Published on Wednesday, October 21, 2009 by The Hill

Progressive House Dems Want Medicare for (E)veryone

by Mike Soraghan

Say hello to "Medicare Part E" - as in, "Medicare for Everyone."

Congressman Dennis Kucinich (D-Ohio) in this file photo. Kucinich called his single-payer coverage proposal "Medicare Part E." But, the question remains, can the so-called 'public option' be re-branded as Medicare, which more people understand but may present other problems for health reform advocates. (SEIU file)

House Democrats are looking at re-branding the public health insurance option as Medicare, an established government healthcare program that is better known than the public option.

The strategy could benefit Democrats struggling to bridge the gap between liberals in their party, who want the public option, and centrists, who are worried it would drive private insurers out of business.

While much of the public is foggy on what a public option actually is, people understand Medicare. It also would place the new public option within the rubric of a familiar system rather than something new and unknown.

The idea has bubbled up among House Democrats and leaders in the past week, most prominently in a caucus meeting last Thursday.

Rep. Mike Ross (D-Ark.) spoke out last week in favor of re-branding the public option as Medicare, startling many because he has loudly proclaimed his opposition to a public option.

Rep. Jim Oberstar (D-Minn.), the veteran chairman of the House Transportation Committee, also voiced his support, as did House Majority Whip James Clyburn (D-S.C.).

John Schadl, a spokesman for Oberstar, explained the congressman likes the idea because people are familiar with Medicare.

"One of his concerns is that people don't know what a public option is. Medicare is a public option," Schadl said. He said Oberstar started talking about "Medicare for Everyone" during August town hall meetings.

A notable incident last summer demonstrated the popularity of Medicare and the confusion over the public option when a man famously told Rep. Bob Inglis (R-S.C.), "Keep your government hands off my Medicare."

Speaker Nancy Pelosi (D-Calif.) planned to unveil a proposal to her caucus Tuesday night that would include the public option favored by liberals in the healthcare bill Democrats want to bring to the floor, according to two House sources.

The plan, called the "robust" option or "Medicare Plus 5" in the jargon that has emerged on Capitol Hill, ties provider reimbursement rates to Medicare, adding 5 percent. Leaders are planning to roll the bill out next week, and are hoping to vote the first week in November

Some Democrats say there's no need to rename a legislative concept that's gained steadily in support since being lambasted as a "government takeover" in August. A Washington Post-ABC poll published Tuesday showed 57 percent of the public supports the idea - up five points since August - while 40 percent opposes it.

"It keeps polling better and better as a public health insurance option," said a senior Democratic aide. "I don't think it's changing." Polling experts, however, have documented that many people don't know what a public option is, and that small changes in language can cause poll results to vary widely. An August poll by Penn, Schoen and Berland Associates showed that only 37 percent of those polled correctly identified the public option from a list of three choices.

"Before this year, few people had ever heard of the term ‘public option,' " Ross said last week.

It's not clear exactly how the new Medicare idea would work. Some want to expand Medicare itself to uninsured people under 65. Others want to simply rename what is now called the public health insurance option.

Oberstar, who supports a "single-payer" system that would be completely run by the government, doesn't want a Medicare public option to be based on existing Medicare rates because he believe Minnesota is one of the states shortchanged by Medicare reimbursements.

Republicans mocked the idea of re-branding a plan they still consider a government takeover of healthcare.

"It didn't matter what they called Crystal Pepsi; no one wanted to drink it," said Michael Steel, spokesman for House Minority Leader John Boehner (R-Ohio). "No matter how the Democrats ‘re-brand' their government takeover of healthcare, the American people oppose it."

Republicans also note that Medicare is already $37 trillion in the hole and is projected to go bankrupt by 2018. "Has anyone noticed that Medicare is completely broke?" said Andrew Biggs, a scholar at the American Enterprise Institute who worked in the White House on President George W. Bush's plan to overhaul Social Security.

The public health insurance option would be a government-run plan designed to push all insurance premiums down by creating more competition in a business where one or two insurers dominate many markets. The idea has gotten a cool reception from some Senate Democrats, and Republicans are adamantly opposed. But Pelosi has flatly stated that the House bill will include a public option.

In a closed-door caucus meeting last week, Ross, one of the most conservative Democrats in the House, offered support for expanding Medicare, saying it would prevent the need to create a new bureaucracy. He said he wasn't advocating a plan, however, and added that the new coverage would have to have much higher reimbursements for physicians and hospitals. He also said it would need to compete with private insurers.

In an odd reversal, that idea was shot down as too liberal by House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), himself a liberal champion. Waxman said expanding Medicare would essentially move toward a fully government-run single-payer system, while the public option was designed to spur competition.

People have been talking about some sort of Medicare Part E since Congress debated the prescription drug benefit, Medicare Part D, in 2003. In the 2004 Democratic presidential primaries, Rep. Dennis Kucinich (D-Ohio) called his single-payer coverage proposal "Medicare Part E."

The idea of expanding Medicare while still keeping private insurance was proposed in 2007 by Johns Hopkins University Professors Gerard Anderson and Hugh Waters. They presented a paper at a forum of the Brookings Institution advocating "Medicare Part E(veryone)," and said their proposal would expand Medicare to ensure universal coverage while allowing people to stay on their employers' health plans.

© 2009 The Hill