Medicare Part E: E for Everyone Who Wants In.

[SirNitram]

Link

Say hello to “Medicare Part E” — as in, “Medicare for Everyone.”

House Democrats are looking at re-branding the public health insurance option as Medicare, an established government healthcare program that is better known than the public option.

The strategy could benefit Democrats struggling to bridge the gap between liberals in their party, who want the public option, and centrists, who are worried it would drive private insurers out of business.

While much of the public is foggy on what a public option actually is, people understand Medicare. It also would place the new public option within the rubric of a familiar system rather than something new and unknown.

The idea has bubbled up among House Democrats and leaders in the past week, most prominently in a caucus meeting last Thursday.

Rep. Mike Ross (D-Ark.) spoke out last week in favor of re-branding the public option as Medicare, startling many because he has loudly proclaimed his opposition to a public option.

Rep. Jim Oberstar (D-Minn.), the veteran chairman of the House Transportation Committee, also voiced his support, as did House Majority Whip James Clyburn (D-S.C.).

John Schadl, a spokesman for Oberstar, explained the congressman likes the idea because people are familiar with Medicare.

“One of his concerns is that people don’t know what a public option is. Medicare is a public option,” Schadl said. He said Oberstar started talking about “Medicare for Everyone” during August town hall meetings.

A notable incident last summer demonstrated the popularity of Medicare and the confusion over the public option when a man famously told Rep. Bob Inglis (R-S.C.), “Keep your government hands off my Medicare.”

Speaker Nancy Pelosi (D-Calif.) planned to unveil a proposal to her caucus Tuesday night that would include the public option favored by liberals in the healthcare bill Democrats want to bring to the floor, according to two House sources.

The plan, called the “robust” option or “Medicare Plus 5” in the jargon that has emerged on Capitol Hill, ties provider reimbursement rates to Medicare, adding 5 percent. Leaders are planning to roll the bill out next week, and are hoping to vote the first week in November

Some Democrats say there’s no need to rename a legislative concept that’s gained steadily in support since being lambasted as a “government takeover” in August. A Washington Post-ABC poll published Tuesday showed 57 percent of the public supports the idea — up five points since August — while 40 percent opposes it.

“It keeps polling better and better as a public health insurance option,” said a senior Democratic aide. “I don’t think it’s changing.” Polling experts, however, have documented that many people don’t know what a public option is, and that small changes in language can cause poll results to vary widely. An August poll by Penn, Schoen and Berland Associates showed that only 37 percent of those polled correctly identified the public option from a list of three choices.

“Before this year, few people had ever heard of the term ‘public option,’ ” Ross said last week.

It’s not clear exactly how the new Medicare idea would work. Some want to expand Medicare itself to uninsured people under 65. Others want to simply rename what is now called the public health insurance option.

Oberstar, who supports a “single-payer” system that would be completely run by the government, doesn’t want a Medicare public option to be based on existing Medicare rates because he believe Minnesota is one of the states shortchanged by Medicare reimbursements.

Republicans mocked the idea of re-branding a plan they still consider a government takeover of healthcare.

“It didn’t matter what they called Crystal Pepsi; no one wanted to drink it,” said Michael Steel, spokesman for House Minority Leader John Boehner (R-Ohio). “No matter how the Democrats ‘re-brand’ their government takeover of healthcare, the American people oppose it.”

Republicans also note that Medicare is already $37 trillion in the hole and is projected to go bankrupt by 2018. “Has anyone noticed that Medicare is completely broke?” said Andrew Biggs, a scholar at the American Enterprise Institute who worked in the White House on President George W. Bush’s plan to overhaul Social Security.

The public health insurance option would be a government-run plan designed to push all insurance premiums down by creating more competition in a business where one or two insurers dominate many markets. The idea has gotten a cool reception from some Senate Democrats, and Republicans are adamantly opposed. But Pelosi has flatly stated that the House bill will include a public option.

In a closed-door caucus meeting last week, Ross, one of the most conservative Democrats in the House, offered support for expanding Medicare, saying it would prevent the need to create a new bureaucracy. He said he wasn’t advocating a plan, however, and added that the new coverage would have to have much higher reimbursements for physicians and hospitals. He also said it would need to compete with private insurers.

In an odd reversal, that idea was shot down as too liberal by House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), himself a liberal champion. Waxman said expanding Medicare would essentially move toward a fully government-run single-payer system, while the public option was designed to spur competition.

People have been talking about some sort of Medicare Part E since Congress debated the prescription drug benefit, Medicare Part D, in 2003. In the 2004 Democratic presidential primaries, Rep. Dennis Kucinich (D-Ohio) called his single-payer coverage proposal “Medicare Part E.”

The idea of expanding Medicare while still keeping private insurance was proposed in 2007 by Johns Hopkins University Professors Gerard Anderson and Hugh Waters. They presented a paper at a forum of the Brookings Institution advocating “Medicare Part E(veryone),” and said their proposal would expand Medicare to ensure universal coverage while allowing people to stay on their employers’ health plans.

Interesting, interesting.. And hopeful.

[CmdrWilkens]

It honestly would make the opt-out clause the Senate has been kicking around workable while also giving the plan a leg up in administration. Because all states currently have Medicare having a Medicare-E run through the same bureaucracy would save money from efficiency gains AND would link the national plan to the ability of states to Opt In and Opt Out of Medicare (adding the Opt Out on the Senate side could get Nelson and a few others on board)

[Guardsman Bass]

Republicans also note that Medicare is already $37 trillion in the hole and is projected to go bankrupt by 2018. “Has anyone noticed that Medicare is completely broke?” said Andrew Biggs, a scholar at the American Enterprise Institute who worked in the White House on President George W. Bush’s plan to overhaul Social Security.

Where are conservatives getting these extreme long-term liability numbers? And what are they using to calculate estimated tax revenues over that period?

On the main point, Medicare has financial problems because right now, you've basically got the aggregate of the elderly using it (who are the most expensive segment of the population) with little financial input into the system, while the rest of the population pays some of the support of it via payroll taxes but gets nothing out of it until they turn 65. If it became Medicare-for-all, though, then you'd presumably have healthier, younger people paying into it via taxes or whatever while not taking out of it, and that would help subsidize the system to a greater degree.

The main problem with it I see is that it would cause some serious confusion, since they're basically using the Medicare label and (possibly) the administrative system with completely different rates, input, and so forth. Wouldn't people look at it and ask, "Hey, if it's Medicare, why am I paying more than grandma?"

[KrauserKrauser]

I was initially opposed to the healthcare reformation until someone just said "Medicare for all!" and for some reason that didn't seem so bad.

Maybe its the idea of utilizing an existing beauracracy instead of creating a whole new one that assuages my worries.

I'm honestly glad they are taking this apporach as while Medicare has its faults its more of a devil you know situation for me.

[Edi]

I was initially opposed to the healthcare reformation until someone just said "Medicare for all!" and for some reason that didn't seem so bad.

Maybe its the idea of utilizing an existing beauracracy instead of creating a whole new one that assuages my worries.

I'm honestly glad they are taking this apporach as while Medicare has its faults its more of a devil you know situation for me.

This, frankly, is a very big part of the problem. There are numerous examples of well-working public healthcare systems from other Western countries, but apparently for the purposes of political discussion in the US, they might as well not exist at all.

Those have been held up as models for a public system also in the US, and have faced all kinds of demonization from opponents of healthcare reform (including, iirc, from you). But the second someone goes "Expand Medicare for everyone" and then suddenly there is no problem? Because it's an indigenous American solution?

Is THAT the only criterion that matters? Though I probably should not be asking rhetorical questions, given how self-evident the answer seems to be.

[Stark]

How serious is the concern that if a 'new' medical safety net was set up, that the others would continue to operate? I'm not well informed on the different types of social security in the US, but perhap people imagine that, as KK says, it would be an additional new system, instead of taking over from the existing one.

[KrauserKrauser]

This, frankly, is a very big part of the problem. There are numerous examples of well-working public healthcare systems from other Western countries, but apparently for the purposes of political discussion in the US, they might as well not exist at all.

Those have been held up as models for a public system also in the US, and have faced all kinds of demonization from opponents of healthcare reform (including, iirc, from you). But the second someone goes "Expand Medicare for everyone" and then suddenly there is no problem? Because it's an indigenous American solution?

Is THAT the only criterion that matters? Though I probably should not be asking rhetorical questions, given how self-evident the answer seems to be.

Is it really that much of a problem? Instead of saying "Healthcare for all!" without an actual framework, especially as none of the proposed frameworks from either side of the aisle remotely resemble anything in any other country, is it so crazy that framing the same idea in existing American institution would be a better tactic. Thre are endless options of how to implement universal healthcare so why not go with the existing framework in the country.

It's not like the Canadian healthcare system came from no where or wholly adopted a different country's system, it evolved out of the healthcare system from one of their own territories. Why reinvent the wheel for your country when you don't have to and can simply grow a system that already exists.

Not only will the same thing be more easily accomplished but it also allows reform of Medicare while getting coverage for everyone.

[ray245]

I was initially opposed to the healthcare reformation until someone just said "Medicare for all!" and for some reason that didn't seem so bad.

Maybe its the idea of utilizing an existing beauracracy instead of creating a whole new one that assuages my worries.

I'm honestly glad they are taking this apporach as while Medicare has its faults its more of a devil you know situation for me.

This, frankly, is a very big part of the problem. There are numerous examples of well-working public healthcare systems from other Western countries, but apparently for the purposes of political discussion in the US, they might as well not exist at all.

Those have been held up as models for a public system also in the US, and have faced all kinds of demonization from opponents of healthcare reform (including, iirc, from you). But the second someone goes "Expand Medicare for everyone" and then suddenly there is no problem? Because it's an indigenous American solution?

Is THAT the only criterion that matters? Though I probably should not be asking rhetorical questions, given how self-evident the answer seems to be.

The idea of medicare for all was adopted in Taiwan, so it isn't something new.

[Edi]

Is it really that much of a problem? Instead of saying "Healthcare for all!" without an actual framework, especially as none of the proposed frameworks from either side of the aisle remotely resemble anything in any other country, is it so crazy that framing the same idea in existing American institution would be a better tactic. Thre are endless options of how to implement universal healthcare so why not go with the existing framework in the country.

It's not like the Canadian healthcare system came from no where or wholly adopted a different country's system, it evolved out of the healthcare system from one of their own territories. Why reinvent the wheel for your country when you don't have to and can simply grow a system that already exists.

Not only will the same thing be more easily accomplished but it also allows reform of Medicare while getting coverage for everyone.

I'm not arguing that it's a bad idea to build on Medicare. What I'm saying is it looks like the opponents of healthcare reform are simply fucking asshats, since they were up in arms and crying about treason at the mere mention of providing healthcare for everyone, but as soon as extending Medicare comes up, the objections seem to vanish or go into much lower gear.

The only reasons I can think of are that it is seen as inherently American instead of some foreign pinko-communism OR the opponents simply know that trying to interfere with Medicare will get them spitted on pitchforks for real. So either it's all about American exceptionalism or political expediency for thoroughly rotten, dishonest motherfuckers. Or more probably both. Take your pick.

Just think for a moment what it looks like whenever you want to bring up opposition to other issues where the grounds are similar. Nothing that was said by proponents of the reform ever registered, did not even seem to have been considered and now as if by magic, it's all okay. The implications are that the opponents were too ignorant and/or stupid to even understand what they were talking about and should thus be dismissed out of hand and if possible, excluded from decision making related to that issue as a consequence so they won't fuck it up.

Another implication is for the overall credibility of these people. If they use the same arguments to oppose something else and they were so full of shit about this, why should their opinion be given much consideration? It starts going into the "Boy who cried wolf" territory.

[KrauserKrauser]

If nothing else it puts it in a frame of reference that we can more easily understand.

Instead of the multitude of options that come from the state "Universal Healthcare" and "Universal Covereage" we are narrowing the argument to "Medicare for all".

Saying either of the former could mean anything from the Swiss approach with private mostly everything and mandatory coverage from heavily regulated private health insurers to a full on UHS UK style with everything run by the government you are needlessly confusing the population when they could have framed the debate in teh first place as Medicare for all and avoided alot of confusion and misunderstanding.

Medicare is a known entity with known benefits and failings. We, the aggregate US population, have experience with Medicare and have little to no experience with foreign systems of healthcare. While Universal Healthcare is the norm in the rest of the West, each country has their flavor of it with their own benefits and downsides. Simply saying that the US is stupid to be better understanding and more accepting of an existing US program and not adopting a wholly new concept from another country and culture is rather insulting.

I guess the health care in Finland was simply copied directly from another country and not an expanded version of an existing healthcare model. Please enlighten me of the history of Finnish healthcare reform if this is not the case and you were willing to adopt wholecloth another country's solution.

[AdmiralKanos]

He's pointing out that you're being childish by thinking it's a totally different concept if it has a different name. There was never any real difference between "socialized health care" and "Medicare for everyone". It's exactly the same idea, just "re-branded".

[TheLostVikings]

If nothing else it puts it in a frame of reference that we can more easily understand.

Instead of the multitude of options that come from the state "Universal Healthcare" and "Universal Covereage" we are narrowing the argument to "Medicare for all".

They are considering RENAMING the public option to Medicare, they are not necessarily thinking about actually changing anything about it. So you will get a big can of UHC with a Medicare label put on it, and suddenly this is no problem whatsoever just because they changed the name (and only the name).

Do you see why this makes you seem like somewhat of a hypocrite?

[eyl]

On the main point, Medicare has financial problems because right now, you've basically got the aggregate of the elderly using it (who are the most expensive segment of the population) with little financial input into the system, while the rest of the population pays some of the support of it via payroll taxes but gets nothing out of it until they turn 65. If it became Medicare-for-all, though, then you'd presumably have healthier, younger people paying into it via taxes or whatever while not taking out of it, and that would help subsidize the system to a greater degree.

I'm not clear on something...in your post, you note that most of the population already pays taxes to support Medicare while not using it. If that's the case, how would you get a greater financial input into Medicare if it was expanded to cover everyone? Or do you envision taxes rising in that case*?

*of course, if care is comparable to private insurance, the extra taxes would be offset by not having to buy private insurance.

[Darth Wong]

On the main point, Medicare has financial problems because right now, you've basically got the aggregate of the elderly using it (who are the most expensive segment of the population) with little financial input into the system, while the rest of the population pays some of the support of it via payroll taxes but gets nothing out of it until they turn 65. If it became Medicare-for-all, though, then you'd presumably have healthier, younger people paying into it via taxes or whatever while not taking out of it, and that would help subsidize the system to a greater degree.

I'm not clear on something...in your post, you note that most of the population already pays taxes to support Medicare while not using it. If that's the case, how would you get a greater financial input into Medicare if it was expanded to cover everyone? Or do you envision taxes rising in that case*?

*of course, if care is comparable to private insurance, the extra taxes would be offset by not having to buy private insurance.

If the money they currently spend on private insurance were redirected to Medicare, their overall out-of-pocket expenses would remain at the same level or decrease, yet Medicare would get a huge infusion of new cash.

[KrauserKrauser]

He's pointing out that you're being childish by thinking it's a totally different concept if it has a different name. There was never any real difference between "socialized health care" and "Medicare for everyone". It's exactly the same idea, just "re-branded".

I don't consider it childish as the use of Medicare establishes baselines as to coverage, benefits, etc. that an American will be familiar with. They should have used this branding from the beginning as it is easily recognizable to the whole country instead of a new concept for the American lexicon.

It ensures that people understand that Medicare is not going anywhere and this is simply an expansion of an existing program which is more palatable. Also it gives credence to some effort in reducing beauracracy by utilizing an existing framework, for example I would support expanding FDIC powers but installing an additional regulatory board to monitor the industry is something I would oppose even if they would be meant to accomplish the same thing.

I was a supporter of the public option to a certain extent but, yes, the new label does make what they plan on doing MUCH more recognizable and acceptable. In other news Branding ideas matters. Also Words mean things.

Also as the article mentions this is not necessarily a re-branding as you all have referred to it has variance even with the new name. Medicare for everyone might literally mean Medicare for everyone, or if they go the weasly route it might be the watered down POS public option they were trotting around before hand.

They honestly have a better chance to make more reforms with the Medicare for all approach as people will know what to expect with the program.