More on Policy and Legislation

With Medicare-for-all unlikely to pass, is Medicare buy-in option a realistic alternative?

With the most expensive medical care in the world and shorter life expectancies, the U.S. is in what the authors call a healthcare crisis.

Jeff Lagasse, Associate Editor

Medicare-for-all, a proposal that would bring U.S. healthcare policies more in line with other industrial nations, faces strong opposition and is unlikely to be enacted in the foreseeable future, especially with division on the issue deep in Washington.

A commentary appearing in the American Journal of Medicine, proposes another approach that the authors believe would achieve wider access to care without triggering widespread opposition: a Medicare buy-in option for individuals under 65 years of age.

With the most expensive medical care in the world, shorter life expectancies, lower immunization rates and higher infant and maternal mortality rates than other OECD nations, the US continues to be in the throes of what the authors dub a healthcare crisis.

They demonstrate a link between these poor outcomes and the fact that millions of Americans have limited or no access to ongoing medical care, due to the lack of health insurance even after the Affordable Care Act narrowed the gap.


Medicare-for-all would solve a host of problems, the authors said. Americans without health insurance receive lesser care and don't live as long as the insured. They're also less likely to have a usual source of healthcare, less likely to fill prescriptions and more likely to postpone or forego care entirely due to cost. Those with chronic conditions are at increased risk of death.

The authors attribute the fierce legislative and public opposition to Medicare-for-all to concerns about disruption of the healthcare industry, which is the nation's largest with more than 16 million jobs. With much at stake, interests like the health insurance business, pharmaceutical industry, and for-profit HMOs and hospitals have stoked fears of expanded Medicare the authors said is unwarranted.

They point to another solution that has been proposed: to expand Medicare by lowering the age of eligibility. But because it would require an increase in the Medicare tax rate, it is not likely to gain much popularity.

A better alternative, they said, is to allow Americans younger than 65 the option to buy into Medicare and pay a premium until they reach the age of eligibility. A good proportion of the 27 million uninsured would have access to preventative care without increasing government costs.

And because the program would be voluntary, people could keep their employer-based or private insurance. The key would be getting the buy-in price right, the authors said, adding that companies that provide health insurance may find Medicare provides better coverage at a lower cost and  may want to opt in.


Both insurers and healthcare organizations are against the Medical For All Act introduced by House Democrats in February.

Payers are against a plan that would eliminate private insurance. Providers say a government-run health plan would ultimately result in lower reimbursement, since that's traditionally been the case.

The American Hospital Association said Congress has a history of slashing provider payments for government health programs and that Medicare and Medicaid reimburse providers less than the cost of delivering care.

The Federation of American Hospitals said it opposes legislation that would needlessly upend coverage for hundreds of millions of Americans, eliminate private health insurance and lead to a massive disruption in care for patients.

America's Health Insurance Plans is against what it calls the one-size fits-all  government system. Under current coverage, Americans have choice and control over their options and treatment, AHIP said.

Twitter: @JELagasse

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