Wednesday, December 9, 2009


Updating the Update (11:30am): sounds as thought the fed employee based public plan offered in exchanges will be triggered, with trigger based on how many private plans are in exchanges. So, main point is a more national choice of plans....again, along lines of fed employees health plan. Also, hospitals are going off about Medicare buy in....they would rather have newly insured have private insurance which would pay higher rates. More here including notion that compromise has new insurance regulation requiring 90% (up from 85%) of revenue must be spent on care...sort of less competition for more regulation notion. This is along the Swiss/Netherlands approach of using private insurance for universal coverage with stringent regulation, notably about how much they have to spend for care (and conversely, how much they can make). Assume this applies to policies sold in exchanges only....but not sure.

NY Times has a bit more on the deal, here is WSJ:
*Medicare buy in for those 55-64; unclear how broad this will be opened up
*Plan to be offered similar to fed employees health plan, instead of public option govt run plan....fed employees plan is essentially the blueprint for exchanges and brings together variety of private insurance options for fed employees to pick from. One upside in negotiations was to use existing office of personnel mgmt infrastructure and not needing for HHS to set up new infrastructure.
*No Medicaid expansion.

Provisions off to CBO for scoring.

Reid's statement here.

Also, good overview of the public's 'we want to save costs but not actually reduce any spending' and the converse of providers 'wanting to save money but not have our incomes cut' perspective on health care costs.

Finally, momentum may be developing for the Senate bill, assuming it is passed, being fully backed by the President, and asking the House to vote on it up or down, bypassing a conference bill. The House can bring a bill to the floor with a rule that says up or down, no amendents...the notion is that it is hard enough to get it through the Senate once, much less twice. Dems in House will be furious, but this is also the quickest way to dispatch with this and move to other things....and the bill and issues dividing the Dems are not like fine wines (the aint getting better with age!).


  1. Didn't you write before about pushing up the age for Medicare in order to save costs?

    This seems to be the total opposite. Haven't had much time to look at anything bc of finals but how the heck do they plan to pay for this? I wonder if the CBO score will be good...

  2. They have scored Medicare buy in as moderately saving in the past. Details are important...who gets to buy in? Only uninsured? The true premium for someone in this age range can be high....private insurance seems to be holding fire because I suspect they suspect that Medicare will end up with the sickest patients. In one sense Medicare is the best place to cover them due to ability to spread risk widely. I said earlier this year I would prefer Medicare for all with high deductible ($10,000 ind; $15,000 family) with private insurance on the deductible amount with everyone buying private with after tax dollars.