When Ann Satterthwaite goes to a birthday party for a friend who's turning 65, she makes up a red-white-and-blue card and holds a ceremony to welcome the new member into the country's greatest health club: Medicare.

For all the political debate on the problems with Medicare, you'd think this program for people over 65 and those with disabilities was on the critical list -- a dying albatross of big government, bad medicine and burgeoning costs perched on the backs of the American people.

It's actually a very successful and popular program. In an era when health care coverage is unraveling -- more people without insurance, more people with inadequate insurance -- Medicare stands out as a model plan. It's universal for people of a certain age. It's (relatively) affordable. There's consumer choice of hospitals and doctors. Once you've got it, you can't lose it.

Yes, the program has issues. The new prescription drug benefit falls short of providing affordable coverage for many beneficiaries. Costs of premiums and supplemental policies continue to rise. But still, compared with the increased costs and shrinking benefits of many individual and employer-based plans, Medicare comes out the winner.

Administrative costs are low -- 2 percent compared with 10 to 15 percent in managed care plans. Medicare beneficiaries are generally much more satisfied with their coverage than are people with other forms of insurance.

Satterthwaite, 73, remembers the years before she got her red-white-and-blue card. A city planning consultant and author who lives in the District, she had to wrestle with private insurers for an individual policy that always had a high price tag, limited benefits and gotcha fine print.

One time she injured her eye while packing a suitcase. She waited to see if the injury would repair itself. When it didn't, she went to her physician, who referred her to an ophthalmologist, who referred her to another specialist to treat her damaged retina. By that time, more than 48 hours had passed. The fine print of her policy said treatment had to be obtained within the first 48 hours of an injury. Her claims for reimbursement were denied. So were her appeals.

Her eye healed, but her rage at the health plan did not.

When her Medicare card arrived, "it was a glorious day. I had peace of mind," says Satterthwaite. "I have this warm, friendly coverage. The forms are straightforward. The money comes quickly. It's the difference between night and day."

Too bad Satterthwaite couldn't have joined the Medicare club when she turned 50.

That's what a lot of Americans would like to do. Nearly two-thirds of men and women between 50 and 64 say they would be interested in enrolling in Medicare early if such an option were available, according to research by the Commonwealth Fund, a New York-based private foundation that supports health policy research. Even a majority of people who were covered through an employer expressed an interest in joining the federal program early.

More than 85 percent of those without coverage reported that they would like to buy in to Medicare. They would have to pay higher premiums, estimated between $300 and $400 a month, but that would still be lower than an individual policy.

The social plague of uninsurance now infects 45 million Americans. Researchers at the Employee Benefit Research Institute announced that fewer Americans were getting insurance through an employer and that the proportion of the population without coverage had edged up to 15.6 percent in 2002.

Men and women between 50 and 64 are especially vulnerable. They may be nearing the end of a working career. They risk losing their health insurance if they stop working before they turn 65. They are also at increased risk for getting sick and being disabled by disease. Health coverage is a priority.

Yet it is prohibitively expensive -- roughly $6,000 to $8,000 for a 60-year-old woman, compared with about $2,000 for a healthy young person. And an older person is more likely to be uninsurable because of a medical problem.

In a Commonwealth Fund survey in 2000, one in five people in the 50-64 age group reported a time without coverage since turning 50. The majority of people without insurance said they had been uninsured for three years or more.

Last year about 15 percent of this Medicare-in-waiting population lacked health coverage -- nearly 7 million men and women, according to the most recent data.

There's an obvious solution: Why not open Medicare on a volunteer basis to these vulnerable citizens? Instead of rhetoric on fixing Medicare, what about real talk on using Medicare to fix some of the problems in American health care for those who are uninsured and underinsured?

There's a real choice on health care in this election. The Bush plan hardly addresses the coverage quagmire. The Kerry plan goes further. He has talked about opening Medicare to this population, but the campaign debate has gotten bogged down in a dogfight over prescription drugs and medical liability insurance.

It's time for clarity and action. Americans understand Medicare. This is the health plan to build on.

As Satterthwaite says, "There's an image of big brother telling you what to do, and that's not the case." She goes to her own doctor. She gets her care in the private sector. But she likes the security of having the government on her side.

"It's a comforting feeling knowing that Uncle Sam is there," says Satterthwaite. "I'm very grateful."


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