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Open Up Medicare To All

The following Op-Ed commentary was published in the Los Angeles Times on Saturday, January 24, 2009.

Jamie Court is president of Consumer Watchdog, which has offices in Santa Monica and Washington.
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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 healthcare program that controls overhead costs, provides broad, affordable access to care and protects patients against big bills. President 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" healthcare 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% on overhead; private insurers typically spend 25% to 27% for overhead and profit.

A recent Congressional Budget Office report comparing healthcare 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 62 and 64 years old 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 seniors.

A UC Berkeley study last month found that a public option like 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 most 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% of physicians accept new Medicare patients, with 80% taking all or most patients, which is comparable to HMO acceptance rates. And with the massive consolidation of insurance companies and of 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 also real but solvable. Predictions of its impending bankruptcy mostly have to do with the fact that the program serves the sickest and neediest patients in the system without a proper revenue base and in an era of costly techno-medicine. There are a number of ways to help solve the funding problem.

First, Obama's promise of new technology for better medical record keeping should limit unnecessary or duplicative procedures. Obama also must grapple with Medicare's unintended incentives to doctors to do too many costly procedures at the end of life that only prolong life but do not improve quality of life. Tom Daschle, the new secretary of Health and Human Services, has already made this a priority by calling for doctors and hospitals to be paid for performance rather than by the number of procedures they perform or drugs they prescribe.

Bringing younger and healthier patients into the Medicare risk pool also would stabilize the program's funding. They don't use as much medical care as older and sicker patients, so their payments would offset the cost of care for the sicker ones. 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'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%.

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