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Skip menuWhy Medicare instead of something new and shiny?
I admit that I haven't crunched all of the numbers. I probably could, or could dig out some actuarial reports, but that's better done by the CBO. This is what I do know: In the next 10-20 years, we hit the top of the he boomer curve and peak enrollment in the old-age programs currently in effect. Medicare as it is today places only the most expensive group — the aging and elderly — under its umbrella, effectively creating the absolute worst-case scenario for cost containment.
Just as in private insurance, spreading the risk over a population that includes those less likely to drive up medical costs in the earlier years while including that portion of the population that will enter the system anyway within 10 years and phasing in the "middle group" over time seems like a way to smooth that bell curve of participation and cost while guaranteeing access to health care for all. It is similar to a pure single-payer model, but allows for opt-in during the phasing process; e.g. patient choice. By making the opt-in a one-time opportunity, revenues and offsets can be reasonably projected and accounted for, rather than simply having to calculate the worst-case among those who drive the highest expenditures.
This idea mirrors HR676, but smooths the shock to the system, giving time to build some decent reserves to offset current budget deficits, too. Most importantly, it utilizes a framework that, once modernized and reformed, offers the best and most efficient way to open the doors to a true, robust public option.