Howard Dean Pushes Medicare Buy-In Proposal: It ‘Must Be Available To Americans From Day One’

The Senate is considering expanding the Medicare program to Americans under 65 years of age alongside a public option compromise that would allow the Office of Personnel Management to regulate competition among private nonprofit insurers. Former Vermont Gov. Howard Dean “injected the buy-in concept back into the negotiations two weeks ago,” Politico reports. And “the turning point in the debate occurred over the past few weeks, as some progressives began to question whether the public option had been watered down too much for it to even be effective. Dean called Reid and Sen. Chuck Schumer (D-N.Y.) to suggest that they revisit the Medicare buy-in proposal, which he pushed during his 2004 campaign.”

In a statement issued to ThinkProgress, Howard Dean — a longtime proponent of the public health insurance option and co-author of Howard Dean’s Prescription For Health Care Reform — explains why he supports expanding the Medicare program:

Proponents of the public option should be happy to hear that the Senate is considering a provision that would allow Americans to buy into the existing Medicare program. Throughout this debate, advocates of a strong public option have had to repeatedly compromise with lawmakers who continue to protect large for-profit corporations and ignore the well being of their constituents. Allowing younger Americans to buy into Medicare represents the best and possibly final opportunity to truly reform the health care system as a whole.

I’ve been a long-time strong supporter of opening up the Medicare system to any American who wants to enroll in it, and I continue to believe that Medicare is a proven success story that delivers quality care efficiently. Allowing Americans under 65 to enroll in this program would generate the kind of competition that lowers costs and improves the delivery of care within the private sector. In order to be effective, however, this option must be available to Americans from day one and should be offered as an option within the exchanges, once they become operational.  Ultimately, if Democratic health reform forces Americans to purchase coverage from private insurers and does not give everyone the choice of a public plan, Democrats and the President will have to face the consequences of their watered down proposals at the voting booth.

Offering younger Americans the option of purchasing Medicare coverage could lower costs, improve the delivery of health care and strengthen Medicare over the long-term. Medicare’s administrative efficiencies and greater bargaining leverage has led the program to spend less per enrollee than private health insurers, suggesting that the program could control costs over time. A recent study found that “since Medicare payment controls were put in place in the early 1980s, Medicare spending has grown much more slowly than in the past.” Medicare has also been the source of important payment “innovations that private plans have generally adopted.” An expansion of the Medicare program would allow policymakers to spearhead the kind of payment reforms that would gradually change the incentives in the health care system from quantity to quality care.


The current proposal would expand Medicare eligibility to individuals age 55 and up, but policymakers may also consider a provision that would trigger a reduction in eligibility age if national health care expenditures don’t decrease by a set amount over time.