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Medicare For All Amendment Needs Debate and a Vote In the Senate

December 14, 2009
Update from Donna Smith, California Nurses Association, on Sen. Sanders Single-Payer Amendment
Single-Payer Amendment Needs Debate and a Vote In the Senate

Time to let Senate Majority Leader Harry Reid know that the American people want a debate and a vote on Medicare for all, single-payer healthcare during this Congressional effort.  And it’s crunch time for the Sanders/Brown/Burris Medicare for all, single-payer amendment in the Senate.

In the effort to move something quickly, some amendments may not be considered unless the Leader perceives the importance of such consideration or the consequences of not hearing amendments that are critical to various Senators and constituencies.

Amendment No. 2837 would extend healthcare as a basic human right to all.  The three original sponsors of the amendment understand that the American people need access to care that is not dependent on wealth or level of private insurance coverage.

Call Senator Reid today.  Tell him you want Senator Sanders’ amendment number 2837 to be debated and you want a vote to be taken.  Phone in DC at 202-224-3542 or the Capitol Switchboard at 866-220-0044 or 202-224-3121, or Senator Reid’s Las Vegas office at 702-388-5020

Medicare Buy-In?
from Don McCanne’s Quote of the Day
December 9, 2009
Harry Reid: Democrats reach ‘broad agreement’
By Carrie Budoff Brown & Patrick O’Connor

Senate Democrats have reached a “broad agreement” on a health reform bill,
Majority Leader Harry Reid said Tuesday night ? a plan that would replace
the public option in the current Senate bill with a new national insurance
plan offered by private insurers, and a chance for older Americans to ?buy
in? to Medicare.

To win over liberals disappointed at losing the public option, Democrats
would allow older Americans starting at age 55 to buy into Medicare, the
popular program for the aged. The Medicare expansion would be a significant
victory for Democrats, who spent years pushing for it. The proposal would in
effect create a public health insurance option for older Americans, since
Medicare is government-funded and government-run.

Comment:  The most efficient, most effective, and least expensive method of
providing reasonably comprehensive health care for everyone would be to
replace all current public and private financing programs with a single,
improved Medicare program that covered absolutely everyone. Some have
suggested that we can do this incrementally, with the first step being to
allow individuals 55 and over to buy into Medicare. Is this a good idea?

Harvard professor Steffie Woolhandler provides us with some insight:
“Lowering the eligibility age for Medicare to 55 only works if it is
mandatory.  Otherwise it becomes the place where all the sickest patients
get dumped.  That might be okay for the sick people since Medicare is often
better and more secure than private coverage, but it would drive total
health care costs (and premiums) up, not down.”

The current Medicare risk pool is composed of seniors with a high rate of
chronic disease and with the expenses of end-of-life care, plus younger
individuals with long-term disabilities. Since this is a very high cost
population, the prorated premiums would be unaffordable for most individuals
55 thru 64. A separate risk pool would have to be established that would be
limited to this age bracket. Unfortunately, 55 thru 64 is still the most
expensive age sector of all individuals under 65 and so premiums would still
be unaffordable for most, especially after you add in the impact of adverse
selection as Steffie Woolhandler has described.

Suppose that a Medicare buy-in for those over 55 were to be established, and
that higher government subsidies were provided to cover the higher costs,
then what do you have? You have created a public option. Yet the reason
being given for the Medicare buy-in is that it is a trade-off to get the
progressives to agree to abandoning the public option.

So the agreement seems to be to eliminate the public option from
consideration by establishing a public option. But is the proposal a public
option that would allow everyone the opportunity to buy into Medicare?
Apparently not. After all, this is Congress at work.

Although details have not been released, it appears that this Medicare
buy-in would be limited by the same rules already proposed for the public
option. Individuals who already are eligible for employer-sponsored
coverage, Medicare, or Medicaid would not be eligible to participate in the
insurance exchange, yet the Medicare buy-in would not be available outside
of the exchange (except perhaps during a transition before the exchange is
established). Thus the net effect of this buy-in is to further limit the
public option only to those 55 and over who meet all other qualifications
for the exchange – a ratcheted-down version of the public option.

An elective buy-in for Medicare will only add to the perpetuation of
inequities, fragmentation, administrative inefficiencies, inadequate fiscal
supervision and other deficiencies that plague our health care financing
system. Adding to our dysfunctional system only compounds the dysfunction.
We need to replace the system with an efficient single payer model.

Could we do that in incremental steps by first moving absolutely everyone
over 55 into our existing Medicare program? Yes, but why would we do that?
There would be complex transitional issues in changing this sector from a
revenue source for Medicare into both a revenue source and an expense as
they become beneficiaries of the program. Another increment could be
MediKids for all children, though that would involve other transitional
issues. Then how soon would we phase in everyone else, with yet still more
transitional issues?

Incremental steps increase the complexities and costs of the transition
while delaying access for many who already have impaired access and
financial burdens caused  by our dysfunctional system.

A single, disruptive transition would actually be more efficient
administratively, while lowering transitional costs. Much more important, a
single transition would ensure that no person would have to wait any longer
to access the care that he or she needs merely because of an inability to
pay for that care.

If we advocate for less than we need, we’ll end up with cheap chits that
will eventually be traded away, and then what are we left with?

– Jean (forwarded from Healthcare-NOW!)

“I refuse to live in a country like this, and IÔÇÖm not leaving.” -Michael Moore

One Comment leave one →
  1. January 5, 2013 23:15

    To keep single-payer supporters in their coalition, though, Democrats pledged to fight for a Medicare-like public option that would allow consumers the opportunity to buy insurance directly from the government. They ultimately abandoned that idea as well.

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