What if the US government made Medicare available on the open market to people under 65? It would simply become one of the options available to individuals or employers seeking healthcare coverage. It would be priced according to what the market could bear, which I suspect would be fairly high because people would be willing to pay extra for the brand name (try to imagine how much a private company would have to spend to develop a brand like that). This means that private insurers couldn’t whine about subsidized competition (OK, OK, I mean they’d have no logical reason to whine, not that that would stop them). Of course, they could start marketing Medicare supplement coverage to The Rest Of Us.
This would have several advantages. It would broaden Medicare’s risk pool, which currently consists of only the oldest and sickest. It would likely be a net non-tax-based revenue generator for the Federal government, again due to the brand premium (pun partially intended). It would provide a “public option” without having to create a new program complete with a new administrative bureaucracy. It would be an evolutionary, rather than revolutionary, step towards providing universal healthcare, and one that’s consistent with American history and American culture (all countries with universal healthcare got it that way, by refining existing systems, with the possible exception of the British who had the luxury to build a new system when the old one was wartorn).
Obviously there’s something wrong with this idea, since nobody with any clout is seriously proposing it. But what? All I can come up with is that it doesn’t provide enough pie for vested interests to stick their fingers in.
Turnips and Potatoes 
Hi Mr. Ebohlman:
You are correct, but it can’t happen in the US at this time due to cultural taboos that have awesome power over 30% of the population and compromises the consciousness of another 30% (the swing voter). These fellow citizens are severly addicted to having the freedom to exploit, and they want that option open to them even if they are being exploited. They just have great difficulty with any policy that helps everybody. Actually, cooperation is the only way our nation can have a long term future in this global marketplace and rapidly warming planet, but too many of our fellow citizens, often unconsciously, strive to hold on to the proposition that all of the economic and health misfortunes should continue to fall on the usually suspects. They know that cooperation and shared sacrifice to over come our challenges would undermine this dearly held world view. You and I know that this is unsustainable, cruel, and stupid, but they are listening to savage and the fat man on talk radio. I think our president my viewpoin. I base this on the tangled strategy he is taken to get at least something started that the better angels of our nature can build upone. Between the irrational fears of the 30% that are far more motivated and certain about what they believe than we are, and the powerful financial interest that profits from this health care system; what we have on the table may be the best we can get. This is not about what makes sense any more than reserving the vote for white male property owners, slavery, seizing one half of Mexico, preventing women from voting, jim crow, Japanese internment, redlining, or fighting to preserve global warming. If it was about making sense I believe United States citizens would be the most richest, healthiest, nurturing, ecological, educated, and fulfilled people on the face of the earth.
I’ve wondered about this too, since those most likely to sign up are the ones the insurance companies like the least, the 50-65 crowd. It seems it would solve a lot of problems.
But then, the bill isn’t about addressing the problems most people think it does.
Curtis is right. It’s too socialistic for today’s political climate. It sounds like “government takeover of health care”, even though the government has been administering Medicaid and Medicare for generations. But the political interest groups who squawk about “government takeover” of the car and banking industries would have no qualms about make similar claims for the insurance industry.
Both programs have an important business advantage in that they spend considerably less on marketing that your typical insurance company.