By Tom Curry National affairs writer
msnbc.com
updated 11/16/2009 10:12:16 AM ET 2009-11-16T15:12:16

Claim: Medicare and Medicaid already serve the needy, so a public option would be redundant.

Some people wonder why a new federal program is needed since two big ones, Medicare and Medicaid, already exist. Together those two programs spend more than $700 billion a year for the medical care of more than 85 million Americans. Couldn't those programs, with their administrative structures and staffing already well established, simply be expanded to pay for medical treatment of the 50 million or so Americans who are uninsured?

Fact or fiction?
A little of both. Yes, in theory, Medicare, which pays medical costs for Americans age 65 and older, could be expanded to include all age groups. In fact, some Democrats want to do just that, by creating a "Medicare for all" single-payer plan. But that idea lacks support in Congress and would require a radical restructuring of Medicare's financing and benefits. Advocates of a public plan also say expanding Medicare to younger people would risk frightening older people enrolled in Medicare and could create a political backlash. Democrats' insurance reform bills do expand eligibility for Medicaid, which pays for medical care for indigent people. But they don't expand Medicaid enough to cover middle-class people who are uninsured or whose insurance costs are relatively high. Public plan advocates contend that middle-class people need their own government program which would compete with private-sector insurers.

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