The Senate health care compromise

The Senate compromise on health care looks promising. Hard to say for sure until the details are revealed, which may not be until the CBO has done its sums. (Jonathan Cohn has this nice piece asking ten good questions about the deal.) Still, it's encouraging. The idea for a national scheme modeled on the one for federal workers is such a good idea, in fact, that I feel ashamed for not having advocated it earlier.

It appeals to conservative Democrats, or should do, because it involves private insurance plans exclusively, overseen by the Office of Personnel Management (the agency that supervises the private offerings in the Federal Employees Health Benefits Plan). In principle, this is much the same as private plans in a regulated exchange, the core of the health reform proposals for months. There is nothing here for conservative Democrats and moderate Republicans (Olympia Snowe) to dislike. At the same time though the idea is hard for liberal Democrats to oppose, because it packages the deal to look like the scheme already in place for federal workers, which liberals are not known for opposing. Kill the compromise because this new "public option", which puts the uninsured on a level with civil servants, is less "robust" than the one liberals wanted? I would not want to have to defend that position. Problem solved! 

The other main component is the buy-in expansion of Medicare to the over-55s. This is obviously intended to appease liberals who feel outwitted on the public option--which they have been. This idea, if it survives, would actually give them the last laugh. It is a bigger step in the direction of single-payer (which is what they have wanted all along) than anything previously thought of. If you are 55 or over and lack employer-based coverage, the plan would let you pay a premium and get Medicare. Again, questions. How big a subsidy, if any? Would the scheme's new revenues be fenced off from existing Medicare funds or not? How do you avoid turning this into a high-risk pool with adverse selection run riot--a potential "actuarial disaster", in Cohn's words. What will health-care suppliers make of this new kid on the block? (We already know the answer to that one: they hate it, and are right to.)

Of course one may ask why this expansion of Medicare is needed in the first place, once you have offered the uninsured their own FEHPB. Also, why make this offer to people aged 55 and over, but not to anybody else? But questions like that would be let logic intrude on this process, and once you start down that road...

The Medicare buy-in could be a tough sell in the Senate, depending on what the CBO comes up with. The public option compromise, on the other hand, looks like a breakthrough.