fresh voices from the front lines of change







LIberal and right-leaning Democrats reportedly have reached a compromise that replaces Senator Harry Reid's version of a national public health insurance option, which states could decide not to offer, for giving workers between the ages of 55-65 the option of buying into Medicare. How good is that deal?

Certainly, a limited Medicare buy-in does not solve the fundamental problem with private insurance facing minimal competition.

But the versions of public option that are pending in Congress -- which would not allow the public plan to fix reimbursement rates at levels lower the private insurance, proving robust competition to reduce premiums -- were not ideal either. The Congressional Budget Office concluded they were good enough to lower premiums overall, and they would at least set up a framework that could be improved upon.

The fight for reform will continue regardless. The need for compromise cannot be wished away. But do we need something that constitutes improvement for most Americans and eases the path to future reforms.

Presumably, a Medicare buy-in would qualify. Medicare is, after all, a public plan. And now more Americans could choose it.

There are still possible devils in the details (Jonathan Cohn has the rundown of potential pitfalls) that could make a less appealing choice than need be. And fewer people would have the choice of a public option under the Medicare buy-in compromise than the public option provision in the House bill.(Chris Bowers deftly crunches those numbers.)

But the choice would exist. A framework would be established, one that could be improved up with increasingly lower age thresholds as more and more people like what they see and want access to it.

I would certainly favor the House approach, and I would recommend fighting for it. But at minimum, we are fighting between two different frameworks for a public option. That ain't bad.

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