Not So Fast Howard Dean: "Medicare Buy In" Might Not End Up What You Think

Howard Dean is going around telling several media outlets that he is very excited about the early Medicare buy-in idea for people between the ages of 55-64. If (and that is a huge "if") the program is designed correctly, it would be avery good idea and a “big step forward.”

The problem is the “Medicare buy-in” they are talking about might not at all resemble the Medicare buy-in that Dean wants. A permanent, real Medicare buy-in for everyone between the ages of 55-64 would be a very positive development. Even if eligibility were restricted to only 55-64 year-olds on the exchange (self insured, uninsured, employees of small businesses), that would still be a step in the right direction.

My greater fear is that this “Medicare buy-in” has already been gutted or will soon be gutted of all value. Kent Conrad is pushing to decouple this Medicare buy-in from Medicare. Conrad wants to make it fake Medicare. He wants people in this fake Medicare to pay much higher reimbursement rates. and be placed in a separate risk pool. The people in fake Medicare might not even be able to use the Medicare provider network. This will make the premiums for Medicare buy-in dramatically higher, and might make the entire fake Medicare program unworkable. Already, the Federal Association of Hospitals is pushing for something like this change to gut the proposal.

It is also possible that the criteria for qualifying for Medicare buy-in will be so stringent that almost no one could take part. It was reported that talks took place about restricting it to only those 55-64 who qualify for the high risk pools. This would mean only people who could not find “affordable” insurance, and have been uninsured for least six months. Only a tiny number of people would qualify under these extremely tight restrictions. Finally, there have also been rumors that the Medicare buy-in program would only be a temporary stopgap measure for only three years. That would make the plan only a small step forward that quickly becomes a step backwards.

If the Medicare buy-in they are currently purposing in the Senate is the same Medicare buy-in that Dean championed during his presidential campaign, that would be a very good thing. But Dean may have been asked to go whip up support for a worthless idea that in no way resembles a real early Medicare buy-in. What they have created behind closed doors may be (or may soon become) a fake “Medicare buy-in in name only.” My recommendation to all progressives still stands: wait until you hear details. The devil is always in the details. Until we hear the full details, and have real indications that it could get the votes, we are simply chasing vapor.

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