The disagreement between Clinton and Sanders over health care reform has always been a matter of HOW we get to universal coverage…not whether or not it is the goal. It is therefore not terribly surprising that Clinton recently said this:

“I’m also in favor of what’s called the public option, so that people can buy into Medicare at a certain age,” Mrs. Clinton said on Monday at a campaign event in Virginia…

The Medicare program covers Americans once they reach 65. Beneficiaries pay premiums to help cover the cost of their coverage, but the government pays the bulk of the bill. Mrs. Clinton’s suggestion was that perhaps younger Americans, “people 55 or 50 and up,” could voluntarily pay to join the program.

The “spin” on those remarks is that they indicate that Clinton is moving to the left in response to the challenge from Bernie Sanders. While there may be some truth to that, it is important to remember that Medicare buy-in has been on the table for most Democrats for a long time.

The idea of allowing people to buy in to Medicare has been discussed in policy circles and in Congress for decades. Mrs. Clinton’s husband, former President Bill Clinton, floated a similar proposal in 1998, including it in his State of the Union address that year. The strategy has been embraced by many advocates of single-payer health care as a way to move more Americans into the existing government system. An incremental expansion of Medicare was the hoped-for strategy of Medicare’s original authors.

Back in 2009/10, Medicare buy-in was discussed as part of Obamacare – until Joe Lieberman weighed in. Given Republican obstruction at the time, health reform would not have passed unless every Democrat voted for it. One defection – ala Lieberman – was enough to end its prospects.

An expansion of Medicaid combined with the option of Medicare buy-in is an incremental path towards universal coverage. That is what Democrats (with exceptions like Lieberman – who was actually for it before he was against it) have been working towards for decades.

Nancy LeTourneau

Follow Nancy on Twitter @Smartypants60.