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Friday, July 20, 2007

Don't we already cover most healthcare costs? You know, old people, Medicare, hint, hint"?

I have tended to have an uncritical belief that extending the equivalent or rough equivalent of Medicare to the whole population will be a huge expense. But wait a second? Doesn’t Medicare – covering people in their 60s and older – mean we are already covering most demands for healthcare? My guess would be that people over 62 or 65 incur two-thirds or more of the actual demand for healthcare? In other words, 70% of the real need for healthcare is already socialized? Then you add in Medicaid, and CHIP. Does anyone have a true figure? Remember, comparing current national expenditure for people not yet in Medicare – people who are covered under the private health insurance system as well as the uninsured, with all the built-in inefficiencies -- to expenditures for Medicare coverage is not apples-to-apples.

“Medicare-for-Everyone” is one of the proposals that have been put on the table by some. I have tended to dismiss it as politically impossible, thinking the added cost would be too enormous to handle, while suggesting that a universal Federal umbrella of the same nature but with kick-in points much higher than Medicare (i.e., much higher deductibles and co-pays) is almost un-opposable politically once it is put before the American people. The universal umbrella concept is very, very simple to understand. This is an absolutely critical factor in building public momentum that the consultant-heavy Democratic candidates don’t quite get yet, and it addresses the two problems with our current mish-mash that dwarf every other concern: (1) the threat of losing everything you own and have built for a lifetime if you lose your job; (2) the drag on employers scared to add new jobs for fear of benefit costs racing out of control. It also retains the political benefit of letting the private-sector insurance companies offer much lower-cost policies underneath the umbrella. It is the 98% solution.

At some point as you lower the deductibles and co-pays of a universal Federal umbrella program, it becomes Medicare-for-Everyone. So if we decide that fiscal prudence means we can only go for the Chevrolet version of quite high deductibles and co-pays (with most able to reduce those with relatively inexpensive private insurance, through their jobs or otherwise, and with current Medicaid applied to helping the poor get it, too), call it “Universal Federal Umbrella Insurance,” and describe it as “Modified Medicare-for-Everyone.” If we can go for the Cadillac and get it down to full Medicare coverage, then take away the “Modified” and go for it: “Medicare for Everyone.” All you need to say to blow away the fears, is this: “The costs will be manageable because we already cover the people who need healthcare the most under Medicare. It is do-able. It is more than do-able, it’s really become critically necessary now.” [AND GET BUFFETT AND GATES TO WORK ON THE BIG CEOs TO LEND VOCAL SUPPORT.”] Whatever you do, candidates, it’s K-I-S-S. It’s the key to everything.


Blogger walldon said...

Wasn't this essentially the plan Kerry had in 2004? Look, if this is something we can get, I'm for it. I'd prefer a universal, single payer, non-employer-based system, but almost anything's better than what we have now.

3:41 PM  
Blogger KISSWeb said...

I think it's close, but he talked about the catastrophic portion as "re-insurance," which flies over the head of everyone. But even Medicare is not truly "single-payer" as I understand the term. I don't think anybody's is completely. Even France and UK allow private policies for coverage gaps. In my view, the umbrella would be strictly single-payer -- maybe with the Feds establishing an insurance corporation like the Postal Service or whatever. Or just continue, I assume out of HHS -- that's probably better. I kinda think Democrats should drop the term "single-payer" because (1) it's not 100% accurate, or there is no universally-accepted meaning, and (2) it's another wonk term that Dems love so much and Repubs have learned to avoid.

5:26 PM  

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