Would the Senate's Proposed Medicare Expansion Lead to Single Payer?


In exchange for dropping the public plan, Senate liberals got a couple of big concessions in the health care bargain made with Democratic moderates. One part was the creation of a nationwide network of non-profit plans administered by the Office of Personnel Management. As I noted earlier today, there are a lot of problems with that component. 

The other major component is an expansion of Medicare that would allow anyone age 55-64 to buy into the Medicare system — initially at full price, and, starting in 2014, using taxpayer-funded insurance subsidies for those who fall below 400 percent of the federal poverty line.

Rep. Anthony Weiner likes this component because he thinks it might "get us on the path to a single payer model." That's probably not the talking point he was supposed to use, and I certainly don't think that single-payer is an immediate likelihood. But given that incremental single payer was the original hope for the public plan, and that Medicare-for-all has long been a slogan used by single-payer supporters, Weiner's take isn't actually all that surprising. 

In fact, the Medicare expansion a pretty great deal for liberals — despite losing the public plan, they'd be getting quite a bit out of this arrangement (should it actually come to pass). But to my mind, expanding a creaking, unwiedly program that's already $50-100 trillion in debt seems like rotten idea. Indeed, the American Spectator's Phil Klein says that it may be worse than the weakened public option proposal it's replacing:

Expanding Medicare would go further to advance the original aims of liberals than the watered down version of the public option. By definition, the Medicare option (which would eventually be offered on the exchange to those over 55) would set reimbursement rates at Medicare levels, thus putting the squeeze on doctors and offering lower premiums that would make it more difficult for private insurers to compete. As with the public option, liberals will try to argue that the Medicare expansion will be funded by the premiums it collects, but it will benefit from the taxpayer-funded infastructure that is already in place to support Medicare—not to mention potential subsidies down the road.

The CBO has not yet evaluated the current proposal, but according toa recent Kaiser Family Foundation study, there are about 4 million uninsured Americans between the ages of 55 and 64 — so that would probably be the minimum amount of people eligible to buy into the expanded Medicare program. Yet according to Census data, the entire 55 to 64 population is 33 million, so there's plenty of room for growth if future lawmakers open the exchanges to more people.

Nor would expanding Medicare be cheap. According to the Wall Street Journal

CBO estimated last year that offering a Medicare buy-in to people age 62 to 64 would cost the government $1.2 billion over 10 years, largely due to the fact that more people would retire early and start drawing Social Security. The analysis assumed people would be charged a premium that covered the average cost of benefits, plus an administrative fee of 5%. Those could be some pretty steep premiums given the age group and the likelihood that the program would attract a disproportionate number of sick people who find it particularly hard to find private insurance.

Not surprisingly, big medical industry groups hate the idea: Insurers, doctors, and hospitals have expressed strong opposition. 

The proposal is also proving troublesome for Republicans, many of whom have been relying on the politically advantageous but problematic argument that Medicare must be protected. Yet, of course, they're against expanding it here — meaning that after spending the last few weeks defending Medicare from reform's proposed cuts, they're back to attacking it. 

Regardless, it's a proposal that deserves serious scrutiny: Growing a troubled but politically popular program like Medicare is likely to be less politically difficult than instituting a new government program. But it's still worrying: As with most of the rest of the major reforms being proposed, the Medicare buy-in expands a failing system, locking more people in — and making true reform ever more difficult. 


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  1. Wait…$1.2 BILLION over ten years? That is supposed to be trillion, yeah?

    1. more like quadillion.

      1. No — billion sounds about right. That’s just the added cost to the government, anyway, not the total cost of running the program. In theory, most of the total cost is paid for by premiums.

        But it’s the premiums that are expensive, because of the risk factors for that age group.

        1. Besides that Mr. Suderman, it falls under the fallacious reasoning of “we’ll make it up in volume,” by permitting enrollment in Medicare at age 55, but essentially paying less reimbursement for each patient. Even with increased premiums paid in, it will lead to less services as doctors will not be inclined to accept the insurance unless they are forced to, either by artificial economics or explicit legislation.

          There is a word for this.

        2. Peter, “the program would attract a disproportionate number of sick people who find it particularly hard to find private insurance.” I would say that sick people find it virtually impossible to find private insurance and that is why we need a public option/guaranteed coverage.

          1. After that lets make sure dead people can get life insurance.

            1. Ass, “After that lets make sure dead people can get life insurance.” Why not try to stop speaking out of your ass and argue the point? Please tell me your given name is Jack.

              1. He did argue the point, through analogy. It’s not his fault you can’t tell the difference between “insurance” and “for-profit welfare program”.

                1. anonymous, Stay away from my food.

                  1. lol whut

                    1. anonymous, Here is a metaphor for you bitch. I don’t like fast food and I like to cook my dinner s l o w l y.

          2. The government goes a long way in making it virtually impossible for sick people to find private insurance, so this is another example of the government “fixing” a problem that they help create.

            1. Hey You or IATMOAFCTUMN, How?

          3. Why should sick people need “insurance”? Why not call it what it is: A welfare/charity program to provide health care. Insurance is people people who aren’t sick already.

        3. The analysis assumed people would be charged a premium that covered the average cost of benefits, plus an administrative fee of 5%.

          Why not just assume that everyone will stay healthy and never need to see a doctor? Both assumptions are equally realistic.

  2. Not surprisingly, big medical industry groups hate the idea: Insurers, doctors, and hospitals have expressed strong opposition.

    My family has a walk-in clinic in a town in Florida with a good amount of retirees. They had to stop taking Medicare patients just to remain in business because Medicare reimburses so little. And apparently dealing with them is hell, even by the low standard set by medical insurance companies. My family is a bunch of statists (well, compared to me), but having dealt with Medicare, they hate it passionately.

    1. It’s kind of amazing that Congress ostensibly started with the goal of getting more people to consume the product of health care, and are now at a point where those who make a living selling that product are strongly against the plan to achieve that goal.

      1. Yea, it probably means that you have a plan that might work. As a taxpayer paying for these services, I want to pay as little as possible for healthy citizens. Any plan that the medical industry is strongly in favor of would probably be a plan that cost too much.

    2. I work for a software company that has to deal with Medicare and most of the customers I talk to will gripe about the low prices paid by Medicare (you’ll have that in a monsoponistic market), but most of them are of the opinion that billing Medicare and collecting that money is relatively easy.

      Granted, Medicare produces new regulations, seemingly just to justify their existence and gives us no time to implement them, but I’ve heard better things about them than BCBS and the privates.

      1. I bet BCBS also doesn’t pay $2B/year in fraudulent charges to Dade County, FL, either. (Or $4B total fraud).

  3. It seems to me that expanding Medicare is a proxy for the public option. They’ll just keep lowering the age at which we can “opt in”. After everybody sees what a “success” it is.

  4. Would the Senate’s Proposed Medicare Expansion Lead to Single Payer?

    Well, let’s see. Every time the Dems get power they can have this exact same fight and end up with a “compromise” that lowers the entry age into Medicare by, say, 10 years. Eventually, yes, you’ll have single payer.

  5. I think the lower age for medicare is to get the AARP and all the folks in that age group onboard for reform.

    The thing that will force a single payer system is the new addition triggering a public option if no private insurance companies join the govt pool. The govt has made the rules such that companies won’t bother joining or if they do, it will bankrupt them. If this happens, the govt will slam insurance companies that don’t join for being greedy and those that do as mismanaged.

    The govt gets their single payer and they also have covered their asses.

  6. So, we’re not pretending to go deficit-neutral anymore? How about a one hundred precent tax on Medicare benefits to pay for the increased Medicare entitlements? We can phase it in, increasing by, say, 25% for each year under 65 the recipient is, until we get to 100%. And then we keep increasing another 25% beyond that until the citizen or immigrant reaches 55. (Apparently time moves backwards in my plan.) Voil?! Everything gets paid for.

    (Don’t worry; we won’t call it a tax.)

  7. Question: It is legal for doctors to refuse to take medicare paitents right? Can the government force doctors to take medicare patients?

    1. Yes, it is. We’re not yet at the point where the government has conscripted doctors to provide their services involuntarily.


      1. No, that’s later. Hey, practicing medicine is a privilege, not a right!

        1. That’s right. Doctors should have to “give back” to the community that grants them this privilege. In fact, doctors should be so tickled to be allowed to practice that they’re willing to work for no more than minimum wage.

          1. I’m tickled shitless 🙂

            1. Sounds like an interesting laxative. Does it come in chocolate form, too?

          2. In fact, may we apply this same standard to other professions of choice?

            Such as:

            1) Trial Lawyers?

            2) Entertainers/Actors?

            3) Professional athletes?

            1. 4) All Government Employess – including Congress?

              You missed one.

              1. I originally included Congress, but then I decided that if they want to privilege of leadership, they don’t get paid and foot all their own expenses, especially discretionary spending.

            2. I’m thinking farmers. Food is a necessity of life.

              If the low wages force people out of the jobs, we can just import some replacements from third-world countries. Possibly Africa.

              1. Only if we can force them to work the fields with obese white women riding their backs.

    2. As others have said, you can refuse to take Medicare, which exempts you from lots of other regulations, but you’re losing a hell of a lot of business.

  8. What really bothers Suderman in all this is that right-wing libertarian makret-fundamentalist dogma is becoming increasingly irrelevant. Pope Benedict knows how you feel, Peter.

    1. Eddddddward. Edddddddward.

  9. Yes, it is legal for doctors to refuse to accept Medicare/Caid patients.

    However, that only works for doctors who have established private practices and have the financial freedom to do so. Doctors on hospital staff and new to practice (less than five years, like myself) don’t have the luxury of being as choosy since we are saddled with enormous debt. Medicare/Caid patients account for 60-70% of hospitals billable revenue. Which is why Joint Commission (JCHAO) visits are especially nerve wracking; without that accreditation, hospitals cannot bill the government for Medicare claims. And they close their doors.

    So, indirectly there is force applied, but not by direct legal fiat. Yet.

    1. To follow up, there are areas of practice where, especially new to practice, where acceptance of Medicare is near mandatory, such as geriatrics/gerontology, internal medicine/primary care, and orthopedics. Or else you don’t build up a patient referral base. General surgery (mine) is another; over 60% of the patients I see are Medicare/Caid (and not all of them are over 65. Many are on disability at younger ages.)

    2. Don’t worry. Some day soon ObamaCare will forgive your med school loans.

      Which doesn’t mean you won’t have to pay them back.

      1. Heh. I was fortunate, somewhat. Family paid for my education, but I am paying back. Preferably as quickly as possible, as even though the interest rate is great (o%), family can be rapacious creditors.

    3. In Canada, doctors are effectively forced to accept medicare patients. Single-payer. That’s why Canada has such a severe doctors and nurses shortage. They are forced to take the low wages paid by the government, so many of them opt to leave for the US, or else not become doctors in the first place.

      Actually Canada gets a lot of doctors immigrating from India and so forth, because it’s a lot easier to immigrate to Canada than the US. I’d be willing to bet a disproportionate number of Canadian doctors are foreign trained imports from third-world countries.

  10. Rep. Anthony Weiner likes this component because he thinks it might “get us on the path to a single payer model.”

    “Thinks it might”? How about some analysis?

    Also, how about dealing with the *existing* Medicare fraud and abuse before those get expanded?

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  12. So when was it that we were going to get serious about taking over some third world country and starting over?

    1. maybe we’ll get space colonies some day?

    2. We thought about it and realized that if we just do nothing, the U.S. will become a third world country. Saves on moving costs.

      1. Hey, I didn’t think of that. And at this rate it won’t take long.

  13. I was thinking a little sooner than someday.

  14. Well, let’s see. By the time I hit 55, the subsidies will have kicked in. If we retire early, my wife and I could probably get our income down to 400 percent of the poverty level. Just gotta hope there’s no wealth test 😉

  15. The analysis assumed people would be charged a premium that covered the average cost of benefits, plus an administrative fee of 5%.

    A 5% admin fee is a joke. The feds will have to invent and pay for a whole new bureacracy to charge and collect premiums, and to kick people off who don’t pay.

    But sure, this gets us on the road to single payer:

    (1) It breaks down the presumption that Medicare is for retirees. Why stop at 55? Slippery slope, babee!

    (2) It creates the bureaucracy to administer Medicare-for-all, instead of Medicare-for-retirees.

    (3) Since Medicare doesn’t cover costs, it grinds down the margins of doctors and (especially) hospitals, forcing up everyone else to pay more, making health care more unaffordable, thus increasing political demand for single payer.

  16. Bad idea. Medicare will be broke by 2017. Medicare denies more claims than private insurers. The first year the plan will cut 1.3 billion from Medicare for heart and cancer treatments. Many employers will drop employees and pensioners over 55 thereby forcing them into the already busted Medicare program. No money for the doctors and hospitals means no treatment. Baby boomers could find themselves with real big problems,like paying out of pocket.The added costs to Social Security for payments for the onslaught of retirees will be 1.6 billion per year.

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