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Wednesday, December 9, 2009


I think my blog posts have made it abundantly clear that I am not shy about offering opinions on a wide range of matters, about many of which I know virtually nothing. See, for example, my strong dissent from Obama's Afghanistan policy. But the latest turn in the health care reform story has me puzzled, and I welcome all the help I can get in understanding it.

As many of you will have heard, late yesterday a group of ten Democratic Senators convened by Harry Reid reached agreement on a totally new direction for health care reform. According to reports, which are fragmentary, the so-called public option will be scrapped or set aside, and instead several new components of reform will be introduced, most notably lowering the age for a Medicare buy-in to 55 for persons who are not now covered by health insurance.

My head snapped up when I read that, because it seemed to me that this was far and away the most revolutionary proposal with any serious hope of being adopted. But maybe I am wrong. This is where I need some guidance from those wiser and more knowledgeable than myself.

Let me explain. Since the end of World War II, the foundational premise of the American health care system has been that families will obtain health insurance through the employer of the family's principal wage earner, assumed to be the father of a two parent family. That assumption fit the facts for a large number of working class or middle class families whose principal wage earner worked in a large industrial firm [U. S. Steel, General Motors, etc.] or for a branch of state, local, or the federal government. Workers generally retired at age 65 [or earlier in industries with very strong unions], leaving all but the workers with the best union contracts without health care coverage in their senior years.

As the numbers of people living well beyond sixty-five soared, a crisis of poverty among the aged developed, and the government's response [fought bitterly by the Republicans, of course] was Medicare. The crisis of health care for the poor was met with the response of Medicaid.

Medicare is a single-payer government run health care insurance plan, and it is the foundation on which is built the relatively secure economic condition of the nation's very large number of senior citizens. My wife and I are now enrolled in Medicare, and I have a very good worm's eye view of how it works. When either of us needs medical attention, we go to the doctor or medical group of our choice [UNC or Duke Health, in our case, for the most part], present a Medicare card, and without co-pays or hassles, receive good care. We pay each month for Medicare Part B, the premium for which is deducted from our Social Secutiry checks, and through my former employer, I purchase a supplementary plan that covers, among other things, prescription drugs. The Federal Government sets the amounts that it will pay to reimburse medical care providers, and periodically I receive a form in the mail that shows how much the doctor or hospital charges for the service [usually an enormous amount], how much Medicare will pay [much, much less], and how much I owe [nothing, because, as the form says, the provider has agreed to accept the Medicare payment as full reimbursement for the service.]

The new proposal being hammered out opens Medicare to some people who are still of working age -- 55. Now, here is what has me astonished. This proposal, though at first it would affect a relatively small number of people, undermines the premise on which the entire American health care system is founded. Once those 55 to 64 whose employers do not offer health insurance are given the option of buying into Medicare, how long will it be before employers stop offering health insurance? How long will it be before there is a demand to lower the cost of the buy-in to the level now charged for seniors? How long will it be before the cry goes up to lower the age to 53, 50, 45?

Am I simply all wrong, or does this look like the first hesitant step toward a single payer national health care system? The insurance industry will of course fight it tooth and nail, because it is a death sentence for them. Republicans, if they have their wits about them, should go ballistic. But employers who see the possibility of shedding the burden of offering health insurance should love it.

I welcome comments. I am really mystified about this one.


Unknown said...

No expert here, certainly, but ......... apparently Medicare is widely considered effective, and so couldn't possibly be run by the government! Logic! So extending Medicare may be the easy way out.....and the US firms do suffer competitively from higher health care costs.....My question is then if we have this gradual approach to a single payer system, will the financing follow, or will financing become the excuse to kill it down the road???

Robert Paul Wolff said...

There is no way that it will be killed. The Republicans would have loved to kill the existing medicare plan when they ran things, and it was not even a possibility. Once people start to depend on it, they will not let it die. I really am puzzled whether I am interpreting this correctly, and, if I am, how it sneaked into the negotiations.

NotHobbes said...

Thank the lord for Aneurin Bevan

Unknown said...

Truly an inspiring figure:
"The National Health service and the Welfare State have come to be used as interchangeable terms, and in the mouths of some people as terms of reproach. Why this is so it is not difficult to understand, if you view everything from the angle of a strictly individualistic competitive society. A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society."
—Aneurin Bevan, In Place of Fear, p106

NotHobbes said...

"Few things matter more to our country than the NHS – it’s an institution that binds the nation together."
The above quote is taken from the Conservative party official site- the very same Conservative party who vehemently opposed the foundation of the NHS.
"A week is a long time in politics" so the saying goes.
I remember another saying, something about leopards and spots..but that`s another story

mlange said...

You seem to understand Medicare better than I do, so I'll ask you my naive question. You wrote that the provider charges a lot, Medicare pays much less, and you owe nothing. So (my naive question) how, under this arrangement, can providers afford to serve Medicare recipients? If providers raise their rates for other customers high enough to compensate for the lower Medicare reimbursements, then what will happen if more patients are on Medicare?

Robert Paul Wolff said...

I think the simple answer is that they set absurdly high rates for various procedures as a marker, and to bleed the people who do not have insurance. But millions of health care providers are making a quite decent living serving vast numbers of medicare patients, and patients with insurance from other sources, which also negotiate rates with the health care providers.