By Tom Curry National affairs writer
msnbc.com
updated 12/10/2009 11:31:49 AM ET 2009-12-10T16:31:49

Claim: A Medicare buy-in costs less than a public option, but only solves part of the problem.

It now looks like an essential element in the Democrats' insurance overhaul will be an expansion of eligibility for the Medicare program. Under a plan being discussed by Democratic senators, people as young as 55 would be able to buy in to Medicare, which is currently open only to people age 65 and older and to the disabled. The Medicare buy-in would be a partial replacement for the government-run public plan. Compared to a public plan, would a Medicare expansion be less costly to the taxpayers?

Fact or fiction?
Fact. A Medicare buy-in for people age 55 to 64 would cover only perhaps 10 percent of the uninsured, leaving millions of younger Americans without that option. Democratic blogger Matthew Yglesias said it will "be necessary to fight for further lowering of the age threshold" to people under age 55, perhaps someday achieving the "Medicare for all" that some Democrats want. A Medicare buy-in, however, would be better than a public option at reducing taxpayers' costs. The reason? Medicare reimbursement rates to doctors and hospitals are lower than private insurers' and lower than any discussed for a public plan. Yet there's concern over a Medicare buy-in's cost. As former Bush administration budget official James Capretta points out, a buy-in would likely attract people with more medical problems, requiring enrollees to pay high premiums. If Congress subsidized those premiums, that would add to the program's cost.

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