The easiest way to do that? Make medicare the public option.
It's a deceptively simple idea. Tell those who are under 65 that they can, if they wish (no mandate here), buy into the medicare system. Once they reach 65 they would be covered as seniors are now. They can buy private insurance if they want, but entering medicare early would be an option too.
Why is this a good idea?
- It's easy to sell. Everyone loves medicare, or at least is unwilling to admit that they don't.
- It's not "creating a new program", it is extending an existing one.
- Medicare is a great success with one exception: it is in real financial danger. Could this also save medicare?
Medicare, as currently configured, only admits those over 65. I think it is safe to assume that older folks are more prone to illness. Allowing younger people in would increase the pool, bring in funds (remember, the young have to pay for medicare), and change the actuarial balance to include those who are less likely to become ill. That's how you run an insurance company.
There are some moving parts and details to deal with, such as letting the poor in for a a reduced cost (or even free), reforming aspects of insurance that are a problem in and of themselves (pre-existing conditions, portability, etc...) but these reforms would simply apply to medicare exactly as they apply to private insurance.
The right will argue that employers will move their employees to medicare due to the cost saving, and this will drive private insurance out of business. True, unless private insurers provide a better service for less. Are we saying they cannot, that private enterprise cannot compete with a government-run program? Hm. That does not sound very capitalist at all, does it?
Extended medicare by making it a volutary buy-in for those who want it would seem to be easier to explain, defend, and implement than either a separate public option, or the establishing of "co-ops". I think Marshall may be right; that this is what Obama should propose.