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I have long supported the expansion of Medicare, which is why I am supportive of a Senate proposal to expand Medicare to include Americans over the age of 55.  I believe that the inclusion of a public option that gives Americans real choices about their healthcare and creates real competition is also essential.

These are two pieces of real reform that go hand in hand.

Medicare is a government-run, single-payer system. What the Senate is working out could move the ball forward, if people under 65 will -- for the first time -- have the option of signing up for such a program under certain circumstances. The specifics of those circumstances matter a lot. The under-65 pool should not be limited to high-risk people only, and subsidies will ultimately be needed for those who cannot afford the premiums.

The other groundbreaking piece of the current Senate proposal is that a significant number of Americans over 55 who do not have access to health insurance today, would be able to get it within six months of the final bill being signed. Of course, more reform and access to choices are needed. However, this proposal moves us in a very good direction. The realities are Congress rarely passes reform that is not incremental and it is important that the increments they pass are headed in a direction we ultimately want to go. Expanding Medicare would do that.

The proposal to expand the Federal Employee Healthcare system could also be a step in the right direction. While I am not a fan of the private health insurance market, with the proper regulations, this could work. The OPM has done a reasonably good job of running the current plan, but Senator Rockefeller’s proposal to require insurance companies to spend 90 percent of their revenues on healthcare is absolutely essential.

We must continue to work towards a system that gives Americans real choices. The truth is America already has a socialist system (the Veterans Administration with 25 million people). We already have a single-payer system (Medicare with 50 million people). And we already have a private insurance system (with almost 50 million Americans uninsured). The American people can reform healthcare by making real choices, but Congress must let us have those choices.

Both the current Senate proposal and the House bill will give us choices that Americans did not have before. The central problem will be that not enough Americans will have those choices.  So while we may be able to take big steps in the right direction – the fight for healthcare reform does not end here. We must continue to pressure Congress to pass real reform.

Originally posted to Gov Howard Dean MD on Wed Dec 09, 2009 at 02:26 PM PST.

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