The Current Health Care Reform Compromise

So the Sen Ten have reached a secret deal. The main points seem to be that the public option is replaced by an sub – exchange of private non profit insurers (which is very close to nothing at all) and people from 55 to 65 can buy into Medicare.

I was going to give a post about why I like this compromise. Ezra Klein beat me to it. I have little to add to his post. He argues that the compromise is actually better than a level playing field public option assuming that extended Medicare pays Medicare rates. The idea is that if people see how cheap insurance is if the insurer pays health care providers Medicare rates, they will eliminate artificial barriers, such as the age limit of 55. His key sentences are “Right now, Medicare’s rates are largely hidden, as no one pays the full premiums, and so no one can really compare it to private offerings. But if the premiums become visible, and Medicare’s superior bargaining power is capable of offering rates 20 to 30 percent lower than its private competitors can muster, we’ll see how long it is before representatives begin getting calls from 50-year-olds who’d like the opportunity to exchange money in return for insurance as good as what 55-year-olds can get. “

This is why I proposed opt-out and accepted limited access to the public option to people on the exchanges. I agree with Klein that if the public sees what a good deal they can get from the US government, provided it uses its bargaining power with providers, the compromise will not last, since people and firms which provide their employees with insurance will demand the option to buy it from the US government. He has, by the way, been arguing this since Edwards proposed a reform with a public option.

I only add a Leninist argument for centrist compromise. The worse it is the better it is. The 55 year limit is totally arbitrary and unfair. I don’t think that’s an easy line to hold once 54 year olds see how much extra they are paying to keep private insurance companies in business. The 65 year minimum for Social Security old age pensions and Medicare is arbitrary too, but it is now so long standing and familiar that tea partiers can sincerely argue that government run health insurance is unacceptable because it isn’t good for Medicare.

I can’t even imagine how people will argue that it was OK to let people over 55 buy in but not to let people under 55 buy in.