Jane, can you explain what this means:

“Lowering the eligibility age for Medicare to 55 only works if it is mandatory.”

Mandatory for whom? I’m a little confused on this point. The reason it’s important is that since “Medicare for all” has been a rallying point of the single payer faction, it would *seem* (operative word) that lowering the eligibility age would be a small step in the right direction. Perhaps not perfect, but a step.

Can you clarify?

Highway to Health
http://videocafe.crooksandliars.com/heather/daily-show-highway-health-senate-fight-09

What’s Contained in the Senate Health-Care Bill – and What It Means

http://crooksandliars.com/susie-madrak/whats-contained-senate-healthcare-bil

people are promoting this because they want to be rah-rahs for a bill — any bill. Just like they’re promoting Howard Dean’s endorsement of this bill, without really considering that Howard Dean is a consultant for a legal firm that defends Pharma. I see their crap on Orange all the time.

thanks a lot for this jane. this was just the issue i was asking about re adverse selection.

Weiner is a Schumer protege umkay ?

for what it’s worth (not an expert), imo the issue is that medicare works because it was set up as a single payer system (that has been undermined to some degree, but that’s a policy complication i’ll put aside for the moment) for the age group it covers.

lowering the eligibility age for medicare to 55 would, imo, be a great thing — but only if it affected the entire age group. alternatively, make it optional and/or limit it to only some of the age group and we risk undermining medicare with adverse selection, additional administrative costs, and probably a bunch of other things i haven’t thought of.

fixing the current problems with medicare and dropping the eligibility age to 55 for everyone would be, imo, a great intermediate step. but that’s apparently not what is being contemplated. (see also my link @4)

…….

if there is a compromise, then the details (including legislative language) need to be made public so we can see for ourselves what it says and make our own judgments.

for example, does it include the deregulation language (undermining states from regulating health insurance)? that imo is a very big issue, and there are many others.

Oh, I think I see. The “mandatory” means that it would be available to *everyone* 55 and older, yes? So if it’s only available to the sickest group from 55-65, that means that we end up with an adverse selection risk, and instead of getting single payer advancement, instead we get insurers “dumping” unwanted customers without a commensurate increase in health customers to balance the actuarial pool.

I get it. Thanks for clarifying.

(OT: did I really just say “actuarial pool?”)

re OT. yes you did, and i think correctly as well. LOL.

Wondering myself what PNHP means by mandatory. Medicare isn’t even mandatory for 65+ folks. You have to sign up. It should be the only plan for which subsidies are provided from 55+. But I’m sure that’s not what they have in mind.

They’ve already announced that only uninsured people below a certain income between 55-64 will be eligible for Medicare. Now that’s still a good thing for a standalone bill, but it’s not enough to trade for mandates, giving up our leverage with PhRMA, etc…My guess is once CBO says how few people they actually expect to use the buy in, this latest deal falls apart like all the others. The only way to make this worth it to people like Dean and Weiner and me is to make many millions of people 55-64 eligible, including crucially the ability for employers to let their employees sign up for it, and then we could use it as a trojan horse for single payer. As it stands now, not there.

Having health insurance will itself be mandatory — that’s what the individual and employer mandates will be for. If you’re between 55 and 64, and you’re not covered under your employer, Medicare will be the obvious best choice. This is true regardless of whether you are sick or not. Many sick people over the age of 55 will either (a) decide to buy private insurance, or (b) stay covered under their employer’s plan. So I fail to see why Medicare will fail the risk allocation test, supposedly driving up its own costs. The CBO said that would have been true about the weak House public option, because that public option was severely hurt by the fact that only a narrow range of individuals could sign up for it, and also by the fact that it wasn’t allowed to set Medicare-like rates.

There is a relevant question about an expanded Medicare buy-in, though. From what I’ve read, the exchange’s subsidies will not kick in until 2014, although the expanded buy-in will be available much sooner. That will still be too expensive for many over-55′ers to handle for now, but at least they would now have a cheaper and much more reliable alternative to private insurance.

I don’t see any real downsides to this swapping of the weak P.O. for this new plan. It seems clear that the P.O. was being used as a trojan horse for expanded Medicare. The administration left the P.O. to be continually watered down in reality, and yet much of its base’s support came from their hopes for what a real P.O. could deliver. In retrospect, that may have been a brilliant plan. “Now we have this public option that will suck — but our base is devoted to the idea of government-provided health care. So, centrist Democrats, you have a win-win option available. Vote for expanded Medicare, and we’ll satisfy the base, while at the same time pleasing more old people — many of whom are wavering, fearful independents who will view the party more favorably.”

Yeah, the more I think about this new development, the more I like it. The fact that the public option seemed to have been used as a negotiating chip all along in no way invalidates the left’s efforts to fight for it. That was one key part of the whole plan. If we had stopped clamoring for the public option, there wouldn’t have been enough pressure put on moderate Dems for them to accept this switcheroo.

at least please please wait until we see the legislative language before supporting a plan you haven’t seen and that could significantly undermine medicare?

That’s definitely valid. I’m not giving it full support until all the details are out. All I’m going by are things I’ve read on the blogs today as being likelihoods.

But I do think it’s worth it to point out that this may be a positive and significant development.

Is Dorgan’s Amendment dead? I want to write down the date & time when I first feel greater contempt for the Democratic Party than I do for the Repubs.
Amazing, only a year ago I wouldn’t have believed this possible!

I think “mandatory” in the pnhp sense means that Medicare eligibility would be given to everyone between 55 – 64 and, assuming that insurance mandates are in the bill, those in the 55 – 64 age group would have to pay Medicare premiums for that insurance, and would be able to use any subsidies provided by the bill to help them to pay those premiums.

Veterans (I’m one) and Medicare ; “The prescription drug benefit in the VA medical benefits program is at least as good as that offered by Medicare.” ; Actually, it’s better.

I put these links up yesterday on either a news desk or seminal diary thread but caan’t find it now:
http://www.medicare.gov/MedicareEligibilityHome.asp?dest=NAV|Home|GeneralEnrollment#TabTop

Those who don’t have the necessary ‘work requirements’ are screwed; look at the premiums.

http://www.medicare.gov/MedicareEligibilityHome.asp?dest=NAV|Home|GeneralEnrollment|PremiumCostInfo#TabTop

Also note the Part B deductible; a $10K procedure(not unusual nowadays) will have you owing $2,155 (or declaring bankruptcy)

Also note the cutoff of “$85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium for 2010.” ; now if they really wanted to address the funding for Medicare Part B (which is where the real funding issues are currently), they would reduce such cutoffs.

I mean,really, someone 65 -or even 55- with an income of over $25,000 (figure chosen because that’s when one has to start paying taxes on Social Security income) can’t handle an increased premium?

Wish y’all didn’t have to cut and past the links but that’s how the ‘machine’ put the links out via the linky icon.
http://www.medicare.gov/MedicareEligibility/Home.asp?dest=NAV|Home|GeneralEnrollment|PremiumCostInfo#TabTop

Jane, This statement of pnhp

Here is the PNHP Statement:

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.

is taken from a statement by Dr. Steffi Woolhandler quoted in a pnhp blog @: http://pnhp.org/blog/2009/12/09/medicare-buy-in/

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.”

Steffi Woolhandler and her co-author David Himmelstein are the co-authors of some of the best studies of the American health care system in the past decade. Their latest study brought us the finding that nearly 45,000 deaths annually in the United States are due to lack of insurance.

Thus far, I haven’t seen anyone ask the very important question of how many of these expected fatalities the new Senate compromise legislation might be expected to save.

i don’t think so. i think it’s about the issue of adverse selection. doubt steffie woolhandler would support individual mandates and financing via premiums would be very high. but i don’t know for sure.

here’s an extended statement. will try to get some more info.

http://pnhp.org/blog/2009/12/09/medicare-buy-in/

edit to add: see that you’ve got the link. must have been typing while you were also

So, it’s ok to trash the shit out of it but don’t support it until the “facts” are in?

one thing I am not for is lowering medicare as mandatory

I believe both aspects need competition, I believe the public sector needs competition from the private and visa versa

We don’t often agree, but I do agree with you on this jane. This is not a well thought out approach.

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.

Plus when the sickest are off the insurance company rolls the insurance companies should make more money. This plan seems like an insurance give away.

We don’t know what the restrictions on access to Medicare will be, so I question why anyone is out there promoting a pig in a poke.

I understand your point jane, wait till there is an actual program proposed and we have been disappointed in the past

for me, best case we could possibly hope for or even want would be an across the board ability to buy into medicare at any age for a set percentage over costs

that would be prefect to me because when a new service is proposed added to medicare the rates would go up according to those added expencses

People 55 to 64 would have to “buy” their medicare from the government and it would be very expensive

” we get insurers “dumping” unwanted customers …”

You broke the code. Private insurers profit from insuring the healthy while the taxpayers go broke insuring the sick.

one thing I am not for is lowering medicare as mandatory

now I see why it’s a non starter, it would have to be mandatory for it to be efficient, however if it were mandatory AND a person could buy optional add on through the private sector me likey

Why is it taking Congress so long to get a “reform” that is a total benefit to the insurance corps?

All this corporate welfare sent the insurance companies way I’m thinking their books are not as good as they seem. I wonder if they are still writing policies for banks?

What the hell do a bunch of physicians know? The really important question is: What do “Fox and Friends” think about it?

I don’t recall any issue that has made it quite so nakedly transparent just exactly how bought-and-paid-for our national “leaders” really are. Accordingly, I cannot understand how anyone, no matter the political persuasion, wouldn’t be able to see just how badly they’re being reamed. HCR is one example. There are plenty of others.

At least we’ve got the blogosphere. So suck on that, MSM.

Medicare was for the elderly who as a group require more frequent access to health care than the average and therefore are in a higher risk category. The government subsidy offsets the cost born by the insurance industry.

Lowering the age eligibility (not requirement) would lower the risk, accordingly. It follows that if everyone were eligible for medicare, the least risk would obtain.

I don’t understand the PNHP’s response to Jane’s question. That seems to apply more to the public option which apparently has received an abortion already.

I just passed through that age group as self employed healthy person. The rates for individuals and small groups for that age group are prohibitive except for the very wealthy.

I believe if it is open to all in that age group that it will attract many healthy, and most are at those ages, many many will sign up.And that will actually help the Medicare financing.

However if there are severe qualifications it will be just more window dressing that relieves for profit insurers from covering all but the healthy.

I tend to favor it as a ramp to increasing Medicare. There will have to be an adjustment in fees to providers however.

On the down side this could be a prelude to a two tiered system that deprives seniors of equal quality of care. Obama cynic that I am, I suspect this can be the case. He does seem to have a certain disdain for the sick elderly, that almost seems psychologically embedded. But that is pure speculation.

Poll number worries on another corporate give away if we can get the news out? Congress does have some really bad poll numbers this vote could be election poison.
The Blue Dogs and GOP must be worried now that the election is coming up.

If they produced that benefit too quickly the taxpayers might catch on .
Do it nice and slow so it looks like they tried their darndest to get us a good bill

They have to make sure they have every possible penny going to the industry. Stick-up artists with the federal govt as a weapon.

I disagree. Or at least you can argue the other side, namely that if they did it quick & dirty they could get away with murder. Like TARP. 3 sentences from Paulson. Yeah, people complained but what difference did that make?

So you’re saying they are not as clever as Paulson.

Too early and too cold in MN for dip in the actuarial pool.

I don’t think they give a flying f*** what we think

Off to swim in the great capitalist cesspool.

US KIA Irak: 4,367

US KIA Afghanistan: 932

US MBS 2009: 42,532

Be good to yourselves, and all other living things.

Namaste

That seems pretty obvious.

Paulson turned out to be not quite as clever as he thought he was, although the banksters ended up with what he originally intended anyhow. He had great friends in Summers and Geithner.

Should start publishing stats since O took the oath.

It seems to me this whole charade of health care reform led by Team Warhawk Peace Prize Holder King of Norway Snubbers was meant ultimately to bail out the health insurance industry who doubtless made the same bad bets on the Wall Street casino joy-ride all the other monied class had done.

Here’s an interesting development. I took myself off the OFA e-mail list because I’ve grown so disappointed in Obama, but I received a personal invitation to an OFA meeting in my area this weekend to talk health care.

Even more interesting is that my blue dog rep, is going to be sending some staffers to the meeting because, I was told, he seems to be under the impression he’s ticking off the left.

I don’t know that anything will come of it, but at least he’s feeling the pressure.

Keep up the pressure folks!

Beats the shit outta thrill-seeker, drive-by liquor store robberies, don’t it?

One I know off the top of my head: over 300 KIA in Afghanistan

LOL

True anyone want to lay odds when the banks will need another bailout cause Paulson fixed nothing?

Agreed!

February.

The stats are kept by year at icasualties. Don’t know how we’d weed out the 1st 20 days of this year, though.

What I can’t totally grasp is the nuts and bolts with Medicare for all (or Medicare eligibility rolled back to age 55).

Currently, Medicare recipients pay a premium that, in the grand scheme of things, is not terribly expensive. And for the poorest and sickest, it would be vastly better than nothing.

However, in order to be fully covered, it’s necessary (and really, it IS necessary) to have a supplemental plan. So the insurance companies would recoup some of their losses to Medicare via an increased number of supplementals to the age 55-64 folks, right? Is it fair to assume that supplementals would rise and rise and rise in cost? So in truth, there would continue to be a caste system, comprised of those who can and cannot afford supplementals? And those who have big $$$ could purchase the premier supplementals?

Another thing. In current time, docs who take Medicare patients are taking a big hit. There is already a shortage of family practitioners and the financial realities of Medicare are an additional barrier to taking on that kind of practice.

If Medicare payouts to docs are to be increased to make things more equitable for them, where oh where is the money going to come from to ramp up service fees? For umpty-million new enrollees? And whatever else I’m missing on the financial front?

Actually, I love the Medicare idea. Just trying to figure out how it would work. Proactive pig in poke, I guess.

Please keep us informed about how the meeting goes.

Thank you for this. Been missing you.

Watched the teevee this morning and heard some of our fine Senators go on and on about this healthcare bill.
And how they just couldn’t support it etc. etc.
My immediate impression was that they were covering their own asses hoping for more of those health industry campaign donations . Hoping they could use that money, to convince the voters they really were, looking out for the voters.

Thanks

Anthony Weiner is saying that lowering the eligibility “would perhaps get us on the path to a single payer model.”

Sorry to say it, but Weiner’s wrong.

Jane, you’re right that the public option we should be getting is the best next step in the right direction.

Thank you for not giving up on it!

Who, Sufi? Thinking I remember that you are in Indiana?

And Ive been missing you…Are you OK? Staying warm? Cheers up there.

Right before taxes come out good choice I take May a little after taxes in case some of them lie and try and hold on a little longer.

ihave seen this time and again in my neighborhood

et them eat cake
Tue, 12/08/2009 – 17:44 — researcher

mega profits off the sick and needy

god that is brillant

you have got to love a country that can design an economic system or systems that can make mega profits off the sick and needy and even the criminals with private prisons.

give cheney credit he invested in wars for profits and private prisons.

is there any more of a self righteous nation than america claiming to be a christain nation while making mega profits off the sick and needy and having these continual wars for profits.

best yet the pres gets a peace award while sending more troops to a foreign country to protect us from their army, navy, and air force that is nonexistent.

bush jr gave the freedom award to those that helped to start the iraq illegal war.

the worst part most americans believe him. they want to because it is muslims and in america’s mind all muslims are terroists.

we invaded iraq to get even for 9/11 we did not care that they had nothing to do with 9/11 just kill muslims.

as a young man I never dreamt that my country could sink so low and be so corrupt in the world and cause such suffering in the world all in the name of capitalism.

even the journalists are in on it including the supreme court. imperialism is everywhere in america. everywhere.

capitalism will warp the minds and create greed beyond belief for those that love capitalism and americans love their capitalism.

few understand what michael moore understands about capitalism. very few.

the devil himself could not have designed a more corrupt evil system than capitalism and christian america loves it.

maybe they really dont believe what jesus taught about love and service to others

naw the christians hold a bake sale and raise 400 dollars for a family that has a medical bill of 40,000 and go bankrupt over medical bills and the self righteous think they are doing the christian thing while they support corrupt politicans that dont support health care for all.

that is how warped religion can become.

The plan to lower the age range is ONLY OPEN to people who have been dumped and maybe to people who are too poor to get any other thing. It is designed to admit the smallest possible number.

Blessings on you for being able to listen to senators. My stomach is no longer strong enough.

by the by…………….it is a BUY IN….and at what price?

I was thinking more of them closing their books for the year in January and then working up their request for more dust, regardless of whether they’re in the red or black. Prolly take until Feb to get the requests drawn up.

and until subsidies kick in ,in 2014, the premiums would be beyond the reach of most people

You’re welcome. Wondered where you’ve been. We usually pass like two ships in the night about this time.

Hey! Hullo. Freezin’ my ample arse, but the sunshine on the new snow is exquisitely beautiful. And I actually found the heart to do some Christmas decorating this year. Also cards. Booyah! How be you?

My stomach can handle it , it’s my brain that hurts

Why worry about an election? The Blue Dogs and other corporate lackeys know they will be rewarded for their service with $1 to $3 million dollar a year jobs in “government relations”, lobbying, etc.

Good reasoning I should add that to win the bet any financial industry can get a bailout to collect banks, insurance companies, hedge funds etc.
Of course if there are multiple bailouts then we get lots of winners.

I know it is off topic but I can’t wait until it gets up. I am heart broken with Obama Nobel speech, He glorify war and disparages non-violence.

http://www.google.com/hostednews/ap/article/ALeqM5iRWjTDaT4JuS0nFj9APZAues8vjAD9CGFID00

We have become a militaristic state. They don’t care a rat’s ass for collateral damage such as sick young or old people.

bingo

Another thing about Medicare. Am I remembering correctly that at age 65 (in current time), it’s a use it or lose it benefit? Part B can/is still covered by employers, but upon unemployment (retirement, whatever), there’s a penalty for waiting beyond a certain point to enroll in Part B (which is what costs beneficiary some money)? So mandatory could indeed be mandatory. Back to use it or lose it.

I put the transcript up over at The Seminal: http://seminal.firedoglake.com/diary/18316

Pretty well, tired, I have to say. We have had a run of “cold”, which means 20s & 30s here, so yes, Im a wimp in cold weather. Trying to face Christmas…..and so it goes. Have done most of the mailing, though. Good to see you; it’s been a while. ;))

Come on, we haven’t become anything, same as it ever was.

Yes, the speech was astounding in that respect.

After watching Blanche Lincoln this AM I can understand Jane’s dislike of this woman.
I didn’t buy her spiel ,not one single word. The only interest she is looking out for is her own,insurance industry dollars are a means to an end , keeping her seat in the senate

is he a monster….wtf is wrong with him?

I do not know those details…but I had posted something similar to your earlier post….it’s not cheap. The MC monthly premium, the supplement, deductibles, etc. + however one handles the drug thing. The current proposal may be a help, but not a solution.

Cause all their deals could unravel 15% unemployment and we get an election where the country goes Right with the Tea Baggers or Left with us and given the GOP’s much lower polling than the Dems below 40% for how many months maybe a year now maybe the GOP/Blue Dogs are worried.
Even the Tea Baggers are trying to run away from the GOP now. The Blue Dogs stand on healthcare the only issue people have been talking about for months has weakened their poll numbers.
Our position on the issues is more popular we can win this.

she is vile……….seems to have no estrogen or female responses imo

I also saw her on something…a whiner and Ms Landieu right beside her….what a disappointment she has been. Her constituents need serious help…

NPR had an amazing piece on the Teabaggers, outside Dallas at a Palin signing (sighting?)….a bunch of people, maybe a “party”. So nice for Dallas…

Any bets on 15% unemployment I take September.

Hi Selise. When I read that I thought of you and intended to comment that this is EXACTLY the adverse-selection problem that Selise has been consistently warning about.

Really, more the ‘burbs.

Joe Donnelly

How much is the tea party percentage wise part of the GOP if you know?

The speech was pretty much textbook U.S. neoliberalism, including the usual selective read of U.S. history that proves how great the country is.

The other factor (besides campaign contributions) is the hammer being the only tool. I think no one can get to a high political position in the U.S. if they haven’t drooled about how to use the U.S. military. The only diff between the Rs and the Ds in that regard is that the Ds think war is OK for humanitarian reasons too. (And O said that in his speech.)

My guess is once CBO says how few people they actually expect to use the buy in, this latest deal falls apart like all the others.

Oh, how cynical of you, naughty boy (or girl, as the case may be). I guess we’ll just have to bend over and grab our ankles again. Are we still not letting the perfect be the enemy of the good, or whatever it is they say? Still playing 11-dimensional chess? Ooh, this is fun.

Just one question: When we find this out for sure, do we get back what we traded away?

Come on, we haven’t become anything, same as it ever was.

You know, I really disagree, at least as to domestic life. The great civilian institutions, such as the arts, science for science sake had more powerful voices than they do now. And cops were to help not to be obeyed or Tazered. Now at home it is as if we are on a battle field. That’s what I hate about this “war” on a tactic.

!. Assume you actually want everyone to have insurance.

2. There is a population of those between 55-65 who require more care/costs. They have to be treated, given 1. You can’t escape their costs, unless you deny their care.

3. If the buy-in covers this population, then they’re covered. This is good.

4. Under the Exchange rules, there is a risk allocation mechanism that moves $$ from plans with lower cost patients to plans with higher cost patients. To the extent this is designed well (it may not be), then the adverse selection/cherry picking problem is lessened, if not eliminated. Everyone in the exchange helps equalize premiums across the exchange — so the “mandate” the Doctors are looking for is built in to the framework.

5. To the extent that risk adjustment mechanism is flawed, then part of the increased costs of serving the sicker 55-65 group gets socialized in the overall costs of Medicare. So, yes, Medicare costs go up slightly for everyone — that is, the extra costs of covering about a couple million or so in this group are spread over a system that covers 20-30 million. Everyone who pays payroll taxes contributes to this.

It’s not ideal, but it’s not a crisis either. What’s the problem?

ughhhhhhhh…………….the man is falling in love with his badself……..Cosby many years ago

if the premiums are too high,it is a non starter

The part that is incredibly odious about this is that the insurance companies will dump as many of those in that age group as they can (the high cost people) and young people will still be forced to buy insurance, without any cost controls in place. I don’t see this as anything more than a windfall to insurance companies, who win both ways.

You must be young.

Every hear of Kent State? Jackson State? People’s Park? Chicago? same as it ever was.

Save your contempt for members you think most deserve it most and work to replace them with someone better. Walking away from the whole party is what throws it to the Republicans. GWB was a lesson that should last a lifetime, at least. That said, I most often feel like scrapping the entire government and starting over.

5. To the extent that risk adjustment mechanism is flawed, then part of the increased costs of serving the sicker 55-65 group gets socialized in the overall costs of Medicare. So, yes, Medicare costs go up slightly for everyone — that is, the extra costs of covering about a couple million or so in this group are spread over a system that covers 20-30 million

Are you calculating in the fact that this age group is less costly than those beyond 64?. There is quite a premium for Medicare that might cover cost beyond the 3% tax in that age group. In fact my guess is for women the medical care needs are even less than the 20-40 age group.

Only guessing but I really don’t think it will increase the cost of Medicare that much.if it is open to all in that age group.

And cops were to help not to be obeyed or Tazered.

I don’t know about that. I’ve seen some that should have been tazered.

New post up top…

It’s not ideal, but it’s not a crisis either. What’s the problem?

Is that the bar now: if it’s not a crisis, then we’re for it. No matter what has been traded away?
Gee, if it passes (which is doubtful), that would make a great bumper sticker for 2010:

Obamacare: Not ideal, but not a crisis either.

No, I do not know…that is sort of what they were talking about…with the outlook depending on some upcoming elections.

In Weiner’s defense, I need to note that:

* The prospects for adverse-selection are no worse under Medicare buy-in than they are in any other form of public option.

* Going through Medicare has the benefits of being an established brand that the public knows and trusts and of having a proven organization already in place including an accepted rate schedule.

* Opening up medicare is “a step” toward Medicare for all, i.e., single payer.

That said, there’s no reason not to fight the 55-and-older restriction. I agree that Weiner was overly quick in giving his approval.

The behavior of the insurers will be the same whether there’s a Medicare buy in or not, because their incentives are the same. The buy in does not change this.

If you assume the PO that is currently in the bills (and no buy-in), then the insurers will discourage the unhealthy/costly group from buying their plans, which will tend to nudge those people towards the PO, which will confront the same issues we’re discussing. The risk-adjustment mechanism is supposed to discourage that by taking money from the low-risk insurers and giving it to the high-risk insurers — e.g., the PO.

If you assume there is no PO and no buy-in, then the insurers have a stronger incentive to discrourage sicker patients from signing up; the reason is that if they people get so discouraged that they just don’t buy insurance from anyone (and pay the penalty instead), the risk adjustment fails, because there’s no high-risk insurer covering them and hence less requirement to transfer the $$. So the high-cost patients just lose coverage.

You must be young.

LOL I remember BEFORE.

Every hear of Kent State? Jackson State? People’s Park? Chicago? same as

Actually I evensee the protests that prompted the brutality as a sign of healthier then than now.

Where are the marches and protests now. Where is the music that was such a part of that.?

But I join with your emotional tone, while not accepting “better is not possible.”.

And cops were to help not to be obeyed or Tazered. Now at home it is as if we are on a battle field.

It sounds like, in the interim, you moved from a small town (where police still help people) to a big city (where police have always considered it their job to protect the desirables from the undesirables).

That’s another possibility. I don’t know the allocation of sickness across the population, but I’d assume that younger people are, on average, healthier, those between 55-65 are less so, and those beyond 65 (me) are the worst of the three groups). The adverse selection within the exchange only relates to the first two groups, because those 65 and over are presumably in Medicare.

So it’s possible that the increased costs we’re discussing (relative to the Exchange population) is not a problem when compared to the Medicare eligible population — I just don’t know. I was just trying to explain what happens with the $$ when these differences occur.

I heard from commentary the other day about how promising the “current” generation is….I guess that = college, etc….bright, hopeful, hardworking….maybe that’s the promise.

I think for some of us we will never recover from the Kennedy loss and ongoing loss of the dream for justice/equality/peace/the Great Society. Instead, we got VietNam & Nixon & forever war. There really was a moment when the possibilities had a look of fulfillment. The current struggle, all the money in dirty politics, have almost overtaken hope. Maybe the energy will be with the coming generation. Who knows…

not sure you’re outline is the proposal, but going with what you’ve written:

!. Assume you actually want everyone to have insurance.

gotta disagree with you here, right at the start. i want everyone to have healthCARE.

already there are too many people who have to go without their medication or a visit to the doctor because they can’t afford the copays or deductibles. that’s underinsurance and people die from that too. every time you increase the cost of premiums or copays, you increase the problem of underinsurance. for people already living on SS and not able to work to supplement their income, what may seem like a small increase to you is really a very big deal.

if that’s the intent of the buy in (and i’m not convinced it is), then it undermines our current medicare system further, especially for poor people who’s life depends on it. that’s not a step forward and i expect the political fall out will be horrible.

….

does anyone have the actual legislative language so we can know what we’re talking about?

It sounds like, in the interim, you moved from a small town (where police still help people) to a big city (where police have always considered it their job to protect the desirables from the undesirables)

Just the opposite. But I am learning something that saddens me, that being how younger folks are now accustomed to conditions that would have been considered little short of living in a Gestapo state. Pat Buchanan was right. It is a culture war and my kind have lost.

Opening up medicare is “a step” toward Medicare for all, i.e., single payer.

just the opposite unless is applies to the entire age group.

think for some of us we will never recover from the Kennedy loss and ongoing loss of the dream for justice/equality/peace/the Great Society. Instead, we got VietNam & Nixon & forever war. There really was a moment when the possibilities had a look of fulfillment. The current struggle, all the money in dirty politics, have almost overtaken hope. Maybe the energy will be with the coming generation. Who knows…

So true. The betrayed generation.

I guess I am still trying to nurture and encourage them away from the cynicism. (sigh)

It is also disturbing to see signs of a similar betrayal by Obam of this younger generation.

just the opposite unless is applies to the entire age group.

Agreed

Has it dawned on folks that support this crap that the insurance companies are penning these so-called compromises? And the predictable responses to them? And what’s lost in the process?

thanks!

It could be that it seems worse now, because we’re more aware of the corruption and the problems. And maybe, just maybe, that means we’re in an early stage of improvement. They say sunlight is the best disinfectant – but it does take a little time for it to work its magic.

hi wigwam. good call. *g*

Absolutely beautiful post.

Bravo. Wish I’d thought of it.

I so hope you are correct…The corruption, $$, lack of honor, abundance of self-interest….we can still hope. Thanks

I don’t have the figures and am going more on experience which can be a land mine of misconceptions. But just wanted to introduce the notion.

But as you say we don’t really know what the bill may hold anyway.

“My guess is once CBO says how few people they actually expect to use the buy in, this latest deal falls apart like all the others”

It would not surprise me if they tout that as a feature rather than a bug (low cost), just like how they tout the IRS-enforced mandate as a feature rather than a bug (look at all the people we insured – nevermind the number of insured increased because you held a gun to their head). It seems like the worse something is, the more it is touted as being good.

Wonderful post. I am going to pass it on.

“They say sunlight is the best disinfectant”

I agree. That’s why Obama abandoned his sunlight HCR promise with lightening speed. C-SPAN wasn’t there for his drug deal with PhRMA and it’s not been there for Gang of Ten or just about anything else of importance.

you’re not disagreeing with me; all i did was state an assumption for a hypothetical. It’s a reasonable assumption, given the support for Medicare (insurance) for all, or generic single payer (insurance) for all.

But sure, the point of the payment/insurance system is to get necessary care to everyone.

That said, expanding eligibility to whatever Medicare provides doesn’t undermine Medicare.

expanding eligibility to whatever Medicare provides doesn’t undermine Medicare.

i am definitely disagreeing with you. i disagree with your assumption and it sure does undermine medicare if, for example, it increases costs, which according to your hypothetical, it does. (there are other considerations as well, but this is imo the most important one, so i’ll leave aside the others for now)

not trying to start a fight or anything. i just disagree. that’s all.

I guess the devil is in the detail on that, but if the buy-in premiums are sufficiently high to cover the medical costs of this added risk pool, then adding them shouldn’t impact the fiscal viability of Medicare.

Of course, such premiums may be so high that most cannot afford them, but that’s where subsidies come in.

assumes a level of regulation sadly lacking at the federal level currently. but yes, it is theoretically possible to protect medicare (although that doesn’t mean it’s a workable po). my current concern is that we don’t support this “compromise” if indeed it is on offer without knowing the details because it is very possible it could undermine medicare and i’d like to see medicare protected.

silly idea i know, but making things better, not worse, was what i thought reform was supposed to be all about.

anyway, i go back to my Q @112:

does anyone have the actual legislative language so we can know what we’re talking about?

To be administratively manageable, Medicare at 55+ MUST BE MANDATORY!!
Those working in unionized, multi-employer industries such as construction, entertainment, service and farm labor often intermingle periods of coverage with periods of non-coverage (unable to pay COBRA rates or maxing out COBRA coverage), and it would be an administrative nightmare for Medicare as payor, for their health funds and for their selected health care providers to monitor months in which they have Medicare coverage and months in which they do not. Many unionized health funds require their participants to assign their Medicare Advantage benefits to their selected health care provider. Congress is notorious for failing to recognize/understand the needs of the millions of employees and thousands of employers in the unionized, multi-employer environment, and this may be another example. Of course, since the anti-transparency Senate Majority Leader leader Harry Reid is refusing to provide specific details prior to CBO scoring, it is difficult to state this with certainty. However, I now publicly pledge to contribute to his 2010 reelection campaign if this systemic issue has been considered or even appears in a finalized Senate bill.

Rahm Emanuel thinks that not having a health care bill passed is what killed the Dems in 1994 — hence the hair-on-fire gotta-get-it-by-Christmas silliness and the beating up of House progressives like Ellison and Baldwin — when in fact it was Rahm’s pushing NAFTA through in 1993 that was the main thing that caused millions of demoralized Demos to stay home the following year.

I myself just called Ellison’s office to let them know that just because Rahm says they need a bill — ANY bill — before Christmas doesn’t make it so, and that a Rahm-favored public-option-less bill that forces people to buy insurance that costs more and covers less (or else pay thousands in fines) is what will demoralize progressives going into next year, just as Rahm’s ramming through NAFTA in 1993 caused the betrayed Democratic base to stay home in 1994.

Emphasize these points, over and over again, when you call:

1) A bad mandate-packed bill without even a PO will hurt Dems FAR FAR MORE than no bill at all, much less a good bill. Don’t be stampeded by fake deadlines into committing electoral suicide.

2) Rahm is the same genius who gave us NAFTA in 1993, which caused millions of unhappy Dems to stay home the next year. Obama and Congressional Dems listen to him at their peril.

Per Ray Grim at HuffPo, “The Public Option is Dead”:

The public health insurance option died on Thursday, December 10, 2009, after a months-long struggle with Senate parliamentary procedure. The time of death was recorded as 11:12 a.m. Eastern Standard Time.

Its death had been rumored numerous times over the past year, but the public option repeatedly and defiantly battled back. The Senate’s insistence on 60 votes, combined with President Obama’s decision not to intervene on its behalf, eventually proved overwhelming.

The public option leaves behind a Medicare buy-in for people aged 55-64, an expansion of Medicaid, a quasi-public option for those under 300 percent of the poverty line and a collection of national private plans managed by the Office of Personnel Management.

The one remaining chance for the public option rested with the House somehow forcing its will on the Senate.

But House Speaker Nancy Pelosi (D-Calif.) pulled the final plug in a press briefing with reporters Thursday.

A bad mandate-packed bill without even a PO will hurt Dems FAR FAR MORE than no bill at all, much less a good bill. Don’t be stampeded by fake deadlines into committing electoral suicide.

A mandate with public subsidies is a pipeline into the Treasury.

in my case it’s even worse, because i don’t think any of the public options to come out of congress this year are even viable.

otherwise, i’m in agreement with all you wrote.

Regarding Scarecrow’s remarks starting @ 94 and what spurred them:

The issue has always been adverse selection, whatever government plan has been in the wings. Insurers all cherry-pick, The practice can’t be legislated away. In a dual (public/private) system, the government always ends up the insurer of last resort just as it ends up the x of last resort where x is any dual use system. Where health care is concerned, the costs are unacceptable because health risks swing too wildly. So we’ve had this issue lurking as long as there was talk of a dual system, i.e., a public option.

The Senate bill does something about adverse selection but, as Scarecrow suspects, it’s not much. I think wishing and hoping that those who signed onto Medicare stay healthy is, er, risky business.

There is however a good model for doing this competently. Jon Walker pointed us to the Dutch system for risk adjustment. It’s clearly described in “Risk Adjustment under the Health Insurance Act of the Netherlands” (http://www.minvws.nl/en/reports/z/2008/risk-adjustment-under-the-health-insurance-act-in-the-netherlands.asp).

The Dutch implemented a private system in stages but understood coming into it that private insurers would be offing customers at every opportunity unless they were compensated for the high risk customers on their rolls. But if the new Medicare customers were in fact high-risk, they would end up compensating Medicare.

(Poetic justice footnote: This would be fair payback for all that Medicare Advantage money.)

The Dutch system works with annual allotments of cash in advance with a year-end true up. The total is about half the amount of premium revenues, but something well short of that ought to work for a 55-65 Medicare extension. They have no trouble deciding on a customer’s risk profile.

It’s worth getting up to speed on this subject. We should have done so all along. Now it’s crunch time.

thanks for that very sad update. stupid dems. and i agree 110% with your comment @134.

i so wanted to be wrong about this — that an insurance industry bailout was being sold as healthcare reform. hard to see it as otherwise though.

Another article on the PNHP website dissecting the gruesome possibilites.

“Here come the sniveling, spineless apologists”

http://pnhp.org/news/2009/december/here-come-the-apologists

if we had a fed gov capable of strong regulation and enforcement, i might agree. but the political reality is that we just don’t. and that’s with the dems in charge, can you imagine how bad it would be with the republicans in charge?

excellent article. Thanks for the link.

So, why aren’t the Republicans and Blue Dogs screaming bloody murder at the prospect of a Medicare-based public option? What’s up with that?

Can it be that they see this as a way to kill Medicare?

Appears to be the case.

Right now, I’m thinking along the lines of zach1256 in post #11. Interesting developments, for sure.

I know what you are talking about, Selise, believe me. I see the Senate and House bills as competing schemes for hosing us. But, as I said, the issue of adverse selection will be with us unless we wake up one miraculous morning to learn we’ve gone to single-payer.

I’d couch it as a point about path-dependency: the system you end up with has a lot to do with how you got there. That includes the vested interests and expectations in play during the transition. And some traits linger. We ended up with employer-based insurance not only because Truman was beaten but because there was a wage freeze making insurance coverage a way for firms to attract employees. Today it’s a way to put employees in mortal fear of being fired and to keep them from quitting.

I’ve even taken your fear to the issue Scarecrow addressed: risk selection. Please do read the Dutch circular. Aside from a paragraph they forgot to translate, it’s as plain as English gets. When I read it I said, “This would never fly here. It’s how a socialized insurance system goes private: it lets private firms into the game provided they carry out the old public function responsibly.”

These aren’t our circumstances. We’re trying to go from private to public. Would Congress extract extensive amounts from insurers to adjust for adverse selection? The question answers itself. But as I said, that much may not be needed, and every dollar helps. And think of all the railing against Medicare and Chuck Grassley’s refrains about adverse selection (which actually are well taken). Why not address them head-on? Think of the idea of payback for Medicare Advantage, which was a public to private subsidy. Do you think the Progressive Caucus would find it hard to ride that hobby horse?

I’m inclined to agree with Anthony Wiener: Medicare is a known quantity and is loved and can be expanded further. The public option to date has been a dumping ground in the making. It will also help toward earlier retirements, which the young need badly. But I take Jane’s point (and yours) to heart: Let’s see the details first.

That said, I can already see risk as a looming issue not just because it was raised in this thred but because it’s been there all along and because Medicare is already cost-stressed. In the context of a Medicare extension I think the politics may make it possible to press for a more aggressive adjustment mechanism and give Grassley what he’s been asking for.

to OccasionalObserver @143:

the issue of adverse selection will be with us unless we wake up one miraculous morning to learn we’ve gone to single-payer.

i don’t expect any miracles. social movements are hard work that for years (sometimes decades) go unnoticed and/or mocked by power centers and their allies. but that’s the only path i see now, and i am very very heartened by what has been accomplished this year given the massive attempt ($$$, effort and disinformation) by dem party elite to keep sp off the table and use the po as a distraction.

i am very skeptical (and i was yelling about risk adjustment last april!) but i will read your link and try to keep an open mind (there’s an extra “)” at the end of your link, but that was easy to get around), it’s already printing out. probably not until this weekend though. thanks for the info, it is appreciated despite my skepticism. always good to learn more….

Thanks for writing back.

I wouldn’t accuse anyone at FDL of expecting miracles, and I wouldn’t be here myself if I didn’t place a hefty premium on activism. I know you comment here regularly, but I chose my screen name for a reason: I wasn’t around when you brought up risk adjustment. Good for you. I think you’ll find the Dutch circular an eye-opener. It’ll also mean that the next time I hear Grassley rant on C-SPAN, I can imagine someone else joining in on my counter-rant: “Why then don’t you propose a fix, asshole?”

Do be skeptical. You’ll be in good company for that’s one more trait we’ll share. As I said, it’s all very path-dependent, and I don’t know how exactly we back into the system we should have had all along. Except by going after the power centers and their allies. But I prefer to do this armed with knowledge of their dirty little tricks and a proposal for neutering them. They never listen, but others will.

PS: Sorry about the extra paren. It’s a nervous tick. ;-)).

yeah, path dependency matters. a lot.

don’t want to over sell myself. last spring i was just trying to figure things out — the disinformation campaign made it harder than it had to be (examples: april, may). and i guess i still am (trying to figure things out, i mean).

anyway, very nice chatting with you. look forward to more (especially after i’ve done my reading homework assignment *g*).

I’ve got news for you. If you even thought to bring up adverse risk selection in April you were onto the issue several months before me. I hadn’t latched onto it till Jon rubbed my nose in it. So we’re playing leapfrog. You’re more than welcome to take another leap ahead. I hope you do.

I believe we’re not seeing “marches and protest” (and music, for that matter) like we did in the 60s/70s is primarily due to the fact that we do not have a draft. In addition to the Civil Rights Movement, the draft is what drove people into the streets. The Power Structure has been exceedingly smart in not instituting the draft; presumably, they’ve taken that approach because they’re smart enough to remember where that led.

Institute a draft and you’ll see both the passive young (18 to late 20s) and their passive parents “get religion” in terms of political activism in a major league hurry.

As long as that doesn’t happen, people are content to stay in the comfort of their living rooms.

expanded statement from steffie woolhandler of pnhp (quoted by jane in the post);

http://pnhp.org/news/2009/december/‘medicare-buy-in’-called-a-subsidy-to-private-insurers