The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Medicare Buy-in Compromise Unraveling?

Posted by Alan on December 13, 2009

Nothing lasts forever … not even health care reform compromises. The Congressional Budget Office is expected to come out with its analysis of the latest proposal – replacing a the creation of a new government-run health plan (the controversial “public option”) with a program in which Americans 55-64 could buy Medicare coverage. However, it’s looking like even if the CBO determines the idea makes financial sense, the votes to go forward with the proposal there doesn’t seem to be enough votes around for it to move forward. Which means the public option remains the big make-or-break element of health care reform in the Senate.

Only a few days ago, along with the idea of empowering the Office of Personnel Management to organize a coverage program, the Medicare buy-in compromise  seemed to be the solution to breaking the public option impasse. Now the idea seems to be losing steam.

First, doctors and hospital groups came out in opposition to the Medicare buy-in compromise, with the Washington Post reporting them as claiming the approach “would be financially untenable and would jeopardize access to health-care services for millions of Americans.”  The medical and hospital groups are concerned, according to the Washington Post, “because the program pays providers at much lower rates than private insurers, and because older Americans are the greatest consumers of health-care services.”

And then two conservative members of the Democratic caucus indicated their disapproval of the Medicare buy-in. According to the Associated Press, Senator Joe Lieberman, who had originally sounded open to the idea, now considers it “a bad deal for taxpayers and the deficit.” And the AP quotes Senator Ben Nelson as saying “I’m concerned that it’s the forerunner of single-payer, maybe even more directly than the public option.”

So while, as the Washington Post and others are reporting, the President Barack Obama and many Democrats are praising the compromise, the fact is, the Democrat’s need 100 percent buy-in by their caucus to pass any bill. (Yes, it’s possible Senators Olympia Snowe and Susan Collins might cross party lines and vote for a bill, but it’s hard to see how these Republican Senators could support any legislation conservative Democrats like Senators Lieberman and Nelson could not).

Democrats are trying to dodge a nasty choice: dropping the public option from health care reform. Liberals have made inclusion of a public option their litmus test for meaningful reform. As the liberal blog Daily Kos put it this past summer, the public option is the compromise progressives are willing to make between a single payer system and the status quo.

In the end, however, liberals will need to decide whether the absence of a public option is enough to get them to walk away from reform. Because there does not seem to be any way they will obtain 60 votes in the Senate for a bill that includes a new government-run health plan. My guess? Liberals will complain bitterly, but ultimately vote for a bill without a public option. Health care reform has been on their agenda for decades and they have moved the issue further through Congress  than ever before. To abandon it now would set back health care reform for at least a decade if not longer. Failure would hand Republicans a huge stick to use against them in the 2010 elections.

Passing reform, even reform liberals perceive as too weak, provides a foundation for future efforts. This might seem like a hollow victory for many progressives, but it would be a victory for them nonetheless. And I just don’t see them trading even a hollow victory for a hard defeat.

One Response to “Medicare Buy-in Compromise Unraveling?”

  1. Government inflexibility and Healthcare reform

    At the peak of the national debate on healthcare reform a central fear of ordinary people and healthcare providers remain unaddressed and rarely discussed. Would bigger government role in healthcare make our government even more inflexible in correcting system failures that impact patient care?
    I submit that the government’s past conduct in fixing existing issues is the barometer for things to come. Issues like the VA’s prior authorization for PCP visits in nursing homes (In some nursing home contracts the VA mandates that they pre-approve most, if not all, visits by the patients’ own PCP before they happen) that practically make veterans second class patients.
    Another current unresolved issue is the DEA requirement that nursing home patients not receive medications ordered by doctors unless there is a hard script given to the nursing home, a process that has caused delays in patient care since its enforcement almost a year ago. All efforts by healthcare organizations such as the AMA and AMDA have been fruitless on this issue as no one in government wants to be the one responsible for changing the rules, even if it makes sense to do so.
    We should pause and consider the root causes for this apparent trend of government inability to respond to concerns or to correct rules that are proven to endanger the well-being of patients. 
    Letters to government, including our representatives, are responded to with generic responses, and the big government systems remain unimpressed by the professionals’ protest of government rules that hamper their effort to provide basic care for their patients.
    Nursing home care is out of site and out of mind for most in healthcare and in government, but there is a growing movement to get attention to a variety of concerns that are the creation of the government’s own, often obsolete, rules. 
    Going back to basics in trying to get the attention of our giant, unyielding, government, a petition was published 3 weeks and is so far signed by hundreds of doctors and other healthcare professionals protesting a specific government action in nursing homes. This petition was sent to many government officials in the executive and legislative branches and we await their response. 
    Happy holidays.
    Jabbar Fazeli, MD

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