added a comment below (0.00 / 0)
As I thought about how little you might make.  

New Jersey politics at Blue Jersey.

[ Parent ]
anyway, it seems like (4.00 / 1)
the subsidies would be the biggest concern for low income people. I am afraid the Senate bill will have lousy, inadequate subsidies.

New Jersey politics at Blue Jersey.

[ Parent ]
So one could argue... (0.00 / 0)
That people like Travis who refuse coverage are a problem, especially since Travis doesn't realize MANY people pay a HELL of a lot more for insurance.    I paid $300 a month when I was self employed, I've paid as little as nothing and as much as $400 a month (which is WAY overpriced) depending on the company.   Most often it was between $100 -$200 a month, so I guess I don't consider Travis's cost that bad.    Income level obviously makes a difference... if Travis makes $25K a year then that's tough... if he makes $50K a year, that's a different story.  The key point here is HE WON'T PAY.   He didn't say he couldn't afford it or couldn't get coverage.  I hope he clarifies BUT that does make a difference.

[ Parent ]
as I said upthread, I don't have an extra $200 to donate to Blue Shield each month (4.00 / 1)
because I like eating food that contains nutrients, and my car requires fuel to deliver me to and from work, and sleeping outside isn't really 'in' this season

[ Parent ]
But regardless (0.00 / 0)
you'd be paying that $200 to someone, whether it's insurance companies or the government in taxes to subsidize healthcare.  

[ Parent ]
it wouldn't be that much of a tax increase (0.00 / 0)
and even if it was I'd rather pay it to the government to provide EVERYONE with care rather than pay what amounts to a youth tax to a for-profit corporation

[ Parent ]
So then the cost isn't the problem (0.00 / 0)
you just have a problem with who it's going to. At least be fair and admit that.  

[ Parent ]
it's both (0.00 / 0)
I'm complex like that

[ Parent ]
as I said below- DTzone is a shill (0.00 / 0)

[ Parent ]
Exactly... (4.00 / 1)
... I'd rather not pay it to private insurance.  I'd like to pay it towards a public option or medicare, something to strengthen a system that isn't driven by profit.

[ Parent ]
And Again... (0.00 / 0)
I don't know how much you make or what you spend it on.   Of course based on experiences, when someone makes the comment you just made it really sends up my BS radar.... Meaning that while I by no means think your rich, I have serious doubts all you do is eat as cheaply as possible, while sitting in an empty studio apartment in the worst part of town and ONLY driving to and from work.    I'm sure you NEVER go out with friends, on dates, buy new clothes, have no TV or Internet service, etc.   I could be wrong, but any time someone I know made a similar statement there was a lot of hyperbole.    My favorites were the friends I knew who were flat broke but somehow ALWAYS had money for beer and cigarettes.  Not saying this is the case, but just pointing out how that statement comes across.

Now for the other question... have you ever priced out private insurance.   I have a waiter friend who paid $75 a month for an HMO privately.  Not GREAT coverage, but it was better than nothing.

[ Parent ]
sure are a lot of personal questions in here (4.00 / 1)
also since when is buying clothing a fast lane luxury?  my company has a lax dress code but the sackcloth and ashes ensemble I tried out last week on casual Friday didn't go over well with the brass

[ Parent ]
Grow up (0.00 / 0)
Stop acting like a petulant little brat.  Your not being attacked.  You want me to attack you, I can.    Your getting way to defensive for a line of questioning you instigated in the first place by stating the cost of your insurance and assuming everyone would agree with you.

My point is that everyone has different priorities.    There are always things that can be cut or changed to afford something that is a priority.   Insurance isn't your number 1 priority and that's cool.    However, based on your comments you to object more to the morality of the payment more than the cost of the insurance.   But if you really want insurance, then I would bet any amount you can find a way.   If your metro area is too much, move to the suburbs and commute or more to a cheaper part of town.  Cut out some of your meals out or cut out a night at the bar.  Get rid of cable or the internet if you have them.    That's all my point is.   You don't WANT insurance, that's fine.   But acting like your so destitute you can't afford it and are living in squalor and doing nothing but work, sleep, eat and drive is a bit much.  That's what I think many of us have an issue with.    

[ Parent ]
His point is that you are not being economically realistic (4.00 / 2)
in your descriptions. That you don't get that is quite apparent to anyone who has grown up in anywhere near the economic bottom. The amount of luxury items that you can "cut" from is really small when you are trying to put food on the table, pay for housing, transportation, etc.  

[ Parent ]
this from a guy who threatened violence downthread (4.00 / 1)
but to your points regarding priorities, did you seriously toss "move somewhere else" and "cut out some of your meals" in with going to the pub, like where you live and eating food are purely optional?

I do want insurance.  I've had a job where my premiums were well covered (I paid like $80-$100 a month), my deductible for high end services was reasonable and I went to the doctor all the time.  I have personal issues which I won't babble about to the world but suffice it to say I should probably see a doctor.  But as I mentioned elsewhere, given the choice between sandwich today and possibly the doctor tomorrow (for an additional fee when I get there) I'm going to have to ask you to pass the mustard.

I never said I live in squalor, but I sure as hell don't spend all of my precious insurance money on whoring and new fangled tape decks for my horseless carriage.  

And at the end of the day it's also about the fact that I like to make choices with my money and as it stands I generally choose not to give large percentages of my income to corporations who were built on excluding people (people like yourself) from coverage and rejecting necessary procedures just to ensure their CEO's yacht gets detailed every week like he likes it.

[ Parent ]
beside the point. (4.00 / 3)
Whether Travis can afford insurance or chooses not to pay for insurance are tow different things.

I'm in a similar boat as Travis from the sound of the discussion (I make very little money, am under 55, and I don't have insurance).

Part of the broader idea is that health care reform was supposed to make it so more people got insurance and that we kept the overall cost in check.

In my lay man's view, it seemed the largest expense and most worrisome to me now is the fact that we are only feeding the private insurance companies who are by definition trying to increase profit margins -- NOT provide health care.

If there is no public option/medicare-buy in for people under 55 then how are we to make sure that we won't be dropped later if we sign up for some shitty HMO today?

I'd like to have a choice in the matter if they are going to force us to purchase insurance.

[ Parent ]
on the other hand (0.00 / 0)
I do want to say $100 out of a minimum wage for two weeks is a huge amount. The employer might as well not offer health insurance at that cost.

New Jersey politics at Blue Jersey.

[ Parent ]
But is travis only making minimum wage? (0.00 / 0)
And wouldn't someone making that little qualify for some subsidies int he proposed bills?

[ Parent ]
Yes, but I didn't really want to go into that (0.00 / 1)
I doubt Travis would even bother to research the subsidies he could get, takes away from bitching on blogs.

[ Parent ]
last I checked to be eligible for subsidies a single person had to make less than $24k (0.00 / 0)
which might fly in Iowa or wherever but in most major metros if you make that much you're paying more than half your monthly income in rent alone

but let us please continue with ad hominem attacks

[ Parent ]
varies by state (0.00 / 0)
the national standard in $24k, but depending on what state you're in, it varies.

A person making $24k is making far more than minimum wage, which is about $15k a year.

[ Parent ]
yes, $24k is more than $15k (4.00 / 2)
and yes, the cost of living varies by state

however most in the states in which the majority of people in this country live, $24k isn't even lower middle class

[ Parent ]
those are the states where the cutoff is higher. (0.00 / 0)

[ Parent ]
Living expenses (0.00 / 0)
I live on $10,000 per year, purely by choice (income is much higher). I don't live in New York or San Francisco, but I live in Portland which isn't exactly cheapo-land. And in my opinion I live quite comfortably.

Don't really have a big point here, except I never understand how everyone spends so much money.

[ Parent ]
so basically I just need to either get a huge raise or not get sick in the next 5 or 10 years (0.00 / 0)
awesome plan bro

[ Parent ]
Why I'm arguing for the mandate. (0.00 / 0)
You don't want to pay health insurance. Period. I don't blame you. Neither do I. But we all "pay" in the long run for the uninsured. And what we're really arguing about is where is the leverage to bring down costs for everyone. If you have an argument for that, I'd love to hear it. And if it can be argued outside your own personal context, all the better. The mandate can make "sense" in economic terms depending on thresholds for where government subsidies chip in, how it's enforced, what the choices are for consumers etc. If what you'd prefer instead is UHC, I understand. But that is not what the argument is about, unfortunately.

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...

[ Parent ]
UM... (0.00 / 0)
$200 a month is not that bad of a cost.  I've paid much more than that before for single coverage.

[ Parent ]
must be nice to live in a world where $200 isn't a lot of money (4.00 / 1)
that's as many as 40 meals, in the right hands

[ Parent ]
Most Americans live in that world lol (0.00 / 1)
a person making minimum wage makes $200 in a week.  

[ Parent ]
a week's wages isn't "a lot of money" (0.00 / 0)
I can't even begin to understand how you could come to this conclusion

[ Parent ]
Most Americans don't make minimum wage (0.00 / 0)
that was my point.  

[ Parent ]
he comes from an upper middle class background (4.00 / 2)
according to his own statements over at mydd. I would ignore him since he's been shilling agaisnt the PO from the start for months now, and for whatever conservadems do.

[ Parent ]
aww someone's cwankey. (1.33 / 6)

[ Parent ]
Only rated 4 because I don't think this is a serious personal insult. (0.00 / 0)
However, be careful. Thin ice.

[ Parent ]
And according to his statements, he has access to insider infos... (0.00 / 0)
...because he's working in the media, or something. Add to this his centrist, often contrarian opinions, and I guess that's the reason hy I simply can't trust him.  

[ Parent ]
I gotta go with Travis on this one (4.00 / 1)
One week's wages is a lot of money.  Particularly, when you are talking about a monthly bill: that obviously is 25% of their total income.

While I don't agree with Travis in general and think even single payer would cost him more than he suspects, his point is still a good representation of a large swath of people out there.  For some this will be a big new payment that has to be squeezed in somehow.  Those that don't have insurance now are often young and 99% of the time don't need it, to them this will feel like a huge problem.

[ Parent ]
"this will feel like a huge problem" (4.00 / 1)
ah yes, Paying Bills: the imaginary issue

[ Parent ]
Conversally (4.00 / 1)
Not having health care: the imaginary issue.

You based your whole line of attack on your own personal life.  That's fine, good even, but you've gotta expect pushback when you do that.  It was you who made your own life choices the center of the debate.

You are treating health insurance as optional and a couple hundred bucks a month as impossible.  That sounds very irresponsible to a lot of people.  Of course, the devil is in the details and you may very well be right, or people's suspicions about your youth and spending choices might also be right.  Or some combination.  Who knows??

In general, you have no need to defend yourself here and no one has the right to question you.  But "in general" got tossed out the window as you continued to make this all personal.

[ Parent ]
$35k in the DC area where rents hover around $1000 for a studio (0.00 / 0)
or as they said in your day "stinkin' rich"!

[ Parent ]
$1000 for a studio in DC?!?!? (0.00 / 1)
Where are you living, Georgetown?  

[ Parent ]
OK... (0.00 / 0)
Now you are being a DOUCHE, DTO.

[ Parent ]
if this was 1998 you'd have a point (0.00 / 0)
go to craigslist, search for apartments under $1000, report back with results for those Georgetown hideaways for less than a grand a month

[ Parent ]
Georgetown Hideaways (0.00 / 0)
Isn't that a bit like saying cars cost so much money... but completely ignoring the availability of used cars?  Who claimed you needed to live by yourself in a Georgetown hideaway?

Again, none of my business... accept you made it the entire point of your criticism.

I once lived in a really nice big house in the mountains.  Then I had a child and we decided to not use day care, so we dropped down to a single income.  I made good money, but we were house poor.  Eventually, we decided to sell the big house and move into a smaller one down in the suburbs.

Again, none of your business, but I wanted to make the point that people make life choices all the time.

[ Parent ]
hey professor (0.00 / 0)
I was making a joke.  There are no apartments any where near Georgetown for $1k a month, as DTO was suggesting.  I think a studio in NW starts at like $1200 for a room the size of an Exxon bathroom.

Also accept != except.

[ Parent ]
And many of us are just as bad off or worse... (0.00 / 0)
My mortgage with taxes is about $1600.    $250 for insurance.    The rest goes to food, gas, etc.    So yes, its tough and it sucks, but it certainly is doable.   Mark's right.  You made it about YOU and got hammered on it.  Not FTR, it was never my intention for you to take it as personally as you did.  So I do apologize.      

[ Parent ]
you have two incomes (0.00 / 0)
well, presumably you did when you chose to buy a house rather than rent

and none of this has a lot to do with this plan being a big X-Mas gift to Cigna and Co.

[ Parent ]
Mortgage? (4.00 / 1)
You can afford a HOUSE?!

(Do you get the point yet?)

[ Parent ]
My point was (0.00 / 0)
for most Americans it won't be one weeks' payment, it'll be a couple days payment. The average person makes $200 in three days.  

[ Parent ]
Feels (0.00 / 0)
Sure.  The poorest get subsidized and I think we all know the subsidies are too low.  As income goes up the subsidies go down, so there will be some who really feel the pinch of the mandate.

On the facts, I agree with you more than Travis, but you need to accept his complaint as at least a good representation of how many will feel about the mandate.  You can claim that these same people just want to freeload the system; after all, they don't really need insurance, they think.  And most of the time they are correct... up until the day they are not.  Then they expect the system to take care of them.

But that wonky perspective doesn't make the feeling go away.  Politically, it is important to understand how people will react.  Travis will not be alone.

[ Parent ]
it's not an issue of feeling like working singles don't need insurance (4.00 / 2)
it's a matter of making them choose between paying their car insurance/eating healthy/saving for the inevitable rainy days and insurance premiums

food today or (maybe) a doctor tomorrow, which shall it be?

[ Parent ]
Then it really won't matter (0.00 / 1)
whether there's a public option or not, the mandate won't be popular no matter what we do because for as many as there are who don't like insurance companies, there's just as many who don't like the idea of paying the government more money either.

[ Parent ]
Cost (0.00 / 0)
The best versions of the public option would have kept costs  down for this same crowd.  But even the House couldn't pass that much.

As you know, a lot of people here thought the public option did something it really did not do.

Both the far left and corporate right know what the real deal was, a conspiracy to ultimately end up with single payer some year down the line.  That is why we fight for the PO and they fight back.  Some got confused and thought it did something really important in the short term, but they were mistaken.

[ Parent ]
Actually for those of us (4.00 / 1)
who supported the public option- the goal was a a moderate plan that would allow competition that you find in other countries  with public private models.  And the idea of including it in the bill was that it would allow the camels nose under the tent such that even if we did not get the whole thing now, at least we could grow it into something.  The point was always competition. Some of you may be ideologues, but not everyone else. Some of us appreciated the economic issues. We are faced with an oligopoly in many regions that can control pricing. This is economic terms was bad enough. Now we face one with a captured market. There were only ever a few solutions to this issue of pricing and cost control.

[ Parent ]
"lol"??? What the eff? Do you think that's funny? (0.00 / 0)

[ Parent ]
Well (0.00 / 0)
First of all... I never $200 wasn't a lot of money.   What I said was $200 isn't an outrageous cost for insurance.   That cost is NOT outside of the normal realm of health costs.   Hell, my wife's PPO with both Her and I on it is $650 a month.  

Is $200 a lot... Depends on what you make in a year and how well you control your money.   I don't know your yearly salary... If you make 50K or more, then yes, I think you should be able to control your finances to afford it... the way millions do every year.   If you make $25K a year, then I agree it becomes much harder.  

No one is saying that there isn't a better way to do it.   I'm just saying that based on what I read, you don't totally have a realistic idea on the costs of healthcare.

Maybe I'm wrong, but I'm guessing you are early to mid 20's on your first job.   Yes it can be hard.  I'm got laid off last month and our household income is about $35,000 right now (until I get a new job) for three of us and we are paying about $250 a month for our insurance.   Granted that's for three of us, it is tough to pay it, but sometimes you make hard choices and choosing insurance is more important to me, so I cut other stuff.     It sucks, but I have a baby so I need it.  I'm also a diabetic, so I need to have continuing coverage.   Love or hate some of the elements of this bill, there are positives to it.    

[ Parent ]
point by point (0.00 / 0)
>Hell, my wife's PPO with both Her and I on it is $650 a month.  

that's your problem (also way to take the PPO and then complain about the costs)

>If you make 50K or more, then yes, I think you should be able to control your finances to afford it

I don't, not that my personal specifics are relevant to the broader discussion

>I'm just saying that based on what I read, you don't totally have a realistic idea on the costs of healthcare.

it's like I'm imagining a world in which all of the other civilized nations have methods of paying for healthcare that doesn't serve as a massive money funnel to private industry...a dreamy fantasy world in which our neighbors to the snowy north don't underwrite CEO salaries and their milk comes in bags

>Maybe I'm wrong, but I'm guessing you are early to mid 20's on your first job.  

delicious backhanded insults

>I'm got laid off last month and our household income is about $35,000 right now

seems like an allstar like yourself wouldn't find himself in such a bind

>It sucks, but I have a baby so I need it.

don't have babies if it's so hard

>I'm also a diabetic, so I need to have continuing coverage.  

type 1 or type 2?  while we're asking personal questions to score points on

[ Parent ]
Travis (4.00 / 1)
Calm the hell down and act like an adult.   There are no insults, believe me, if I wanted to insult you, I don't do back handed... I'll come out and call you a stupid fuck if I think you are one.

1) I don't HAVE my  wife's PPO.  I simply was pointing out what the price was to show you that health care can be quite high.  

2)  Your personal situation is relevant to your discussion saying you won't pay $200 for insurance.    To the bill, no it isn't relevant.  But you made a blanket statement that $200 is way overpriced for insurance and act like you are being personally raped by the insurance companies.  I'm pointing out to you right now that $200 a month, while not cheap, is not WAY out there for insurance costs.    

3) Hey, I'm all for Single Payer or Public Option.   I'd vote for it, support it, etc.   However, I'll tell you right now, Single payer will cost you quite a bit in taxes.  Yes I know you and I are both fine with paying it... but the cost per individual is likely higher.   While I support Single Payer, its not politically possible right now.    The insurance lobby would NEVER let it happen as it kills their business.    the AMA will never let it happen as it costs them fees.   Yes its greedy and it sucks.  It's reality.    

In our country a system with regulated costs would be much more likely.  But a fight would need to be won.    You seem to forget that this fight has been waged for 60 years and this is the first time we are actually close.   There is a lot of disappointment but there are several good things in this bill.   Im not saying passing this means that we can change it in the future, but I do feel we have a better chance.   But anyone thinking that we would get everything we desired in 2009 was fooling themselves.

4) See now your acting like a spoiled child.  Stop taking things personally and being a jackass.  People get laid off, it happens.  I'm working on getting a new job and expect to have one by years end.   I was just giving you my situation and showing you it is indeed doable with a low income.  

5) As for the babies comment, I recommend you never make an ignorant statement like that again.  You have the guts to make a comment like that to most people in person and they most likely will beat the shit out of you.  Don't attack someone's kids, that's being an fucking asshole.    Act like a man instead.

6) Type I.  I'm very happy we might see an end to the ridiculous exclusions with insurance.

Chill out, stop taking things personally and above all, don't ever fucking attack someone's kids.   That's really a piece of shit thing to do.

[ Parent ]
If you think his anger is something (0.00 / 0)
you are will truly discover it when this shit pile his the public view.  

[ Parent ]
I wasn't attacking anyone (0.00 / 0)
I was simply stating that you seem to have been arguing from the standpoint that life is very difficult for you because you chose to have children.  To which my counterpoint stands.

You, DTO and Matson seem to want to make this a personality conflict when really it's a conflict of ideas.  I personally believe that healthcare is a right and that nobody should die of preventable illness because our asshole president (as he has explicitly stated) feels that legislation should be crafted to protect private industry regardless of the detriment to the citizenry.  You guys seem to think that as long as you have yours and you can figure out a way to make it work for you, everyone should be satisfied...and that anyone who disagrees is being petulant, entitled, or perhaps "spoiled".

Also, speaking of things that aren't classy, invoking rape isn't really an awesome thing to do when it's not germane to the discussion at hand.

[ Parent ]
You are the one that made it personal (2.00 / 2)
Don't blame this on us.

Then again, the fact you said "To which my counterpoint stands" proves you really are a stupid fuck asshole who doesn't deserve to be trusted in any conversation anyway.  And I don't cuss.

[ Parent ]
Yes that's why you up rated a comment above (0.00 / 0)
in which DTO pushes a personality attack against me. I advocate you look up the person who is posting along with you to see his background on this issue.

[ Parent ]
Yes that's why you up rated a comment above (0.00 / 0)
in which DTO pushes a personality attack against me. I advocate you look up the person who is posting along with you to see his background on this issue.

[ Parent ]
Uprating (0.00 / 0)
I don't agree totally but I'm against rating in general unless its spam.

[ Parent ]
That's great (0.00 / 0)
but what you're looking for is something free...not going to happen.

We pay money to for profit corporations for necessities all the time, we do it for food, shelter, clothing. People have a right to eat, be clothed and be sheltered? No?

Don't you think bread would be cheaper if Hostess wasn't trying to make a profit out of it? Don't you think a pair of jeans would be cheaper if Levis wasn't trying to make a profit out of it? That's life in a captalist society...this is why people turned to Communism.

[ Parent ]
oops, veered a bit too far right, there (4.00 / 1)
It is a proven fact that socialized medicine is much cheaper and more efficient that capitalist medicine.  Capitalism seems to fail in a certain sub-category of services with health care being the primary example.

[ Parent ]
True (4.00 / 1)
But the problem in our current society is businesses have abandon ethical actions.    Its about squeezing every last bit of profit and not caring about the employees or the community.   Even 20 years ago, this wasn't as bad as it is now.       CEOs got fucking greedy.

[ Parent ]
Are the profit margins on (basic utilitarian) food, shelter and clothing excessive? (0.00 / 0)
If it is, why don't we have some kind of government program that directly sells food and clothing? (We already have government housing, I believe.) And no, "OMFG THAT'S COMMUNISM!!!1!!1!!" is not an answer.  The armed forces directly sells goods, I believe; why can't we have government supermarkets and such?  Unless there isn't really a profit margin as it is.

[ Parent ]
*Shaking my head* (0.00 / 0)
For your sake, I really hope you grow up in the next year or two.  

You attacked my kid.   Honestly, I would have decked you if you were talking in person.   I would have then picked you up and bought you a beer but you would have gotten punched very hard.     Keep your mouth shut about people's kids.  My life is great with a child.   I NEVER ONCE said it wasn't.   I simply mentioned I had a kid and a wife which makes insurance COST MORE and household expenses as well.  If you are ever lucky enough to have a family, you will understand just how much more life with a family is.    You need to apologize for attacking my kid.   That was a douche move.

This started as a conflict of ideas.  YOU turned it into a conversation about your personal situation by invoking the statement that you wouldn't pay $200.   I called you spoiled because of your immature know it all attitude, not for your opinion.    You beginning to act like an asshole brought out that comment.  

As for your opinion.  I agree that healthcare is a right.   I am a strong supporter of the PO and of Single Payer.  I'm also realistic.   Yes I'm a couple (literally) of years out of my idealistic 20's now, and so my prospective has changed.   I know that government doesn't work like that, especially in this day and age (and having worked as a contractor for a few years too).   Big changes all at once just don't happen....   Again, anyone who expected 100% progressive health care was fooling themselves.    Washington is a city of out of touch pragmatists.     I also know that blaming Obama for everything is just way to simplistic.    Yes he does have his share, but there's been too much saying that Obama is the same as Bush... (Not saying you said this) That's revisionist ignorance from people who either don't know or forgot JUST how shitty 2000-2005 really were.

And finally "Also, speaking of things that aren't classy, invoking rape isn't really an awesome thing to do when it's not germane to the discussion at hand." - Seriously, I know you aren't an idiot and you know that this was pure hyperbole.   TO even make that statement just turned your somewhat thoughtful post into pure garbage.    

[ Parent ]
the abstract statement (0.00 / 0)
"if you find children expensive, perhaps you shouldn't have made that choice" is not the same as a specific attack on your child and your inability to tell the difference is unsurprising and baffling all at once

using rape in hyperbole is like using the holocaust in the same manner- it doesn't reinforce your point and it kind of cheapens the concept

I wanted to respond to substantive policy points here but all I'm reading is that "things are hard" and "we can't make changes" so I give up on this discussion as you seem more concerned with alpha male behavior than discussing the relative merits of a youth tax that will line the coffers of private industry, which my horrible president will sign with a big shit eating grin on his face

[ Parent ]
Only 40? I had months where I squeezed 80 out of this. (0.00 / 0)
However, ok, food is cheaper here in Germany than in the US, I guess.

But, really, for $200, you can have 40 meals at McD, right? So, 200 bucks really is a lot of money.

[ Parent ]
As a retiree (4.00 / 1)
I pay ~$200 per month for Medicare including my Rx and supplemental coverage. The Medicare comes out of my Social Security payment, and I have the other two paid automatically from my checking account.

A younger sister who lives in Michigan is on a Medicare Advantage plan. She's been boo-hooing because her insurance company says she'll be getting less under the reform plans.  

[ Parent ]
Not sure of your statistics, Chris (4.00 / 1)
First of all, the 7% figure for Americans age 55-64 you quoted is actually the percentage of all Americans at less that 200% of poverty level. I suspect that 7% underestimates the percentage of all Americans age 54-65 considerably.

According to the linked source, the number of Americans living below 200% of federal poverty level is 31% (18+13) of a total population of about 300 million. 31% of 300 M is 93 million. 7% of 93 M is 6.5 million, the number of uninsured in this age group. This is much greater than the 3.25 million you calculate.

Furthermore, I don't see that applying the 33% number would apply very accurately to that age group. I would think that with the increased medical problems of older people, considerably a considerably higher percentage would apply. Guess 50%. If, so 50% of 6.5 million is 3.2 million who would be covered by the expanded medicare proposal, not the 1.08 that you calculate.  

A Medicare buy in means that Medicare is no longer a single payer system (4.00 / 1)
Rachel Maddow had Sanders on talking about this, and they both noted how good this would be because it would expand Medicare, which is a single payer system. Neither noted that this proposal means that Medicare would no longer be single payer.  

That is a breathtaking development. What does that do to the longer term politics here? What does it do to the possibility of actually fixing health care down the line?

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

It does? (4.00 / 3)
Why wouldn't it be?  From wikipedia:

"Single-payer health insurance collects all medical fees and then pays for all services through a single government (or government-related) source.[1] In wealthy nations, this kind of publicly-managed health insurance is typically extended to all citizens and legal residents... The term single-payer thus only describes the funding mechanism-referring to health care being paid for by a single public body from a single fund-and does not specify the type of delivery, or who doctors work for."

Single-payer means exactly what it says... a single payer is responsible for paying whatever the location service is provided, as opposed to the current system where people have various different payers (insurers) and different places they can go.  Just because you allow people to buy into it doesn't mean that it's not a single-payer system.

[ Parent ]
I'm not sure it's as clear cut as you say (0.00 / 0)
although its certainly less clear cut than I said. The definition is distinguishing payment to health providers versus delivery of health care, leaving the question of where the funds for the payment come from open (it is generally taxes.)

Still, the idea of paying premiums does seem to undermine the idea of Medicare.  

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

[ Parent ]
Medicare recipients pay premiums now.... (4.00 / 1)
About $110 a month for Part B, I believe.  Part A is free, and part D is well... a mess.... but people pay premiums for that, too!

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!

[ Parent ]
True, which is no doubt part of the reason people (4.00 / 2)
don't necessarily recognize that it's a government program. Medicare should be the model for what government can do, but neither most citizens or Democratic officials seem to see it that way - even though it's extremely popular.

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

[ Parent ]
Isn't it amazing how (0.00 / 0)
the same people - namely, Lieberman and Nelson - who loathe government are somehow okay with a Medicare buy-in?

I suppose I should be happy about that, but I'm not.  We need to get back to the point where we accept government's right to do more for us.  Obscuring the government-ness of one of the most popular government programs doesn't help that cause one bit.

[ Parent ]
If the Senators from the insurance industry don't want it DOA (0.00 / 0)
I'd kick the tires and see if the thing's even got a transmission in it...

[ Parent ]
As mentioned below... (0.00 / 0)
People pay premiums now...

And I'm not sure whether it matters whether premiums are collected via taxes or "billed" in the sense that it would be if you "buy-in" to it.  While one is more transparent, I don't really see the difference as far as whether it's "single payer" or not.

[ Parent ]
I agree with you on the definition of single payer (4.00 / 2)
But I think it matters a great deal for how people think of it. We might be adding people into the system while helping to further undermine the idea behind that system.

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

[ Parent ]
I agree (4.00 / 1)
I'm very concerned that switching from the PO to Medicare buy-in, with no accompanying rhetorical argument or explicit acknowledgement that Medicare is government-run, may be undermining the idea of active government.  While this might bode well for Medicare for All in the future, it sets us back on a lot of other important issues.

[ Parent ]
Premiums vs. Taxes (0.00 / 0)
What's the difference? Either way the government says you must pay X to receive benefit Y.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
Policy design influences politics (4.00 / 2)
The strength of Medicare and SS are that everyone pays in taxes that are specifically designated for the purpose of funding these programs, and everyone see benefits as a result. That's one reason that these programs are popular, and that people are willing to pay higher taxes to fund them.  The efforts to add premiums into the mix lead people to conflate a social insurance program with traditional insurance.  I'd prefer we were making that distinction clearer, not more obscure.

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

[ Parent ]
Don't disagree (0.00 / 0)
But I don't see quite the mutation you seem to be concerned about. The government would still be the payer. The real question is how to structure payment for a component that is not an inter-generational program. Sure, I'd prefer we enroll people, send them an ID card and adjust taxes accordingly. However, I don't see direct billing to be quite the threat you see.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
Social insurance vs. public option (0.00 / 0)
is that it's no longer social insurance once you start getting all Ferengi with it, counting shekels, complicating the eligibility rules, slotting it into the exchanges, rating insureds... Medicare starts to behave more like a public option than like social insurance.  I'm not sure this type of weakening is good for typical leftist concepts of social safety nets.

[ Parent ]
I think David Kalb has a very legitimate point (0.00 / 0)
By switching from the PO to the Medicare buy-in, we might be gaining on policy grounds but we're retreating on ideological grounds since no one seems to know that Medicare is a government program.  While policy is ultimately more important, ideology and rhetoric have a huge influence on the political debate and, thus, what kind of policies end up getting passed.  And liberals have continually ceded ground on the debate over role of government, and this year was no exception - where conservatives vociferously attacked the idea of active government, liberals were by comparison dismayingly silent.  IMO, re-legitimizing an active role for government in helping ordinary Americans is not only important ideologically, but is one of the two biggest things we can do to greatly increase the chances of passing liberal/progressive legislation in the future (the other being public financing of elections).

With that in mind, our goal should be to get people to realize that Medicare is a government program.  Since most government programs don't bill people (Medicare Part B apparently being an exception) but collect through taxes, direct billing vs. taxes is a somewhat important distinction, though I understand that direct billing is probably the only workable choice if this Medicare buy-in is voluntary.

So while I agree that direct billing will probably have to be the way to go, I just want to stress that this issue is not an insignificant one.

[ Parent ]
Social insurance ideal vs. current reality (0.00 / 0)
Look, many of us would obviously prefer a single payer, health care for all social health insurance right be implemented immediately. We're not there now. Not even remotely in that neighborhood. So we really have to deal with what is, and how to best structure, maximize and leverage these 'gains.' I will concede preserving the inter-generational social insurance compact of traditional, retirement Medicare is important.

Let me point out an advantage of implementing Medicare premiums for non-retirees. I tried to articulate it here yesterday, however Ezra does it better:

Meanwhile, the Medicare buy-in lets people in the broader insurance market see what national bargaining power can do for individual premiums. Right now, Medicare's rates are largely hidden, as no one pays the full premiums, and so no one can really compare it to private offerings. But if the premiums become visible, and Medicare's superior bargaining power is capable of offering rates 20 to 30 percent lower than its private competitors can muster, we'll see how long it is before representatives begin getting calls from 50-year-olds who'd like the opportunity to exchange money in return for insurance as good as what 55-year-olds can get.

There's a real value to shining light on the negotiating power of public, government insurance plans. Medicare premiums for non-retirees will do that and may help solidify support for expansion of government administered health insurance for all.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
I would've thought that having "free" insurance, i.e. no premiums (4.00 / 1)
but tax withholdings instead, would've illustrated the point a lot better.  Speaking for myself out of my own personal experience, I notice costs a lot more when I have to pay a bill (because I have to actually look at the bill and write a check) as opposed to when it's deducted from my paycheck (since I don't have to do any extra work; I just deposit my paycheck and don't give it a second look).

That said, I agree with what you wrote.  My broader point was that we have to make sure people know and understand that Medicare, even the buy-in, direct billing of premiums variant, is indeed a government program.  Since Joe Lieberman and Ben Nelson apparently don't know this, we should probably wait until after they've voted for it.

[ Parent ]
we'll have to see the deails (0.00 / 0)
Maybe it is Medicare Part E and not the same as Medicare. Maybe they pay a fixed fee and otherwise are in the program.Who knows? Frankly I think our senators are unlikely to know what they are agreeing to.

New Jersey politics at Blue Jersey.

[ Parent ]
Question on TPM's info about buy-in (0.00 / 0)
That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized--people will have to pay in without federal premium assistance--and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

Doesn't it sound like the buy-in option would be available to everyone in the exchange in 2014 regardless of age?

I think it's very unlikely (4.00 / 1)
that we can parse TPM's write-up so finely. Remember it is a quick blog post on what an aide told them he (or she) was told by a Senator after the meeting, not legislative language. It's just as likely that the writer means the same age range, or the game of telephone went bad.


New Jersey politics at Blue Jersey.

[ Parent ]
Sadly... (0.00 / 0)
...I think it means just what it says -- the Medicare option will be included in the exchanges in 2014 and will only be available to those eligible for the exchanges.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
Which... (0.00 / 0)
Which is why we need to get the amendment passed opening up the exchanges to all citizens.

[ Parent ]
Will there be mandates? (4.00 / 2)
   Is there any word on a mandate to buy coverage?  Are they really going to force us to buy overpriced private insurance (whose non-profit profits are dumped into outrageously high administrative costs) without subsidy?  By "us," I am of course referring to under 55 riffraff.  

Too bad for Democratic politicians... (4.00 / 2) the time they know how badly they've handled this, it'll be too late and they'll all be out of office.

Too bad for the rest of us, by the time we realize how bad this heath care bill is, none but the richest of us will be able to afford health care.

Good for some of us, we won't miss Harry Reid when he loses reelection next year. Good riddens.

To be fair to Reid (0.00 / 0)
I'm not sure what exactly he could've done to avoid this.  The anti-PO Gang of Four (Nelson, Lieberman, Landrieu and Lincoln) were digging in pretty hard.  I suppose he could've threatened to take away chairmanships but that might've required a majority of the entire caucus to sign on.

[ Parent ]
No, he's weak. (0.00 / 0)
"Give 'em Head" Harry has got to go.

[ Parent ]
Triggered Public Option. (4.00 / 3)
  I cannot believe that there are people who actually believe the trigger will get pulled.  Surely no one on Open Left believes that?
 All insurance companies have to do is create some crappy non-profit plan.  It does not matter how high the premiums are.  Please, insurance companies love these non-profit exchanges!  They will be all over it.  People pay just as much for insurance and they still get to have posh meetings at expensive hotels to burn the profit.  The trigger is an insult to my intelligence.

there are some idiots over at daily kos (4.00 / 1)
who believe it. But they will believe anything so long as they think it will help president obama. you are not dealing with rational thought anymore. this is all pure make believe.

[ Parent ]
This is the perfect centrist bill. (4.00 / 3)
   Centrist: describes a bill that is passed only because everyone dislikes it.

 I want the Baucus bill back.  That was better.  At least one senator out of 100 would have liked it.

"Increase Choice and Competition" (4.00 / 1)
   I am so glad that Obama thinks this deal will increase choice and competition.  I was naive to think that reform had to do with improving health care for the American people.  What a revealing statement!

I feel, surprisingly, incredibly neutral about this. (0.00 / 0)
On the one hand, we're actually talking about expanding Medicare.  The real thing.  Not "medicare-like," but actual Medicare.  That's a really good thing, and something we've been wanting and calling for.

On the other hand, we're talking about limiting who has access to it to only those in a certain age group, and then to only those who don't have health insurance, which kinda kills the whole downward pressure cost containment thing, which was like half the reason we were doing all this.

I don't know if opening Medicare in this fashion will create a strong enough slippery slope to make it further expandable in the future.  And without continued expansion, I don't think it's really a fair trade that's being discussed here.  We get a very limited expansion in exchange for the insurance industry being able to continue doing what they've been doing with only a few minor regulations tacked on.  We're giving up than we get.  (Par for the course, granted.)

Now if we were talking a flat Medicare expansion to everyone 55+ -- or if it were a buy-in for everyone, not just those 55-65 -- then you'd have me.  But I think the limitations on who's going to be eligible don't make it worth the cost of no cost containment on the insurance industry.

All that said, even if this is what we end up with, we'll just have to make it work for us as a basis for further Medicare expansion, and as far as that goes, I think it kills a lot of anti-expansion and process arguments.  We'll be on better ground, but rather than seeing any immediate benefits, this is something that we'll only begin to be able to take advantage of decades down the road.  This is winning a process war, which is necessary to advance the ball farther.  It's still not the same thing as a victory for health care reform though (at least, not before Chris, Mike, Jane, and so many others decided to start shifting goal posts), so I'm still not going to call it a "win" or a "victory."  But it's a step in the right direction that, if we start taking advantage of it right away to form our message (which should basically be along the lines of "expanding Medicare now so that we can expand it in the future"), we can use to push for further reforms.  Pretty big if, but other than helping the few people who might be able to afford the approx $600 premiums (if anyone's got a better source on that than Politico, I'm all eyes), that's about all the good I'm seeing out of it.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

Addendum. (0.00 / 0)
In case I haven't been clear, the Medicare buy-in, as to the best of our knowledge it currently stands, does not change my mind as far as what I think should happen with the bill.  Kill it.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
Disappointed Personally, But Politically This Looks OK (0.00 / 0)
Personally, this is a downer for me. As a young person with a pre-existing condition, the one thing I wanted most out of health care reform was some form of guaranteed insurance security. That is, a public plan of some sort that I'd be able to buy into and that would have to take me at some kind of reasonably affordable price. Looks like that's out, unless and until we go back for another bite and lower the age on the Medicare buy-in or expand access to the public employee health plan or what have you.

I don't trust regulation to provide that security in the long run, and I'm a bit worried about a mandate that makes me buy insurance in that environment. What's the relationship going to be between the community rating rules and the subsidies? I gather the community rating aspect is going to be a little wiggly... like they'll still be able to charge you more for a PEC, but only within limits, like 2x or 3x the normal/healthy rate. Well, until GOP gets back in power and the regs get gutted or go unenforced, of course. If the subsidies don't get pegged to that reality (and I gather they're pegged to your income, not your premiums) things could get pretty hairy for younger people with pre-existing conditions who want work outside the group-plan environment. I really wanted some guarantee that I wouldn't have to work my whole life for employers who offer group plans, and I'm not sure that has been accomplished here. At least right now I have the option of forgoing insurance if I want to work for myself, but if I'm mandated to buy it and won't be able to afford it even with subsidies, that would severely curtail my career options. Hopefully it doesn't work out that way, but I don't exactly trust them to get this right for obvious reasons.

But, that's me, and I'm probably part of an awfully small constituency here. Overall, in the awful environment we're working in, this is a pretty good deal. There's at least something to build on in the future here, something more than just vulnerable regulation and unpopular mandates with equally vulnerable subsidy rates. It'll be a lot easier to go back and argue for changing buy-in age ranges and stuff like that than it will be to get something like this passed from scratch. And since what I really wanted going in was Medicare for all, or at least the option for everyone to buy into it, this is a good start.


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