Will Medicare Compromise Finally Secure Health Care Reform?

A wide spectrum of senators have to be sold on the policy for it to have a shot

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A new health care idea stormed the Senate this week: Instead of insisting on putting a public option at the center of health care legislation, high-ranking Democrats want to allow Americans from age 55 to 64 to buy-in to Medicare. The proposal drew sweeping support, including from some of the public option's staunchest backers.

Democratic leaders are moving forward with the idea but will sideline the much-debated public option, which would remain in legislation but only go into effect if "triggered" by the failure of other provisions in the bill. This too earned applause. But in the months ahead, just as important as the legislation's quality is its political viability. Does this thing have a chance of passing? In the Senate, every vote matters.

  • Only If They Go Fast The Weekly Standard's William Kristol says it "depends on creating a sense of inevitability this week -- which in turn depends on giving enough to all the demurring Democrats (an abortion fig leaf for Nelson, no public option for Lieberman) so it would be hard for those who know better to hold out against the pressure." But Kristol notes that Sen. Lieberman has asked for a time-consuming CBO score, which would threaten that "sense of inevitability." He concludes, "it could all fall apart"
  • Reform's Last Best Chance ABC News's Rick Klein thinks this could be "the real deal." He writes, "[P]art of what makes this breakthrough stand out is that it builds on fresh ideas in a debate where it seemed everything had been said -- and seems to be disliked just enough by all the relevant parties. If it works, it's going to mean balancing the constituencies all over again -- convincing liberals that this is almost as good as a full-on public option, convincing moderates that it's not as bad as one, then maybe even bringing a Republican or two on board for good measure."
  • Could Secure Anti-Abortion Dems Washington Monthly's Steve Benen points to Sen. Nelson, a conservative Democrat who threatened to torpedo any bill that did not include strong anti-abortion measures, which has led some to conclude his vote as a firm no. But Benen writes, "Let's not forget that just a few weeks ago, Nelson said he doesn't like the existing restrictions on abortion funding, but added, 'If there's no public option, perhaps some of the [abortion] problem goes away.' Since he's signaled at least some support for the compromise, perhaps last night's deal will keep him in the fold."
  • Rural Moderates Skeptical The New Republic's Suzy Khimm reports that Sen. Kent Conrad, a conservative Democrat from North Dakota, is skeptical. "And although he described himself as being 'intrigued' by the newest public option compromise being put forward, Conrad also reiterated that would oppose a Medicare buy-in that did not address his concerns about low payment rates to rural hospitals." Conrad also wants the 55-64 Medicare buy-in to be a "separate pool," but Khimm notes that this would "severely diminish any cost-saving potential for the proposal."
  • Could Lose Liberal Votes The Washington Independent's Mike Lillis surveys "the tough road ahead." For example, progressive Dems could vote no in protest: "liberal Sens. Bernie Sanders (I-Vt.) and Roland Burris (D-Ill.) have hinged their backing for the overall bill on the inclusion of a strong and immediate public option." Cost will be important as well. "Democrats were smart to withhold the details of their plan, which allows them to tweak it as is necessary to keep costs down."
This article is from the archive of our partner The Wire.