In its editorial about the Senate’s public option compromise and the Medicare-buy in for Americans between the age of 55 and 64, the paper concludes that “the last-minute introduction of this idea within the broader context of health reform raises numerous questions, not least of which is whether this proposal is a far more dramatic step toward a single-payer system than lawmakers on either side realize”:
Once 55-year-olds are in, they are not likely to be kicked out, and the pressure will be on to expand the program to make more people eligible. The irony of this late-breaking Medicare proposal is that it could be a bigger step toward a single-payer system than the milquetoast public option plans rejected by Senate moderates as too disruptive of the private market.
But the irony is just the opposite: despite heated rhetoric about the public option and a government takeover of health care, health care reform would actually expand private coverage and reverse the current trend of Americans losing private insurance.
According to the latest Census, as the rate of uninsured Americans balloons, the number of people with individual coverage and employer-sponsored private coverage is decreasing. Between 2007 and 2008, the percentage of Americans enrolled in all private insurance decreased from 67.5% to 66.7%, and that number is expected to fall even further without reform. The Senate health bill will move a large number of the uninsured population into a private plan within the state-based exchanges. The Congressional Budget Office (CBO) estimates that approximately 18 million uninsured Americans would enroll in private insurance. It may be the greatest expansion of private coverage in the nation’s history!
Of course, the Senate bill is not without its public components like Medicaid and now Medicare expansion. But past analysis of Medicare expansion proposals estimate that the plan would not undermine the private health care system. The proposal could attract roughly 3-4 million new enrollees, on par with the CBO’s estimates for how many Americans would enroll in an opt-out public option. And under that scenario, the CBO concluded that the government’s commitment to health care expenditures would remain roughly the same.
The number of Medicare enrollees could certainly grow over time, but the theory behind inserting a public component into health care reform has always relied on competition, not dominance. It’s the idea that private insurers can compliment the public health system and that each sector can use its inherent advantages to lower costs, improve the delivery of care, and expand coverage. It’s the yeong – yang, the push and the pull and the understanding that private health insurers are not entitled to new customers. They have to earn them by providing quality care more efficiently.
But, the Washington Post can actually see single-payer from its editorial headquarters. It’s gone rogue.