Forbes

ReidCare’s Mandate Will Raise Health Care Costs for Poor

Plan chooses ideology over humanity

In a democratic polity, no movement can achieve its agenda in one stroke without compromises. But any compromise along the way ought not to drag its intended beneficiaries through hell.

Yet that's exactly what ReidCare would have done. Advocates of universal health coverage who hold their fellow humans dearer than their ideology should thank Sen. Joe Lieberman, the man most responsible for killing ReidCare, rather than hissing "mass murderer" at him.

It is no secret that the left wants a single-payer health care system in the U.S., a la Canada and Europe. If it had its druthers, it would abolish the private health insurance market today, impose a general health care tax and use it to finance universal health coverage. But since it can't pull that off without triggering another civil war, it has to settle for incremental approaches to reach that end.

But ReidCare—the brainchild of the Democratic Senate majority leader Harry Reid—was the worst proposal yet on the table. Even though it's not going anywhere anymore, it has exposed the zealotry and heartlessness of the left on this issue.

ReidCare abandoned the controversial public option that couldn't obtain the 60-vote filibuster-proof majority, in lieu of a Medicare buy-in. One can agree or disagree (as I do) over whether the public option—a government-run health insurance plan that would compete with private plans—would really succeed in lowering health insurance costs. But at least it constituted a serious attempt to give Americans, who will be forced to buy coverage through an individual mandate, affordable options from day one. The Medicare buy-in didn't even pretend to do that.

As its name suggests, it would allow 55- to 64-year-olds to buy into Medicare, a program that is currently reserved for seniors 65 and older. But Medicare already faces a projected deficit of $50 trillion to $100 trillion over the long term. It is on track to go bankrupt in eight years even without ReidCare. With ReidCare, its demise would have been greatly expedited.

No one, however, expects the left to be exercised over the fiscal lunacy of the buy-in idea. Indeed, as far as it is concerned, the faster people are crammed into Medicare, the better it is because the fiscal hole this will create will have to be plugged with higher taxes that could ultimately be applied toward universal health coverage. Nor should anyone be surprised if the left shed no tears for all the underpaid Medicare providers who would have been driven out of business if Medicare expanded its market share. This too is a necessary prerequisite for government-run health care.

But what the left should care about is what the Medicare buy-in would have done to the program's target group: the 55- to 64-year-old uninsured. ReidCare will raise Medicaid eligibility to 150% of the poverty level—which means near-free health care would be given to all couples, young and old, who make up to $21,855. But what about couples in this age group making, say, $22,000? They won't qualify for Medicaid. The Medicare buy-in, likely their best option, would have cost them around $15,200, according to an analysis by the Congressional Budget Office of a previous proposal. Individuals making over 150% of the poverty level, or $16,500, would have had to pay $7,600.

In other words, come 2011, when the individual mandate will kick in—if Democrats succeed—the uninsured working poor in the 55-to-64 age group would have had to fork over a whopping 50% to 70% of their income to buy into Medicare. Sen. Reid planned to help these folks with subsidies...by 2014. But what were they supposed to live on until then? His good intentions? How could he and his comrades in good conscience believe it is right to force people to buy coverage now—under threat of fines or jail, mind you—while leaving any relief to the vagaries of politics years from now?

If Americans are dying due to lack of insurance, as Ezra Klein, the writer who called Lieberman a mass murderer, believes they are, can Klein imagine how many more would be driven to starvation, ruin and possible death if ReidCare confiscated a big chunk of their wages every year in order to achieve universal coverage? An individual mandate is bad enough. But an individual mandate that doesn't come with help attached—how can they possibly accept that?

If the left wants to take an incremental yet principled way forward, now that the Medicare buy-in is all but dead, it ought to take guidance from the school choice movement. Many free-market advocates (like me) believe the best way to improve education is to get the government completely out of the business of running schools. But they also understand that they can't simply will away public schools overnight. Hence, they have accepted all kinds of half-way measures, including school vouchers, education credits and charter schools, that give at least some parents a way out of their dysfunctional public schools. Over time, the hope is that these market-based reforms will prove their efficacy over government-based solutions and lead to a fully privatized system.

But here's the thing: If the entire school choice movement were suddenly stopped in its tracks so that not another voucher was handed out or a charter school opened, choice advocates could still live with themselves secure in the knowledge that the partial changes they did make helped many and left no one worse off.

Could ReidCare advocates honestly have said the same? No. What the Medicare buy-in idea reveals is that the left cares little about who it tramples in its health care battle so long as it can keep marching toward socialized medicine. Americans can sense this triumph of ideology over humanity, which is why they are abandoning Democratic reform efforts in droves. If Democrats want to win them back, instead of ramming something through the Senate as they are hoping to do, they ought to pause till they recover their moral compass. Otherwise, they will have a hard time finding their way back to Capitol Hill next November.

Shikha Dalmia is a senior analyst at Reason Foundation and a biweekly Forbes columnist. This column originally appeared at Forbes.com.

Shikha Dalmia is Senior Analyst





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