The Senate negotiators trying to negotiate a deal on the health care reform bill need to see an "ear, nose & throat" doctor about their tone deafness. Americans don't want the Federal government to expand the Medicare program because it is an entitlement program that over time takes an ever increasing amount of taxpayer revenue. For crying out loud the Medicare program is currently in a state where it pays out more money than it takes in, you people are just going to make it worse, your living in a dream world and your actions will wreck the America that exists in the real world. The Senate negotiators idea is apparently to allow retired people 55 years or older to buy into the Medicare program in a program overseen by the Federal Office of Personnel Management. This is a dumb idea because this class of people will be a sickly class of people and if their premiums are to cover their costs the premiums will have to be sky high and so over the long-term no matter what deal is struck in the short-term the premiums charged won't cover the expenses and the shortfall will come out of the Medicaire budget which is already in a state where it needs to be cut. The bottom line this idea worsens the insolvency problem of the Medicair program not helps it. Senator Rockefeller said something interesting today on this subject he said "If we're not going to get the public option ... then there have to be other ways to encourage discipline and self restraint" in the health insurance industry to hold down overall costs". If the Senate negotiators want a good idea, keeping in mind their is no perfect idea here-health care isn't free it has to be paid for, this is it. First, authorize all insurance issuers, that means private and all private issuers, to pay hospital providers "Medicare Rates" for people 55 years and older that are "retired". The rationale is that because these people are retired they deserve a break from health care providers on charges which a Medicare rate payment structure will provide and the competitive harm to private insurers will be limited because it is not like the system will have some public insurer paying rates lower than the private insurer - there will be no public insurer and all the private insurers will get the benefit to pay health care providers medicare rates. The way the system will pass on the savings to these retirees is the following. First, the system needs to distinguish between wealthy retirees and non-wealthy retirees, only non-wealthy retirees are entitled to an insurance premium break. During the yearly open enrollment period for getting insurance through the state exchanges, the non-wealthy retiree will get certified as a non-wealthy beneficiary for sake of argument it could be a retiree with income under 400% of the Federal Poverty Level; the retiree would be certified the same way other people will get certified for Federal susbsidies to pay for health insurance. The law will limit private insurance companies from charging these retirees certified for the discounted rate greater than double what they charge their lowest charge beneficiaries. Remember the law will restrict insurance companies from charging greater than a 3 to 1 ratio based on age so this is just another little calculation the insurance company actuarials will have to perform. The critically important benefit of this idea is that it won't put the costs of paying for these retirees' health care needs on the books of the Medicare program. As for the Senate negotiators idea to expand the Medicaid program to allow low-income people to get health insurance through Medicaid, that is a good idea in so far as it mirrors the House idea to allow people with incomes up to 150% of the poverty level to join Medicaid. These people with their low income and the overall system deserve the break from Health care providers that Medicaid provides in lower fees and it is a good idea because it would save the Federal government money because these people would be entitled to hefty subsidies if they were placed in the exchanges. But this 150% is about the limit because Medicaid pays health care providers such low rates, if Congress takes too much money here from America's health care provider system it may contract and then there won't be enough services available to fill the American people's needs. This paragraph assumes that the Federal Government will pay every penny of additional cost the health care reform law wil bring about to Medicaid programs across the nation from increasing the rolls of these Medicaid programs; states can neither afford nor is it fair to require them to pay for this Federal mandate on their Medicaid programs.