• It’s universal coverage, stupid

    I’ve read all the arguments against (and for) raising the age of Medicare eligibility, but not this one: the ambition of universal coverage — or at least universal access to affordable, comprehensive care — is not itself universal. If you haven’t noticed, there is still lots of opposition to the ACA. There are still efforts at repeal. There are still legal challenges. Some are still trying to delay or obstruct implementation or otherwise encouraging failure. Medicaid won’t be expanded in all states, not immediately anyway. Expect exchange setup to be a huge lift, with many start-up problems that could undermine support.

    In that context, nobody can say for sure how things will play out. Nobody knows the outcome of the next few election cycles. Progress toward universal coverage could stall or be reversed. Even a fully implemented ACA won’t achieve it.

    Why, then, would anyone in favor of universal coverage, anybody pro-ACA, or anyone who voted for the legislation support increasing the age of Medicare eligibility? Why would they risk the chance that some 65 and 66 year olds would lose access to insurance?

    Those in favor of raising the eligibility age say in reassuring tones that it’s risk free since we’ll have the ACA exchanges and Medicaid expansion to help fill the gap. But those same people aren’t putting their full weight behind ACA implementation. Some are actively opposing it. And they look dumbstruck at anyone who resists erosion of Medicare.

    Well, it’s really not so hard to explain. It’s universal coverage, stupid. Why should we expect any two people who disagree over that to agree on revoking Medicare eligibility to anyone?


    • I really think that we should lower the eligibility age to 60 or 0 rather than raising it… but I guess that is a political nonstarter.

    • Just to take a contrarian view, consider the long term. There are the crazies now who are not implementing the ACA. But the insurance exchange bit will then get implemented for them, and you know how state legislatures can flip and implement the Medicaid expansion (plus the financial pressures to do so could be considerable). If they raised the eligibility age it would likely be phased in.

      Obviously this is not risk free. But the downside risks might be containable. The upside (if you’re liberal) is that the Republicans will presumably give ground on taxes, which is another important challenge for the country. It isn’t only about health care.

      Or you might be a Republican like David Frum or Gail Wilensky who thinks that moderately regulated competition could bring healthcare costs down. In this case you are putting more people in the competitive marketplace (ignoring Medicare Advantage for a moment). Folks like these would essentially like to turn the entire Medicare program into a premium support with competition style plan, including the traditional Medicare program as a competitor. This competition could reduce healthcare costs.

      I am a single payer guy at heart, actually. I am just trying to present the alternatives.