Grayson Offers Medicare Buy-In Bill, Makes Impassioned Speech
So, where was access blogger Stoller's boss when this speech would have made a difference?
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the timing on this one might be pretty good ackshully
there's a small -- very small -- chance that a 4-page bill that looks like it fixes several of the biggest problems immediately compared to a 2000+page monstrosity that might start fixing problems in 4 years could be used as leverage to whip up public sentiment for killing the monster bill.
Could be
My question still stands, though...
On another note: I dug up a great chart that shows the difference between Canada and US health care cost increases after Canada adopted single payer and now I can't find it. Do you know where it is?
NOTE Update here in Medicare buy-in. More sane than the so-called "public option," for which the usual suspects continue to whip.
First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi
charts
i remember the one you had, it looked similar to this one, but you can also use this one or probably this one to illustrate the point.
much, much more sane than the po, but ...
i've been trying to make educated guesses at what the premiums would be. nb: grayson's bill breaks down the age groups into more than i could get data on from here.
[very] rough calculations:
age 55-64: ~$660/month
age 45-54: ~$440/month
age 19-44: ~$285/month
age 0-19: ~$225/month
good: no recissions, no denials of care, no in-network/out-of-network problems, 100% portable [live anywhere in the country], accepted by ~80% of drs
bad: high premiums, low actuarial value [probably ~75%] so you would probably want to buy some kind of medigap insurance if you were sick or worried about getting sick
the bill could be improved [probably later] by adding a tax on the rich to subsidize those who need help
gotta go do other stuff for a bit. back later.
So, the issue is subsidy
But then, if you don't have single payer, that's always the issue.
First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi
at least these subsidies
at least these subsidies wouldn't go to insurance companies. the money would go to drs and hospitals.
but yes, those prices would be steep for a lot of people who need decent insurance right now and subsidies would be needed if we were going to help all of the uninsured/underinsured.
alternatively, to avoid the subsidy problem, you could assess a payroll tax [or income tax] on those who chose medicare, instead of charging them a premium. this would mean that low-income people would pay less and high-income people would pay more. if you did it this way, [1] the bill would have to be scored by the cbo, which would mean that scheduling a vote on the bill could be problematic, and [2] the republicans would kill it.
so, technically you could do this entirely through taxes and without subsidies and still have a non-single-payer system. as for political feasibility, there's a possibility you could actually get some republican yes votes on this -- if people can be portrayed as 'paying their own way [ie paying the full premium without help from the govt].
Well, that amount would take my entire income
So I'd need to leave the country to arbitrage the money I have, or go naked until real Medicare kicks in (which is the current plan). Not apetizing. Why don't they just take the Medicaid money out of that bucket and put it in this one? How hard can that be?
First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi
go naked until real Medicare
go naked until real Medicare kicks in (which is the current plan)
that's my current plan too.
Why don't they just take the Medicaid money out of that bucket and put it in this one? How hard can that be?
that would be excellent. it would maybe [maybe not] need to be scored by cbo and the republicans would probably hate it, but it would be a good idea.
on second thought: medicaid ...
people in medicaid: ~50-60 million
# of medicaid recipients who are NOT elderly or disabled: ~44 million
uninsured: ~45-50 million people
underinsured: ~20-50 million people
total medicaid spending: ~$319 billion/year
medicaid spending on NON-elderly/disabled: ~$93 billion
i'd be reluctant to use the elderly/disabled portion of medicaid spending for subsidies for medicare for the rest of us, so that leaves ~$93 billion to be used to subsidize up to 100 million people, give or take. that works out to $930/year subsidy [$77/mo] and given that non-elderly medicaid recipients are only costing us $1708/yr for kids and $2142/yr for adults [way lower than my calculated medicare buy-in], it doesn't look like such a good idea after all.
They've budgeted for Medicaid expansion
Why not put that money for Medicaid expansion to subsidize Medicare buyin?
First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi
if by 'budgeted for medicaid
if by 'budgeted for medicaid expansion' you mean the 'reform' bill, then the $$$ for the medicaid expansion [and subsidies to buy insurance once the exchange/s open/s] will come from the cuts in medicare, from the excise tax on 'cadillac' plans, etc.
if otoh you mean that medicaid spending is expected to go up even if 'reform' fails, then that expansion is seldom enough to cover the increase in medical costs, let alone provide care for more people as they become unemployed and drop off of the private employer-sponsored insurance rolls. that's definitely not going to be enough to subsidize any medicare buy-ins for anybody.
without a big increase in [tax] revenues for medicaid, pretty much any idea along these lines amounts to stealing from the poor to help the less poor. there are a few states with reasonably generous medicaid spending [looks like maine is one of them] so it's possible that some states would choose to use some portion of their medicaid spending to subsidize a medicare buy-in for some people. some states do use some of their medicaid $$ for subsidies to help people buy private insurance, so it could happen at the state level.
Shit, you're right
You're totally p0wning me on this, Hipparchia. All I can see in defense is that I'm doing three things at once and don't multitask well.
Heh. By funding Medicaid expansion with Medicare cuts, they make a functioning Medicare buyin impossible. They really do play 11 dimensional chess, except against us.
First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi
good use of the socratic method, actually
and something to point to if other people bring it up. heck, even *i* thought it sounded really good at first.
Its like Cheney said... "deficits don't matter" :o)
One way to subsidize it simply (and frame it as a tax cut) is to provide an advanceable, refundable tax credit for 75% of the premiums.
Jay Rockefeller's 55+ Medicare buy-in bill had that tax credit. http://rockefeller.senate.gov/press/record.cfm?id=312784
"go naked..."
Reminds me of these awesome ladies.
I wish I had the ovaries to do something like this. Sigh. I really was born into the wrong generation.
Never vote for people who hate you.
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The Widdershins
awesome indeed!
i've never heard of them. thanks for the introduction!
even at those prices
it would still be cheaper than my premiums back in the days when I could afford insurance.
back when i could afford health insurance
i was paying ~$450/month in premiums, which compares favorably to the ~$440 my age group would [maybe, if my calculations aren't way off] have to pay for medicare today. that amount would be a real squeeze for me, especially since i would probably buy some kind of medigap thingy too, but it would be doable.
Sam Gibbons's old 3 page bill would be better
His 1991 Universal Medicare bill would have opened Medicare to all ages and funded the expansion with taxes and not premiums. http://www.scribd.com/doc/24875006/Medicare-Universal-Coverage-Expansion-Act-of-1991
A Tricare buy-in would have been better
Since his 4 page bill doesn't improve Medicare's benefit package, I wish Grayson had made it a Tricare buy-in instead.
While Medicare is better known, in terms of coverage and ease of expansion , the Pentagon’ public option for military reservists and their families, Tricare Reserve Select is a much better, well, public option.
Granted, Tricare’s administrative costs are higher than they should be since its administered through private contractors, but for one premium (unsubsidized, $179 a month for an individual, $704 a month for families), Tricare offers low annual deductibles and copayment caps ($50/$100 deductibles for individuals/families, $1000 copayment cap for either) and covers hospitals and providers at Medicare rates and prescription drugs at VA prices.
In contrast, for similar coverage under the Medicare system, it’d be split up into 4 policies and presumably 4 premiums for a buy-in, Part A (hospitals), Part B (providers), Part D (drugs) and a private Medigap policy to provide a catastrophic cap. And of course, Medicare has no provision to provide family coverage, so each family member would have to pay their individual premiums separately. Even if the total cost were the same, can you imagine the public reaction to requiring a family of four to write 16 (!!!) Medicare/Medigap premium checks a month versus paying just one monthly premium to Tricare?
16 checks?
it's the guvmint after all, they can do direct deposit/withdrawal into/out of your bank account, no reason that couldn't apply here.
tricare has one advantage in allowing you to go to military providers [providing space is available] as well as civilian, so more providers to choose from than medicare. worldwide portability too. not a bad deal. maybe somebody should call grayson up and ask him to propose a tricare-for-all public option if his current one is voted down.
tricare reserve select plan brochure, should anybody be interested.
16 automatic bank debits doesn't sound much better
My concern isn't the need to buy a lot more stamps, but just to point out that Medicare needs to be improved as well as expanded. As for the guvmint doing direct withdrawals, ionly Part A and Part B premiums would go to Uncle Sam. Part D and, of course, any Medigap policies would be paid to private insurers.
I was thinking about Tricare's civilian providers (its tied to Medicare, if a doc takes Medicare patients, he must take Tricare patients at the same rate), hadn't even thought about military providers. If I'm not mistaken, Tricare also has a space available arrangement with the VA. Veterans groups are a little touchy that the VA healthcare system isn't funded adequately to provide services for every veteran (despite the fact that its socialized medicine system provides the most cost-effective medical care in the country). But if the veterans are getting the care they deserve and there's space available for civilians, then I'm all for a Medicare or Tricare with a "public option" (that is, the VA) system. :o)