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.