The Public Option Compromise: A Slippery Slope Liberals Are Happy to Slide Down

This is a great photo.
This is a great photo. Photo: Getty Images

It's looking increasingly likely that the Senate's so-called "Gang of 10" — five liberal Democrats and five moderate Democrats — may come to an agreement on how to scrap the public option while maintaining the support of the entire caucus. As we wrote yesterday, the public option could be replaced with a private program similar to the one available to members of Congress. But liberal senators are finally demanding something in return for their repeated concessions to a small coterie of moderates, and what they may be getting is the expansion of Medicare and Medicaid. People 55 to 65 would be allowed to "buy-in" to Medicare coverage (it's currently available only to people 65 and over), and Medicaid would be expanded to cover families at 150 percent above the poverty line (it's 133 percent in the bill's current incarnation). Though the proposal would spell death for the public option, liberals are excited about the idea not only because it could help to finally push health-care reform forward, but because expanding Medicare might put the country on a path to a single-payer system — the liberal ideal of health-care reform from the start.

• John Nichols thinks "real reformers" should be "excited" about the proposal because it's "a smart way to achieve a needed goal" and "a savvy intervention in the current health-care and economic debates that has long-term repercussions. Once the eligibility age is lowered, it won't go up. Once the precedent of lowering the age as a means of expanding access has been established, it can be revisited to further expand access." [Beat/Nation]

• Bed Adler also believes that "[i]f Medicare becomes a more popular and cost-effective program for people aged 55-65 than private insurance, there will surely be calls to expand it further." At the same time, moderate Demcocrats "get to tell their constituents ... that they maintained their small government credentials by not creating the new federal program. Instead, they expand Medicare, which everyone loves, even the congressional Republicans whose hero Ronald Reagan got his start in politics opposing its creation." [Gaggle/Newsweek]

• Matthew Yglesias also hopes this could "set a precedent for further expansions of buy-in possibilities over time." [Think Progress]

• Jonathan Cohn says that "making Medicare available to older workers earlier would seem like a smart move, as policy (by helping people who genuinely need the assistance) and politics (by giving a particularly skeptical age group more reason to value reform). And, in a sense, it would bring the public option debate full circle," since "the original notion was to create a program like Medicare. And what's more like Medicare than Medicare itself?" [Treatment/New Republic]

• Matthew Continetti calls it "a ludicrous idea" to expand Medicare, because "[t]he coming entitlements crises mean that America ought to raise the age requirements for eligibility in welfare programs, not lower them. Moreover, the entire point of health care reform, the president says, is to reform — i.e., lower the future cost of — entitlements. Making it easier to go on Medicare would do precisely the opposite. [Blog/Weekly Standard]

• Kate Pickert writes that "pulling the public option out of the Senate bill and adding in a massive expansion of Medicare could change the tenor of the debate in any number of unpredictable ways. Trying to gauge potential reactions is part of what the group of 10 Democratic senators is doing now — letting a few details and ideas creep out here and there." [Fix/WP]

• Greg Sargent expects that any deal the Senate reaches will likely be forced upon the House, despite a large bloc in the latter chamber demanding a public option. [Plum Line/Who Runs Gov]

• Michael Tomasky says "there will be no reason whatsoever to mourn the public option's death" if the Medicare/Medicaid expansion deal goes through, because "this would be way more progressive than establishing a weak public option that probably (as presently constructed) wouldn't work very well anyway. If these are the terms, liberals ought to be as willing to throw out the public option as if it were last night's meat loaf." [Guardian UK]