The short answer – subject to Senate revisions – is that those without employer-provided insurance would have more options for buying coverage, but if they are younger than 55, their money would go to a private insurer, no matter what. Rates would be more competitive than what they are offered now, but possibly less so than under a “public option.” And if they are between 55 and 64, they might be able to buy into Medicare early, though at what prices remains to be seen.
The race to revamp the American health care system and turn it into an even bigger and more incomprehensible mess than it is today continues. Watching the congressional back-and-forth on this is a fascinating comic exercise, sort of like putting a chess board between a pair of beached Beluga whales and waiting for a game to break out.
If you start with the basic premise that by far the biggest problem with the American health care system is the bureaucracy and the paperwork – I talked to one set of hospital officials in New Jersey who said that half of their administrative personnel were devoted exclusively to chasing claims from all the various insurance companies – then this galactic battle going on right now is already hilarious. Congress is basically arguing over what the best kind of system to install is without addressing the paperwork/bureaucracy problem. To use a very hokey medical metaphor, this is sort of like a bunch of doctors arguing over how to cure the hangnail on the left hand of a patient dying from a gunshot wound to the face.
Okay, fine, so single-payer is off the table, no use continuing to whine about that, even though it’s the obvious solution to all of? the biggest problems and congressional aides in private admit this. So your next-biggest problem is cost, and you can try to address that with some kind of public option, which would force private companies to take a bite out of their own profits or their own inefficiency to drive down rates in order to compete with the naturally cheaper public plans.
But we can’t have that either, of course, because the name of this game is passing something the Obama administration can call health care while preserving massive subsidies to the insurance and pharmaceutical industries. In that regard, the government under the new plan will continue to be barred from negotiating bulk rates for pharma purchases for Medicare, while insurance companies won’t have to trim profits or paperwork to compete with a real public option. The Obama administration also recently reversed itself on yet another campaign promise and decided to come out against plans to allow pharma purchases from Canada, further protecting the pharma industry.
So the old system of inefficient bureaucracies and artificially high prices has basically been completely protected. What we’re left figuring out is exactly how to pay for a hugely expensive new program without taking significant money out of the pockets of these industries. The other challenge for the Obama administration is how to unite Congress enough to pass this gigantic new venture that really doesn’t achieve much, and the strategy there is turning out to be just what you’d expect: rather than pushing a single cohesive plan that makes sense in the long term, party leaders are putting forward a confused mish-mash of non-plans and trying to buy off the various segments of the Congress with pork and other forms of bribery as a means of solving the extremely short-term problem of how to pass this bill in time for the 2010 elections.
This latest plan to reduce the Medicare age is a great example. Rather than put forward a real public option that actually lowers costs and gives people everywhere the ability to buy into a plan, the Democrats are now pushing a plan to offer Medicare to people age 55 and over.? The idea here is to include something that sounds enough like a “public option” that the liberals will be placated and ultimately vote for the bill. It shouldn’t escape anyone’s notice that under this arrangement, all the younger, healthier people who are just starting their careers and most need cheap insurance will be forced to buy private plans while older citizens will be offered the public teat just as they start to become very expensive to their insurers.
I get that some people think this is a good idea, and it’s hard to argue that any kind of expansion of Medicare is a bad thing, given that the program has been popular and successful throughout its history. But this move just smacks of the bass-ackwards Solomonesque bargaining that has marked this whole health care effort from the start. If expanding Medicare is good for people aged 55 and up, why isn’t it good for everybody? Why isn’t it a good idea to provide cheaper insurance for people in their preventive care years, so that they cost Medicare less as they do get older?
Answer: because it’s a political non-starter, because hopsitals and doctors won’t tolerate having to take Medicare rates from everyone, nor will the pharma companies or the insurance companies tolerate having to compete with Medicare for their most profitable customers.
So what they’ll do instead is expand Medicare for people aged 55 and up in exchange for the preservation of subsidies everywhere else in the system, as well as an individual mandate that increases the revenue flow for private insurers by forcing millions of new (and relatively young and healthy) customers their way. This isn’t a health care strategy, it’s a big baby that’s been hacked up into parts and fed in descending size order to the administration’s weightiest political lobbies. I almost can’t wait to see what the next “compromise” is.