Public Option, Bye-Bye? Senate Reaches a Health-Care Deal

The Senate team negotiating the final version of health-care reform has arrived at a deal, Harry Reid, D-Nev., announced last night. The package, Reid said, has been sent to the Congressional Budget Office for cost analysis. Details are still sketchy; even senators not on the negotiating team know the particulars. Here's what we do know.


The bad news? The public option is gone.

The good news? The public option is gone.

Why is the absence of a public option in the Senate bill good news? Because the formula for public options considered by senators were so watered down as to be virtually meaningless. In its place, reports say, the bill will offer two features that could lead to a more progressive form of health-care reform in the long run:

  • an opening of Medicare to people between the ages of 55 - 64
  • a federal health-insurance exchange based on the system enjoyed by federal employees and the senators themselves

The Medicare expansion would be a buy-in for those younger than 65, and would start immediately. People in the younger cohort would pay a premium. The Medicare expansion would start almost immediately upon passage of the bill, but federal subsidies would not kick in for a couple of years -- meaning in the short run, a Medicare card won't be cheap for the younger boomer set.

However, by experimenting with the expansion of Medicare to include a younger population, we have something of a laboratory for a future single-payer system.

When it comes creating accessibility, the Medicare expansion makes sense. People in the 55 - 64-year-old age group find it very difficult to obtain private coverage as individuals -- especially women. And they're the most likely to be out of work, hence uninsured, in this dismal economy. Folks in this age group are, as a whole, more healthy than the elderly population now served by Medicare, so that should help bring down costs. Yet, because they have more health woes than the younger population, the accessibility of this public plan to them could allow for a healthier pool of insurance subscribers drawn from the rest of the population.

The other big piece of the compromise is the creation of a federal insurance excange based on the Federal Employees Health Benefits Program.

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