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‘Choose Medicare’ worthy of discussion

Oregon Sen. Jeff Merkley and Connecticut Sen. Chris Murphy have slightly different approaches to health care reform, but they are joining forces on a bill that proposes letting some Americans opt in to a new expansion of Medicare. Whether that specific legislation ever becomes law is not relevant now — at this point, no Democratic proposal has a prayer of gaining any traction in the Republican-controlled Senate — but it is an important part of the discussion Democrats want to have about health care, one in which Republicans ought to participate.

In a nutshell, Merkley and Murphy’s bill would create something called Medicare Part E, and let working-age individuals and their employers choose whether to buy coverage through Medicare instead of the private insurance market. Part E, as the two senators envision it, would limit participants’ out-of-pocket expenses (something traditional Medicare does not do) and cover pediatric services.

Individuals already enrolled in Obamacare could use any subsidy they receive to buy into Medicare, and the new system would extend subsidies to people earning less than 600 percent of the poverty level, up from 400 percent under Obamacare.

The element of choice is where Merkley and Murphy part ways philosophically. Merkley supports Sen. Bernie Sanders’ Medicare-for-all proposal, which would cover everyone in the country, essentially replacing the private insurance market. Murphy does not go that far, preferring to let the marketplace determine whether Americans want a Medicare approach.

The attraction of the Medicare-for-all idea is that it would keep costs down, because Medicare has the bargaining power of 45 million enrollees. Increase that number by adding working-age Americans, and the bargaining power gets even stronger, the argument goes. The Merkley-Murphy plan would have individuals and employers cover the costs of buying in to Medicare, but what the actual premiums would be is unknown. The bill also would let Medicare negotiate prescription drug prices, which would help bring costs down.

Standing in the way of that approach is the Republicans’ adamant opposition to a “government takeover of health care,” and the need to spend more on subsidies.

The plan also will likely face opposition from providers. Many physicians, for instance, don’t take Medicare patients because of the low reimbursement rates. And those rates vary from state to state, a frequent criticism of the existing Medicare system.

This is just the latest current Democratic proposal to revamp health care. By one count, there are five: Sanders’ Medicare-for-all bill, a universal coverage “Medicare Extra” proposal from the center-left Center for American Progress, and no less than three Medicare buy-in bills, including Merkley and Murphy’s.

Polls continue to show health care is a major concern for voters heading into the mid-term elections. The Democrats are busy drawing up plans.

Meanwhile, Republicans have been content to try to dismantle Obamacare piece by piece without any plan to replace it.

Whether any of the Democratic proposals have a prayer will depend to a large extent on whether the Democrats manage to retake control of either or both houses of Congress in November.

Obamacare was far from perfect when it was enacted, and is further from ideal now. A national debate over the future of health care is vital. It remains to be seen if Congress is up to the task.

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