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Something similar to this has been diaried before, but my suggestion is slightly different.  Instead of creating a new government insurance program out of whole cloth, why not simply allow people to PAY for Medicare?  The CBO has already studied allowing 62-64 year olds to buy in to Medicare and found that it would dramatically reduce costs per recipient. Making Medicare open to everyone would be more popular and would probably provide better healthcare than a so-called "public option"

The republicans are making headway against the public option by calling it socialized medicine.  Unfortunately, they have an easier job since the word "public" isn't particularly highly respected in this country:
Public Education
Public Transportation
Public Hospital

The reason for this may be partly due to historical accident, but for whatever reason "public" has become associated with the Great Society, while "Social Security" and "Medicare" are associated with the New Deal.  As a Redstater once said (and was picked up by thereisnospoon in a diary right after the election)

The voters have long supported socialism. This country was dominated for 50 years by the New Deal coalition, remember? The Reagan and Gingrich revolutions were never against the New Deal. They were against the Great Society. Thus, people have never opposed socialism for themselves. People have for decades wanted free public schools, grants to go to college, retirements, medical care, money to keep their businesses and farms afloat, etc. So in other words, Americans supported the socialism that benefitted them and people like them. They just opposed it for the other guy. The Great Society was easy pickings, because it went to a small segment of society that, let's face it, most people didn't like anyway.

Since New Deal programs are popular, we use different words to describe them.  I remember my conservative great uncle rail about government programs, but when I asked him about his social security he said: "I PAID for that!" Of course, he didn't.  He paid much less into the system than he's getting out, but in his mind, it was OK because it wasn't a tax and it benefited people who worked for a living.

The huge irony that we have today with healthcare is that the truly indigent actually have better healthcare than the working poor.  Before you flame me, remember that the truly indigent qualify for medicaid, but most people with with low-paying jobs have no healthcare at all.  Personally, I've known several individuals who, as children, only got medical care when their parents LOST their jobs.  

What we really need in this country is not a healthcare program for the poorest of the poor, but a program that serves people who do work and do have some money.  

So, back to the concept of a "buy-in."  Buy-in is an extremely good term to use in this context.  "Buying" is capitalism.  It's what people with money and jobs do.  It's patriotic, remember?  "Buy-IN" implies entering into something.  When you buy into something you're becoming part of a club (anyone ever had someone try to sell you a timeshare?).  When you "buy-IN" you're becoming part of something special, something that not everyone can belong to.  Remember that "psychic wage?"  Well, my great uncle receives a psychic wage because in his mind he has "paid" for his social security and is now enjoying the fruits of his labor.  

A "medicare buy-in" sounds both capitalist and exclusionary, a "public option" sounds socialist and sub-par.  (Ever go to a restaurant and see a section on the menu with "vegetarian options?"  Just a warning, don't eat 'em).  

Allowing any person to pay for medicare-quality coverage would actually be better than the public option they're debating now.  First of all, the short-term cost would be minimal-- if new medicare enrollees are paying for it, the government isn't paying for it (you could even charge individuals under 65 a bit of a premium to help bail out medicare for the elderly).  Second, the current congressional plan for a public option pays doctors more than medicare rates.  I don't know about you, but increasing costs per person doesn't seem to be a good strategy for increasing the number of insured.  Third, a new bureaucracy wouldn't have to be created out of whole cloth.  Medicare was built before the insurance companies owned the place.  Create a government health care system now and it's bound to be designed in large part by the health care industry.

Now a medicare buy-in isn't perfect.  In order to be a true buy-in it can't cover everyone immediately.  But appropriations bills are easier to pass than bills such as this (as they cannot be filibustered).  Congress can provide assistance to those with lower incomes in a separate bill.  

Of course, the biggest problem with a "medicare buy-in" may be that it implicitly reinforces our society's idolization of capitalism and our disdain for those who don't make much money.  While I see that as a problem, it's a battle that I'm willing to fight on a day when people who work two full-time jobs can get the medical care they need.

Originally posted to John Chapman on Sat Aug 08, 2009 at 02:56 PM PDT.

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