Let’s start with the actual problem:
[R]elative to those with insurance before age 65, those without insurance prior to Medicare eligibility spent much more money on health care after they became Medicare eligible. In other words, people wait to get care until their Medicare kicks in. This is bad both for health and for the federal government’s bottom line.
More specifically, it’s bad for Medicare’s bottom line. Here’s the evidence:
[This is] extracted from McWilliams et al.’s papers (references listed at the end). First, from , we see that after age 65, uninsured adults with (chart A) and without (chart B) hypertension, heart disease, stroke, or diabetes all have a significant and improved change in trend in health status after obtaining Medicare. Insured adults, however, do not experience a change in trend. Medicare improved the health of the uninsured; delaying Medicare would delay that help.
The argument for why things would be different this time around is that Obamacare will prevent 65 and 66 year olds from becoming uninsured. Through the Medicaid expansion, or through the exchanges, everyone would get coverage. Therefore, there would be no jump in quality once people get Medicare.
This might be true if everyone was sure the Medicaid expansion was going to happen everywhere. This might be true if we believed that 65 year olds would all be able to afford insurance in the exchanges. Both of those things are far from assured.
I’ve been asked why I think it’s fair to make 64-year-olds pay so much for insurance in the exchanges, but not 65-year-olds. Short answer: I don’t. I’ll say it again: I have always found it baffling that Medicare is American-as-apple-pie if you’re 65, but communism-at-our-doorstep if you’re 64. If you’re offering to let people younger than 65 get Medicare to alleviate the unfairness, I’m all ears. Hurting 65-year-olds to quiet your discomfort? I’m not as interested.
One last thing. Below is the percent of Americans who were uninsured by age group in 2011. If you can look at that and tell me that you really think that taking people out of Medicare and placing them in with another group will not make at least some of them uninsured, then you’re not paying attention.