Why I Like the Senate Health Compromise

Why I Like the Senate Health Compromise

Why I Like the Senate Health Compromise

A mostly political weblog.
Dec. 9 2009 11:02 PM

Why I Like the Senate Health Compromise

Is the proposed Medicare buy-in a stalking horse for ...: I've always liked the idea of a Medicare buy-in for those 55-65, now part of the proposed Senate health deal . Why? Because Medicare is an accepted and successful program. Also because

1)  if the "buy-in" is unsubsidized, the new 55-65s will be paying much higher premiums for Medicare than the already-in 65+ crowd , whose premiums are subsidized by the Medicare portion of the Social Security payroll tax.**

2) Eventually these younger Medicare enrollees will start to complain to their Congressmen, "Why am I paying $550 a month when these old geezers pay so much less--even though they are bigger risks?"

3) Eventually, Congress will be forced to adjust the two premiums to bring them closer to parity--i.e. force to raise the premium on older Medicare recipients;

4) But that means many older Medicare recipients will be too poor to pay the increased bill. They will have to get subsidies;

5) Once these subsidies are accepted, there will be less reason not to raise Medicare premiums even further on the more affluent 65 recipients, while protecting the non-affluent with the subsidies;

6) Eventually, rich 65+ recipients might pay something close to the full cost of the Medicare insurance they are getting;

7) What's the phrase they use for a government program in which the rich get little or no benefit but the poor get full benefits, with those in the middle getting middle-sized benefits. ... Oh, right: Means-testing . The Medicare buy-in looks like a back door route to means testing what will be the most expensive part of Social Security.. ...


Since means-testing is probably what we will need to save Social Security's solvency --at least it is for those of us who don't think Orszag & Co. are going to be able to bend the cost curve without degrading medical care--I'm for the Medicare-buy in. ...


**-- That's true even before you consider the possible effect of "adverse selection" on premiums--i.e., if the sickest of the 55-65 year olds are the ones who gravitate toward Medicare's security, driving up its premiums, while the healthiest decide not to pay them and stay in the "private" insurance market. ...