I had a conversation with Senator Blanche Lincoln a few weeks ago. She surprisingly showed up to the end of the year University of Arkansas Young Democrats meeting in Fayetteville. Tons of candidates where there including many from Democratic primaries and even judicial candidates. Each gave a 10-15 second speech, just saying their name and what they were running for. Other than that, it was a meet and greet. However, Blanche Lincoln was not expected to attend. When she came in, she gave a good five minute speech as to why we should support her campaign. It was a nice off the cuff speech. After that, she wondered the room talking to individuals.
We had a pleasant conversation, although not without disagreement...
I introduced myself by my full name and asked if she had heard of me. Since I was one of the admins of the Facebook group that attempted to draft Bill Halter into the race, I thought she might have been aware of our efforts. However, she did not recognize me. So, I fessed up and told her who I was and that I was a blogger from Blue Arkansas, a progressive leaning blog. I told her that we had already endorsed several candidates including Bill Halter. She asked me what issues we were pushing for on our blog. I listed a few, but emphasized that we were really formed around the health care debate and our support for a public option or Medicare buy-in. We then began to discuss the viability of a Medicare buy-in.
She said that she opposes a Medicare buy-in because she thinks it would cost more to buy a policy through Medicare than to get insurance from an insurance company. I was struck by this comment. No where in the public record did I remember Blanche Lincoln opposing a Medicare buy-in. Based on my memory, Joe Lieberman alone was the one who caused it to be taken out of the Senate bill. When I said this to her, she seemed confused herself and reiterated that she did not support a Medicare buy-in because of the cost an individual would have to pay for the policy compared to a private insurance policy.
Having recovered from my shock at hearing her oppose the Medicare buy-in, I asked her how that could be true. I told her that Medicare has a 3% overhead (no profits) while insurance companies make 15-20% of their premiums go to profits and overhead. She didn't really have an answer for me. I also suggested that even if she were correct, that a Medicare policy would cost more, the quality of the policy would likely be better. She actually agreed with me there for an instant, agreeing that people who have Medicare generally like the quality of the policy. She then said that it was the Congressional Budget Office (CBO), not her, that argued that the Medicare buy-in would be more expensive, still not addressing the point that it would be a better policy. However, when looking at the CBO's report, they simply mention it at the end of their report as a POSSIBILITY, not a probability. So, the claim the the CBO said it WOULD happen is incorrect. They simply said it might happen. Senator Lincoln's argument that it WOULD happen is her own. This view also ignores all of the benefits such a plan would have.
From the CBO report, page 40:
An advantage of this option is that it would provide
health insurance coverage to some people who without it
would have been uninsured. In addition, the option
would reduce the cost of insurance for some individuals
who otherwise would have had private nongroup coverage.
Another advantage of the option is that the buy-in
program would provide better insurance coverage for
many individuals than would private nongroup policies
because it would not include any restrictions on coverage
for preexisting conditions. Providing such insurance coverage
for so-called near-elderly individuals who otherwise
would have been uninsured could lead to improvements
in their health—for example, through better management
of chronic diseases. (CBO did not estimate the
potential budgetary effect of such improvements in
health status, although better health could reduce Medicare’s
spending for those individuals after they turned 65.
However, such improvements in health status might also
reduce the number of people who died before turning 65,
which would increase outlays for Medicare. Little information
is available on the net effect of those countervailing
factors.)
A disadvantage of this option is that the ability to buy
Medicare coverage at age 62 would encourage some people
to retire earlier than they otherwise would have. Some
of those early retirees could face financial hardship in
later years because many people underestimate the financial
resources needed for retirement. In addition, because
the cost of the coverage would not be subsidized, many
low-income near-elderly people would continue to be
uninsured. A potential problem with this option is that
the amount of adverse selection that the program experienced
could be greater than anticipated, which would put
upward pressure on premiums and in turn reduce participation.
(The potential for adverse selection would be limited
in that the program would be offered only to individuals
ages 62 to 64, who are more similar to each other in
their health status and attitudes toward insurance than
are individuals in the general population.)
I actually suggested to her, that they could subsidize a Medicare buy-in, just as the government is subsidizing private health insurance and it would help such a problem. I also suggested that they could open up the Medicare buy-in to those with employers, which would prevent such POTENTIAL problems from occurring. However, she dismissed the ideas without giving reasons. At which point, I realized I was taking up quite a bit of her time and thanked her for the conversation, allowing her to move to others in the room.
After looking over the CBO report, it seems that the CBO was actually very positive about the idea. The only real draw back, according to the CBO, was that it might cost a slight reduction in revenues on the order of 1 billion over ten years. That is a drop in the bucket of the 700+ billion dollar health care reform bill. She seemed to ignore all the positives the CBO mentioned, including that the increased competition with the private industry would drive down prices for those who DON'T buy into Medicare.
I realized that this conversation was new information at the time, but did not realize its potential importance until seeing a poll of primary voters and their preferences for a Medicare buy-in yesterday.
DFA/Research 2000 - Arkansas Democratic Primary Voters
QUESTION: Do you favor or oppose the national government offering everyone the opportunity to voluntarily buy into a system like Medicare that would compete with private health insurance plans?
| FAVOR | OPPOSE | NOT SURE |
ALL | 77% | 11% | 12% |
MEN | 74% | 13% | 13% |
WOMEN | 80% | 9% | 11% |
LINCOLN | 78% | 10% | 12% |
HALTER | 87% | 6% | 7% |
Are Lincoln voters, nearly 80% of which support a Medicare buy-in aware that their senator opposes it? Was she really in league with Joe Lieberman when he prevented it from being in the final bill? According to our conversation, she did not support it at the time either. Maybe she just let Lieberman take the fall.