Wonks Anonymous does not hold out high hopes for the passage of the Senate's version of health reform by the House. Even if Pelosi backs it up 100% there will be some arcane rule that the Republicans and their fellow travelers - that would be the so called moderate Democrats - can use to kill the bill. this combined with Obama's current spineless position on the bill will kill it.

We will have to settle for incremental change which all of our conservative friends assure us that they support. So Wonks Anonymous has an incremental proposal.

Let people who have trouble getting insurance on the private individual insurance markets buy in to Medicare for a premium that covers their average costs to the system.

One of the parts of the reform, one that would have been enacted immediately, was the expansion of state high risk insurance pools. These are state administered insurance marts that sell health insurance - more or less at cost - to individuals who have been refused insurance by the individual insurance market.

Think of this as a sort of geezer ghetto on steroids. Pool all the people who have a serious or somewhat serious health problem and charge them the average cost of providing insurance to the pool. Assigned risk insurance is naturally quite expensive and only becomes affordable with large state subsidies. Premiums vary from $1,362 for Washington State down to $377 for Maryland. Mostly this depends on the level of subsidies offered. Cost shares are high and restrictions on this coverage are numerous.

So the moderates want the Federal Government to step in to encourage states and rationalize assigned insurance as well as to come up with a pot of money for more subsidies to persuade the health insurers to offer more affordable insurance to more sick people. This will most likely cost a bundle and may cause a few more people to get coverage.

Naturally expenses will be limited by the need to secure bipartisan support and the whole thing will probably not do much to help a whole lot of people.

Wonks Anonymous has a better idea. Expand Medicare to cover people who insurance companies consider to be high risk. Let people over 50 and people with chronic health problems buy in to Medicare paying the average benefit and administrative costs for their insurance.

In 2008 Medicare spent $468 billion to cover 45.2 million beneficiaries which comes to about $862 per beneficiary per month. See the Trustees Report here for details. This is already less than the premium charged by the high risk pools of five states and current Medicare beneficiaries are not in good health. Many on Medicare are disabled by expensive diseases like End Stage Renal Disease or in the very expensive last stages of life. Other, less expensive, states are likely offering subsidies although the information here is not clear.

So why not let Medicare offer to sell them insurance? Why not add in people over 50 who may be able to buy private insurance but only at prohibitive rates? Medicare's actuaries can determine the initial monthly premium based on their estimates of the likely average cost of providing insurance to the pool of likely applicants. Premiums would be adjusted annually, maybe quarterly, based on actual claims history of the pool who buy in to Medicare.

This is a pay as you go program. The insured pay the cost of their insurance to Medicare. The net change in the deficit is zero so this can be passed by a simple majority of the Senate under reconciliation rules.

But will it work? Won't this program suffer the same problems as the current high risk pools? Won't it just attract sick people who have higher than average costs resulting in expensive insurance that no one wants to buy?

Yes and no. The costs of buying in to Medicare under this program will certainly be higher than the costs of insurance for a healthy 25 year old. Wonks Anonymous is not convinced that they will be higher than the costs of private insurance to people over 50 and to people with chronic conditions.

Private insurers tend to overestimate medical risk. These folks are terrified of actually having to pay a claim. Private insurance also recognizes that older people and people with previous illnesses will be more willing to pay for protection against medical risks. Private insurers charge older people and sick people more because they know that they can get more from them.

Finally Medicare's administrative costs are about 10% lower than those of private insurers.

So why not try it? Let people over 50 and people who cannot get private insurance buy in to Medicare. Wonks Anonymous would bet that they will get less expensive health insurance than they would from the private market and that states will wind up paying less in subsidies. Certainly it will not be any worse than the current assigned risk pools which our betters now want to expand.

Plus no filibusters and no tiresome interviews with Ben Nelson.