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Open up Medicare to everyone

Posted: Wednesday, January 28, 2009

My parents can get Medicare, so why not me?

Americans should not have to turn 65 years old or become disabled to have access to a public health-care program that controls overhead costs, provides broad, affordable access to care and protects patients against big bills.

President Barack Obama should open Medicare to all Americans who lose their jobs, cannot afford private health insurance or simply prefer it to private insurance or an HMO.

Part of the promise of Obama-care is that patients would be able to join a "public" health-care plan, with or without subsidy, if they don't have a private policy. Descriptions have been vague. Obama sometimes mentioned the federal employee health-benefits plan, which is merely a collection of private insurance policies. At other times, he discussed "the public option" as though it would be a stand-alone plan like Medicare, which directly pays doctors and hospitals.

By almost every measure, Medicare is cheaper and more effective than private plans, according to government and academic research. Medicare spends 2 percent on overhead; private insurers typically spend 25 percent to 27 percent for overhead and profit.

A recent Congressional Budget Office report comparing health-care reform options found that allowing Americans to buy into Medicare before turning 65 would lead to more people with coverage at lower costs. The CBO estimated that a Medicare buy-in for those between ages 62 and 64 would cost $7,600 a year, including drug coverage. A comparable policy on the private market at that age costs $10,000 and up - way up - in combined premiums and deductibles and is, unlike Medicare, available only to the healthiest senior citizens.

A University of California, Berkeley study in December found that a public option such as Medicare could result in $1 trillion in national savings over 10 years by driving down costs, improving efficiencies and fostering innovation.

Critics contend that Medicare pays doctors so little that many physicians won't accept the coverage, and that it is too bureaucratic and financially unstable. Medicare does use its size to drive down what doctors and hospitals are paid. However, the Medicare Payment Advisory Commission reports that 97 percent of physicians accept new Medicare patients, with 80 percent taking all or many patients, which is comparable to HMO acceptance rates.

And with the massive consolidation of insurance companies and HMOs, doctors and hospitals report to our group that Medicare payments are often as generous, if not more generous, than those of HMOs and private plans - and received with less hassle and more consistency. Studies by AARP and the Commonwealth Fund also show that Medicare patients are more satisfied with every aspect of their care than patients with private plans.

Medicare's financial challenges are real but solvable. Predictions of its impending bankruptcy mostly have to do with the program serving the sickest and neediest patients in the system without a proper revenue base and in an era of costly techno-medicine.

Allowing employers to offer Medicare is one way to widen the risk pool. Payroll deductions for Medicare would be less than what the average employer and employee now pay, according to congressional research.

Finally, the President Obama's pledge to give the Medicare program the authority to buy prescription drugs in bulk for the program's 44 million recipients would be another cost-saver. This should drive down prices for recipients by about 60 percent.

With Medicare as the public option in his health-care plan, the new president could increase its buying power to further reduce expenditures. Obama-care should make Medicare as big as Americans want it to be.

• Court is president of Consumer Watchdog, which has offices in Santa Monica, Calif., and Washington.



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