Free Markets, Free People

The Grayson Medicare-For-All Bill

Everyone’s favorite maniac congressman, Alan Grayson of Florida, introduced a bill yesterday that would quite simply open up Medicare to all citizens and legal residents of America. It is the purest “public option” proposed thus far. And it might just work.

Already the leftosphere is singing Hosannas. From Firedoglake:

As quixotic efforts go, I’ll take Alan Grayson’s HR 4789, a four page bill which “allows any American to buy into Medicare at cost.” You cannot possibly get more simple than that, it would not add one cent to the federal deficit, and it would offer people the option of purchasing Medicare (and its provider network) or purchasing an insurance product from a private company.

To Down With Tyranny:

This evening Alan Grayson, Orlando’s spectacular and effective fighter for ordinary working families in a Congress that overwhelmingly caters to wealthy and powerful special interests, introduced the most real and straight forward healthcare reform bill that’s come up so far. Unless Obama makes the House leadership kill H.R. 4789– a distinct possibility– this should pass the House more easily than anything that’s been proposed for healthcare reform so far. And I bet it could even win cloture in the Senate! His bill offers the opportunity for everyone in the country to buy into Medicare. “Obviously,” said Grayson, “America wants and needs more competition in health coverage, and a public option offers that. But it’s just as important that we offer people not just another choice, but another kind of choice. A lot of people don’t want to be at the mercy of greedy insurance companies that will make money by denying them the care that they need to stay healthy, or to stay alive. We deserve to have a real alternative… The government spent billions of dollars creating a Medicare network of providers that is only open to one-eighth of the population. That’s like saying, ‘Only people 65 and over can use federal highways.’ It is a waste of a very valuable resource and it is not fair. This idea is simple, it makes sense, and it deserves an up-or-down vote.”

To the Huffington Post:

When Rep. Alan Grayson (D-Fla.) first became a father, his health insurance company refused to pay for the birth of the child, and Grayson had to pay $10,000.

Grayson told the House that story Tuesday during an impassioned and personal speech urging fellow lawmakers to support legislation that would allow Americans to buy into Medicare. Grayson introduced a four-page bill Tuesday that would make that a possibility. He asked would-be opponents to grant Americans the option to buy into the same health care plan that the federal government already offers.

And, of course, Daily Kos:

So instead of pontificating about how there is no SP or PO in the current HCR bill, he is solving the problem by offering a separate simple bill that would essentially do the same thing…allow Medicare for All…


There would be no pre-existing conditions and no medical underwriting, presumably the pools would be large enough to spread the risk.

There is no funding required for this since subsidies are not proposed for this bill. It would essentially be a PO starter. Then it could be added as an option to the exchange and subsidies could in theory be applied just like any other plan in the exchange.

We should support an “Up or Down” vote on this plan!!!

The bill’s genius is its simplicity, and specifically the promise to charge premiums to new enrollees, which would appear to make the bill deficit neutral. Here’s the entire text:

H. R. 4789

To amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States to buy into Medicare.


March 9, 2010

Mr. GRAYSON (for himself, Mr. FILNER, Mr. POLIS of Colorado, Ms. PINGREE of Maine, Ms. SHEA-PORTER, Ms. SCHAKOWSKY, Mr. FRANK of Massachusetts, Mr. KUCINICH, Ms. EDWARDS of Maryland, Ms. WATSON, and Ms. JACKSON LEE of Texas) introduced the following bill; which was referred to the Committee on Ways and Means


To amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States to buy into Medicare.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,


This Act may be cited as the `Public Option Act’ or the `Medicare You Can Buy Into Act’.


(a) In General- Part A of title XVIII of the Social Security Act is amended–

(1) in section 1818(a), by striking `or 1818A’ and inserting `, 1818A, or 1818B’; and

(2) by inserting after section 1818A the following new section:


`Sec. 1818B.

`(a) In General- (a) Every individual who–

`(1) is a resident of the United States;

`(2) is either (A) a citizen or national of the United States, or (B) an alien lawfully admitted for permanent residence; and

`(3) is not otherwise entitled to benefits under this part or eligible to enroll under this part;

shall be eligible to enroll in the insurance program established by this part. An individual may enroll under this section only in such manner and form as may be prescribed in regulations, and only during an enrollment period prescribed in or under this section.

`(b) Enrollment; Coverage- The Secretary shall establish enrollment periods and coverage under this section consistent with the principles for establishment of enrollment periods and coverage for individuals under section 1818, except that no entitlement to benefits under this part shall be effective before the first day of the first calendar year beginning after the date of the enactment of this Act.

`(c) Premiums-

`(1) IN GENERAL- The provisions of subsections (d)(1), (d)(2), and (d)(3) of section 1818 insofar as they apply to premiums (including collection of premiums) shall apply to premiums and collection of premiums under this section, except that–

`(A) paragraphs (4) and (5) of section 1818 shall not be applicable; and

`(B) the estimate of the monthly actuarial rate under section 1818(d) shall be computed and applied under this paragraph based upon costs incurred for individuals within each age cohort specified in paragraph (2) rather than for all individuals age 65 and older.

`(2) AGE COHORTS- The age cohorts specified in this paragraph are as follows:

`(A) Individuals under 19 years of age.

`(B) Individuals at least 19 years of age but not more than 25 years of age.

`(C) Individuals at least 26 years of age and not more than 35 years of age.

`(D) Individuals at least 36 years of age and not more than 45 years of age.

`(E) Individuals at least 46 years of age and not more than 55 years of age.

`(F) Individuals at least 56 years of age and not more than 64 years of age.

`(d) Treatment- An individual enrolled under this part pursuant to this section shall not be treated as enrolled under this part (or any other part of this title) for purposes of obtaining medical assistance for medicare cost-sharing or otherwise under title XIX.’.

There are no hidden takeovers of medical reporting systems, individual mandates, abortion mandates, or anything else. Nor is anything about pre-existing conditions, “Cadillac plans”, or any of the other issues plaguing ObamaCare at the moment. If you want to buy in, you can. If not, then so be it. So simple it’s almost irresistible. Especially when one considers the popularity of a public option in most opinion polls done over the last year. To be sure, when people are confronted with the costs of a public option, or most anything else promised via ObamaCare, they lose interest. But Grayson’s bill doesn’t have that problem, seemingly, because it’s charging premiums, and there aren’t even any provisions calling for subsidies. Again, it’s almost irresistible.

However, if we game out how this would actually work, then we start to see the problems.

First off, since the vast majority of us get insurance for ourselves and our families through our employers, we won’t likely be buying into Medicare. Nothing about Grayson’s bill changes the employer/health insurance relationship, so as long as we stay employed, we’ll remain a part of that system. Seniors, of course, are already a part of this system, so there’s no change there as well. Those most affected will be part-time employees not otherwise covered, the self-employed, the unemployed and the basically uninsurable. Other than the self-employed, the remainder of these likely Grayson bill participants are not likely to be able to afford the full cost of Medicare premiums, assuming that the government actually charges full price. So the emergence of subsidies is almost guaranteed, which will cost taxpayers even more.

Secondly, the more people who enroll in Medicare, the more providers accepting Medicare payments that will be necessary to accommodate them. Since Medicare pays doctors at a lower rate than private insurers, doctors and hospitals won’t want to take on many of these new patients, who basically cost them money. Just by way of example, get out your trusty phone book, call around for a dentist in your area who takes Medicaid payments, and see if they have any openings in the next year or two. That’s what would happen with a Medicare-for-all plan as well. Oh, and don’t forget that Medicare turns down requests for reimbursement at a much higher rate than private insurers do.

Most significantly, with a public insurer in the market place, one who can dictate prices and standards to providers, and who does not have to turn a profit in order to stay in business, the entire health insurance dynamic will be irrevocably altered. In order to stay in business at all, private insurance companies will need to join the Medicare and Medicare Advantage network, and will subject to whims and vagaries of Congress when it comes to reimbursements, executive pay, and whatever else suits Capitol Hill’s fancy (which, naturally, will be a great source of graft). Restrictions on denying coverage to those with pre-existing conditions, and mandates for covering everything from toe fungus cream to abortion will be introduced to the menagerie of legislation supporting Grayson’s simple four-page bill, until one day the idea of just taxing taking contributions from everyone’s paycheck for Medicare insurance and giving it to them “for free” is but a small step that might be done in a three-page bill. Eventually, Medicare-for-all and universal health care will be indistinguishable, including the waiting lines, “death panels” and substandard care.

Just one small, simple, four-page step. That’s all it will take. And it might just work.

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29 Responses to The Grayson Medicare-For-All Bill

  • “it would not add one cent to the federal deficit”

    “There is no funding required for this”

    Ah yes, free health care.  It will work exactly the way we drew it up! *maniacal laughter*

  • This bill doesn’t do anything about cost control either.  In fact, it doesn’t make sure that the cost are “revenue neutral”.
    This once again opens the door to all kinds of fee manipulation, and given that Medicare and Medicaid already treat the cost of administration as a separate line item from a separate source (which makes their administration cost look incredibly low), great care has to be given to proper crediting of expenses.
    In other words, this program should not be subsidized by the government in any way.  All labor done by federal employees and all other expenses in regard to this program should be passed along to the costs to enroll.

    • Late last year, O’Keefe and fellow activist Joe Basel went into the Detroit and Chicago offices of the U.S. Department of Housing and Urban Development (HUD) with a hidden camera. They pretended to be scam artists, asking employees there to participate in a complex kickback scheme involving federal incentives for first-time home buyers. In the excerpted footage shown to me by O’Keefe, the staffers seemed only to happy to comply.

      I’m sure there are more ways to skin a federal employee.

  • It’s DOA.

    And Grayson is still a loon.

  • Keep in mind that Medicare is one of the big three driving unsustainable deficits.  So the idea that making this bigger will be deficit neutral is simply a lie.  Medicare is already, horrifically, non-deficit neutral.
    If I don’t sign up do I get the option of not paying the Medicare portion of my FICA tax?  If the answer is no then I’m subsidizing this.

  • It’s not a half bad idea, provided that it’s amended to make sure that the premiums that get paid are based on the actual costs of both care and administration.  I’d also like to see a clause inserted that allows people to opt out of Medicare too, when they decide they don’t want it anymore.  Some Republican should amend this thing to include that.  And then if it passes and becomes law, maybe the American public will discover that Medicare buy-in is a bad deal because of the high premiums (due to waste and fraud) and the small number of doctors that accept it.
    Of course, I’d prefer that Rep. Grayson take this bill and do something redactable with it.  But if he’s bound and determined that Something Must Be Done, I’d rather have this Something than the other one.

    • But if he’s bound and determined that Something Must Be Done, I’d rather have this Something than the other one.

      Which is part of what makes Grayson’s bill so alluring.  Compared to the monstrosity that is ObamaCare, this little four-page wisp of legislation is so appealing.

  • MichaelWEventually, Medicare-for-all and universal health care will be indistinguishable, including the waiting lines, “death panels” and substandard care.

    I think we’re in for that no matter what happens.  The fact is that the health care “system” we have is broken.  One can argue about why that is (cough – government interference – cough) and what we ought to do about it (cough – free markets – cough), but the central fact is that the system is broken and will only get worse.  So, the government will do SOMETHING, and you can be your sweet Aunt Sally’s a** that it won’t be less intereference, bureaucracy, and general incompetence.

    So, this bill of Grayson’s looks – at first blush – like the best outcome we can realistically hope for.  Yes, it COULD turn into Obamacare as politicians intent on buying votes will push to increase subsidies for it, but it could also go the other way: in the age of Tea Parties and staggering deficits, it will be at least a bit harder for the Congress to simply throw more money at the program.  It’s being sold as a sort of government insurance program: if you want it, you pay for it.  If it stays that way, if people INSIST that it does not become just another welfare scheme, then it might actually work.  And who knows: as more people become familiar with Medicare and see just how bloody awful it can be, then there might be more impetus to scrap the program altogether.

    Hey, a guy can dream, can’t he???

  • Maybe Rep. Slaughter can just deem this bill to have been passed as well?

  • Nope, too simple, no place for payoffs, kickbacks, bribes, pandering,  to be hidden.  Why do you think we NEED 2000+ page documents?  It’s not just a stage prop you know, despite what Imeme thinks.

  • What’s in this for the SEIU ?

    • Nothing.
      Which is why it’ll go no where.

      • I should add the obvious that HCR is NOT about REFORM, but government CONTROL.
        Much like gun control is not about reducing crime (there’s so many better methods with out overarching negative consequences.)

  • From Roll Call: “The Senate Parliamentarian has ruled that President Barack Obama must sign Congress’ original health care reform bill before the Senate can act on a companion reconciliation package, senior GOP sources said Thursday.

  • It’s a joke. You could get the same  “simple” bill just by taking the title of the current one, house or senate, and replacing all those pesky details with “benefits to be determined later by the President”. Which is exactly what Grayson does;

    “`(b) Enrollment; Coverage- The Secretary shall establish enrollment periods and coverage..”

    Talk about signing a blank check.


    • Just sign here sir, uh, no need for you to fill in the amount line, make it out to United States Treasury Department, thanks.

  • yes lets expand a program that is already broken and is about to eat up the lions share of our entire budget.

  • How will “buying into Medicare” be any different from purchasing a $165 per month Regence individual plan like I can do right now?

    • For starters, doctors will be paid less.

      Also, it’s highly doubtful that those who buy in will pay full price — Medicare is already broke, so what’s a few hundred billion more.

      More problematic is the fact that, as more and more people “buy in,” the ability of health care providers to profitably deliver service will be jeopardized, fewer providers will enter the market and some will leave altogether.   That spells long waits, denial of service and substandard care.

  • That was proposed by Sheila Kuhel in California – popular approval but was vetoed by the Gov
    I’d like to point out that by providing universal healthcare, that means less cost through good lifelong care.  We pay at the ER for our failures to support our society.  Just as we pay taxes and medicare there could be a flat rate healthcare tax deducted from payroll – say 2% – like medicare employers would have to match that amount. 
    Right now insurance companies – which report to ‘shareholders’ first are essentially driven by Wall Street  – not the best interests of society.  The bills currently under consideration have been twisted so far that they amount to another subsidy to the financial markets.  The hype and hysteria over “socialized medicine” is marketing to keep the american consumer as a health care customer.  a deplorable practice that will continue to erode our ability to compete globally.

    • I continue to be baffled as to why some people think that, as in math, one can string along an even number of nonsensical statements and make a brilliant argument.  It just doesn’t work that way.

      For example, universal health care does not mean “less cost through good lifelong care.”  It means maximum separation of most beneficiaries from the costs of providing the benefit, and maximum payment for the benefit for some beneficiaries.  The only somewhat accurate characterization in there is that it would provide “good” care — not “great”, “excellent” or “the best.”  The fact is, we could easily pay for all of the 1970’s health care we want today, and it would be very cheap.  What cannot do is get the best possible health care without actually paying for it.

      Also, the idea that the interests of shareholders and those of “society” are somehow mutually exclusive is tired, Marxist claptrap that has no basis in reality.  Shareholders only get what they want (i.e. profit) if the company provides a service that customers want.  Relatedly, you should keep in mind that Medicare which denies more claims than private insurers do, by quite a lot.

      Lastly, I have no idea what you think this is supposed to mean:

      The hype and hysteria over “socialized medicine” is marketing to keep the american consumer as a health care customer.  a deplorable practice that will continue to erode our ability to compete globally.

      Keeping consumers as consumers?  Why is it deplorable to be a consumer?  Are you not a consumer if someone else pays the bill?  And what exactly is the “hype and hysteria” over “socialized medicine”?  Have you actually paid any attention to how those systems work and treat their patients?  Would you honestly rather visit a hospital in Havana than one in Houston?  What exactly are you trying to say?

    • ” flat rate healthcare tax deducted from payroll – say 2%”

      I am afraid that is wildly optimistic. Germans, for example, pay 14% divided, like our Social Security tax, between employer and employee. That only covers 60% of the plan’s cost. I doubt we can do it cheaper. 

      “We pay at the ER for our failures to support our society”

      Pay at the ER or pay in taxes, what difference does it make? I isn’t going to be free, no matter how many laws are passed.

      “Right now insurance companies – which report to ’shareholders’ first are essentially driven by Wall Street  – not the best interests of society”

      So what? And what makes you think that profitable insurance companies are not in the interests of our society? Are unprofitable companies in the best interests of our society?

  • Great Idea. Wish it could be supported by each and every American. 

  • I have Medicare…I’m over 65 and thus far it works really really well.   

    I would love to see all Americans be able to buy into the system.    Wondering if employers could offer it in addition to other insurance options to their employees?  (must admit I didn’t read the bill so I don’t know the answer to this)  But if employed people could also buy in the pool would be expanded.   And if the pool expanded to include those younger workers & their families… would be possible to offer  higher compensation to providers.   It would be a single payer system that really works and eliminate all the death panels offered by the insurance companies LOL.      Health care is a necessity, not a luxury.   The healthier Americans are…the better off the country is.

    As to costs of health care escalating so much